How the Game Is Played

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Obama Administration

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.

Steve M. has a good point

… 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.

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21 Comments

20 Comments

  1. uncledad  •  Nov 22, 2010 @6:38 pm

    “This stuff happens over and over and over, and the Dems remain helpless to stop it”

    Maybe they don’t want to stop it; I mean what do the democrats really have except the fact that they are not republicans? If either party decided to really work with the other to move meaningful legislation they would lose the only thing they have to run on, the fact that we aint them. Sometimes I think it is all theatre, one stupid fucking political skit after another, narrated by a corrupt punditocracy, monitored by the “polling” industry, one god dam fake distraction after another all the while the folks that have the real money are robbing us all blind. Though I could be wrong!

    On a brighter note my local comcast outlet here in nwi has leased a channel to RT (russia today) it’s an english language russian cable news channel, it’s about as fair and balanced as FAUX but on the complete other side of the fence. I can’t believe comcast is allowing a somewhat anti-american bias to go out on their wire, hell they even broadcast Thom Hartmans cable show every night!

  2. c u n d gulag  •  Nov 22, 2010 @7:08 pm

    “… 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.”

    It won’t.
    Not ever.
    Not until Democrats stop coming to full-contact, no-hold’s barred games of “RISK” with balls and jacks, and come to gun fights armed only with SPORKS!!!

    God, Chicago Cubs fans, I understand your pain better every day. No matter how great the manager, the coaches, the hitters, the fielders, the starting pitching, the relievers you’ve got, you still can’t manage to win a World Series.
    Republicans, on the other hand, win the World Series some years without even making the playoffs. I guess it’s hard to lose when you have the umpires and media on your side.
    Hell, most days Republicans throw their cap on the field, and the Democratic opposition turns tail and runs off the field like their Mommies called them in for a snack break in Pee-Wee League.
    Christ……………………

  3. Bonnie  •  Nov 22, 2010 @7:26 pm

    On a different note, today is the day in 1963 when JFK was assassinated. I had graduated from high school in June of 1963. It’s impact is still with me. Even Republicans mourned his death. That was a time when all Americans displayed humanity towards one another. Now, we have an entire political party ready to destroy our country for their own bratty, selfish reasons. Every day the Repugs engage in this effort of theirs, they commit an act of treason.

  4. c u n d gulag  •  Nov 22, 2010 @7:32 pm

    Thom Hartmann’s show? And Russian news! I’m Russian/Ukrainian, and a HUUUUUGE Hartmann fan! What chann…?
    Oh, never mind. I live in a Cablevision monopoly area, with only Verizon to pick off dissatisfied stragglers.

    And uncledad, I think you’re right. It is all a show. It’s “Punch & Judy” political puppet theatre. Except, instead of taking turns on beating-up one another like in “Punch & Judy,” the puppets go around and beat us, taking turns…
    Don’t forget to laugh! The puppet-master’s HATE that, and if you don’t make the effort, a hand is about the best thing that’ll be stuck up your ass.

  5. uncledad  •  Nov 22, 2010 @8:29 pm

    Thom Hartmann’s show? And Russian news! I’m Russian/Ukrainian, and a HUUUUUGE Hartmann fan! What chann…?

    Don’t know about your area, I’m really shocked it is on here, comcast is notorious for raising money for the wing-nuts, I won’t be surprised if it gets yanked. I do enjoy much of it though, it’s interesting to here news about the USA without the cheerleading, they also have some fairly decent documentaries, though the production value of the news broadcast reminds me of my AV classes back at Purdue! It’s a little dated, anyway they have a youtube channel, you may be able to see some Hartman there?

    http://www.youtube.com/user/RussiaToday

  6. erinyes  •  Nov 22, 2010 @8:34 pm

    “I do believe he’s on to something”
    Me too. The opposition consists of heartless killers, and brainless followers.

