Who Do Republican Congressmembers Hate More, Patients Or Doctors?

In 2011, the Washington Post's Wonkblog brought some clarity to the much-used term, "doc-fix." They made it sound so easy.

Ever since Medicare was created in 1965, the federal government has struggled to decide how much to pay Medicare doctors for their services. Democrats and Republicans alike have drawn up complex formulas with wonky names to set reimbursement levels. The Medicare Economic Index was the formula of choice in the 1970s. That was ousted in the 1990s by the Volume Performance Standard.

In 1997, Congress created a new formula called the Sustainable Growth Rate, or SGR. Using Medicare spending in the 1990s as a baseline, the formula factored in overall economic growth to create the annual Medicare budget. The goal was to control Medicare spending by tethering it to the rest of the economy’s growth. And, for a few years, this worked fine; the equation pretty accurately predicted how much Medicare would cost. But, as health care costs outpaced the economy, it has stopped working, leaving the entitlement with a multi-billion-dollar shortfall.

What’s the doc-fix? When Medicare funding falls short, Congress is left with two options: Cut doctors’ pay or appropriate additional funds. Legislators don’t really like the first one; they worry providers would flee the program if their salaries were slashed. So since 2003, under both Democratic and Republican control, Congress has passed short-term doc-fixes to keep provider payments stable (or, in some cases, give doctors a slight raise). These pay-patches have ranged from a few years to just 30 days. In 2010 alone, Congress has passed five separate doc-fixes, none longer than six months. Last December, Congress passed a one-year doc-fix that cost $19 billion and lasts til the end of 2011.

…Has Congress ever failed to pass a doc-fix? What happens then? Last summer, a doc-fix got held up as part of a larger package of stimulus spending and unemployment benefits, allowing a 21 percent cut in doctor reimbursements to go into effect. Then, the Center for Medicare and Medicaid Services told providers to hold off on submitting claims for two weeks in hopes that, by then, Congress would come up with a solution. Congress eventually did, but not without many provider complaints on the disruption to cash flow that the uncertainty had caused.

Congress has become so dysfunctional-- with so many nihilistic right-wing extremists who would rather cause harm and pain than solve problems-- that Boehner and Cantor realized they would have to trick the dominant psycho-wing of their own party to pass it this year. The Senate needed it fast and Reid asked Boehner to get on the stick… so he waited until enough of his own members were visiting K Street to collect bribes Thursday before having Cantor quickly calling the question and passing it on a voice vote. Right-wing extremists are chewing off their legs in anger at having missed another opportunity for a hostage crisis.

Angry House conservatives denounced the Republican leadership for abruptly ramming through a fix to Medicare doctor payments on Thursday without a full roll call vote.

“Outrageous,” Rep. Louie Gohmert (R-Texas) told The Hill after complaining about the maneuver to a colleague. “I think it’s outrageous.”

House Republican leaders had planned to bring up the “doc fix” under a procedure requiring a two-thirds majority to pass, but after a series of closed-door meetings on Thursday morning, they determined they didn’t have the votes to meet that threshold and didn’t want to stay in session long enough to set up a simple majority vote.

So with just a few members on the House floor before a scheduled vote on an unrelated Ukraine measure, Republicans brought up the Medicare bill by voice vote. When no one in the chamber objected, the measure passed.

“Bullshit,” said a visibly annoyed Rep. Mick Mulvaney (R-S.C.) as he emerged from the floor following the Ukraine vote. When Mulvaney was asked to comment about the upcoming GOP budget, he replied: “I can’t talk about the budget because I’m so pissed about the [doc fix].”

Democratic leaders signed off on the move, and rank-and-file members were more amused than anything else.

Rep. Gerry Connolly (D-Va.) said he was one of just a handful of Democrats on the floor when the voice vote occurred and that he was surprised when no recorded vote was requested.

“There was a voice vote and you could hear 'nos' all from our side of the aisle,” he said.

He said it was his understanding that Senate Majority Leader Harry Reid's (D-Nev.) office pushed House leaders to not require a recorded vote because it was necessary to send some form of the doc fix to the upper chamber quickly.

…Rep. John Dingell (D-Mich.), the retiring dean of the House, mused to reporters, “I’ve seen a lot of dumb things, but I’ve never seen anything as comical as this.”

What happens when Boehner and Cantor run out of ways to trick the morons and sociopaths in their caucus. What happens to our country when the people who mean it harm take over for real?