Something that isn’t getting big headlines, but ought to, is the fact that on December 1 the Medicare reimbursement rate for physicians will drop by a whopping 23 percent. It is anticipated that a lot of physicians will drop their Medicare patients as a result.
Last Friday the Senate passed a “doc fix” to keep the current reimbursement in place for one more month, and it is expected the House will do the same when it reconvenes after Thanksgiving. Then the lame duck Congress will try to pass something more long-term before it passes into history.
The cuts are the result of a Clinton-era attempt to control rising Medicare costs. Sometime in the 1990s Congress passed a formula for physician reimbursement called the “sustainable growth rate” (SGR) that tied physician reimbursement to the Gross National Product. This may have seemed a good idea when the economy was growing. But when the economy stopped growing, it seemed to be a very bad idea.
Instead of repealing the SGR forumula, Congress kicked the can down the road. Beginning in 2003, every year Congress passed a one-year “doc fix” to override cuts to the reimbursement rate mandated by the SGR. Every year until this year, that is.
Early versions of the Patient Protection and Affordable Care Act (PPACA), or the health care reform bill, provided for repealing the SGR. But that repeal added to the cost of the bill. So the SGR repeal was removed, along with some other things, to lower the bill’s price tag and buy the last few hesitant votes to get the thing passed.
Dems figured this was not necessarily a loss, because there was no reason the repeal couldn’t be introduced in a separate bill, and if worse came to worse they could kick the can down the road one more year, as they’d been doing for the past several years.
Republicans, however, sensed opportunity. With the help of Blue Dogs, Republicans were able to block a separate SGR repeal bill and also refused to support the annual “doc fix.” Then they went home to their constituents and blamed the looming cuts in Medicare reimbursement on “ObamaCare.”
And you can just bet that if the 23 percent cut isn’t stopped, and lots of seniors suddenly find themselves without doctors, the Right will milk that for all it’s worth and persuade the older folks that their problems were all caused by those tax-and-spend socialist Democrats. I can see all the tea party marches / power chair rallies already.
And this, my dears, is how the game is played.
As listed in the last post, there is a growing realization that Republicans deliberately are trying to wreck the economy so that Democrats can be blamed for it. Paul Krugman wrote more about this today.
The fact is that one of our two great political parties has made it clear that it has no interest in making America governable, unless it’s doing the governing. And that party now controls one house of Congress, which means that the country will not, in fact, be governable without that party’s cooperation — cooperation that won’t be forthcoming. …
… These days, national security experts are tearing their hair out over the decision of Senate Republicans to block a desperately needed new strategic arms treaty. And everyone knows that these Republicans oppose the treaty, not because of legitimate objections, but simply because it’s an Obama administration initiative; if sabotaging the president endangers the nation, so be it.
… as I see it, for 30 years we’ve had a country that’s nominally democratic, but in which presidents are allowed to govern only if they’re Republican or forced to defer to Republicans.
Don’t think of the Democrats and Republicans as the two major political parties in a democratic system; think of the Republican Party as the U.S. equivalent of, say, the people who really run Pakistan — the generals and members of the intelligence establishment. Pakistan has elections, but if you’re elected, you’re still not free to do what that crowd doesn’t want you to do. Cross them and you’re likely to suffer the consequences.
I’d never quite thought of it that way before, but damn, I do believe he’s on to something.
We don’t have literal coups or assassinations (so far), but that seems to be because our authoritarian permanent government doesn’t need them, and because maintaining the illusion that we’re not a country run by a strongman force strengthens the Republicans in the long run. As Krugman notes (and as Zandar notes), Republicans seem able to run the country this way without attracting any scrutiny from even the most plugged-in observers. Hard to imagine when that will change, if ever.
“Our nation is in much worse shape, much closer to a political breakdown, than most people realize,” Krugman writes.
My illustration of the Medicare cuts is just one tiny little example. At least some Republicans want to play politics with the lives and health care of seniors, just to stick another knife in Democrats. This stuff happens over and over and over, and the Dems remain helpless to stop it.