Abstract
The Democrats' loss of their 60-vote Senate majority after Massachusetts' January 19 special election creates major challenges for passage of comprehensive national health care reform. Critics of the Democrats' proposals have raised concern about the cost, the expanded government role in health insurance markets, and the lack of new mechanisms for controlling the growth of health care spending. Whatever the fate of current reform proposals, Congress cannot avoid important decisions about Medicare. Without new legislation, Medicare payments to physicians are scheduled to be cut by 21% on March 1, 2010, and the Hospital Insurance Trust Fund will become insolvent by . . .