Welcome to the doc fix-fiscal cliff loop…forever

posted at 2:41 pm on December 12, 2012 by Mary Katharine Ham

Peter Suderman of Reason explained eloquently Tuesday what’s been bugging me about the fiscal cliff, perhaps more than anything else—that it is a huge, high-stakes deal which simultaneously solves exactly none of our long-term fiscal problems. There is so much public agonizing over so very little problem-solving. It means everything and nothing all at once.

Why? Because they want it to. The perpetual state of distraction is helpful for ignoring bigger, stickier wickets. Permanent “temporary” fixes allow them to ignore the cost-cutting measures they’ve imposed on themselves while still getting budgetary credit for them.

The whole thing is well worth a read, as Suderman explains the “Doc Fix Economy.”

The way the doc fix developed is somewhat convoluted. In 1989, Congress set up a fee schedule governing how Medicare pays physicians. In 1997, Congress made those fees subject to something called the “sustainable growth rate” (SGR), which was a formula designed to restrain spending growth in Medicare’s physician reimbursements. The formula tied total spending on physician payments to inflation, in hopes of keeping physician spending from growing faster than the economy as a whole.

No one worried much about tying doctor payments to the economy because at the time the formula was passed, the economy was humming along nicely. But when the economy entered a recession in the early 2000s, something unexpected happened: The SGR’s reimbursement formula suddenly called for physicians to get less than they were expecting. So in 2002, Congress did nothing as the formula cut doctor reimbursements by 5 percent. That never happened again.

The next year, when the formula called for another reimbursement cut, Congress passed an override. And each year since, Congress has followed the same pattern. The SGR calls for a reimbursement cut. Congress either freezes payments or gives physicians a small increase for a short period of time. Sometimes the overrides last for a few months. More often they last for about a year. But a permanent fix never arrives. And each time the formula calls for a bigger cut—because with each override, Medicare’s physician payment levels grow further and further from the trendline called for by the formula. If the doc fix is allowed to occur this year, physicians face a 26.5 percent cut in Medicare fees. At the same time, the long-term cost of a permanent fix grows each year. Last year’s one-year fix cost $18.5 billion. This year’s is expected to cost about $25 billion. Estimates put the cost between $244 and $370 billion over a decade. The ever-rising cost means that with each override the chances of a permanent fix grow even harder.

I’d add that the failure to pass a budget for three years, even though they’re required by law to do so, is a flagrant move to turn all of government budgeting over to this process. Sen. Harry Reid has openly stated he doesn’t care to put his budget down on paper because voters might not like it. This dereliction of duty has gone virtually unremarked upon in the press. The public doesn’t care much for process stories, and therefore won’t care about a lack of budget unless the press floods the zone on the story, as they no doubt would if it were a Republican Senate who’d flouted the law for three years. In the end, however, 2012′s results were a vindication of Reid’s tactics, as illustrated by Sen. Patty Murray’s assurance that there’s no need to have a budget this year, either. Every year without so much as a nod to the budget process (which wasn’t great to begin with) brings more brinks upon which to teeter, more distraction from real problems, and sweet release for politicians who don’t have to own up to their irresponsibility.

Like the casino boss in “Ocean’s Eleven,” we’re stuck watching a flashy pantomime of these arses while they rob us blind. Spoiler alert: Harry Reid does not look like George Clooney.


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Ramirez, always a national treasure

Schadenfreude on December 12, 2012 at 2:44 PM

Like the casino boss in “Ocean’s Eleven,” we’re stuck watching a flashy pantomime of these arses while they rob us blind. Spoiler alert: Harry Reid does not look like George Clooney.

Thuggish charlatans rule, from the left to the right.

p.s. but Harry is as stupid as Clooney

Schadenfreude on December 12, 2012 at 2:45 PM

Finally someone is writing about this. Thank you MKH.

My recent nightmares have centered around Boehner and Obama making secret deals in private, as a substitute for holding public budget talks.

esr1951 on December 12, 2012 at 2:45 PM

BREAKING NEWS!!!

Gov’t arrests illegal immigrant Senate intern, Departmet of Homeland Security directed federal agents not to arrest him until AFTER THE ELECTION.

