Bush walks like a duck as GOP bolts
Bush walks like a duck as GOP bolts
By: David Rogers and Patrick O'Connor
Politio
July 16, 2008
From Medicare to mortgages, President Bush's lame-duck status is more and more evident in Congress, as restless Republicans defect and power shifts to activist Cabinet members, such as Treasury Secretary Henry Paulson, willing to engage with Democrats.
Within hours of receiving Bush's veto message on Medicare legislation on Tuesday, lawmakers overrode the president, putting into law a bill that many Democrats ?- only weeks ago ?- didn't think had enough votes to get through Congress.
Instead, Republican defections tipped the scales dramatically, and on the veto override, 153 members of the president's party joined 230 Democrats on the 283-41 vote. The Senate followed, 70-26, with 21 Republican defections.
The current crisis over the mortgage finance industry shows the other side of the coin. The president used a televised news conference Tuesday to endorse Treasury's plan to shore up investor confidence in the two troubled giants: Fannie Mae and Freddie Mac. But again, Republicans are defecting, prompting delays in the House and forcing Paulson to rely on Democrats to see the bill through Congress.
A Wall Street veteran with a measure of moxie, the Treasury secretary dominates the political stage like few others in the Cabinet. Together with Federal Reserve Chairman Ben Bernanke, Paulson can overshadow Bush himself in today's economy.
But with the Dow Jones falling below 11,000 Tuesday and inflation rising at the fastest pace in decades, it is a perilous situation. And Paulson faces both political sniping from the White House and sometimes heavy-handed dealing by Democrats as he seeks to address the Fannie and Freddie crisis.
Treasury's plan asks for temporary 18-month authority to extend credit and even purchase an equity interest in the two government-sponsored entities, or GSEs, which have seen their stock value plummet in recent weeks. To expedite matters, the legislation would be added to a pending housing bill in Congress. And to make the deal work ?- and help Paulson with the White House ?- Democrats said Monday that they would drop $4 billion in community development block grant, or CDBG, funds, which had provoked a Bush veto threat.
Those signals changed late Tuesday as more Republicans defected, providing an opening for the Democratic leadership to delay action and also restore the community development funds. The Congressional Black Caucus had protested the loss of the money, but the decision jeopardizes the larger package and could put Paulson in an untenable situation.
Just hours earlier, the secretary had told the Senate Banking Committee that his working assumption had been that the CDBG funds would be dropped, and urged agreement in dealing with the market crisis.
"I just hope we can get this done quickly; we don't take hostages," Paulson told senators. "It would just be a great signal for the whole world to move this through quickly."
During the same hearing, Paulson endured a verbal pounding from conservative Sen. Jim Bunning (R-Ky.), but his larger problem lies with Republicans in the House.
Minority Leader John A. Boehner (R-Ohio), who had talked with the secretary on Saturday about the Treasury plan, signaled his concern to Politico on Monday night. This sentiment became more public Tuesday as Rep. Spencer Baucus of Alabama, the ranking Republican on the House Financial Services Committee, also asked for more time to consider the Treasury plan. And more than two dozen Republicans signed a letter to House Speaker Nancy Pelosi (D-Calif.) suggesting that the risks to the taxpayer were too great to proceed quickly.
"It's nonsensical," said Rep. Jeb Hensarling (R-Texas). "You can't have it both ways and say, ?'Yeah, they're about to go belly up, so I'm going to increase their responsibilities and increase their financial exposure.'"
"Nobody wants to see Fannie and Freddie fail," he said. "But what are the methods, and what are the legislative tools that we use to assure that the problems in the housing market are not exacerbated?"
"You're drowning, so go out to deeper water. How much sense does that make?"
The Associated Press reported shares of both mortgage companies continued their fall on Wall Street on Tuesday. Fannie Mae fell more than 27 percent to $7.07. Freddie Mac shares declined about 26 percent, to $5.26. Shares of each company have lost about half their value since the beginning of last week.
