Tuesday, November 23, 2010

HCR Favored by Public

Poll: Voters like health reform

by Steven Thomma - Nov. 23, 2010
McClatchy Newspapers

A majority of Americans want Congress to keep the new health-care law or actually expand it, despite Republican claims that they have a mandate from the people to kill it, according to a new McClatchy Newspapers-Marist poll.

The post-election survey indicated that 51 percent of registered voters want to keep the law or change it to do more, while 44 percent want to change it to do less or repeal it altogether.

Driving support for the law: Voters by ratios of 2-1 or greater want to keep some of its best-known benefits, such as barring insurers from denying coverage for pre-existing conditions. One thing they don't like: the mandate that everyone must buy insurance.

On the side favoring the health-care law, 16 percent of registered voters want to let it stand as is.

Thirty-five percent want to change it to do more. Among groups with pluralities who want to expand it: women, minorities, people younger than 45, Democrats, liberals, Northeasterners and those making less than $50,000 a year.

Lining up against the law, 11 percent want to amend it to rein it in.

Thirty-three percent want to repeal it.

Among groups with pluralities favoring repeal: men, Whites, those 45 and older, those making more than $50,000 annually, conservatives, Republicans and "tea party" supporters.

Independents, who helped swing to the Republicans in the Nov. 2 elections, are evenly divided on how to handle the health-care law, with 36 percent for repealing it and 12 percent for restraining it (a total of 48 percent negative) while 34 percent want to expand it and 14 percent want to leave it as is (also totaling 48 percent).

Fifty-nine percent of registered voters vs. 36 percent want to keep the requirement that insurance companies provide coverage to people with pre-existing conditions.

The section of the law requiring insurance companies to allow young adults to remain on their parents' policies until age 26 also is popular. Sixty-eight percent vs. 29 percent polled said keep it.

The survey of 1,020 adults was conducted Nov. 15-18. The margin of error was 3 percentage points.

Sunday, November 21, 2010

As stimulus funds near end, new pain will begin
by Ronald J. Hansen
Nov. 21, 2010
The Arizona Republic LINK

If people didn't like the federal stimulus, they may hate when it's gone.

As the year winds down, the $862 billion plan to rescue the economy from the depths of the recession enters a new phase in which tax cuts and credits expire and countless hard-to-replace construction projects will end. Thousands of workers in some states could lose their jobs.

The political power shift brought about by the midterm elections has likely settled any lingering doubts that the stimulus will largely run out, as scheduled, in the coming months. A smaller package of federal aid that passed in August, primarily for teachers, also will rapidly disappear. With the new Republican majority in the House next year, there will be little support for similar additional measures.

Worries about the national debt and a negative view of the stimulus augur a new period when more businesses must survive on their own and governments must tighten their belts. The austerity will be widely felt.

Nearly every worker in the nation will see slightly slimmer paychecks as $400 individual tax cuts are slated to end this year.

Tax credits, such as those offering incentives for energy-efficiency improvements for homeowners, also are set to lapse at year's end. The earned-income tax credit, which rewards the working poor, will no longer include funding for those with a third child.

In Arizona, lawmakers face at least an $800 million "funding cliff" as stimulus aid for Medicaid begins declining in January and ends by July. The extra aid expires as states operate under new federal health-care mandates that block coverage cuts in Arizona. The combination effectively exacerbates the already-bleak budget outlook, said John Arnold, state budget director for Gov. Jan Brewer.

Arnold would not speculate on what the budget crunch means for state employees, but he left no doubt additional cuts are unavoidable.

"Will state expenditures decline? I think that's highly likely," he said. "Where that will be targeted - we'll get back to you in January."

Education, especially for universities and community colleges, may face deeper budget cuts than in recent years because provisions of receiving some stimulus aid that required states to maintain 2006 spending levels are expiring.

Mixed impressions

When President Barack Obama signed it into law in February 2009, supporters hoped the American Recovery and Reinvestment Act would serve almost as a second New Deal to pull the economy away from the abyss.

The stimulus did pump life into the economy.

The White House estimates that by the end of the year the stimulus will have saved or created 3.5 million jobs.

Social Security recipients got one-time $250 payments.

