This was a big day in the final push towards passage of health care legislation. The House released the final text of the reconciliation bill and the Congressional Budget Office released a very good score for the bill. According to the CBO, the bill will reduce the federal budget deficit by $138 billion over the next decade. No legislation has had this much potential to reduce the deficit since the Clinton years.

The bill itself contains no surprises. It does have a provision to boost Medicaid payments to physicians, which should help address the access issues I discussed the other day. The public option is probably dead (unless the Senate tries to revive it, which seems unlikely), but I remain hopeful that a future Congress can enact it once people realize that the government can do some things pretty well.

The final House vote is scheduled for Sunday. Anything can still happen, but this feels like history in the making.

The Times reports on doctors who are dropping patients on Medicaid because states are slashing reimbursement rates to health care providers. The article focuses on Michigan, one of the states hardest hit by the recession and where the state legislature has already enacted deep cuts to provider payments. As a result of the cuts, more Medicaid enrollees are forced to either go without care or travel long distances to see a physician willing to treat them.

Most states, including Minnesota, are being forced to reduce payments to Medicaid providers. Unfortunately, passage of the health care bill isn’t likely to provide a quick fix to the problem. It will provide some additional funding to pay for individuals who previously weren’t eligible for the program, but states will still be on the hook for a large share of Medicaid costs. And state finances are likely to look pretty shaky for years to come. Unless states can persuade Congress to pick up a higher ongoing percentage of the Medicaid tab, it’s going to be increasingly difficult for them to ensure that people on Medicaid have access to the care they need.

Frederik Pohl is one of the few surviving members of science fiction’s Golden Age elite and the only one to maintain a blog. I spent some time perusing it today and it’s filled with wonderful stories about his friendship with Isaac Asimov, the rapid rise of the science fiction publishing scene, and his own career as a writer and futurist. Pohl is 90 years old and still writes with clarity and verve. Some SF writers are cranks and misanthropes, but Pohl’s blogging has the same compassion and wit that made Gateway one of my favorite books. I hope he continues posting for a good long while.

I’m posting early today because I’ll probably be away from my computer for much of the evening. I’m training in a new nurse and I’m trying to come up with a plan for covering everything she needs to know. It will probably look something like this:
– Mark’s Hair: Care & Maintenance
– Mark’s Ventilator: What The Hell Are All These Dials For?
– Mark’s Hair: Advanced Care & Maintenance
– Mark’s Remote Control: Unraveling Its Secrets
– Mark’s Wheelchair: Taming Its Inner Beast
– OMG, Mark’s Turning Blue!: Keeping Cool in an Emergency

You know what my wheelchair is missing? A vodka-cranberry juice dispenser. And a smokestack. And brass control levers. And sound effects. In other words, pretty much everything found on this steampunk-themed wheelchair. The guy who designed this chair doesn’t say whether he does work for hire, but I wonder if my savings are sufficient to pay for a similar custom job. I’ll pay extra if he can come up with copper ventilator tubing that coordinates well with my ascot and goggles.

Thanks to William for the link.