WASHINGTON (AP) — U.S. Sen. Robert Menendez employed as an unpaid intern in his Senate office an illegal immigrant who was a registered sex offender, now under arrest by immigration authorities, The Associated Press has learned. The Homeland Security Department instructed federal agents not to arrest him until after Election Day, a U.S. official involved in the case told the AP.

Resist We Much on December 12, 2012 at 2:47 PM

Three uber-liberals as your picture for this – perfect!

Thanks for the reminder of why I go to far fewer movies than ever.

beatcanvas on December 12, 2012 at 2:47 PM

Keep cutting the Dr’s fees and when the patient numbers from Medicare go thru the roof let’s see how many Docs hang around.

docflash on December 12, 2012 at 2:48 PM

You make me sad MKH, because I know it’s the truth; but at least you got a Reid jab in there. That guy looks like more like the Crypt Keeper each day. If I ever heard him laugh, I’d have a heart-attack.

Meric1837 on December 12, 2012 at 2:48 PM

Peter Suderman of Reason explained eloquently Tuesday what’s been bugging me about the fiscal cliff, perhaps more than anything else—that it is a huge, high-stakes deal which simultaneously solves exactly none of our long-term fiscal problems. There is so much public agonizing over so very little problem-solving.

Precisely. They are rearranging the deck chairs on the Titanic, and will continue to do so as long as the passengers are distracted by the spectacle. If the Democrats win it means only slightly less than if the GOP wins.

I would like to believe the Republicans aren’t complicit in this charade, but I no longer really believe that.

sharrukin on December 12, 2012 at 2:49 PM

I’d add that the failure to pass a budget for three years, even though they’re required by law to do so, is a flagrant move to turn all of government budgeting over to this process. Sen. Harry Reid has openly stated he doesn’t care to put his budget down on paper because voters might not like it. This dereliction of duty has gone virtually unremarked upon in the press.

The house should hold the debt ceiling talks hostage until filthy Harry produces a budget. Period.

antipc on December 12, 2012 at 2:58 PM

$100,000,000,000,000 in unfunded liabilities.

Everything else is a smoke screen.

Akzed on December 12, 2012 at 3:02 PM

esr1951 on December 12, 2012 at 2:45 PM

check this one out esr

http://ace.mu.nu/

scroll down the story that starts with Senator Jeff Sessions

DanMan on December 12, 2012 at 3:04 PM

Sen. Harry Reid has openly stated he doesn’t care to put his budget down on paper because voters might not like it. This dereliction of duty has gone virtually unremarked upon in the press.

Sadly, it was the Weeping Boner’s job, leading the House – the holder of the purse strings – to force the Senate to confront budget reality and either work to pass budgets or let the feral government shut down. But, instead, we had the idiot Boner passing CR after CR to help Hairy Reed and his Indonesian continue on with budgetless spending that also enshrined the insane Porkulus year after year after year.

Hairy Reed is a despicable pile of slime. There’s no doubt about that. But, it is the House that originates all spending and unltimately bears responsibility for the fiscal situation. The Weeping Boner was scared that he would be blamed for Reed and the Indonesian shutting down the feral government and chose, instead, to stab the Tea Party and America in the back and support the America-hating dems in their continued asinine, un-Constitutional spending. The House GOP also bears huge responsibility in this because they passed the Weeping Boner’s idiotic deals through and didn’t make the reasonable move to toss the Weeping Boner from the Weepership back in March of 2011 when it was perfectly clear that Boner was an idiot who was doing nothing but giving aid and comfort to the America-hating left. It was this inaction and stupidity by Boner and the House GOP that served up the disastrous 2012 (in addition Romney’s own laughable campaign – which shouldn’t have mattered … but all added together, it did).

Don’t expect any backbone from the Weeper and his House of fools this time around. They’ve been enabling leftist America-haters in the Senate and at Pennsylvania Ave for two years, now, and there’s no reason for anyone to believe they’ll change their ways at this point. They are totally useless.

ThePrimordialOrderedPair on December 12, 2012 at 3:08 PM

Spoiler alert: Harry Reid does not look like George Clooney.

But they are different cheeks of the same horse’s arse.

chemman on December 12, 2012 at 3:15 PM

Resist We Much on December 12, 2012 at 2:47 PM

Hah, the decent leftists abound.