And workers got those $400 tax breaks, what Princeton University economist Alan Blinder called "possibly the worst advertised program in the history of the republic." He predicted that workers who didn't notice they were getting them will notice when they're not.

Arizona benefited in various ways. More than 90 percent of the $76 million in stimulus funding for Arizona wastewater and drinking-water system projects has been received. Thirteen of the 46 projects are completed. The projects have directly funded more than 800 jobs around the state, and because the projects got under way, hundreds more jobs are funded using the state and local dollars that also help pay for the work.

But the stimulus hasn't brought a windfall of jobs. And as goes the stimulus, so too will many of the jobs that came with it.

Mike Markham, chief operating officer for Markham Contracting in Phoenix, said his company has won a half-dozen stimulus contracts worth $35 million, some of which is shared with subcontractors. Even so, since 2008 his family-owned company has cut two-thirds of its workers, about 200 layoffs.

"Seventy percent of our work has been stimulus work this year," he said. "We would have had to reduce our company even more without the stimulus."

Markham's last stimulus project, widening Grand Avenue, currently funds 18 of his workers and about the same number of subcontractors, too. It is expected to end in March.

Earlier this month, a South Carolina company that manages a former nuclear-weapons complex told its workers that 1,400 of them will soon lose their jobs. Of those, 800 were funded by the stimulus.

One stimulus program divided $1 billion among the states to partner with the private sector to provide jobs to welfare recipients who wanted to work. The program helped create about 250,000 subsidized jobs nationwide, according to estimates by the nonpartisan Center on Budget and Policy Priorities, a Washington-based think tank that advocates for the poor and middle class. Funding for the program expired in October.

Since its inception, Obama's critics cast the stimulus as a colossal waste. That view now predominates in public-opinion polls.

In early October, an ABC News/Washington Post poll found that 68 percent of people surveyed viewed the stimulus as a waste compared with 29 percent who see it as money wisely spent.

One reason for that perception may be a belief that government spending was growing even more rapidly than it did.

Between January 2009 and July, federal government spending increased about 10 percent, according to data tracked by the Federal Reserve Bank of St. Louis. But cutbacks by state and local governments in the same period meant that overall federal, state and local spending climbed just 3 percent.

That's largely because, unlike Congress, state and local governments generally have to balance their budgets. As tax revenue plummeted, so did governments' ability to maintain services and employee levels.

Also undermining the popularity of the stimulus were delays in some programs, which dampened the intended economic jolt.

The $5 billion home-weatherization program, for example, stalled for months while state and local officials around the country waited for a ruling from Washington on fair wages for the projects.

Now, the projects are midway to a use-it-or-lose-it deadline, and states are working urgently to keep the funding. As of early November, more than $3 billion, or 64 percent, of all the money remained unspent, according to the U.S. Department of Energy. In Arizona, 68 percent of the $61 million awarded for weatherization remained unspent.

Obama himself has offered a measured defense of the legislation.

In October, he called the stimulus "the most serious investment in our infrastructure since President Eisenhower built the interstate highway system in the 1950s." A day later, the New York Times published an interview in which he said "there's no such thing as shovel-ready projects," a concession that the pace of the stimulus hasn't matched need.

Up to private sector

Going forward, the onus will be on the private sector to revive the economy.

The private sector has added jobs 10 straight months, a welcome change after seeing losses in 23 of the 24 preceding months.

Real gross domestic product, the broadest measure of economic output, has grown five straight quarters. Before that, it had declined four straight quarters.

Even so, economists say the growth is tepid and far too modest to bring down the unemployment rate, which has remained stuck between 9.5 percent and 10 percent nationally for the past 15 months.

Blinder, the Princeton economist, predicts the likely loss of stimulus measures, along with other social-safety-net items like extended unemployment insurance, will hurt the economy noticeably. The outcome will be far worse if the Bush-era tax cuts also expire at year's end, he said.

"If everything runs out and the stimulus expires, this is a potentially catastrophic outcome for the U.S.," said Blinder, who has served as vice chairman of the Federal Reserve System's board of governors.

In Arizona, the job numbers have improved in recent months, but there are still 50,000 fewer people working now than when the stimulus began.

That helps explain why the state's budget remains a problem.

The trouble only worsened after voters rejected referendums that would have allowed lawmakers to tap funds from the early-education program First Things First and from a land-conservation fund.

