President Bush yesterday vetoed the bill shielding Medicare payments to doctors, and even he must have been praying that Congress would overrides the veto and save him and the country from his folly. By nightfall, they had done just that. The House of Representatives passed the bill again within hours of the veto — by a whopping 383 to 41 — and the Senate, where Republicans stand more solidly with the president, rebuked him by a vote of 70-26.
Arkansas has more at stake than perhaps any place in the land. That is because health care for the elderly in this poor rural state is more marginal than in almost any state and physicians already tend to be paid less for Medicare treatment than affluent areas. If the president’s veto were sustained, payment rates to doctors would have been slashed another 10 percent, and more physicians would elect not to take Medicare cases. More rural hospitals and clinics would have vanished.
Bush was almost apologetic about his veto. He regretted that reimbursement for physician care would be reduced but the remedy in the bill, he said, was irresponsible. What he meant was that it scaled back the foolish ideological gimmick that he imposed on Medicare in 2002 when Republicans had solid control of Congress. That gimmick produced the fiscal crisis that in turn would cut doctor payments.
The president never liked the idea of government-guaranteed health care for the elderly, a legacy of our own Congressman Wilbur D. Mills, when he chaired the Ways and Means Committee. So the 2002 law sought to give big insurance companies a role and a chance to make big profits off the program. It created private “Medicare Advantage” plans that would be administered by the insurance companies. To lure people away from traditional Medicare the Advantage plans offered more benefits, and the government would shell out much more of your tax money for patient treatment in those plans. It guaranteed the companies a handsome profit, but the Advantage plans cost the government 17 percent more than for care under traditional Medicare.
The law also inserted a trigger. When total Medicare expenditures exceeded targets, as they obviously would do as more people opted out of low-cost Medicare for the high-cost private plans, then reimbursement rates to doctors would be reduced automatically. To the cynical, it seemed a surefire way to wreck Medicare over time by driving away physicians and starving rural hospitals. And that is precisely where it is headed.
The new law prevents the payment cut by reducing the huge subsidy for insurance companies. The president wants the companies to keep those subsidies.
While it was a Democratic initiative, let it be recorded that the votes were a bipartisan expression of faith in the Medicare program, one of the most successful government initiatives in our history. And it should not be lost on anyone that every member of the Arkansas delegation, Republican and Democrats alike, did the right thing and prevented another tragedy at the hands of this misguided president.
