When Senate Majority Leader Harry Reid, D-Nev., kicked off the three hours of debate prior to voting on the Protecting Access to Medicare Act of 2014 by saying “this legislation is not perfect, it’s not ideal,” that statement quickly turned out to be quite euphemistic. 

"It's a sham. It's a lie. It's nothing but gimmicks. It's corruptible. There's no integrity in what we're getting ready to vote on," said Sen. Tom Coburn, MD, R-Okla., "We're not fixing the problem today. We’re taking a big old can and kicking it down the road and, worse than that, we're not even being truthful about what we're doing."

The idea that the bill is full of budget gimmicks -- perhaps most notably the notion that Congress will actually adhere to the Bipartisan Budget Act of 2013 to get a handle on Medicare spending -- was a common theme.

Calling SGR a "Medicare migraine," Sen. Mark Warner, D-Va., said, "it's time for this Senate to take two aspirin and get rid of this migraine," and urged that the U.S. Senate has a remarkable opportunity to score a twofer by ending the SGR fiction and eliminating OCO, the Overseas Contingency Operation, which some members of Congress proposed using to fund full SGR repeal. 

"We will once again avoid the opportunity to get rid of some budgetary fakery that makes some of our efforts that may be legitimate seem illegitimate because we can’t clean up our books," Warner continued. "What takes the cake is what passes for rational accounting and scoring practices in the federal government."

Sen. Jeff Sessions, R-Ala., said the "plain financial truth" is that the temporary Sustainable Growth Rate patch, which postpones for another 12 months a final decision about the scheduled 24 percent pay cut to physicians treating Medicare patients without determining a way to pay for it violates the Bipartisan Budget Act of 2013 Congress put in place only three months ago.

"We're just going to take care of the doctors who need their money and we’re not going to pay for it," Sessions said. "It violates the budget."

What’s more, the “total cost of the patches exceeds the cost of repeal,” Warner added. The Congressional Budget Office's most recent estimate of the overall cost to reform SGR is $116 billion. The U.S. has already spent more than $146 billion on temporary patches.

Sen. Ron Wyden, D-Ore., explained that all sides agree the current Medicare payment system doesn't work well for any stakeholders: doctors, seniors, or taxpayers. “It’s time to end this fiction and wipe SGR off the books."

"I think there is a growing awareness that simply spending what we already have and punting on the need to fix the urgent structural problems, it can’t be ducked much longer," Wyden said. "I have to be concerned that patch 17 will lead to patch 18, and 19. The reality is if all you do is take what you've got and extend it, we’re not going to turn this around."

Congress essentially had two options: The temporary fix it voted in favor of Monday, or "we could really take care of it," said Sen. Benjamin Cardin, D-Md.

Coburn explained that Congress has missed the SGR deadline in the past and, while it does create extra work for doctors and CMS, all parties also get back on track.