Without those dollars, the state is left with about $500 million less than what lawmakers had hoped by now.

And sales-tax revenue, the state's primary source of cash, is $74 million below forecasts.

Read more: http://www.azcentral.com/business/articles/2010/11/21/20101121stimulus-funds-near-end.html#ixzz15wnd5XTZ

Estimated cost of the stimulus

The stimulus provided a burst of spending and tax breaks, but the impact will wane over the years.

Fiscal yearAmount (in billions)
2009$184.9
2010$399.4
2011$134.4
2012$36.1
2013$27.6
2014$22.4
2015$4.7
2016-$7.3
2017-$7.5
2018-$6.1
2019-$1.4
Total$787.2*

*Based on 2009 estimate. Latest estimate is $862 billion.

Source: Congressional Budget Office

GDP during the recession

National economic output improved as the stimulus rolled out, but economists worry the pace of growth is stalling.

Period% change from preceding quarter
2007 Q42.9
2008 Q1-0.7
2008 Q20.6
2008 Q3-4.0
2008 Q4-6.8
2009 Q1*-4.9
2009 Q2-0.7
2009 Q31.6
2009 Q45.0
2010 Q13.7
2010 Q21.7
2010 Q32.0

*Stimulus passed into law.

Source: Bureau of Economic Analysis



Read more: http://www.azcentral.com/business/articles/2010/11/21/20101121stimulus-funds-near-end.html#ixzz15wobO7MU

Buffett admits Socialist Philosophy

Warren Buffett: I 'Should Be Paying A Lot More In Taxes'
Amanda Terkel
aterkel@huffingtonpost.com
Posted: 11-21-10 12:13 PM

LINK

WASHINGTON -- Billionaire Warren Buffett rebutted claims that the Obama administration is unjustly hurting business orders with high taxes by saying that in fact, the wealthy have never had it so good.

"I think that people at the high end, people like myself, should be paying a lot more in taxes. We have it better than we've ever had it," he told ABC's Christiane Amanpour in a clip played on "This Week" on Sunday.

When Amanpour pointed to critics' claims that the very wealthy need tax cuts to spur business and capitalism, Buffett replied, "The rich are always going to say that, you know, 'Just give us more money, and we'll go out and spend more, and then it will all trickle down to the rest of you.' But that has not worked the last 10 years, and I hope the American public is catching on."

On Tuesday, Buffett wrote a New York Times op-ed in the form of a letter to "Uncle Sam," thanking him for saving the U.S. economy:

When the crisis struck, I felt you would understand the role you had to play. But you've never been known for speed, and in a meltdown minutes matter. I worried whether the barrage of shattering surprises would disorient you. You would have to improvise solutions on the run, stretch legal boundaries and avoid slowdowns, like Congressional hearings and studies. You would also need to get turf-conscious departments to work together in mounting your counterattack. The challenge was huge, and many people thought you were not up to it.

Well, Uncle Sam, you delivered. People will second-guess your specific decisions; you can always count on that. But just as there is a fog of war, there is a fog of panic -- and, overall, your actions were remarkably effective.

Buffett isn't the only billionaire who has argued for higher taxes. Both Microsoft co-founder Bill Gates and his father, Bill Gates, Sr., recently came out in support of a Washington state measure to "create a 5 percent tax rate on annual income exceeding $200,000 for individuals and $400,000 for couples, and a 9 percent tax rate on income that tops $500,000 for individuals and $1 million for couples."

Buffett has spoken out in the past about taxes for the wealthy, telling the Senate Finance Committee in 2007 that the estate tax should not be repealed. "I think we need to...take a little more out of the hides of guys like me," Buffett testified.

Saturday, November 20, 2010

Utah's Compact

Utah's 1070 opponents (unlike here) are not wimps
EJ Montini
Arizona Republic
Thursday, November 18, 2010

LINK

Are people in Utah actually tougher than people in Arizona?

Are people in Utah actually more open-minded than people in Arizona?

Are people in Utah actually more willing to take a stand than people in Arizona?

Am I actually about to say that the answer to each of these questions is “Yes?”

Actually, yes.

As is happening in a lot of states, legislators in Utah have proposed a version of SB 1070. Unlike a lot of states – particularly ours – a collective of mainstream politicians , business people and religious leaders have come forward to oppose them. We're talking about the type of people who can't be written off as open-border advocates, kooks or malcontents.

