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With Medicare vote, G.O.P. splitting from Bush

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"I see this as a process success for Harry Reid, who was able to link the doctors fix to reelection politics in November," said Sen. Richard Burr (R) of North Carolina after the vote. "It's a vote against privatization and for universal healthcare. When a number of Republicans realize what they have done, they will encourage the president to veto this bill," he added.

But the mood in much of the GOP caucus was more subdued. "I don't know why the president would veto this bill with a significant vote on both sides of the aisle," said Sen. Michael Enzi (R) of Wyoming, who opposed the bill. "People will just stay with their votes to be consistent – and the vote would be the same."

In fact, these votes mirror a pattern of Congress deferring mandated cuts in physician fees. The "sustainable growth rate" system for determining annual physician fees was set up in the Balanced Budget Act of 1997 in a bid to rein in soaring entitlement costs. In 2002, the SGR system reduced fees by almost 5 percent, but it has been deflected by legislative action since 2003.

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