Bush Vetoes Medicare Bill (H.R. 6331)


Today, July 15, President Bush vetoed H.R. 6331, the Medicare bill that would stave off a big cut in reimbursements to doctors and replace it with a slight increase.

If you think drafting and passing legislation is dull and boring, picture this:  On Wednesday, July 9, the U.S. Senate floor was crowded with 97 Senators, a majority ready to vote to save Medicare, but prevented from doing so because of a Republican filibuster.  Democrats had crafted legislation to suspend for 18 months an automatic 10.6% cut in Medicare payments to doctors this year, and another scheduled 5.4% cut next year.  The House of Representatives had passed the bill as H.R. 6331, but Republicans in the Senate were engaged in a filibuster to prevent the bill coming to a vote on the Senate floor.  Doctors were threatening to stop taking new Medicare patients if their fees were cut, claiming that such a payment schedule would not even cover a typical internist’s overhead.  Some internists even threatened to stop serving existing Medicare patients. http://www.medicalnewstoday.com/articles/114493.php  The Center for Medicare Services had used its administrative powers to suspend the automatic cuts to July 15.  Senator Harry Reid called for a cloture vote to stop the filibuster, but he needed 60 votes. 

Half-way through the cloture vote, it appeared that the vote was headed for defeat by the same margin as the previous cloture vote on June 27, because only 9 Republicans were voting for cloture, and there were only 49 Democrats on the floor.  Then a roar went up in the chamber.  Senator Edward Kennedy (D, MA) and Senator Barack Obama walked in through the main door.  Obama’s arm was draped around the shoulder of Senator Kennedy, who had been absent from Washington for several months undergoing treatment for brain cancer.  After Senator Kennedy cast the 60th vote to stop the filibuster, 9 more Republicans crossed party lines to vote for the cloture motion, so HR 6331 was passed by 69-30.  http://www.cqpolitics.com/wmspage.cfm?docID=news-000002913551&parm1=5&cpage=1 Only Senator McCain failed to vote on this vital bill. http://www.senate.gov/legislative/LIS/roll_call_lists/roll_call_vote_cfm.cfm?congress=110&session=2&vote=00169, http://www.opencongress.org/bill/110-h6331/show

Unfortunately, the happy ending is not yet in sight.  The insurance industry immediately launched a web-based letter writing campaign to ask President Bush to veto H.R. 6331 because it would reduce payments to providers of Medicare Advantage plans. http://capwiz.com/naifa/issues/alert/?alertid=11593781  The President has responded to insurance industry pressure by vetoing the bill.  Although the bill passed the House by an overwhelming margin, and by a supposedly “veto-proof” margin in the Senate, the prospects for H.R. 6331 are now uncertain.  The 69 yeah votes in the Senate last week included 18 Republicans, 9 of whom switched their votes only when the bill was sure of passage.  The President only has to persuade 3 of those Senators to change their minds again to sustain his veto.

The real fight is about how to pay for the Medicare doctors’ fees and about Republican plans to privatize Medicare.  A Republican Congress created an alternative to traditional Medicare, allowing Medicare-eligible seniors to enroll in private insurance plans called “Medicare Advantage” plans.  Many studies have determined that the Medicare Advantage plans receive about $1000 per year per beneficiary more than traditional Medicare.  Democrats want to reduce these subsidies to the private insurance plans and shift the money to traditional Medicare.  Democrats want to fix the Medicare funding problem within the Paygo (Pay-as-you-go) rules by reducing the subsidies to the insurance companies, while the Republicans want to postpone the mandatory cuts in doctor’s fees by increasing the deficit (borrow more money from the Chinese). 

H.R. 6331 does not eliminate the subsidies to the Medicare Advantage plans.  Rob Cunningham of Health Affairs Journal said on July 10: “Easily lost in all the political drama is the modesty of the compromise that won over so many Republicans in both chambers. The controversial benchmark system for setting bid targets for MA plans remains untouched, despite repeated recommendations from the Medicare Payment Advisory Commission to equalize payments for MA and traditional Medicare. The bill phases out a payment adjustment to MA plans for indirect medical education (IME) by a maximum of one-half of one percentage point a year, worth a total of $12.5 billion from 2008 to 2013. But as the Congressional Budget Office points out, the current IME adjustment represents a double payment to MA plans, because Medicare’s fee-for-service hospital rates, on which MA benchmarks are partially based, already include an IME add-on.”  http://healthaffairs.org/blog/

The Republicans have been especially keen on Medicare Advantage Private Fee-for-Service (PFFS) plans.  Several studies have shown that both Medicare Advantage managed care plans and Medicare Advantage PFFS plans fail to provide any better care than traditional Medicare.  MA PFFS plans in particular are 17% more expensive than traditional Fee for Service Medicare.