The type of people who aren't intimidated by political blowhards and who don't cower in the face of publicity stunts from the local sheriff.

Just last week the group put their names to a document they call “The Utah Compact.”

Essentially, it calls for finding a way to deal with the illegal immigration problem that does not simply involve rounding people up and shipping them out.

The document says, “Immigrants are integrated into communities across Utah. We must adopt a humane approach to this reality, reflecting our unique culture, history and spirit of inclusion. The way we treat immigrants wills ay more about us as a free society and less about our immigrant neighbors. Utah should always be a place that welcomes people of goodwill.”

One of those who signed the compact, Utah's Attorney General Mark Shurtleff, said, “We are different from Arizona. We do things differently here. We want to show people we can do something about this issue in a compassionate and lawful way.”

The idea of having a discussion about illegal immigration that doesn't involve shouting or insults got started several years ago when a conservative think tank in Salt Lake City, the Sutherland Institute, published a paper that began, “We confidently recommend that Utah public policy should seek to fully assimilate otherwise law-abiding immigrants already residing here.”

Last summer I spoke with Paul Mero, president of the Sutherland Institute. Among the ides being discussed was that Utah issue its own work permits for those in the state illegally but who have not committed any other crime. If the federal government were to allow such a thing in Utah it could serve as a test case and counter point to Arizona.

I spoke with Mero again this week.

“I heard that there were 17 different immigration bill filings (in Utah),” he said. “But my guess is that with the Utah Compact group you will see one alternative to the Arizona-style bill.”

Mero didn't say exactly what would be included in the alternative bill. Those details have yet to be released.

But he did say this, “I think in Utah there is a critical mass of community leaders who are willing to face reality. That reality is that we have undocumented immigrants living in Utah, and we are willing to step back and be reasonable. That is, not follow Arizona into a police state, enforcement only approach.

We can agree that the feds screwed up and the states are left holding the bag. But what we do about it can be different. … Our ultimate response really does say more about us as a people than it does about undocumented immigrants.”

Mero and others have been working since June on alternative legislation to an SB 1070 bill. When introduced in Utah something will happen there that never occurred here. And hasn't still. "It's going to create such a wonderful public debate," Mero said.

Thursday, November 18, 2010

Fox News president: NPR execs are 'Nazis'

Fox News President Roger Ailes slammed NPR executives as "Nazis" in a new interview, saying the publicly financed radio network espouses the "left wing of Nazism."

The comments -- published as the second part of an interview with The Daily Beast's Howard Kurtz -- were in reference to the firing of former NPR and current Fox News employee Juan Williams, whom Ailes called a "pure liberal."

Williams was fired by NPR last month after saying on a Fox News program that he gets nervous when he sees airplane passengers wearing Muslim garb. The firing prompted an anguished debate in media circles about the role of television news analysts, and a firestorm among congressional Republicans over whether NPR should continue to receive public funding."They are, of course, Nazis," Ailes said of NPR. "They have a kind of Nazi attitude. They are the left wing of Nazism. These guys don't want any other point of view."

Ailes, a former Republican media consultant who has turned Fox News into the nation's most-watched cable news network, also was not shy in his critique of Comedy Central's Jon Stewart, whom he called "crazy" and dependent on the polarized media views he lampoons each weeknight on cable television.

"He's crazy. If it wasn't polarized, he couldn't make a living. He makes a living by attacking conservatives and stirring up a liberal base against it," Ailes said of The Daily Show host. "He loves polarization. He depends on it. If liberals and conservatives are all getting along, how good would that show be? It'd be a bomb."

When Kurtz noted that Stewart took shots at the more liberal MSNBC during his Oct. 30 "Rally for Sanity" in Washington, Ailes balked.

"Oh, horses--t," Ailes said. "Look what he does to Sarah Palin."

Ailes told Kurtz that Stewart's free to go after cable news talking heads for the entertainment value, "but don't give me a social speech on the steps of the Washington Monument. Don't lapse into non-comedy."

On the topic of NPR, Ailes echoed conservatives' attacks on NPR as a government-funded left-wing news organization.

"They don't even feel guilty using tax dollars to spout their propaganda," he said. "They are basically Air America with government funding to keep them alive."