  7. erinyes  •  Nov 22, 2010 @8:42 pm
  8. Candide  •  Nov 22, 2010 @9:00 pm

    I think you’re right, Maha, the Republicans will gladly flush the US economy down the toilet in order to gain some small political advantage at the polls. However, other than not wanting to give more tax cuts to the rich, Obama seems to have adopted the Republicans game plan for the economy (bailouts for billionaires). The Rethugs may be totally amoral scumbags who’d gladly sell Grandma to the glue factory, but the Dems make their job easy for them.

    The one comfort I get from all this is that, if we wind up with Sarah Palin as president in 2013, she will inherit an ungovernable mess which the Rethugs created. I’m sure she’ll blame it all on Obama (not without some justification), but that will do her little good. The super rich and greedy pigs whose economics policies has brought America to its knees will likely be worse off from having destroyed what was once the world’s wealthiest nation. I guess you could say “what goes around, comes around.”

    Small comfort, I know, and it won’t help the millions who will be living in tents as a result. And most of them will never understand what happened to them, which is perhaps the biggest tragedy of all.

  9. maha  •  Nov 22, 2010 @9:10 pm

    erinyes — A hoot. And I even remember “Myron Floren.”

  10. Swami  •  Nov 22, 2010 @9:21 pm

    Our nation is in much worse shape, much closer to a political breakdown, than most people realize,”

    Gee, I thought that had already occurred. Wasn’t that one of Karl— the architect— Rove’s crowning achievements?

  11. Loz  •  Nov 23, 2010 @5:24 am

    Hi Barbara – I have posted your story onto my blog tonight. I hope it helps
    Cheers
    Laurie

  12. joanr16  •  Nov 23, 2010 @9:47 am

    tied physician reimbursement to the Gross National Product

    I know I’m a candidate for Remedial Economics, but try as I might, I can’t see how that would ever make a lick of sense.

  13. c u n d gulag  •  Nov 23, 2010 @9:59 am

    Joan,
    How the “H”-“E”-double toothpicks are you?
    I was worried about you. I missed your comments since I hadn’t seen one in awile – or was I not paying attention, and am completely off track? Anyway, glad to see you back.

  14. Mike G  •  Nov 23, 2010 @1:36 pm

    This is Politics 101.
    Take out a full-page ad in the AMA Journal, and some DC TV ads so the Gasbag Class will see it:

    Medicare Reimbursements Dropping 23% on December 1
    Thank the Republican Party
    (details of the doc fix bill, and which way each party voted on it)

    I’m sick of the Dems acting like the Washington Generals.

  15. joanr16  •  Nov 23, 2010 @2:06 pm

    Hi Gulag… it’s nice to be missed! In short, “Internet connectivity problems.” Santa & I are in negotiations for a new notebook and a high-speed wireless plan. He may have to sell some of the Eight Tiny Reindeer to make it happen, but I have been a good girl this year, so here’s hoping.

  16. Swami  •  Nov 23, 2010 @2:31 pm

    joanr16… I’m glad to see that you’re back posting. I had my concerns also when I didn’t see your regular participation. I wasn’t sure whether you had fallen prey to the state of our economy and were no longer able to afford to be a participant in our democracy by way of internet access, or if you had found benefit in our present economy and were off enjoying a 21 day tour of the Holy Land. In any event, it is good to see you back because your comments are always thought provoking and enjoyable.

    In response to your comment above… I have to agree that it does make you want to scratch your head and question how does the GDP factor into what a doctor should be paid for a legitimate and honest service rendered.

  17. c u n d gulag  •  Nov 23, 2010 @3:12 pm

    joan,
    Santa’s a well-known Liberal. You know, GIVING toys, not selling or taking them. No down payment, no credit terms, no requirements except that you be nice and good. So, instead of selling some of his reindeer, maybe he could withhold some toys from the top 2% of the wealthiest children.
    But, if he did have to sell, hmmm…
    Let’s see, there’s:
    Dasher
    Dancer
    Prancer
    Vixen
    Comet
    Cupid
    Donner
    Blitzen
    Rudolf

