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Posts published in “Day: July 15, 2008”

The Medicare override

Gets easy to forget exactly what some of those federal health programs do; in light of two key congressional votes today, let's review on Medicare. Medicare is a big program, which specifically "is a federal health insurance program for people 65 years or older and for people with certain disabilities or kidney failure. It covers about 39 million Americans." In Idaho 162,984 people (or 13.3% of the population) use it. In Oregon, the number is 492,890 (15%). And in Washington, 737,168 (13%). About as many people as live, in all, in the state of Idaho.

Today' event was an unusual veto override by Congress, on a bill (HR 6331) which directly concerns how Medicare financially will be continued over the next year at least. The bill has multiple elements (as will any about such a large program) but the core of the thing is simple enough. Because of various financial triggers already in place, Medicare has been scheduled to cut pay for doctors by about 11%. As anyone familiar with Medicare payments knows, a lot of docs around the country already refuse to take Medicare patients precisely because payment already is so low; an additional 11% cut would drive away so many as to make health care inaccessible for many of the people who rely on Medicare. The bill passed by Congress and vetoed by President Bush would avert the 11% cut by, as one news story noted, "cutting payments to big insurers, such as UnitedHealth Group Inc. and Aetna Inc., which have contracts with the Medicare program." That, in other words, is whose ox gets gored by the bill.

The vetoed bill returned to Congress today for override votes, and both chambers did vote to override, so the bill will become law. A number of organizations (AARP, for example) are sure to highlight the override votes, but we thought a look at the Northwest pattern was merited here.

The Senate voted 70-26 to override. In the Northwest delegation, two of the Northwest's six senators voted against override - Idaho's Larry Craig and Mike Crapo, neither facing re-election this year. Oregon Republican Gordon Smith, facing a rough re-election fight (noted in passing, not as mind-reading), broke to vote in favor of the override. The region's three Democrats all voted to override.

The House voted more lopsidedly, 383-41, to override. As you might expect, all of the region's Democrats voted to override. But so, it turns out, did five of the six Northwest Republicans - all from Washington and Oregon along with Representative Mike Simpson of Idaho.

The lone Northwest House member to vote for the veto, for the 11% cut in payments to doctors: Idaho Representative Bill Sali.

Sali has addressed the legislation, and his take on it is available on his website. It speaks for itself generally, though we should note that Sali's concern seemed focused on the 1.7 million or so participants in one subsidiary program, Medicare Advantage, rather than the 39 million who would be affected by the cuts in Medicare generally.

Politically, we're in the position of having yet to see much evidence of a partisan sea change in Idaho, of the sort trumpeted by the Wall Street Journal today. But in Sali's case, a vote like this, which has good reason to infuriate (and even frighten) somewhere close to 100,000 Medicare participants, plus friends and family, in his district alone, could provide some real raw material.

“Danger zone”

On the home page of the Coos Bay/North Bend airport web site, there's a neat UTube showing the three and a half minutes or so leading up to land at the airport, showing the landscape around, the sea, the roads - it's a little hypnotic. There's a theme song, too, Kenny Loggins' "Danger Zone."

Which has some applicability at this point, since a danger zone is what the community seems to be moving into.

The Oregonian on Sunday ran a useful perspective on how smaller regional airports are rapidly losing their commercial flights. The focus was on the long-standing Pendleton-Portland run, which looks to be going away; and this does mark a sea change. But at least, Pendletonians, who are in decent driving distance from Walla Walla or (a bit further) the Tri-Cities, won't be totally cut off; flights to Walla Walla apparently will continue, possibly as well as elsewher.

Consider though the Coos Bay/North Bend area, a couple of hours by car from any community much larger than itself and separated from almost all by mountains. This small coastal metro really is almost as remote as you get for a community of its size in the Northwest. But it has had a solid commercial airport, the only one on the Oregon Coast.

Its airline, its only airline at present, is Horizon Air/Alaskan, which has had regular flights to Portland - an important link. As of October 11, that flight will go away (the same day, Klamath Falls-Portland, to another community nearly as remote, will end). The reasons given by the airline, which seem understandable, involve the cost of fuel and the need to run more efficient (larger) planes which won't come close to filling seats at the smaller airports. The logic is there; the decision is not irrational.

The other truth, of course, is that this news is horrendous for the community, for businesses, for individuals, for a wide range of interests. Try growing your businesses in a remote community without commercial air service; you won't find it easy. Business leaders were quick to try to find a way to retain the flight (and meet with the airline), but how, really, could they persuade?

In the absence of answers, the suffering begins. We will be seeing more of it before long.