The Senate passed a major Medicare bill tonight by a vote of 92–8. It has already passed the House — 392–37 — and will be signed by President Obama. It puts an end to a two-decade charade under which Congress passed annual bills to avoid scheduled cuts to doctors’ Medicare reimbursements by making cuts elsewhere. A lot of those cuts were not very well-designed and some were gimmicks, but those seeking to make major changes to Medicare — a.k.a. all conservatives who believe our entitlements are poorly designed and unsustainable — have now given up the leverage that this annual charade, called the “doc fix,” provided, because senators and congressmen were too eager to satiate doctors’ interest groups.
Ryan Ellis of Americans for Tax Reform has made the case for the bill nonetheless on a couple of occasions on our site, noting that it includes some good reforms to Medicare that could well recoup its short-term costs in the long term. (The bill costs more over the next ten years than was scheduled to be spent under current law, so Congress had to suspend a rule against such spending — Senator Mike Lee raised an amendment to restore that rule, which failed.)
But the much bigger deal in the bill, a number of right-of-center health-care experts seem to believe, isn’t about spending levels. The bigger problem is that the bill builds on Obamacare by pushing doctors into a different payment system that is said to improve but really just reinforces Medicare’s basic central-planning structure.
Jim Capretta explained the issue in an NR piece tonight, and Yuval commented on it a couple weeks ago. I could go on: AEI’s Scott Gottlieb took issue with this part of the plan; Senator Ben Sasse, a former HHS official, made the case against it in a Politico op-ed and voted against the bill tonight; AEI’s Joe Antos was against it, too. . . . In other words, the vast majority of conservative health-care pros opposed the package, especially because of the above issue, the bill’s promotion of what are called& ACOs
This so-called permanent doc fix, by the way, will not be permanent. Medicare’s actuaries predicted in a report on the bill that other big changes to doctor compensation will still be needed not long down the road. There will be other chances for conservative health reform, but it seems safe to chalk this one up as a loss, and certainly no better than a draw.