Congress sent President Bush one of the strongest rebukes of his administration Tuesday, overturning his veto of a Medicare bill by a substantial margin in both chambers.

    The override marked a victory in a long ideological battle between Bush and congressional Democrats, largely over private Medicare plans known as Medicare Advantage. The legislation cuts those plans substantially.

    After Bush vetoed the bill (HR 6331) Tuesday morning, the House voted to override him, 383-41. The vote surpassed the two-thirds majority required and the 355-59 tally by which the House originally passed the bill June 24.

    The Senate followed suit, 70-26. The bill now becomes law.

    The Senate originally passed the bill July 9, 69-30. Four Republican senators who voted against the bill's passage switched to vote in favor of the override: Roger Wicker and Thad Cochran of Mississippi, Richard G. Lugar of Indiana and Christopher S. Bond of Missouri.

    Edward M. Kennedy, D-Mass., who voted for the bill July 9 but has been away while recovering from surgery for brain cancer, did not return for the override vote. Nor did Barack Obama of Illinois, the presumed Democratic presidential nominee. Senate Majority Leader Harry Reid, DNev., said Obama would have been available to vote if needed.

    John W. Warner, R-Va., who voted for the bill July 9, did not vote Tuesday.

    Presumed GOP presidential nominee John McCain of Arizona also did not vote.

    "We wasted no time in reversing the president's carelessness and protecting our nation's doctors and the patients they treat - and this responsible and overdue Medicare fix is now law," Reid said in a statement.

    Democrats have tried repeatedly to cut payments to the private Medicare Advantage plans, only to be defeated by Bush's veto threat and by his GOP Senate allies.

    The administration sees the private plans as the future of Medicare, enabling patient choice and providing private sector solutions for the entitlement program.

    But Democrats complain that the plans are too expensive. They structured the Medicare bill to successfully pit physicians and seniors against the private health insurers by using cuts to the private plans as a way to fund the reversal of a scheduled 10.6 percent cut to Medicare's physician payment rates. Doctors had threatened to stop seeing new Medicare patients if the payment cuts went through.

    The override is the fourth of Bush's presidency. In 2007, Congress voted to override his veto of a popular water resources bill (HR 1495). This year, Congress overrode his vetoes of two versions of the farm bill (HR 2419, HR 6145).

    Embracing the House's Tack

    During floor debate, conservative Republicans attacked both the substance of the bill and the process Democrats used to pass it.

    "These are not pro-patient policies. Rather, the bill reduces patient access and choices," said Senate Republican Whip Jon Kyl of Arizona. Kyl also criticized Democrats for pushing the House bill at the expense of legislation that was being negotiated by Max Baucus, D-Mont., and Charles E. Grassley, R-Iowa.

    Baucus had been talking with Grassley before the House's June vote to pass a modified version of Baucus' original bill (S 3101). The overwhelming House vote prompted Baucus to end discussions and move forward with the House bill, which ultimately became law Tuesday.

    In his veto message to the House, Bush said he supported the legislation's goal of stopping the cut to Medicare physicians' payment rates, but he objected to the reduction in payments to the private Medicare Advantage plans.

    The measure will replace the 10.6 percent cut to physician pay rates with 18 months of stable payments. The cost will be offset by cutting bonus payments to the Medicare Advantage plans. Those cuts total $12.5 billion over five years, according to the Congressional Budget Office.

    Also included in the bill is an 18-month postponement of a program that would have had makers of medical supplies bid for government business. The program went into effect July 1, but the bill rolls it back. The bidding program is expected to save taxpayers about $1 billion a year.

    Temporary Fix

    When the law expires in 18 months, Congress will have to take up the issue again - possibly as part of a broader health care overhaul during the next presidency. In 2010, physicians will face at least a 20 percent cut to their rates, which would be even more expensive to prevent.

    "We have a 20 percent cut that'll go into effect if we don't do something," said Joe L. Barton of Texas, the ranking Republican on the House Energy and Commerce Committee.

    Neither side made a serious effort to overhaul the payment system this time around. "We are just kicking the can down the road," said Rep. Pete Stark, D-Calif. "But the truth is, none of us ... have any idea how we are going to solve the physician reimbursement issue."

    The cuts are required as part of Medicare's cost control formula, written in 1997 as part of the Balanced Budget Act (PL 105-33). According to the formula, if spending on Medicare's physician services grew too much, the formula would demand cuts in the future, as it began to do in 2002.

    Congress has stepped in to stop those cuts almost every year since then.