Schadenfreude on December 12, 2012 at 3:17 PM

Resist We Much on December 12, 2012 at 2:47 PM

Since the AP article’s intro didn’t list the party my guess is he is a democrat.

chemman on December 12, 2012 at 3:20 PM

The scary thing is that a perma-”Doc fix” is the “conservative” position.

Don’t worry – they’ll keep most of the defense sequestration (on second thought – worry).

Steve Eggleston on December 12, 2012 at 3:20 PM

I agree with everything here except the Republicans could FORCE the Senate to pass a budget, just say that’s the only way you’re going to deal with these people. Don’t sign any agreements unless they’re in a reconciliation agreement between the House and the Senate to resolve the differences in the budget.

bflat879 on December 12, 2012 at 3:20 PM

Since the AP article’s intro didn’t list the party my guess is he is a democrat.

chemman on December 12, 2012 at 3:20 PM

Give the man a ceeegar. Menendez is a Jersey Rat.

Steve Eggleston on December 12, 2012 at 3:20 PM

One more thought, the House should pass a bill that says, if there is no budget, all spending remains EXACTLY the same, no increases, period. The Senate and Obama have gotten away with continuing resolutions that increase spending. That needs to stop.

bflat879 on December 12, 2012 at 3:21 PM

DanMan on December 12, 2012 at 3:04 PM

Special people have special rules. Isn’t that special?

esr1951 on December 12, 2012 at 3:26 PM

I’d add that the failure to pass a budget for three years, even though they’re required by law to do so, is a flagrant move to turn all of government budgeting over to this process. Sen. Harry Reid has openly stated he doesn’t care to put his budget down on paper because voters might not like it. This dereliction of duty has gone virtually unremarked upon in the press. The public doesn’t care much for process stories, and therefore won’t care about a lack of budget unless the press floods the zone on the story, as they no doubt would if it were a Republican Senate who’d flouted the law for three years.

Any attorneys in the house? Why can’t we the people sue the Senate? Seriously, “required by law to do so” usually means consequences for failure to do so – and no, not just “elections” and “well the voters sent Reid back”, that’s bullsqueeze – those are electoral consequences, or lack thereof – I mean LEGAL consequences for breaking the f-ing law.

Or are they exempt from that, too?

Midas on December 12, 2012 at 3:29 PM

Keep cutting the Dr’s fees and when the patient numbers from Medicare go thru the roof let’s see how many Docs hang around.

docflash on December 12, 2012 at 2:48 PM

Doctors, unlike hospitals, and immune to EMTALA threat. They always have an option to stop accepting any insurance, both brands of Mediscam including, and switch to cold hard cash. They will, of course, have to charge less, and settle for fewer patients, but it’s still a decent living – and a much friendlier and honester crowd in the office.

Archivarix on December 12, 2012 at 3:29 PM

Schadenfreude on December 12, 2012 at 3:17 PM

War on Wymminesses!

Resist We Much on December 12, 2012 at 3:30 PM

Since the AP article’s intro didn’t list the party my guess is he is a democrat.

chemman on December 12, 2012 at 3:20 PM

He’s from Sopranos State, aka New Jersey. Here, even if you’re a Republican, you’re still a Democrat. Case in point: Gov. Chris Christie.

Archivarix on December 12, 2012 at 3:31 PM

Any attorneys in the house? Why can’t we the people sue the Senate?

Midas on December 12, 2012 at 3:29 PM

Because the Weeping Boner and his GOP House allowed Hairy Reed and the Indonesian to make a mockery of the Constitution with continued budgetless spending. It was the House’s job to force a budget, not pass ridiculous CRs time after time.

Of course, the Indonesian has committed tens of clearly impeachable acts that the House hasn’t even bothered to mention (something like one a month since the Dog-Eating Retard slimed into office) let alone take action on.

ThePrimordialOrderedPair on December 12, 2012 at 3:36 PM

Since the AP article’s intro didn’t list the party my guess is he is a democrat.

chemman on December 12, 2012 at 3:20 PM

But of course. The MSM always unexpectedly forgets to ID Democrats in scandals.

