TightWind is written by Kyle Baxter. Stay Hungry. Stay Foolish.

The Senate and reconciliation healthcare bills exclude the “doc fix,” which would add an additional $200 billion to the total cost:

A little more than 24 hours after releasing the reconciliation bill’s preliminary score—the one that picked up the majority of the headlines and votes—the CBO released another report, this one produced at the request of Rep. Paul Ryan (R-Wis.). It said that if in addition to the health care bill, the Democrats also pass legislation known as the “doc fix”—which would cost an additional $208 billion—the total effect would be to add $59 billion to the deficit over the first 10 years. 

Defenders of the reform bill now argue that the doc fix is a separate issue. But Democrats didn’t always think so: Last summer’s first draft of the House health care bill included the doc fix. And Senate Majority Leader Harry Reid (D-Nev.) has reportedly used the provision to ensure support from the American Medical Association. Are we somehow supposed to believe that it’s good enough to bargain with but not good enough to figure into the budget? 

In 1997, Congressional Republicans and President Clinton passed a budget bill that significantly reduced Medicare’s reimbursement rates for doctors. This new formula, in the intervening years, would have seriously cut payments to doctors, and threatened their ability to stay profitable. Every year this happens, though, Congress has passed a “fix” that eliminates the rate decrease for the year.

If it isn’t passed this year, payments will be cut by 21%. The doc fix, or permanently replacing the formula rather than patching it on a year-to-year basis, is something that must be implemented if Medicare is to remain usable.

As Suderman notes, this was initially in the Democrats’ proposal, most likely as the key sweetener to receive support from the A.M.A. Democrats later removed it, though, because its cost made the bills look bad.

Democrats argue that their healthcare reform bills shouldn’t be responsible for the doc fix’s cost, because they didn’t create the problem. That’s their argument as to why the $208 billion, which if included in the bill would mean it adds $59 billion to the deficit, shouldn’t be counted with the bill.

This is an attempt to absolve responsibility. If Democrats want to reform healthcare, than they must be responsible for all parts of it–and that certainly includes Medicare, the biggest drag on the U.S. federal budget as time goes on. This means that the doc fix’s cost must be included in the total cost of reform, whether it’s in the current bill or not.

This is just another example of the Democrats trying to shirk their responsibility. If they want to be in power, and if they want to reform healthcare, than it is their job to fix it, not ignore inconvenient realities for their own benefit.