House Democrats hope to regroup and bring the housing bill out to the floor ?- with the Treasury language ?- next week. But at a time when Pelosi is talking up the need for a second economic stimulus package, any decisions that weaken Paulson could be costly.
"This is a serious situation," said Larry Summers, who held Paulson's post in the second Clinton administration. "We are in much more danger of responding insufficiently than responding excessively. It is time at last for policy to get ahead of the curve."
Summers spoke after a meeting between the speaker and economists like himself, all of whom urged a mix of public investments in infrastructure, new tax cuts and steps to address higher energy costs. But Paulson was a crucial ally for Pelosi in the first stimulus package last winter, and to get anything enacted into law will surely require his help with the White House.
"We're in a box here, and I don't know how else we get out," Sen. Chuck Hagel (R-Neb.) said after hearing Paulson's testimony on the Treasury plan.
"This administration has never ever had a strategic concept of what they were going to accomplish for the long-term good of America," Hagel told Politico. "They have been consumed with terrorism; they have been consumed with national security."
"If Paulson and [Defense Secretary Robert] Gates and, I think, [White House chief of staff] Josh Bolten would have been at the front end of this administration, at the beginning, I think you'd see a whole different landscape, but we've never had any strategic thinking."
The Medicare measure, which now becomes law, blocks a scheduled 10.6 percent cut in Medicare reimbursements for physicians, but it pays for itself by effectively taking money from private Medicare Advantage health plans championed by the administration as an alternative to the government-run program for the elderly.
For this reason, Democrats never expected to prevail when the package was brought to the House floor in late June. But Republicans defected in huge numbers, and resistance in the Senate collapsed last week.
The 21 Republicans who opposed the president grew from 18 last week. The number would have been higher but for the absence of Sen. John Warner (R-Va.). Altogether, four more Republicans ?- three of whom are up for reelection in November ?- switched against Bush on the override.
If the reduction in Medicare spending had taken place, MDs would have suffered a 10% decrease in their fees received from treating Medicare patients.
littlek wrote:Go Teddy! ... Now he needs to go rest.
That's not where he needs to go...
Phoenix32890 wrote:Well, that's two points for old Teddy. One of the worst things that happened to Medicare was having private insurers in on it. It just upped the ante for everyone, and caused situations where clerks were making medical decisions about what was to be paid or not.
That last paragraph may sound strange from someone who believes in the smaller the government the better, but Medicare had become a hybrid fiasco.
People over 65 pay for Medicare. When the privately run "Medicare Advantage" plans came into being, (read H.M.O.") many people jumped on the bandwagon because they thought that they were getting away with murder because on the surface it cost less. Ultimately, it cost MORE for everyone on Medicare.
But what about all the holes in the original medicare plan, that private insurers pay for? Consider for example, that medicare pays for only ONE mammogram and additionally, medicare does not pay for refractions when having eye exams.
If you don't have a refraction, there's no way you can buy glasses from an optometrist.
There are many, many other holes in the original medicare program, so the private plans do serve a a fuction in filling the so-called medigaps.
Miller wrote:Phoenix32890 wrote:Well, that's two points for old Teddy. One of the worst things that happened to Medicare was having private insurers in on it. It just upped the ante for everyone, and caused situations where clerks were making medical decisions about what was to be paid or not.
That last paragraph may sound strange from someone who believes in the smaller the government the better, but Medicare had become a hybrid fiasco.
People over 65 pay for Medicare. When the privately run "Medicare Advantage" plans came into being, (read H.M.O.") many people jumped on the bandwagon because they thought that they were getting away with murder because on the surface it cost less. Ultimately, it cost MORE for everyone on Medicare.
But what about all the holes in the original medicare plan, that private insurers pay for? Consider for example, that medicare pays for only ONE mammogram and additionally, medicare does not pay for refractions when having eye exams.
If you don't have a refraction, there's no way you can buy glasses from an optometrist.
There are many, many other holes in the original medicare program, so the private plans do serve a a fuction in filling the so-called medigaps.
