The ACP Advocate Blog
by Bob Doherty
Thursday, January 8, 2009
Will the "Blue Dogs" have doctors singing the blues?
Having a big Democratic majority in Congress doesn't guarantee smooth sailing for the Obama administration.
The Washington Post notes that "the last two Democratic presidents, Jimmy Carter and Bill Clinton, saw their party leaders on Capitol Hill turn against them, leading to electoral disasters for the party in 1980 and in 1994. An energy crisis helped to do in Carter, while a failed health-care proposal contributed to a Republican congressional landslide two years into Clinton's first term."
Getting the support of a coalition of fiscally-conservative "Blue Dog" House Democrats may be Obama's biggest challenge. With 47 members, the Blue Dogs have enough votes to block expensive government programs if joined by their GOP colleagues.
What makes a Blue Dog bay all night? The federal budget deficit, which is expected to grow to over $1 trillion in current budget year.
To stop the flow of federal red ink, Blue Dogs want to require that every dollar of new spending be paid for by cuts somewhere else. The Democrats had such a pay-as-you go (pay-go) rule in the last Congress. As an internal operating rule, it wasn't legally binding on them, so they could (and sometimes did) waive it when inconvenient. Writing pay-go into law, as the Blue Dogs propose, would force Congress to make the necessary budget offsets. Think if it as pay-go on steroids.
Jared Allen writes in The Hill that so far, the Blue Dogs are taking Obama's commitment to tackle spending "on faith." Before long, though, I expect that the Blue Dogs will want a lot more than promises from the president's bully pulpit.
Faith might get a believer into heaven, but it won't balance the federal budget.
Doctors may be the ones singing the blues if the Blue Dogs carry the day and pay-go becomes law. Physicians want Congress to eliminate accumulated physician payment cuts caused by Medicare's SGR formula, which will cost upwards of $300 billion, according to the Congressional Budget Office. Congressional leaders are considering "re-basing" Medicare spending so that Congress isn't forced to find $300 billion in offsets. If the Blue Dogs don't go along, it will be very hard to get an agreement on eliminating the SGR.
As fiscal conservatives, Blue Dogs might - and I hope they will - be persuaded by the evidence that primary care doctors deliver better care at lower costs, and therefore should be paid competitively with other specialties. But if they aren't, then higher Medicare pay for primary care might have to be offset by cutting payments to other doctors.
Fiscal discipline is a good thing, but I worry about creating a fiscal straitjacket which will make it harder to for the government to do the things that really need to be done. Like improving pay for primary care, eliminating accumulated Medicare pay cuts, and expanding health insurance coverage.
Today's question: Do you believe that Congress should be required to pay for new spending with dollar-for-dollar cuts in other programs or revenue (tax) increases, even if this makes it harder to get agreement on needed health care reforms?
About the Author
Bob Doherty is Senior Vice President, American College of Physicians Government Affairs and Public Policy; Author of the ACP Advocate Blog
Email Bob Doherty: TheACPAdvocateblog@acponline.org.Follow @BobDohertyACP
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