NPR gets no direct funding from the Corporation for Public Broadcasting, but does receive federal grant and contract money, as well as funding from foundations that are federal grantees. NPR officials say this federal money constitutes a low single-digit percentage of its annual budget, about 2 percent depending on the year.

The Arizona Republic is a member of the Politico Network.

Bush Tax Cuts Failed


Were the Bush Tax Cuts Good for Growth?

November 18, 2010, 8:45 AM

Liz Peek at FoxNews.com congratulates me for writing about the importance of economic growth. So in the spirit of maximizing growth, I want to pose a question: Why should we believe that extending the Bush tax cuts will provide a big lift to growth?

Those tax cuts passed in 2001 amid big promises about what they would do for the economy. What followed? The decade with the slowest average annual growth since World War II. Amazingly, that statement is true even if you forget about the Great Recession and simply look at 2001-7.

The competition for slowest growth is not even close, either. Growth from 2001 to 2007 averaged 2.39 percent a year (and growth from 2001 through the third quarter of 2010 averaged 1.66 percent). The decade with the second-worst showing for growth was 1971 to 1980 — the dreaded 1970s — but it still had 3.21 percent average growth.

The picture does not change if you instead look at five-year periods. Here’s a chart ranking five-year periods over the past 50 years, in descending order of average annual growth:

DESCRIPTIONBureau of Economic Analysis, via Haver Analytics

I mean this as a serious question, not a rhetorical one: Given this history, why should we believe that the Bush tax cuts were pro-growth?

Is there good evidence the tax cuts persuaded more people to join the work force (because they would be able to keep more of their income)? Not really. The labor-force participation rate fell in the years after 2001 and has never again approached its record in the year 2000.

Is there evidence that the tax cuts led to a lot of entrepreneurship and innovation? Again, no. The rate at which start-up businesses created jobs fell during the past decade.

The theory for why tax cuts should create growth and jobs is a strong one. When people are allowed to keep more of each dollar they earn, they are likely to work longer and harder. The uncertainty is the magnitude of this effect. With everything else that’s happening in a $15 trillion economy, how large of an effect on growth do tax cuts have?

Every available piece of evidence seems to suggest that the Bush tax cuts did little to lift growth. I have yet to hear a good argument to the contrary, but I’d be fascinated to see another blogger or an economist take a crack at it.

Update: A reader asks for statistics on real economic growth (that is, adjusted for inflation). The above chart is already adjusted for inflation.

Saturday, November 13, 2010

Despite Claims on Yahoo! Message Board, Islam isn't Violent

The Biggest Lies About Islam

Azeem Ibrahim

Posted: November 12, 2010 05:50 PM

In recent days, President Obama stood before a crowd of 6,000 people in Indonesia and addressed the deterioration in relations between the Muslim world and the West. In what was seen as a follow-up to his historic address at Cairo University last year, he reaffirmed that bringing the Muslim world and the West together remained a priority. As before, he said that the key to achieving better relations was finding common ground and forging new links which enabled more people from Muslim countries and non-Muslim countries to get to know each other. "I believed then, and I believe today," he said, "that ... we can choose to be defined by our differences, and give in to a future of suspicion and mistrust. Or we can choose to do the hard work of forging common ground, and commit ourselves to the steady pursuit of progress."

Very well, but how? I spend a lot of time in the US, and it is striking how ignorant so many people are about Islam, particularly in certain parts of the media. Pundits and columnists repeatedly get away with making claims about Muslims and Islam which fuel mistrust between Muslim countries and the West. Most of the time, these claims are not just wrong. They are embarrassingly wrong. What is so galling is that these errors are rarely called out because so few know the truth.

So, for my humble contribution to improved relations, I would like to present and debunk the top three lies which make the rounds about Muslims.

Lie One -- Muslims hate the west and what it stands for.

Probably the deepest and most comprehensive survey of worldwide Muslim opinion was conducted by the Gallup polling organization between 2001 and 2007. It was based on interviews with 50,000 Muslims from thirty-five countries (covering the Middle East, South and Central Asia, etc.). And its central finding was that the conventional wisdom that Muslims worldwide feel overwhelmingly negative toward the Western world is completely false. As Gallup put it: "When Muslims were asked what they admired most about the West, only 2% in Iran, 6% in Saudi Arabia, and 10% in Egypt said 'nothing.'" It also showed that the two aspects that Muslims most admired about the West were its technology and democracy. Only a very small minority condone acts of terrorism. And strikingly, the research found that Muslims around the world in fact admire the American values of freedom and a strong work ethic.

