Ted Kennedy Shows Up to Vote; McCain Absent

When Ted Kennedy came onto the Senate floor, his colleagues cheered.

He was there to vote on the bill that would prevent a 10.6 percent cut to physicians who treat Medicare patients.

Just before Congress broke for the July 4 holiday, the bill missed the 60 votes needed to pass by just one vote.

Today, Kennedy, who is battling a brain tumor, brought that vote to the Senate floor. “Aye,” the 76-year-old Kennedy said, grinning and making a thumbs-up gesture as he registered his vote.

Meanwhile, it appeared that Republican members of the Senate had been released to vote as they wished after it became apparent that the 60-vote threshold would be met. Pressure from seniors,  the AARP, and the AMA  had been mounting on members who voted against the bill June 26.

Republicans resisted voting for the legislation because while it spares physicians, it  would reduce the fat subsidy that Congress has been giving  private insurers who offer Medicare Advantage.  President Bush and Senate Republicans had been strongly against any cut in the Advantage program.

In the end, the vote was 69 to 30 in favor of the bill. President Bush had threatened to veto the bill if it passed the Senate, but 67 votes make it veto-proof. And since the House has already voted 355-59 in favor of the bill, Congress appears able to over-ride any veto.

According to Roll Call, 18 Republicans broke with their party to pass the House-backed bill.

Sighs of relief could be heard on the Democratic side as lawmakers, beginning with Sen. Kay Bailey Hutchison (R-Texas), chairwoman of the Republican Steering Committee, joined with Democrats to pass the bill. Hutchison’s Texas colleague, Sen. John Cornyn (R), who was on the receiving end of an American Medical Association ad blitz slamming his pre-recess position, also ended up voting for the bill.Other Republicans who voted to proceed to debate on the politically charged bill included Sens. Elizabeth Dole (N.C.), George Voinovich (Ohio), Susan Collins (Maine), Norm Coleman (Minn.), Pat Roberts (Kan.) Gordon Smith (Ore.), Lisa Murkowski (Alaska), Bob Corker (Tenn.), Johnny Isakson (Ga.), Arlen Specter (Pa.) and Mel Martinez (Fla.).

McCain did not appear.

McCain’s Predicament

Today, Bloomberg News did an excellent job of explaining why McCain might not show up:

“Senator John McCain will be on the spot, in person or by his absence, when the Senate takes up a measure today to halt a cut in Medicare payments to doctors.

“Republicans have stalled Democratic-backed legislation to reverse the 10.6 percent cut in doctors’ fees by reducing payments to insurance companies instead. Democrats on June 26 fell one senator short of the 60 they will need to force a floor vote. Two senators were absent: Edward Kennedy, a Democrat from Massachusetts who is being treated for brain cancer, and McCain of Arizona, the presumptive Republican presidential nominee.

“For McCain, whose schedule indicates he will campaign today in Pennsylvania and Ohio and whose office won’t say whether he’ll show up in the Senate, the vote is a political dilemma. “

“In one case McCain could be voting against his party and in the other he could be voting against an issue framed as pro- senior and pro-physician,” Robert Blendon, a health policy professor at Harvard University’s School of Public Health in Boston, said in a telephone interview yesterday.”

It is worth noting that McCain is one of few Republican senators who voted against the original legislation that created Medicare Advantage and provided what many view as windfall subsidies for private insurers.

Maggie Mahar is an award winning journalist and author. A frequent contributor to THCB, her work has appeared in the New York Times, Barron’s and Institutional Investor. She is the author of Money-Driven Medicine: The Real Reason Why Healthcare Costs So Much, an examination of the economic forces driving the health care system. A
fellow at the Century Foundation, Maggie is also the author the increasingly influential HealthBeat blog, one of our favorite health care reads, where this piece first appeared.

7 replies »

  1. It is really sad that insurance companies are making more and more profit, and yet the senior coverage is decreasing everyday. Doctors are paid so little now that they have to see the double the amount to make up for it. This means, they will miss things for sure simply beacause of the time restraints. Seniors don’t have better access either. Healthcare is a different animal, and when it’s privatized, people will be cared for significantly less. They (insurance co) just want to keep the majority of the money to themselves. keep on denying good drugs. Requesting more paper work to be done for simple tests. Doctors are sick and tired so they just don’t want to offer it anymore simply because it will take time out of their busy day.