    Well, you can’t touch Rudolf, he’s an icon. More on him later, though.
    Dasher, Dancer, Prancer, and Comet sound kind of, well, let’s just leave it at Santa DA, and they DT; and Vixen and Cupid might be transexuals, not that there’s anything wrong with that, but, in todays job market, why give an employer another reason NOT to hire an unemployed reindeer? So, Santa’s got to keep those 6. I mean, how many other people hire reindeer? Santa may be a Liberal, but he’s got pretty much of a monopoly on jobs for reindeer, unless you count being a filet or part of a stew in a Nordic country as part of a good career move.
    That leaves Donner and Blitzen. Those sound a little like the names a right wing reindeer supremacist would take. So, I’d start with them. Donner is a takeoff on the old Germanic word for thunder. But, you can’t blame a reindeer for what his parent’s named him. I mean look at poor Rudolf. Not only does he have a Teutonic name, but they have to give him a cover story for his drinking. Yeah, his nose’s red to guide the sled. HA!!! Who believes that? Children! He just got himself a great agent and a PR firm, that’s all.
    It’s Blitzen that bothers me, because it sounds like he’s trying too hard. Trying to sound like a tough guy. Maybe he’s a phony, a ‘naughty boy,’ and has a ‘wide stance,’ so Santa can check with the other reindeer. And if it’s true, well Blitzen it is. But, that may be discriminatory. I don’t know, maybe the easiest thing to do is look for cause (I said cause, not Claus). I’d have old Rudolf take a breathalyzer, or pee in a reindeer Dixie cup. If he doesn’t pass, then you’ve got a good reason to can him. He probably doesn’t need the job, he can live off of royalties on the song and TV show – unless the agent who gave him that ‘red nose’ cover story kept all of the money. Oh, well…
    Or, maybe keep the lot of them, and contract out a couple of his little helpers to “Elfpower” for outside employment, and they can donate a part of their wages.
    This way, Santa keeps his reindeer, you get your notebook and wireless, and we don’t have to listen to the children of the top 2% whine about how they’re going to go Galt!

    PS: I hope you get your wishes.

  18. Pat  •  Nov 23, 2010 @3:23 pm

    Sounds like 3rd Party Time to me… We’d benefit a lot from multiple parties with huge voting blocs that could extract concessions from the party of “Hell No!”

    A little OT but friend just turned me on to a great essay written in the 40’s but if you didn’t know that you’d think it done just last week. It’s in a book of essays but I’m referring to the essay (first one in my copy of the book) having a title the same as the book title which is “Cult of Power” by Rex Warner. He’d come across it some years back in a sale of books at Emory University in Atlanta from Jimmy Carter’s personal library.

    Without going into detail it identifies stages in movements that ostensibly strive to free themselves of any number of societal fixtures that they claim to be oppressive. But rather than progressing to a next stage replete with the desired exemplary concept of “unfettered man” that next stage is something altogether different. Our current situation seems to reinforces these ideas which, as he points out, repeat predictably throughout history, albeit in varied forms.

    There are many books and essays in this area but each attacks the problem from a slightly different angle. Anyway, maybe others will find it as interesting as I did. I am debating as to where we actually are in the stages Warner lays out…

  19. kth  •  Nov 30, 2010 @10:55 am

    Late, but please keep hammering this issue (I linked you on my Facebook page). My folks think that Obamacare means that, in the near future, doctors won’t accept Medicare. I didn’t know wtf they were talking about until I saw this item; apparently the olds (if they watch Fox, which they nearly all do) think that the “doc fix” has something to do with the health care reform.

  20. maha  •  Nov 30, 2010 @11:07 am

    kth — Thanks; yes, Fox and other right-wing “news” outlets are deliberately fudging facts to keep people confused about what is going on with health care reform. I believe most of the ordinary citizens who want health care reform repealed have no idea what the health care reform law actually provides, and they want it repealed because they believe the lies. I sincerely believe that once it goes into effect and people come to understand what it really does, they will like it a lot. Unfortunately, since most of it won’t go into effect until 2014, the Right has plenty of time to demagogue and weaken the law by taking it apart, piece by piece.

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