The kerfuffle over the “doc fix” took a truly courageous turn yesterday in the United States House of Representatives. I will review the general idea of the doc fix but Todd Zwilich today on NPR’s The Takeway gave a fantastic and hilarious take on the history of this money hole, also known as the SGR. In 1997 Congress passed the balanced budget act, which required them to at least appear to be balancing the federal budget. But they couldn’t really so the found a big expenditure, medicare, and did a sort of retro-accounting move. They decided that sometime in the future, say, 2014, the medicare payment system would have to be reset and doctors would take a pay cut of, say, 24%. The took the 24% and added it to the budget for 1997 and wallah! Balanced budget. Todd Zwilich calls this “the worst kind of shell game accounting” that Congress has ever come up with. Tom Coburn (R, Oklahoma), who is a doctor himself, calls the whole thing “funny money”.
OK, so partisanship being what it is, the big push to “fix” the SGR, which is a bipartisan initiative, is going nowhere because the Rs and the Ds can’t decide on how to get the $180 billion it would take. So they needed to pass a patch, a 1-2 year measure to postpone this big pay cut. John Fleming (R, Louisiana), also an MD, acknowledged that “no one wanted to vote for it, and no one wanted to vote against it.” So what did they do, these poor congressmen, so that no one had to come down on either side, thus endangering their chances for re-election? I’ll paraphrase Zwilich:
Eric Cantor (R, Virginia), the House Majority Leader, literally ran out of an office, onto the floor of the House, up to Steny Hoyer (D, Maryland), had a quick conversation, and presto! The bill was passed, without anyone having to soil their hands by voting for it. When the Representatives got to the floor themselves, they were surprised to find the whole thing over with. Now, I have no idea what murky vagaries of House Rules makes this possible, but I do know that our brave congressmen at least had the grace to look slightly embarrassed.
Now the bill (to pass the one year patch, in case I’ve lost you) goes to the Senate. The Senate must vote on it by Monday, which is when the last patch expires. Docs, don’t make your boat payment quite yet. Unless Senators are braver than Representatives, or have the same murky rules, you might be 24% in the hole by Tuesday.