Medicare veto override a triumph for single-payer advocates, Krugman writes


Ostensibly, the vote was against pay cuts for doctors. But it was really about “creeping privatization of Medicare,” writes left-wing columnist Paul Krugman.

Krugman blames Medicare deficits on the Medicare Modernization Act. Not Part D, but Medicare Advantage private fee-for-service plans. He asserts that these rapidly growing plans cost the government 17% more per beneficiary, while threatening to “undermine Medicare’s universality.” Insurance companies “cherry-pick healthier and more affluent older Americans, leaving the sicker and poorer behind”—in the wonderful “traditional” Medicare system that leftists want all Americans to have.

Krugman notes, correctly, that previously payments to doctors were maintained through “bipartisan fudging.” That is, “politicians from both parties got together to waive the rules. In effect, Congress kept Medicare functioning by expanding the federal budget deficit” (NY Times 7/11/08).

President Bush vetoed the bill preventing a 10.6% cut in Medicare fees because it was attached to payment cuts to Medicare Advantage plans. In addition, in his veto message he stated: “[The bill] would imperil the long-term fiscal soundness of Medicare by using short-term budgetary gimmicks that do not solve the problem; the result would be a steep and unrealistic payment cut for physicians—roughly 20% in 2010—likely leading to another expensive temporary fix” (Iglehart JK, N Engl J Med 10.1056/NEJMp0805760).

Krugman is exultant because the Democrats’ ability to stop a filibuster and override a veto make “the odds of achieving universal health care, soon,…look a lot higher than they did just a couple weeks ago.”

The AMA also celebrated, calling the legislation a significant victory. Through paid advertisements, the AMA exerted intense pressure on Republican senators initially opposed to the measure, Iglehart noted. The bill also staves off the scheduled 2009 cut.

“Good job, AMA leadership,” writes Dr. Thomas LaGrelius, president of the Society for Innovative Medical Practice Design (SIMPD). “You made the enemy very happy.”

The bill also killed competitive bidding for new equipment, which reportedly would have saved the program billions of dollars. For example, copayments for an oxygen concentrator for Medicare beneficiaries now total $1,428 over 36 months—more than double the purchase price. Medicare rents it for $198.40/mon, and the copayment is 20%. Medical equipment suppliers lobbied fiercely against this provision (Consumer Power Report #136, 7/18/08, citing Michael Leavitt, “Will Congress Continue a Medicare Scam?” Wall St J 7/9/08). (DME suppliers posted numerous comments in response to this article, regarding the value of the follow-up services they provide, and the Medicare rules and regulations.)

Additional information:


  1. I await the 20% or more cut, thus we will have a certain choice to stay or go; it seems they want to keep us onboard by dangling carrots before us, carrots that are by now rotting and clodded. We should recognize them for what they are, hold our nose and run away.

  2. Amazing, this is the third time congress has veto Bush in 8 years.
    They were the water issue, the agricultural issue and the doctor’s payments.
    Why did congress did it? Because of the fear of retaliation congressmen felt from the broad base of beneficiaries that know the enormous difficulties doctors are going through to just see a patient. These difficulties are the enormous paperwork that takes away from the medical patient relationship to become the doctor activity a computer relationship. The fear of treating a patient due to the medical boards zealots. The barely covering compensation for all the hassle of coding and billing. The enormous debt that doctors accumulate when providing medication to patient (remicade or other infusions doctors have to pay to be reimbursed -perhaps- later). The loss of confidentiality, respect and freedom of the profession. The abusive behavior of the insurance companies against doctors extends against patients and all this made the public call the congressmen and told them that election day is near and that if they play with the medical care they will notice the public discontent.

    What all this means for us. First the public understand our struggle, fears and suffering. Second they care about medical care more than Irak’s war (this as this issue affects them directly) and third, that we should procure their support to free ourselves from what is coming…electronic medical records…aggressive medical boards inquisitorial injustice, more loss of confidentiality rights and extended criminalization of our activities…
    That they will pay us less every year…sure they will …that doctors didn’t do anything to lobby against bush veto as they have lost all moral to stand up for their rights in a solitarity front… is a given…All doctors are scared and like atoms without cohesion wonder in a gas like state independent and not caring over no one else praying that the system won’t touch them…
    Well colleagues …welcome home …you will be touched and we better get organized to stand together to defend the profession …or the single payer (the insurance companies and their spear and shield ,medicare) will make being a doctor becoming a technician to the administrators of medicine sitting over our heads…they will use the medical boards, the hospital boards, the pharmaceutical companies the insurance companies and all the legislators …even if they have to pay them more than what they pay them now…Indeed our profession got in trouble when the public was told they had no responsibility controlling how much doctors are to be paid for their services…The public loved it ..But now not so much as seen in the outcry to block bush’s veto.

  3. Cash at the time, not accepting Medicare money, liberates.

    It does require cutting overhead, going gradually and rebuilding a practice based on word of mouth that you take time and care about all of a patient’s concerns. A $50, 15 min visit takes care of 3/4, I find. A more interesting practice results from people dissatisfied with the superficial, standard or unfeeling inattention usual at Kaiser, Medicaid clinics, etc.

    Warning. That also means patients have tried others first and have more challenging conditions.