WASHINGTON (AP) — It's become a symbol of sorts for the federal government's budget dysfunction: Unless Congress acts before Jan. 1, doctors will again face steep Medicare cuts that threaten to undermine health care for millions of seniors and disabled people.

This time it's a 27.4 percent cut. Last year, it was about 20 percent. The cuts are the consequence of a 1990s budget law that failed to control spending but was never repealed. Congress passes a temporary fix each time, only to grow the size of reductions required next time around. Last week's supercommittee breakdown leaves the so-called "doc fix" unresolved with time running out.

A thousand miles away in Harlan, Iowa, Dr. Don Klitgaard is trying to contain his frustration.

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