Lie Two -- Muslim scholars support violence.

The best way to illustrate this lie is by an analogy, a little thought experiment. How would you feel if every time you opened a paper or watched the news you heard newspaper columnists, TV pundits, politicians, and even some academics telling you that Christianity is a religion of hate. And that they knew this because Pastor Terry Jones threatened to burn the Koran. "Look," one might say, "this guy has a church, he leads a community, he is a Pastor and a Christian. He speaks for Christianity."

Then imagine how you'd feel if you rarely heard anyone pointing out the obvious: that Terry Jones isn't a real pastor (his qualification amounts to a degree there's no evidence he took -- it was an honorary degree -- from an unaccredited theological school. And lest we forget, he has form when it comes to lying about his credentials -- in 2002 a German court found him guilty of falsely claiming he was a doctor). That while he may speak for his congregation of fifty, he doesn't speak for the other roughly 2.1 billion Christians in the world. And most of all, that his own prejudices are in no way representative of the doctrine or beliefs of a religion which has been around for the last two thousand years.

This is more or less how much media punditry in the US and often beyond makes Muslims feel.

Those firebrands who call for violence in the name of Islam are not scholars. They are invariably attention-seekers who invoke Islam to give a spurious authority to their claims.

But when the media cover the likes of Abu Humza, Omar Bakri and Anjum Chaudhry as Muslims, it gives ordinary people who know no better the impression that they represent Muslims, even though they have no Islamic qualifications, they just like to dress up in traditional clerical garb. Of course, the media buy it, and the false perception that Muslim clerics support violence gains ground.

For example, even after Omar Bakri was not permitted to return to the UK by the Home Secretary, Sky News flew an entire team of reporters to Lebanon to get his views, thus giving him a platform even when he was no longer in the country and regarded as 'not being conducive to the public good'.

Lie Three -- Muslim moderates don't condemn violence done in the name of Islam.

Wrong. They do. There are countless examples from around the world over the last ten years at least. The Muslim Council of Great Britain has repeatedly condemned violence. Syria's most senior Islamic leader described 9/11 as a terrorist act. Dr Tahir ul-Qadri, a very influential Muslim scholar from Pakistan, wrote a 600-page fatwa this year condemning terrorism and dismantling al-Qaeda's violent ideology. Lest anyone doubt the seriousness of this as a challenge to al Qaeda's ideology, he has received death threats from their supporters. He is on record as saying explicitly that "he wants to address the Muslim audience who are misguided" and tell the "western world that there is NO verse which advocates killing, brutality and terrorism."

The full list of scholars, clerics, imams and others who have spoken out against violence in the name of Islam is much too long to reproduce here, although you can find a partial list at here.

Nobody who sees it could doubt that the vast majority of Muslim leaders around the world teach true Islam -- which, to quote Dr. ul Qadri, stand for "peace, love, compassion, human dignity and mercy, [not] any kind of violence, militancy, terrorism, brutality." Will you be able to find characters who tell you otherwise? Yes. But are they speaking for Islam? No. They are Islam's Terry Joneses.

If President Obama's vision is to be realized in the twenty-first century, the media need to start doing some homework, and waking up to these lies.

And we as consumers of such media need to start waking up to the media's pro-conflict agenda. The sad reality is that violence is news, but coexistence isn't. If some nutcase wearing the right clothes who claims to speak for Islam makes some incendiary comment, the media will report it. But if a delegation of internationally respected scholars make a combined statement rejecting violence, they won't. As consumers of news, we need to be aware of this.

Armed with this understanding, we can begin to forge the common ground to which President Obama alluded in his speech. Knowing this, we can begin to heal this divide which sears such an ugly scar on our times.

Dr. Azeem Ibrahim is a Research Scholar at the Kennedy School of Government at Harvard University, Member of the Board of Directors at the Institute for Social Policy and Understanding and Chairman and CEO of Ibrahim Associates.

