There are few things that go on in Congress that are less sexy than the annual ritual of jettisoning the “sustainable growth rate” of Medicare, and I have struggled to find a way to discuss last week’s example in a way that might be of the slightest interest to anyone who isn’t a doctor or a lobbyist.

Commonly known as the “doc-fix,” the ritual became necessary after Congress enacted the Balanced Budget Act of 1997, which sought to restrict the growth of Medicare spending by capping how much doctors could be compensated for their services. Ever since, Congress has been unwilling to live with the consequences of their own actions, and they keep applying “patches” that prevent the doctors from taking their statutory haircut. At this point, a gap has opened so wide that without a patch doctors will see a 24% reduction in their compensation on April 1st. If that were to happen, a lot of Medicare recipients would discover that their doctor is no longer willing to treat them.

There was a lot of talk this year about applying a permanent fix, and that is something that newly-minted Senate Finance Committee chairman Ron Wyden (D-OR) still seems interested in doing. But, as has become the norm, Speaker Boehner can’t get anything remotely ambitious accomplished in the House. In fact, Speaker Boehner discovered last week that he couldn’t even apply the patch.

Emily Ethridge of CQ Roll Call explained what happened to Mary Agnes Carey of Kaiser Health News:

MARY AGNES CAREY: The “doc fix” bill was originally scheduled for consideration on the suspension calendar in the House. This is usually reserved for non-controversial matters that require two-thirds votes for passage. But at the last minute, this was switched to a voice vote. How did that happen?

EMILY ETHRIDGE: Right, it was very surprising. The bill was brought up, and it was debated, and then Republican leaders and some of the members, including some of the members of Republican Doctors Caucus met off the floor. The House went into recess, and they were meeting off the floor, and staff was meeting, and we were trying to figure out what was going on. And once they emerged from their meeting, about 45 minutes or an hour later, they came back, and all of a sudden the bill was passed by a voice vote. And we heard from a lot of members that they were surprised. They didn’t know that was going to happen, and they thought they were going to take a regular roll call vote on this bill this morning, and it didn’t happen.

I wrote about this spectacle on Thursday right after it occurred, noting that Rep. John Dingell of Michigan, who has been serving in the House since 1955, said that it was the most comical thing he had ever seen.

Speaker Boehner realized that he couldn’t pass the bill under regular order or under a suspension of the rules, so he had Rep. Steve Womack (R-AR) gavel in a surprise end to a recess of the House, call a quick voice vote in a largely empty chamber, and ignore the obvious ‘no’ preference of those who were actually there to voice their preference.

According to Emily Ethridge, the cost of this doc-fix is $140 billion over 10 years, which seems like a lot of money to spend without actually consulting the full House. It’s mind-boggling that they would simply ignore that they failed the voice-vote, too, and just declare the bill passed.

Ruth Marcus had an extraordinary way of characterizing what happened.

The capital’s dysfunction has its unfortunate exceptions. Gridlock yields to interests powerful enough to trump habits of obstruction. The result is compromise of a peculiarly distasteful variety — bipartisanship in the form of can-kicking, budgetary obfuscation and unaffordable generosity to those with the best-connected lobbyists.

One such example was on display this week as lawmakers neared agreement on the so-called “doc fix,” the perennial problem created by an overambitious Clinton-era attempt to rein in Medicare spending.

I may be nit-picking a bit because I agree with Ms. Marcus’s distaste for can-kicking and budgetary obfuscation, but this wasn’t bipartisanship in any commonly understood meaning of the term. It was, to be blunt about it, an example of the Republican leadership passing a bill that simply did not and could not pass. The Democratic leadership was fully complicit in the coup (or whatever you want to call it) but “bipartisanship” normally means that members of both parties come together to pass a bill, not to pretend that they passed a bill.

There was plenty of grumbling on the right, with some even comparing Boehner to Vladimir Putin. But, the backlash was muted by the fact that no members had to take a recorded vote in favor of spending the $140 billion.

I expected more of a backlash from the base, but even over at Red State the reaction was fairly calm.

This is part of a disturbing pattern of leadership using over-hyped deadlines as leverage to pass bad legislation. In this case, the doc fix deadline was set at April 1.

Remember, this pattern will not change with Republicans in charge of the Senate, unless we change leadership in both chambers. They have shown that when they are up against a Washington deadline – be it a debt ceiling, budget bill, or any number of program reauthorizations – they will press the panic button and give into Democrat demands.

Red State was already calling for a replacement in the House and Senate leadership. Calling what Boehner did “passing bad legislation” is an acceptance that the bill actually passed in some kind of legitimate way. When President Obama uses an executive order, these folks compare him to Czar Nicholas II, but they basically shrug when Boehner spends $140 billion without the approval of his own chamber.

Which all gets back to the fact that the Tea Party faction of the Republican Party is too divorced from reality, and too strong in Congress, for Congress to operate and for our government to function.

So, the main reaction to Boehner’s gambit is simple relief. He “passed” a bill that needed to be passed, and no Republicans actually are on the record as supporting it.

And this party is likely to pick up seats in November?

What does that say about the people in this country?

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Martin Longman is the web editor for the Washington Monthly. See all his writing at