Democrats Split As Nancy Pelosi Betrays Seniors

Nancy Pelosi’s irrational behavior regarding the Medicare “doc fix” is creating rifts between Pelosi and other Democrats. For the past several months we’ve had a repeated pattern of the Democrats taking the lead in trying to fix the problem while the Republicans have blocked passage. Suddenly it is Nancy Pelosi who is jeopardizing Medicare.

The Senate passed a six month temporary fix last Friday which differed from the House proposal. While far from perfect, the Senate bill would have at least bought some time to again work on a long term solution. It was initially assumed that the House would quickly approve the Senate bill but instead Pelosi has insisted she will not act upon a Medicare fix which does not also include the jobs proposals in the House bill.

While fighting for the jobs proposals are admirable, this should not be done at the expense of passing the Medicare fix. Failure to pass the fix endangers the Medicare program and will cause seniors, the disabled, and military families to have difficulty getting access to health care. (Medicare directly covers seniors and the disabled while Tricare, which covers active members of the military and their families, bases its fee schedule on the Medicare fee schedule).

As Nancy Pelosi and Harry Reid took differing positions, Politco reported this morning that  Congress battles as Medicare burns. There even appears to be some disagreement with Pelosi among the House Democratic leadership, as reported by The Hill:

Rep. Robert Andrews (D-N.J.), the Chair of the Education and Labor health panel, tells The Hill that Congress should quickly pass a bill delaying cuts to Medicare physician payments. The comments seem at odds with House Speaker Nancy Pelosi’s (D-Calif.) statement Monday that the House should hold off on taking up the Senate’s Medicare doc fix until the Senate passes a tax extenders bill, which some House members fear might go nowhere if it’s uncoupled from the must-pass doc fix.

“Leverage is less important than ensuring seniors can see their doctors,” Andrews said as he was entering a meeting in the office of House Majority Leader Steny Hoyer (D-Md.). “So I think it’s important to pass it.”

As I said earlier as my Facebook status, also posted to Speaker Pelosi’s FB page (and on Twitter in an abreviated 140 character version):

Nancy Pelosi: We expect Democrats to fight to preserve Medicare, not give Republicans political cover to destroy it. So far it has been the Republicans who have been blocking the payment fix, but if you follow through with threats not to pass the latest temporary fix passed by the Senate the Democrats become responsible for endangering Medicare, and risk losing the senior vote.

Nancy Pelosi Gambles With Future Of The Democratic Party By Rejecting Medicare “Doc Fix”

Harry Reid might be the leader of a House of Congress from Nevada but it is Nancy Pelosi who has turned into quite a gamble–a gamble which if she loses will probably turn the Democratic Party back into a minority party. On Friday the Senate passed a six month Medicare “doc fix” but regrettably could not also pass jobs legislation. Now Nancy Pelosi is threatening that the House will not pass the Senate bill until they also pass jobs legislation.

If her gamble works and the Senate passes the original House bill as opposed to the more limited Senate bill then Nancy Pelosi will come off as a legislative genius. However this is a very high stakes gamble. If she fails then it will be the Democrats who will receive much of the blame for the failure of passage of the Medicare fix.

Failure to pass the Medicare fix will lead to serious limitations on medical care for the elderly and disabled individuals now on Medicare. In addition, Tricare pays based upon the Medicare fee schedule so this will also adversely affect U.S. military personnel and their families.

Conservatives already are beginning to realize that Nancy Pelosi might have handed them a tremendous gift. Ed Morrissey writes:

In other words, Pelosi has handed the Senate Republicans the key to a filibuster not just in the Senate but also in the House, all to demand a massive expansion of the deficit on two separate fronts.  The GOP couldn’t have possibly asked for a better political position even if they had begged Pelosi not to throw them into that briar patch.  And if the “doctor fix” fails to get out of the House, it won’t be Republicans who get the blame, since Pelosi can call a vote on that any time she desires.

Let’s hope that Republicans manage to keep this advantage for as long as it takes Pelosi to realize that she’s blown it.

Morrissey is incorrect on an earlier point claiming, “the passage of the ObamaCare legislation whose financials were specifically predicated on keeping the Medicare reimbursement cuts in place.” A permanent fix was originally planned to be part of health care reform but Republicans made this politically impossible by counting the paper costs of this fix as part of the health care legislation.