  2. Greg, John B., Tammy,
    Greg–You’re entirely right–this fight was not about the docs. (No one really wanted to take an axe to their fees. It’s a crude solution. Some doctors are over paid for certain services; others are underpaid. Medicare needs to go through its fee schedule and re-distribute some of the dollars.)
    The fight was over whether Medicare should continue paying private insurers 13-17% more than traditional Medicare woudl spend if it covered these services directly.
    The Bush administration (and many conservatives) want to privatize Medicare. They hoped that if they gave insurers enough extra money, they would give seniors some extra benefits (while keeping much of the bonus for themsleves. Because of the extra benefits, more and more seniors) would sign up, and they might reach a critical mass before Bush leaves D.C. in January.
    IF they succeeded, they figured there would be so many people on Medicare Advantage that the Democrats wouldn’t be able to touch the program, and eventually Medicare Advantage would bankrupt traditional Medicare.
    At that point, everyone would have to go on Medicare Advantage, Medicare would be privatized, and insurance company exectuives (rather than elected legislators) would make all future decisions about what Medicare covers, how much seniors have to pay in deductibles co-pays, etc.
    This is al part of the grand plan to let corporate America take over the country.
    But then Ted Kennedy showed up . . .
    John B– Because Medicare is paying the extra money to
    Medicare Advantage, seniors on traditional Medicare have had to pay higher deductibles and co-pays since Medicare Advantage was created in 2000.
    So seniors are paying for this.
    As for Medicare Advantage giving seniors something extra, they tend to provided something that is easy to see (like paying for eye-glass frames) while taking away things that are hard to see when you look at the policy (ie. co-pays on a $100,000 cancer drug can be $20,000. You don’t find out until you get cancer.
    There are lots of cuts Medicare Advantage plans have made–you don’t get everything you get under traditional Medicare. (Scroll down to my next post on this blog.)
    And MA plans are not spending all –or even most –of the bonus they get from Medicare. They are keeping most of it to boost their profits.
    Tammy–. Under Medicare, your mother should be able to see a doctor with a co-pay of $10 to $15. Maybe she isn’t signed up for Medicare B. It’s not free, but it’s a very good deal and it covers doctor’s appointments.
    (Medicare A, which everyone has, covers hospitals . Medicare B, which covers doctors, is voluntary. )
    I’d suggest you call your local Medicare office, ask if she is on Medicare B, and find out how much it would cost if she signs up. (Call– don’t let them send you material to read. The material is too confusing–too many choices, too many pages.)
    All you really need to know is “Medicare B covers doctors. Because it’s voluntary, your Mom might not have signed up for it.
    If she didn’t, how much would it cost if she did sign up now? (They would take the cost out of her Social Security check –so you want to know how much it would cost each month.)
    The Medicare office might also talk about “Medicare D”–that helps pay for drugs. It also is volunatry and would be an additional expense. Unless she takes a lot of expensive drugs, it may not be necessary. But she definitely should see a doctor–which means she needs Medicare B..

  3. My mother is 72 lives with me because she can’t afford to live on her own, can’t get any additional benefits because she live with me and I according to the state make to much money.
    When my mother is sick and needs to go to the doctor it’s a battle she refuses to go because it creates a bill that neither she or myself can afford to pay. So, tell me how many other families are doing the same? They need the health care but can’t afford to go?

  4. Medicare Advantage penetration is just over 22%. Medicare Advantage plans are more generous because Medicare has been paying Medicare Advantage plans much more per enrollee compared with what the same enrollees would have cost in the traditional Medicare fee-for service program. It comes out of traditional Medicare.
    These extra payments could be used to provide better benefits for traditional Medicare, like filling in the doughnut hole and reduce out-of-pocket costs for seniors, as well as filling out the bone to doctors by creating a viable alternative to the ineffective sustainable growth rate mechanism currently used to determine the physician payment update.
    Seniors may not pay as much in taxes as everyone else, but they do pay taxes. Many Seniors are still working after 65 because they cannot afford the living standards. My pop worked and paid taxes until he was 83. And private plans have their share of paying fraudulent claims like Medicare. Overseeing my parents finances for 28 years, I’ve seen it in both.
    Again, traditional Medicare needs to be able to compete on a level playing field with private Medicare Advantage plans, which requires the elimination of these extra payments.

  5. To be sure, Greg, you should take one more look at how Medicare Advantage plans are financed. It is not true that “Every senior in Medicare is paying more to fund insurance industry overpayments.” In fact, they’re not paying anything at all because for most plans Medicare pays the beneficiary’s full premium. (Some more generous plans have an additional premium for the beneficiary to pay.) And who pays Medicare? Not the seniors, but all people who work in this country and their employers via the 1.45% tax that we both pay.
    Add to all this the fact that most MA plans are muuuuuch more generous than Medicare itself is and you’ve left Seniors with very little incentive to complain about the MA plans.
    I’d also go over your “massive fiscal burden” numbers again. MA penetration is what, 10%, 15%, 25% at the max? (Can someone answer this?) And of those the most egregious overspending is on the MA Private Fee-for-Service plans, which is a small fraction of the MA-covered lives.
    What you’ve really got here is the ultimate in low-hanging/politically delicious fruit for the democrats. But MA plans’ payments became fully risk adjusted only a year and a half ago, and the data on how that has balanced payments is still being analyzed, as far as I know. (Anyone know the anser to this also?) And I’d also be willing to bet that MA plans do a much better job at not paying fraudulent claims (anyone see the $100m to dead doctors article?) than Medicare does.
    These plans ARE getting paid too much but we have to be careful not to throw the baby out with the bathwater.

  6. This is not about the docs. This is about Seniors and what the privatization of Medicare (thru Medicare Advantage) has really meant to their pocketbooks. Every senior in Medicare is paying more to fund insurance industry overpayments. The money used to pay Medicare Advantage insurers is coming out of traditional Medicare.
    It is time for the Congress to examine whether the extra payments to Medicare Advantage plans are the best use of tax-payers dollars for the beneficiaries the program is designed to serve.
    These payments could be used to provide better benefits, like filling in the doughnut hole and reduce out-of-pocket costs for seniors and the disabled, as well as to create a viable alternative to the ineffective sustainable growth rate mechanism currently used to determine the physician payment update.
    Traditional Medicare needs to be able to compete on a level playing field with private plans, which requires the elimination of these (bribes) extra payments. Then Medicare will continue to be there for millions of Americans 65 and older, just as it has since 1965.
    In fact, the Medicare program will be stronger without the massive fiscal burden Medicare Advantage plans impose. Removing this liability from Medicare could also be the first step towards strengthening the program’s long-term solvency.

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