Insight, analysis & opinion from Joe Paduda


A bit of sanity on Capitol Hill?

The Senate rejected the Medicare Physician Fairness Act rather resoundingly today, preventing a ‘fix’ that would have added a quarter trillion dollars to the deficit.
Senate Dems were trying to pass the bill separately from any overall reform bill, as combining the two would have pushed the total cost well over a trillion dollars over ten years – a figure that would, in all likelihood, doom the bill.
But an interesting coalition of all 40 Senate Republicans, Evan Bayh of Indiana, Russ Feingold of Wisconsin, Claire McCaskill of Missouri and Ron Wyden of Oregon – a pretty broad spectrum – voted no, killing the bill in a procedural vote.
This is good news. Not because we’re still stuck with the dysfunctional Medicare Sustainable Growth Rate mechanism, but rather because fully a dozen Dems stepped up to the plate and rejected a huge increase in government spending on an entitlement program. Lest my Republican readers get too excited, their party has yet to participate in any meaningful, helpful way in the discussion, and Minority Leader McConnell’s snarky comments today were yet another example of his inability to set aside petty, stupid, childish politics for the good of the country.
Here’s hoping that the rejection means we will actually, finally, seriously start talking about cost. This is where the GOP should show some leadership, which will require McConnell et al get a sudden injection of statesmanship. None of the bills currently before Congress – with the exception of Wyden-Bennett – reduce costs.
We should throw them all out, pass Wyden-Bennett, and get on with other matters.
Yeah, right, that’s really going to happen…

2 thoughts on “A bit of sanity on Capitol Hill?”

  1. I’m genuinely confused, maybe you can help me out.
    As far as I know, the payment fix is sleight of hand so that the numbers don’t appear in deficit calculations, even though the government is spending the money. By doing a one-year fix instead of a 10-year fix, there’s a smaller number, but next year they’re going to do the same thing, and the next year and the next year and the next year, and after 10 years of one-year fixes, you’ll have exactly the same situation as if you’d just passed the bill yesterday.
    Is there a flaw in that reasoning?
    If not, and I don’t think there is, why is this sanity? It seems like just perpetuating the insane practices of the last decade with regard to this issue. But all that matters is how it plays politically, so people are actually acting like it’s a good thing the bill got killed.
    Doesn’t make a lot of sense to me.

  2. Joe, you must explain sometime — if you haven’t already at some past point that I missed — why it is you have faith in an act of Congress to cut costs. This seems to me a constant theme from you, that Congress must take the lead in bending the cost curve.
    I’m of the opinion that the LESS Congress has to do with something, the more likely it is to result in cost savings. Look, for example, at what has gone on with durable medical equipment over the years. It’s one of the most wasteful segments of the healthcare industry, and yet anytime Congress attempts to reign it in, the folks who sell oxygen tanks or rent homecare beds or sell power scooters bring their lobbyists to bear, and Congress blinks.
    The same thing happened every time we wanted to consolidate and close military bases. Every Congressman with a base in his district that might be affected was an instant “no” vote. This problem got solved with the establishment of the BRAC system, taking the closing and realignment of bases out of the hands of Congress, and putting it in the hands of an independent commission. It’s still not perfect, but it is demonstrably better in that it achieves the objective of lower cost through base closing and realignment.
    I’d really like to see a post from you on this, because, as I said, I detect a theme that you think cost-cutting can come from Congress. Perhaps you can point out something I’m not seeing.

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Joe Paduda is the principal of Health Strategy Associates




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