Regardless of countless acts by the Republicans to play politics here and block a permanent fix, Morrissey is correct that the Democrats will pay the price politically if Nancy Pelosi is the one to prevent passage of the fix which has now passed the Senate. Loss of the senior vote will be devastating to the Democrats.

Republicans, Not ObamaCare, Are Chasing Doctors Out Of Medicare

The Houston Chronicle has an article about an increasing number of Texas primary care doctors not accepting Medicare, largely because of  uncertainty caused by the flawed physician payment formula which I’ve discussed here many times in the past.  I’ve seen several conservative blogs which are twisting this to claim that the doctors are leaving because of cuts in Medicare brought about because of Obama’s health care plan. This is totally false. Here are the facts:

  • The health care reform bill increases payment for primary care doctors, and does not cut Medicare payments as some conservatives are claiming
  • The problem with the flawed payment formula goes back to 1997, well before the current health care reform
  • The Democrats have been trying for several months, both as part of the health care reform legislation and in separate legislation, to fix this problem. They have proposed legislation that would both protect doctors from pay cuts and provide an increase in reimbursement.
  • The Republicans have repeatedly blocked these attempts, including filibusters in recent months which have greatly increased the uncertainty discussed in the article.

Despite the right wing spin, if doctors do not accept Medicare it has nothing to do with “ObamaCare” and everything to do with Republicans screwing doctors and our patients.

Related Stories:

Republicans filibuster fix in April

Republicans filibuster fix in March over Democratic objections

House passed temporary fix after Republicans blocked permanent fix

Harry Reid attacked by Republicans when he tried to fix the problem last fall

Obama criticized for trying to fix problem as part of health care reform

Republicans play politics, screwing doctors

Benefits of health care reform for primary care doctors. (Does anyone really believe that the AMA would have endorsed the plan if it cut physician pay rather than providing benefits for their members?)

Sue Lowden Backs Down on “Chickens For Checkups”

From time to time I’ve received everything from chocolate to venison from patients, but they have never given such gifts with an expectation of using them for payment for medical services. Nevada Republican Sue Lowden has raced a lot of ridicule since she suggested battering for medical services as a potential solution to the health care crisis. When we first heard this, many bloggers along with myself gave her the benefit of the doubt and at least thought she meant bargaining over prices, as opposed to bartering. I also noted that this happened to be the topic of the Dilbert cartoon published that same day.

Lowden stuck with this argument, and made it clear she was really advocating true bartering–chickens for checkups.

“Let’s change the system and talk about what the possibilities are. I’m telling you that this works. You know, before we all started having health care, in the olden days, our grandparents, they would bring a chicken to the doctor. They would say I’ll paint your house,” she said. “[That’s] what people would do to get health care with their doctors. Doctors are very sympathetic people.”

“I’m not backing down from that system,” she added.

Greg Sargent reports she is finally backing down:

It took around two weeks and a good deal of national ridicule, but Nevada GOP Senate candidate Sue Lowden has finally backed off of her apparent advocacy for a “chickens for checkups” barter policy to bring down health care costs.

In an interview with a local station in Nevada today, Lowden clarified her original comments, claiming she’d been taken out of context. Lowden added she had merely made a “casual statement” designed to describe an ongoing reality, and hadn’t intended to offer a policy prescription.

“They took it way out of context,” Lowden said in the interview, blaming Harry Reid’s campaign tracker for plucking the quote out of an hour-long conversation about multiple topics.

“The truth of the matter is there is bartering going on in this state and in the country,” Lowden said. “It has been going on for years.” She added she had merely made “a casual statement talking about the reality of what’s going on.” Audio here.

In a follow up interview, Lowden spokesperson Crystal Feldman confirmed her intent. “Sue’s comment on bartering was never a policy proposal,” Feldman said, adding it was “an insight on how struggling families in Nevada are working to pay for medical care during these tough times.”

The problem for Lowden stemmed from the fact that she seemed to stray into advocating for a barter system, rather than just describing existing circumstances. In her original quote, Lowden said that “bartering is really good” to “get prices down in a hurry,” urging people to “go ahead and barter with your doctor.”

