Paul Krugman's column outlining the Democrats' dramatic victory on Medicare this week is both uplifting and depressing. The basic lay of the land was this: There's a provision in Medicare law that cuts reimbursements whenever Medicare growth outruns a certain target estimate. This year, the cuts would've slashed doctors fees by more than 10 percent, which could've led some doctors to stop accepting Medicare patients. Of course, there were other places to make up the money. Medicare Advantage, where Medicare pays private plans a certain amount of money to offer private coverage to Medicare beneficiaries, was 17 percent over budget. Cut reimbursements to those plans and you'd make up the shortfall. Republicans filibustered. And a month ago, it looked extremely unlikely that Democrats could break that filibuster. So compromises were drawn up and cuts drew closer. But then a funny thing happened: The Democrats decided not to save the Republicans. They just let the cuts come. Suddenly, doctors got into the act, lobbying furiously for the Democratic bill. Republicans began flipping. And with a dramatic vote by Ted Kennedy, Democrats overcame Republican opposition. Krugman sees this as a hopeful sign of Democratic unity, and it is. But it's also a depressing example of Republican intransigence on even simple, broadly popular pieces of legislation. Insofar as there's anything to celebrate here, it's the potential activation of doctors, and their realization that the best way to protect their practices is to fight for reform in such a way that they have a lead seat at the table. Now, I'm a bit torn on that, as there's a lot of waste in the medical community, and a lot of specialists getting paid too much to do too little. Cost matters, and if we're going to get it down, doctors will have to take a hit too. For instance, if it were up to me, I'd tilt the incentives back towards basic care providers, and away from specialties. Lots of doctors wouldn't like that. But putting that aside, from a sheer political power perspective, an alliance between Democrats and doctors could prove a very powerful thing indeed.