... while at the same time making obscene profits. No longer, tho.
Cycloptichorn
7.13.2008
Doctors Dropping Medicare - The Domino Effect
When the docs in my area began dropping Medicare, their patients had no where to go but to the docs like me who still participate in the plan.
And so, over the past year or so, I began seeing more and more new older patients in my practice. The shift in my practice demographic was almost palpable as these new Medicare patients began filling my appointment book months in advance for routine annual visits. Add in a few retiring docs, and the influx of older women became too much to ignore.
On the day I saw seven new Medicare patients, all coming from the practices that had stopped taking Medicare, I knew that I had to do something.
The Practice Impact
Now I already see more Medicare than most of my colleagues in 0b-gyn. I'm known for managing menopause, and that tends to draw an older crowd to start with, who move into Medicare as they age. Plus, I like the older patients, and almost went into geriatrics at one point.
But this was getting to be too much. The Medicare patients were taking all my new patient appointments.
You see, unlike younger patients, Medicare patients usually call far in advance for their appointments, and fill up my new patient slots for weeks to months at a time. That leaves no room for the 25 year old who just moved to Manhattan and needs her pills refilled within the month, the 35 year old who thinks she is pregnant, the 45 year old with hot flashes who can't wait till March, the Italian tourist with the UTI or the 16 year old whose mom just found out she was having sex. If I don't have the slots to see these patients soon, they'll find someone else who does.
These younger patients provide the variety that drew me to this field in the first place - the opportunity to care for women at all stages in their reproductive lives, with medical problems that change with each decade. My research arena is contraception and std's, and that means younger patients. I especially love the teens, and ran the adolescent gyn and teen pregnancy clinics at my former jobs. I really missed seeing these patients in my practice as the older patients began taking all the new patient appointments.
What are the financial impacts? Well, if the visit is medically complicated, Medicare pays reasonably well for my time, although it's still less than half of what I get from managed care for the same services. At current volume levels, it's not that much of a problem. But if Medicare were to increase much beyond that, it could impact the bottom line significantly.
And finally, I have to be honest and admit that my temperament is not suited to seeing a large volume of elderly patients in one day. I can't stand having patients waiting in my waiting room because I am behind. Older patients just take more time per visit, no matter what the reason. I can handle a few Medicare patients a day, no problem. But more than, and I am guaranteed to get behind on schedule. And that stresses me to no end.
My Response
In response to this rapid change in my practice demographic I advised my staff that if a non-Medicare patient called, for whatever reason, she got offered an appointment immediately, even if it meant adding her onto the beginning or end of an already full day.
I thought that would solve the problem.
But after a few months, it became clear that this was not working. New patient slots continued to be filled months in advance by the Medicare patients.
So I put a moratorium on new Medicare patients except those referred by colleagues for a problem. I am continuing to see my current Medicare patients, as well as my own patients who transition into Medicare.
I feel terribly guilty about all this, but it's working. I'm seeing more and more new younger patients. The Medicare new visits are still coming, but on a more limited basis, and overall Medicare now comprises about 20% of my visits. Which is fine for now. This solution is working for me and for my current patients, as well as for my referring docs.
Of course, it's not working for those women out there still looking for a new gynecologist.
Posted by TBTAM at 7/13/2008
Source: The Blog That Ate Manhatten
Miller wrote:If the reduction in Medicare spending had taken place, MDs would have suffered a 10% decrease in their fees received from treating Medicare patients.
Don't forget the 10% decrease for treating active duty military families. They pay on the same scale as Medicare.
"It is largely funded by cutting about $13 billion in reimbursements to insurers such as UnitedHealth Group Inc and Aetna Inc that contract with the Medicare program.
The Bush administration opposes any effort to trim payments to private health plans. The president has said the move would limit plan choices for seniors. But doctors and the seniors' group AARP waged an aggressive lobbying effort to prevent the doctors' pay cut. "
So when will the premiums be increased? Do you really expect the insurance companies to take the hit? Just another tax increase coming our way.