Republican Gets Health Care Ideas From Dilbert

Dilbert.com

Steve Benen quotes Sue Lowden’s ideas on getting down the cost of health care:

Lowden is a former state senator and chair of the Nevada Republican Party. She’s also, according to nearly every recent poll, the favorite to defeat Senate Majority Leader Harry Reid (D) in November. Lowden is not, as one might imagine, a supporter of recent improvements to the broken health care system, and she was asked at a candidate forum the kind of policies she’d prefer to see. Among her proposals:

“…I would have suggested, and I think that bartering is really good. Those doctors who you pay cash, you can barter, and that would get prices down in a hurry. And I would say go out, go ahead out and pay cash for whatever your medical needs are, and go ahead and barter with your doctor.”

I wonder if she had read today’s Dilbert strip (above) before making this suggestion. We know Scott Adams was joking, but apparently this Republican candidate is serious.

One problem is that pay to one’s doctor is a small part of health care costs. Presumably she means bargain as opposed to bartering to bring down the cost. For the sake of discussion, let’s say that a patient took her advice and I agreed to take 25 percent of the price for my office calls. That’s fine for someone who just needs one or two visits, but a person with serious chronic problems could still run up a huge bill over time. Insurance just might come in handy here (especially if the insurance cannot drop them because of having chronic medical problems).

The bigger problem which comes up when I have uninsured patients is not payment for the office calls but payment for everything I order outside of the office for diagnosis and treatment. Just because I agree to cut the charges for office calls (if Lowden meant bargaining) or agree to accept her goat (if she really means bartering), doesn’t mean that the reference lab I send the patient’s blood to will give them a break. The same is true if x-rays are needed. If surgery is needed the patient then not only needs to make a deal with the surgeon but also the facility where the surgery is performed.

If medications are needed it might be possible to give samples (but pharmaceutical companies are getting stingier with them). It might even be possible to get the patient free medications from a patient assistance program if their income is low enough to qualify. They also better be able to wait a while to get their medications.

This would be quite a challenge for a healthy person to go to all the work, and tolerate the delays, in order to receive medical care at a discount. (Hey, isn’t delays the reason conservatives say we should be terrified of the Canadian system?) If someone happens to be sick, this process goes from unlikely to succeed to virtually impossible. It’s just another unrealistic Republican suggestion for health care.

Republicans Causing Over 200,000 To Lose Unemployment Benefits

Because of Republicans blocking unanimous consent of a temporary spending measure over 200,000 people will have their unemployment benefits cut off on Monday. They might be restored retroactively, but many of these people are probably do not have spare money to hold them over. The Hill reports:

Starting Monday, more than 200,000 unemployed Americans won’t see jobless benefits they’re expecting because Congress failed to act.

The interruption in benefits will last two weeks at a minimum, according to Judy Conti of the National Employment Law Project (NELP), since lawmakers return from spring break on April 12.

As the two-week recess began, Congress was at an impasse over how to extend the emergency unemployment insurance program and other expiring provisions, including increased COBRA health insurance subsidies for the unemployed, the Medicare doctor payment rate and federal flood insurance.

Senate Republicans said the $9.3 billion, 30-day extension preferred by Democrats should be paid for, while Democrats said the bill’s cost didn’t need to be offset because the program was “emergency spending.”

Making matters worse, the Republicans are trying to play politics and blame the Democrats for the problem. They insist upon paying for this emergency spending now, but had no problems in the past with conducting the Iraq war or passing George Bush’s Medicare changes without funding them. They also have had no problems with the increases to the deficit caused by George Bush’s tax cuts which were initially provided to only the ultra-wealthy. Republicans have also blocked efforts to achieve a permanent fix to the flawed Medicare payment formula.

Harry Reid has scheduled a cloture vote for when Congress returns on April 12 but even if passed this delay can cause hardship for many who are now unemployed and dependent upon the benefits for day to day expenses.

Tom Coburn Follows Jim Bunning In Screwing Much Of America

The Republican Party has a never ending supply of people willing to step up to screw American. Last month it was Jim Bunning. This month it is Tom Coburn, with the GOP leadership backing him. Coburn has blocked acceptance by unanimous consent spending including of extensions of unemployment payments, subsidies for Cobra payments, and extension of Medicare and Tricare payments at current levels.