I am STILL waiting for the stark, raving, deranged, Progressive lunatic — but I repeat myself…over and over again — on TH to provided me with the “Proof E11111eventy!11!11!11!” that he promised me more than 2 years ago that would “utterly destroy” my “manufactured outrage” directed at Democrat officials in Bell, California, ‘cuz ‘erybody knows that all of the people that ripped off the poor people living in the very poor, heavily Hispanic community of Bell were ALL REPUBLICANS!!!

**eyeroll**

Resist We Much on December 12, 2012 at 3:39 PM

Any attorneys in the house? Why can’t we the people sue the Senate?

Midas on December 12, 2012 at 3:29 PM

For what?

Resist We Much on December 12, 2012 at 3:40 PM

I’d add that the failure to pass a budget for three years

1333 days. 3 years, 7 months, 23 days.

Shouldn’t someone be impeached or removed from office for not doing their job?

LoganSix on December 12, 2012 at 3:40 PM

This dereliction of duty series of criminal acts [Reid's refusal to pass a budget for three years] has gone virtually unremarked upon in the press.

FIFY; GOP House and Senate Leadership response: crickets …

ThePrimordialOrderedPair on December 12, 2012 at 3:08 PM

Stole my thunder; well said!

ShainS on December 12, 2012 at 3:41 PM

Any attorneys in the house? Why can’t we the people sue the Senate?

Midas on December 12, 2012 at 3:29 PM

For what?

Resist We Much on December 12, 2012 at 3:40 PM

Conspiracy to commit fraud?
Racketeering?
False representation?
Grand Theft?

LoganSix on December 12, 2012 at 3:42 PM

Any attorneys in the house? Why can’t we the people sue the Senate?

Midas on December 12, 2012 at 3:29 PM

For what?

Resist We Much on December 12, 2012 at 3:40 PM

Intentional Infliction of Emotional Distress? ;-)

ShainS on December 12, 2012 at 3:44 PM

Permanent “temporary” fixes

In my experience in writing and supporting software apps, I have maintained for years that there is nothing more permanent than a temporary fix. Seems that politicians subscribe to the same view…
Wish I could ‘work’ as little as these guys and still keep my job.

Jack Slade on December 12, 2012 at 3:44 PM

ThePrimordialOrderedPair on December 12, 2012 at 3:36 PM

Thanks but a) I know the House is sackless and won’t do anything, and b) that wasn’t my question.

Can *we* – you know, “we the people” – enlist a class action suit against them somehow? Damnit, anything would be better than watching these people simply, openly and literally break the law daily, for years on end.

If there truly is no legal approach to take, then the tyranny is already far worse than anyone’s been complaining about – and there *is* a founder-provided and supported remedy for that.

Midas on December 12, 2012 at 3:45 PM

For what?

Resist We Much on December 12, 2012 at 3:40 PM

Did you read the blog post where it talks about the failure to do that which is required by law? Did you read the part of my question that asks if that is true, what can be done about it?

I guess I’m not following why you’d ask that if you’d read any of the above.

If they are required by law to pass a budget, then failing to do so is breaking the law. Typically that means consequences, and not just ‘electoral’ ones. People don’t get to continue breaking the law just because they get re-elected. There are examples of elected officials experiencing consequences for breaking the law.

I know there’s a distinction between civil and criminal offenses, etc, I’m just sick to death of these people breaking the law openly, routinely, and not being held accountable (again, don’t give a damn about ‘electoral consequences’).

Midas on December 12, 2012 at 3:50 PM

Conspiracy to commit fraud?
Racketeering?
False representation?
Grand Theft?

LoganSix on December 12, 2012 at 3:42 PM

You’re going to have to be more specific. Those are crimes, not torts. Yes, there is civil RICO, but it would only apply to the Democrat Party in the context of, say for example, collusion with unions to extort businesses pay campaign contributions (protection fees) and hire only union workers or face the legal might of Democrats and physical might of unions. In such a case, there would probably be more than 2 predicate acts in furtherance of a conspiracy, racketeering or other specified illegal activity. That requires proof of an “enterprise” between the two and, though that clearly exists on many levels, I am not sure that RICO would be applicable or be allowed.

If you are referring to acts like Reid’s failure to put a budget up for a vote, then there is no cause of action that the citizens can plead in a civil suit — at least, I’m not aware of any — because they have immunity. Impeachment by the House and then conviction/removal by Reid’s Senate (yep) are the only procedural recourse. The people get the government that they vote for.

