The Senate passed the bill blocking a 10.6 percent Medicare payment cut today by a veto-proof margin of 69-30.

A hat tip to the Democrats who played this scenario balls-out. They took the initiative after the bill passed so decisively in the House. The Republicans were snookered, and in today's repeat vote, it appeared that 8 of them flipped their vote. Kudos to the lobbies that strong-armed them. They were placed in a no-win situation of trying to defend the insurance companies against physicians and seniors.

The Democrats even had a flair for the theatrical, with Ted Kennedy dramatically returning for the vote.

So, what does it mean? Pretty much nothing. Instead of a 10.6 percent pay cut, physicians get a sub-inflationary 1 percent increase. There is another substantial payment cut next year, and we do this all over again. The entire payment system needs to be scrapped, and fundamental reform needed. Payments need to be divorced from volume, and the disparity between procedural and cognitive services has to be fairly reconciled.

However, this charade seriously damaged the Republicans. They pretty much crapped on the medical profession, a normally reliable ally. The appearance of defending insurance companies over the interests of physicians is inexcusable. The fact that McCain was absent from today's vote spoke volumes.

In the eyes of this swing voter, this debacle will certainly weigh significantly come November.