Last month Bunning backed down following a threat that he would have to remain to physically filibuster. This time we have to wait longer to see if the problem is fixed as Congress is going on a two week break. The Democrats hope that pressure from constituents who are harmed by this measure will lead the Republicans to back down.

While I would prefer that Harry Reid had kept the Senate in session until this was resolved there is at least one benefit to this break. President Obama has taken advantage of it to install fifteen recess appointees to avoid further Republican filibusters. The Republicans have exercise what the White House is accurately calling An Unprecedented Level of Obstruction in delaying these appointees, who have waited an average of 214 days for Senate confirmation.

American Osteopathic Association Endorses Health Care Reform Legislation

The AOA has joined the AMA in endorsing the health care reform legislation along with making recommendations for changes. The recommendations include eliminating the flawed physician payment formula and significantly modifying or abolishing the Independent Payment Advisory Board.

Following is the text of the item in today’s AOA Daily Report which includes their letter to President Obama, Speaker Pelosi, and Majority Leader Reid:

The full AOA Board of Trustees convened today to finalize the AOA’s official position on health system reform legislation as Congress nears a final vote after a year-long debate.  The Board examined how the bill aligns with AOA policies established by the AOA House of Delegates over the last 30 years and developed a letter to President Obama, Speaker of the House Nancy Pelosi, and Senate Majority Leader Harry Reid delineating our unanimous support of advancing the legislative process as well as our strong recommendations on how to ensure access to care, promote primary care, provide for fair physician payment, and reduce overall health care costs, especially by enacting federal PLI reform.  Read a copy of the letter here.

Earlier I posted a copy of a statement faxed and emailed to physicians in support of the legislation by the American Medical Association along with links to letters sent by the AMA with their suggestions for improvements in the legislation.

AMA Supports Passage Of Health Care Reform With Recommendations For Improvements

The American Medical Association which previously endorsed passage of the House and Senate health care reform bills has sent out a fax to physicians supporting passage of the revised bill to be voted upon this Sunday. The fax states that “We worked hard and made significant progress toward resolving” problems with the original Senate bill. They also state there are issues “that cannot be addressed through the current reconciliation process and will need to be address by Congress and the administration.”

The AMA calls for changes including repealing the Medicare sustainable growth rate formula, making changes in the Independent Payment Advisory Board, the cost-quality value index, rules for data release, and enactment of effective medical liability reforms.

While they consider this bill “an imperfect product” and see problems in the bill which I agree with, the  AMA concludes that this bill “does, in fact, improve the ability of patients and their physicians to achieve better health outcomes.”

Update: The American Medical Association has also released a press release supporting the bill and a letter to Nancy Pelosi outlining their view. A more detailed explanation of these points was included in this  letter to Harry Reid and Nancy Pelosi in January.

Update 2: The fax has also been sent by email making it easier to post on line. The text is under the fold.

Update 3: The American Osteopathic Association supports health care reform legislation.

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GOP Fundraising Documents Cost Them A Donor

The recent accidental release of a presentation for donors prepared by the Republican National Committee continues to create embarrassment. The presentation shows how the GOP, lacking any real policies, tries to fool donors with appeals based upon fear. Ben Smith reports on one former donor who has decided not to contribute to the party:

A prominent Evangelical figure and Republican donor says he will end his contributions to the organized Republican Party in reaction to the leaked fundraising presentation that advised using “fear” to solicit contributions and displayed an image of President Obama as the Joker from Batman.

Mark DeMoss, who heads a major Christian public relations firm in Atlanta and served as a liaison to the Evangelical community for Mitt Romney in 2008, wrote Chairman Michael Steele yesterday that he was “ashamed” of the presentation, calling depictions of Obama, Speaker Nancy Pelosi, and Majority Leader Harry Reid “shameful, immature and uncivil, at best.”

“I’m afraid the presentation is representative of a culture and mindset within the Republican National Committee,” DeMoss, a past member of the RNC’s “Eagle” program for top donors who gave the party $15,000 in 2008, wrote in the letter to Steele, which he shared with POLITICO. “Consequently, I will no longer contribute to any fundraising entity of our Party—but will contribute only to individual candidates I choose to support.”

Personally I think people should have become wise to the minset of the Republican National Committee when they sent out fund raising letters in 2004 trying to scare people by saying John Kerry would take away their bibles. Better late than never. The full text of the letter is under the fold:

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