From the New York Times.

The Senate majority leader, Harry Reid, Democrat of Nevada, needed 60 votes to proceed. He won only 47. And he could not blame Republicans. A dozen Democrats and one independent crossed party lines and voted with Republicans on the 53 to 47 roll call.

The Medicare bill has become a proxy for larger issues in the debate over legislation to overhaul the health care system.

Mr. Reid said the bill, by averting big cuts in physician fees, guaranteed that doctors would continue accepting Medicare patients. But since none of the costs were offset or paid for, Republicans said it was fiscally irresponsible, and some Democrats said they shared that concern.

By addressing doctors’ fees in a separate bill, Senate Democrats could hold down the cost of the broader health legislation, keeping it within the limits set by President Obama. House Democrats are considering a similar tactic. Republicans said it was a transparent ploy to hide the cost of a health care overhaul.

Democrats had hoped that by passing the Medicare bill they could appease doctors and secure their support for the broader legislation.

Senate Democratic leaders said the bill to protect doctors’ fees had strong support from the White House, the American Medical Association and AARP.