This week’s debate over the Medicare bill (H.R. 6331) ranks as the biggest battle over health care policy since last year’s bitter debate over the reauthorization of the State Children’s Health Insurance Program (SCHIP). President Bush, vowing to oppose any bill that would curtail the personal choices or benefit options of seniors enrolled in Medicare, vetoed the Medicare Improvement for Patients and Providers Act. Earlier this week, however, the House voted 383 to 41 to override Bush’s veto, and the Senate followed suit, overriding the veto by a vote of 70 to 26.
Despite the media hype to the contrary, the recent Medicare debate was never about stopping an 11% cut for Medicare doctors. No responsible member of Congress — Democrat or Republican — argued that physicians should be subjected to such a Medicare payment reduction. But repeated legislative attempts — all offered in good faith — to address the physician payment problem and prevent such a cut were thwarted by the Congressional leadership. That’s a fact. And any assertion, or suggestion, to the contrary is demonstrably false.
At issue were key Medicare policy questions. As President Bush made clear in his July 15 veto message, the bill harms Medicare beneficiaries because it takes “private health options away from them.” CBO estimates that by 2013 the bill would result in 2.3 million fewer Medicare beneficiaries in Medicare Advantage plans. The bill’s payment reductions are targeted, not at managed care plans, but at the rapidly growing private fee for service plans. These new plans are especially popular in rural areas, where, according to Health and Human Services Secretary Michael Leavitt, 60% of all Medicare Advantage enrollees have enrolled in them.
The bill also stopped HHS from introducing a new program of competitive bidding for durable medical equipment and supplies, such as wheel chairs and oxygen equipment. The competitive bidding program would have resulted in a 26% reduction in Medicare costs for these items. In stopping the competitive bidding, Congress is forcing HHS to terminate the initial contracts; seniors will pay more and taxpayers will foot the bill for the inevitable litigation.
Finally, Congress is imposing new rules to limit health plans’ flexibility in designing their own drug formularies, or preferred lists of drugs. This will undercut their ability to negotiate lower prices, and drive up costs in the Medicare drug program. Taxpayers and seniors alike will pay the price, yet unknown, for this provision, the latest evidence that Congress is unwilling to control the rapid rise of crushing entitlement costs.
Nothing can disguise the fact that this was a major health policy defeat for conservatives. Yet a number of members of Congress rose above political expediency and took a stand on behalf of principle. Those members of Congress who stood with the President on the Medicare bill did so in defense of the right of individuals to exercise personal choice in health care, and they did so in the face of massive political pressure, defying a formidable coalition, led by the AARP and the American Medical Association, of some of the most powerful interest groups in Washington.
The most important principle in health policy is personal freedom. Bush did the right thing on Medicare, and a principled minority in Congress followed suit. Defying overwhelming political pressure, and the massive efforts of powerful and well funded special-interests groups, they stood their ground. It was a demonstration of political courage. We salute them.
Senate:
Wayne Allard (R-CO)
John Barrasso (R-WY)
Robert Bennett (R-UT)
Sam Brownback (R-KS)
Jim Bunning (R-KY)
Richard Burr (R-NC)
Tom Coburn (R-OK)
Larry Craig (R-ID)
Mike Crapo (R-ID)
Jim DeMint (R-SC)
Pete Domenici (R-NM)
John Ensign (R-NV)
Mike Enzi (R-WY)
Lindsey Graham (R-SC)
Chuck Grassley (R-IA)
Judd Gregg (R-NH)
Chuck Hagel (R-NE)
Orrin Hatch (R-UT)
Jim Inhofe (R-OK)
Jon Kyl (R-AZ)
Mitch McConnell (R-KY)
Jeff Sessions (R-AL)
Richard Shelby (R-AL)
John Sununu (R-NH)
John Thune (R-SD)
David Vitter (R-LA)
House:
Todd Akin (R-MO)
Gresham Barrett (R-SC)
Joe Barton (R-TX)
Rob Bishop (R-UT)
Roy Blunt (R-MO)
John Boehner (R-OH)
Kevin Brady (R-TX)
Stephen Buyer (R-IN)
Dave Camp (R-MI)
John Campbell (R-CA)
Chris Cannon (R-UT)
Eric Cantor (R-VA)
John Carter (R-TX)
Tom Cole (R-OK)
Mike Conaway (R-TX)
John Doolittle (R-CA)
John Duncan (R-TN)
Jeff Flake (R-AZ)
Trent Franks (R-AZ)
Jeb Hensarling (R-TX)
Sam Johnson (R-TX)
Jim Jordan (R-OH)
Steve King (R-IA)
Ron Lewis (R-KY)
John Linder (R-GA)
Kenny Marchant (R-TX)
Jim McCrery (R-LA)
John Mica (R-FL)
Randy Neugebauer
Ron Paul (R-TX)
Mike Pence (R-IN)
Rick Renzi (R-AZ)
Mike Rogers (R-MI)
Ed Royce (R-CA)
Bill Sali (R-ID)
Steve Scalise (R-LA)
Jim Sensenbrenner (R-WI)
Adrian Smith (R-NE)
Tom Tancredo (R-CO)
Dave Weldon (R-FL)
Lynn Westmoreland (R-GA)