Friday, November 12, 2010

Medicare cuts not from Health Care Reform

Doctors brace for possible big Medicare pay cuts

WASHINGTON – Breast cancer surgeon Kathryn Wagner has posted a warning in her waiting room about a different sort of risk to patients' health: She'll stop taking new Medicare cases if Congress allows looming cuts in doctors' pay to go through.

The scheduled cuts — the result of a failed system set up years ago to control costs — have raised alarms that real damage to Medicare could result if the lame-duck Congress winds up in a partisan standoff and fails to act by Dec. 1. That's when an initial 23 percent reduction would hit.

Neither Democrats nor newly empowered Republicans want the sudden cuts, but there's no consensus on how to stave them off. The debate over high deficits complicates matters, since every penny going to make doctors whole will probably have to come from cuts elsewhere. A reprieve of a few months may be the likeliest outcome. That may not reassure doctors.

"My frustration level is at a nine or 10 right now," said Wagner, who practices in San Antonio. "I am exceptionally exhausted with these annual and biannual threats to cut my reimbursement by drastic amounts. As a business person, I can't budget at all because I have no idea how much money is going to come in. Medicine is a business. Private practice is a business."

The cuts have nothing to do with President Barack Obama's health care overhaul. They're the consequence of a 1990s budget-balancing law whose requirements Congress has routinely postponed. But these cuts don't go away; they come back for a bigger bite.

Doctors have muddled through with temporary reprieves for years. This time, medical groups estimate that as many as two-thirds of doctors would stop taking new Medicare patients, throwing the health program for 46 million older and disabled people into turmoil just when the first baby boomers will become eligible.

Health care for military service members, families and retirees also would be jeopardized because Tricare payments are tied to Medicare's.

Former Medicare administrator Gail Wilensky, a leading Republican policy expert, says lawmakers coming back to Washington next week better take note. "We simply cannot let physicians take a 23 percent reduction in payment and think that we are not going to seriously disrupt access for beneficiaries," Wilensky said.

Yet there's no agreement among lawmakers and the Obama administration on how long a reprieve to grant or whether the cost — about $1 billion per month — should be added to the deficit or paid for with spending reductions elsewhere.

The last reprieve, in June, was paid for after a struggle to come up with offsets acceptable to Democrats and Republicans. The deadline for congressional action expired, plunging Medicare's claims system into confusion for weeks.

How did it get to be such a big mess?

There's widespread recognition that the way Medicare pays doctors is flawed because it rewards sheer volume of services, not quality results. But there's no agreement on a better way.

So in the 1990s lawmakers devised a formula for cuts as an automatic braking system to keep Medicare humming along at a sustainable growth rate.

Except every time costs went up, they hit the override button. Repealing the formula now would cost more than $280 billion over 10 years.

The American Medical Association is calling for a 13-month reprieve that would give Congress time to work on a new payment system; the administration supports that approach.

"The single biggest step we can take to strengthen Medicare ... is to make sure these disruptive cuts don't take effect," said Health and Human Services Secretary Kathleen Sebelius. "We will ultimately need a permanent fix ... but in the meantime, we don't want any doctor to be stuck in a limbo where they don't know week to week how much they'll be paid."

The AMA and Obama would settle for adding the cost to the deficit. Most Republicans and many conservative Democrats want it paid for.

Aides to the Senate Finance Committee chairman, Sen. Max Baucus, D-Mont., say he's working toward the longest possible extension that will get the 60 votes needed to pass the Senate.

Last summer, when Congress missed the deadline for an extension, Wagner had to tap her line of credit to pay the salaries of her nurses and office staff. Medicare is only a fraction of her practice, but the cancer surgeon said private insurance companies also held up payments waiting to see what would happen. "I didn't get a check in the mail for almost a month," she said.

As a doctor, she recognizes there could be grave consequences if she follows through on not taking new Medicare patients. Older women are more likely to have malignant disease than younger patients. "Those are cancers that are waiting at the door," Wagner said. She would continue to see established patients.

But she's getting closer and closer to the breaking point with Medicare.

"Stick me with a fork," said Wagner. "I'm done."

___

Online:

American Medical Association: http://www.ama-assn.org

Congressional Budget Office: http://tinyurl.com/2ul73ew

Medicare: http://www.medicare.gov