Democratic leaders failed Wednesday to garner enough support in the Senate to consider a plan to permanently cancel an upcoming 21 percent cut in Medicare payments to doctors.

The Senate blocked the so-called "doctor fix" -- a 10-year $247 billion measure -- by a vote of 47-53, with 13 Democrats joining all Republicans in opposition. The plan required 60 votes to move forward. 

The vote represents a setback for Democrats in their push for a sweeping overhaul of the health care system.

The measure originally was expected to be part of the health reform legislation grinding its way through Congress now. But separating it allowed Democrats to prevent the measure from pushing health reform legislation over the $900 billion ceiling set by Obama. The president asserts that the 10-year plan will be paid in large part through savings in Medicare.

Republicans and several moderate Democrats opposed the "doctor fix" because it would be paid for by more federal borrowing for the seniors' health care program already steep in debt. They also opposed adding to the federal deficit, which hit an all-time high of $1.42 trillion in the fiscal year that ended Sept. 30.

Supporters of the measure, including the powerful American Medical Association and the AARP, argue that a long-term fix is needed to provide certainty to doctors, and thereby their patients, who fear the cuts and therefore refuse to treat Medicare patients.

The proposal would have replaced a formula from the 1997 Balanced Budget Act designed to hold down Medicare costs by setting yearly and cumulative spending targets. If actual spending exceeds the target for a given year, reimbursement rates for doctors are lowered the next year. Expenditures have exceeded projections for the past seven years and Congress has passed legislation to override the cuts all seven years.