Back in 1997 the Congress had a decent enough idea. They wanted to restrict the growth of payments to Medicare doctors. Health inflation started to skyrocket in later years, far beyond regular inflation. So every year, Congress put a patch on this restriction, called the sustainable growth rate (SGR). People knew that Congress wouldn’t restrict the payments, but it became this “surprise” to the budget every single year.

The Obama Administration wanted to do away with the gimmick, and saw health care reform as an opportunity to do that, and admit the reality that Congress will never cut these payments. But Republicans saw a political opportunity. They could claim that Congress took the budget hit for health care reform “off the books,” when in fact they were just admitting that the real budgetary cost of Medicare is higher than what is typically acknowledged. So when it came up for a vote today it was sufficiently demagogued enough that it only mustered 47 votes, with fiscal scolds puffing out their chests and claiming that such an expense has to be “offset.” Even Steny Hoyer got in on that act, demanding that a doctor’s fix must be tied to adopting pay-go rules.

Never mind the fact that a one-year fix will pass with almost unanimous support. And all of these politicians will run back to their districts and tell people that they saved doctor’s livelihoods and hospitals and access to health care. It’s basically just a game.

But this is playing out in the middle of the health care debate. And it’s making the Democratic leadership look awful. Harry Reid is claiming that the AMA promised Republican votes for the fix, and he was led astray. The very notion of deals with the AMA to fatten the pockets of their Medicare doctors in exchange for health care support is unseemly. And nobody looks like they know how to count, in addition to the fact that they are relying on Republicans to be interested in governance rather than winning the day-to-day political battle.

Scarecrow has more.

David Dayen

David Dayen