Yesterday, the American College of Physicians issued a long letter imploring President Bush to sign H.R. 6331, giving a long list of anticipated adverse consequences of not doing so.  http://www.eurekalert.org/pub_releases/2008-07/acop-aip071408.php 

Unmindful of the pleas from America’s doctors, President Bush has vetoed the bill.  In remanding the bill to the House of Representatives, the President said that H.R. 6331 would reduce options for Medicare beneficiaries, “particularly those in hard-to-serve rural areas. In particular, H.R. 6331 would make fundamental changes to the MA PFFS program. The Congressional Budget Office has estimated that H.R. 6331 would decrease MA enrollment by about 2.3 million individuals in 2013 relative to its current baseline, with the largest effects resulting from these PFFS restrictions.

“While the [Medicare Modernization Act of 2003] MMA increased the availability of private plan options across the country, it is important to remember that a significant number of beneficiaries who have chosen these options earn lower incomes. The latest data show that 49 percent of beneficiaries enrolled in MA plans report income of $20,000 or less. These beneficiaries have made a decision to maximize their Medicare and supplemental benefits through the MA program, in part because of their economic situation. Cuts to MA plan payments required by this legislation would reduce benefits to millions of seniors, including lower-income seniors, who have chosen to join these plans.”  http://www.politico.com/blogs/thecrypt/0708/Bush_vetoes_Medicare_bill.html

The Administration did have one valid criticism, when President Bush’s statement said “H.R. 6331 would delay important reforms like the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies competitive bidding program, under which lower payment rates went into effect on July 1, 2008.”

Nevertheless, do not be misled by the reference to low-income beneficiaries participating in Medicare Advantage plans.  The Republicans have a long-term plan to solve the projected insolvency of the Medicare system by privatizing Medicare, and they view the Medicare Advantage Plans as a stepping stone to that goal.  The Democrats acknowledge that Medicare expenses are growing at a rate that will lead to a problem in ten years.  However, Democrats view the Medicare Advantage program as a failed experiment in Medicare privatization.  Introducing insurance companies as middle men in the senior health insurance system adds cost rather increasing either efficiency or quality.  

Another way must be found to control the growing cost of health care in this country.  Democrats are not offering a separate long-term Medicare solution, but many view this problem as part of the overall problem of introducing a universal health care system for everyone in the United States.  This will not be a single payer system like traditional Medicare, but some parts of the system such as a national health database and information system could be used by doctors to treat patients of all ages.

Why don’t the Republicans recognize the failure of the Medicare Advantage plans and allow them to be eliminated?  Why do Republicans stick to their ideological beliefs in the face of the facts?  Perhaps it is because their brains lie to them.  A recent Op-Ed piece in the New York Times explains how this may happen.  http://www.nytimes.com/2008/06/27/opinion/27aamodt.html?scp=1&sq=Your+Brain+Lies+to+You&st=nyt

When facts are first learned, they are stored in the hippocampus.  However, information does not stay there.  Every time information is recalled, it is processed and restored.  Over time, the information is gradually transferred to the cerebral cortex, and the facts are separated from the source context.  The brain may disassociate information that is learned to be false from the disclaimer, so that the “fact” is stored in the cerebral cortex even though it learned from a source that identifies the information as false.  This storage of false “facts” in the cerebral cortex is easier when the “facts” fit a previously learned belief system – ideology or world view.  It takes an unusually intelligent person to identify “facts” previously learned as true with new information that shows those “facts” to be false, and to modify one’s beliefs accordingly.  So a Republican who has been taught in his/her early years that private enterprise is always more efficient than any government program, that a laissez-faire economy is always superior to any other, may listen to or read the results of many studies showing that Medicare Advantage plans are more costly than traditional Medicare, and still believe that Medicare Advantage PFFS plans are the solution to reining in rising Medicare costs.  All the evidence refutes this belief, but the Republican attitude “My mind is made up; don’t confuse me with the facts!” is entirely consistent with recent brain research.


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3 Responses to “Bush Vetoes Medicare Bill (H.R. 6331)”

  1. Harvey Bellin Says:

    “Bush Vetoes Medicare Bill (H.R. 6331)” is a very well documented posting. This posting sets a gold standard for what an intelligent policy blog can be. It is a stark contrast with the idiocy on so many partisan blog sites that are little more than intellectual autoeroticism.

  2. barbarareynolds Says:

    Go Harvey!!!

  3. vote for third party Says:

    We the citizens of the United States of America deserve QUALITY HEALTH CARE period….the exact care we GIVE to congress and their families…the care the wealthy expect….and get…etc…

    A lot of greedy people (CONGRESS, AMA, FDA, INSURANCE COMPANIES) are fighting for the abundance of money to be made on the backs of hard working people…but giving back inferior care to boot…

    Congress will push the public to the point of no return and the people will go with third party honest men and women who follow the constitution…

    I would rather spend my tax money on what is right for humanity and also the poor than over kill by greedy people who would take all and more rather than share a little….ex…bank bailouts, airlines, car companies etc…but no help for the people….

    Pray for peace and the people in charge….

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