WASHINGTON -- Doctors' Medicare fees would be cut 21 percent next year unless some change is approved, and quickly, but Senators sent a strong signal Wednesday that they're reluctant to spend billions on a long-term solution.

Despite a strong effort by the American Medical Association, the Senate rejected a bid to continue debate on a 10-year plan by 13 votes because of concerns it isn't paid for.

James Rohack, the AMA president, said he's ``deeply disappointed,'' and Senate Majority Leader Harry Reid, D-Nev., vowed he'd pursue a ``multi-year fix'' after dealing with healthcare legislation.

Before the end of the year, the change is expected to pass -- because Congress is highly unlikely to put doctors and seniors in a precarious position.

First, however, there's going to be a lot of political turmoil as lawmakers sort out all sorts of tough questions.

Should the change be part of the big healthcare overhaul? Should Congress pass a long-term fix, or simply one that applies for a year or two? Also, how will this be paid for -- since the federal deficit last year hit $1.4 trillion and a lot of lawmakers are reluctant to make it bigger?

Advocates of a strong fix have warned that if the currently scheduled payment system goes into effect, patients would have a harder time finding doctors willing to treat them. ``These cuts threaten to disrupt the relationships between people with Medicare and the doctors who care for them,'' according to Joe Baker, the president of the Medicare Rights Center, a nonprofit, nonpartisan consumer advocacy group based in New York.

Members of Congress agree on this much. ``The one thing we have to understand is we are going to make sure that senior citizens have the ability to go to a doctor when they're sick,'' Reid said.

``That's the key,'' he said. ``We want to make sure that more doctors take Medicare patients, not less.''

Beyond that, solutions to this problem are proving elusive.

Part of the problem involves disagreements over how long a fix is necessary.

The Senate Finance Committee, as part of its $829 billion comprehensive healthcare plan, agreed to increase doctors' payments 0.5 percent next year, at a cost of $10.9 billion.

Sen. Debbie Stabenow, D-Mich., and others want a 10-year, $246.9 billion plan that would freeze rates during that period, a plan that's been widely praised by the doctors' group and AARP, which represents seniors.

``While short-term fixes have temporarily averted widespread access problems, they have also grown the size of the problem -- and the cost of reform,'' Rohack said at a Washington news conference. ``This bill does away with past budget gimmicks and instead lays the foundation for fiscally honest and responsible repeal of the broken formula.''

Skeptics countered that the 10-year fix dramatically adds to the deficit, and that argument doomed the bill Wednesday.

``It just adds almost $250 billion to the deficit, to the debt for the coming years. And I just don't think we can do that anymore,'' said Sen. Joseph Lieberman, a Connecticut independent who caucuses with the Democrats.

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