Unfortunately, there is no cause of action against politicians for lying (unless under oath, of course), not doing their jobs, and for being cowards.

Resist We Much on December 12, 2012 at 3:59 PM

Here’s hoping the whole thing crashes and burns. Maybe people will finally wake up.

GarandFan on December 12, 2012 at 4:01 PM

BUDGET DEFICIT SKYROCKETS TO $172B IN NOV, UP $52B FROM OCT…

Resist We Much on December 12, 2012 at 4:07 PM

Spoiler alert: Harry Reid does not look like George Clooney.

No, but he does look like someone’s hemorrhoids and is just about as pleasant.

SWalker on December 12, 2012 at 4:33 PM

No, but he does look like someone’s hemorrhoids and is just about as pleasant.

SWalker on December 12, 2012 at 4:33 PM

Key word – about.

Steve Eggleston on December 12, 2012 at 4:48 PM

Lie from the fed released:

Release Date: December 12, 2012
For immediate release

Information received since the Federal Open Market Committee met in October suggests that economic activity and employment have continued to expand at a moderate pace in recent months, apart from weather-related disruptions. Although the unemployment rate has declined somewhat since the summer, it remains elevated. Household spending has continued to advance, and the housing sector has shown further signs of improvement, but growth in business fixed investment has slowed. Inflation has been running somewhat below the Committee’s longer-run objective, apart from temporary variations that largely reflect fluctuations in energy prices. Longer-term inflation expectations have remained stable.

LIES.

Ah, so $85 billion a month now. That’s $1,020 a year, give or take, or most of the federal deficit. It would be nice if this was “sacrifice free” but of course it’s not. We can predict it shouldn’t be due to arithmetic (when you increase the quantity of money you decrease the value of each unit) but what’s worse is that the math has validated empirically.

All we should have to do is look at the employment rate of the population. After all, The Fed has massively accommodated thus far, yes? Therefore there should be improvement. There is, right?

tom daschle concerned on December 12, 2012 at 4:49 PM

Spoiler alert: Harry Reid does not look like George Clooney.

No, but he does look like someone’s hemorrhoids and is just about as pleasant.

SWalker on December 12, 2012 at 4:33 PM

Hemorrhoids are easier to get rid of than Dingy Harry is.

slickwillie2001 on December 12, 2012 at 5:55 PM

Harry Reid does not look like George Clooney.

Hey, Harry Reid can’t even compare favorably to hair shaved off George’s ***. And I don’t even LIKE Clooney.

As for the Doc Fix: everyone knows that Congress LIKES this method. From their standpoint, it keeps physicians eternally beholden to their largesse. Only, it doesn’t. Go ahead, let the Doc fix lapse for ONE year, and brace yourself for the results.
Any physician that spends more than….oh, about 15 seconds per year worrying about this hasn’t done the internal math correctly.
Our practice saw about 52% Medicare patients, who provided EIGHT percent of practice revenues. We could have dropped Medicare, halved our workloads (if our driving force was simple profit/loss), fired some staff, and reduced income by less than 10 percent. A cut of 26% in reimbursement? Excellent excuse for physicians across the country to drop additional office staff, tell Medicare to **** themselves, and knock off at 3:15 every afternoon with weekends off.

Congress will do no such thing, and know they can’t. But please: Give it a try—I’ve never seen my home on a weekday in daylight. I’d like to see what it’s like.

orangemtl on December 12, 2012 at 7:12 PM

Harry Reid does not look like George Clooney.

True. He looks like a screw worm infected dirt bag.

woodNfish on December 13, 2012 at 12:35 PM

orangemtl on December 12, 2012 at 7:12 PM

Yes, they are in a pickle here, aren’t they? Unless they pass a law saying physicians must accept Medicare/aid, they can’t really not pass the “docfix”

They need to change the law so that the fix is permanent. At least then projected costs of Medicare/aid would be more accurate. I’m sure they use the intended reimbursement rates instead of what really happens.

(I’m assuming Medicare/aid will continue on. I’m not saying I agree that it should.)

cptacek on December 13, 2012 at 3:04 PM