If you were hoping for a quick resolution of the Medicare physician payment issue, think again.

The “doc fix” issue is part of a broader and more complicated debate: how to finance an extension of the current payroll tax cut for the rest of the year and federal benefits for the long-term unemployed.  Both parties want to stop a scheduled 27 percent cut in Medicare physician payments but disagree over how to pay for it.  The current extension expires at the end of February.

“There are a lot of key issues, a lot of them not easily solved…. I think we’ve got some work to do,” said Rep. Kevin Brady, R-Texas, a member of the House-Senate conference panel expected to begin talks on the issue next week.  “I don’t see these as simple issues…. If [they] were, it would have been done before the holidays,” he said Wednesday.

House Minority Leader Nancy Pelosi, D-Calif., said Democrats would continue their push for a surtax on millionaires as a way to finance the payroll tax extension and to use money from the drawdown in U.S. overseas war operations as a way to finance a partial or permanent solution to the Medicare physician payment formula.   House Republicans have previously rejected both ideas and are likely to do so again.

House Speaker John Boehner, R-Ohio, signaled that Republicans may return to the same bargaining stance they held in December before they agreed to approve the Senate-passed legislation extending the payroll tax cut and stopping the Medicare physician payment cut for two months.  “We were picking the right fight, but I would argue we probably picked it at the wrong time,” he said.

Boehner didn’t elaborate on the Republicans’ specific plans on the issue. The Republican-led House sought late last year to extend doctors’ payments for two years at a cost of $38 billion and paying for it by cutting programs established by the 2010 health law and reducing Medicare and Medicaid payments to hospitals.

Even if those areas are resolved, another dispute could complicate matters: President Barack Obama’s decision Wednesday to reject the Keystone XL oil pipeline project, which Republicans favor.  When asked if Obama’s move would play a role in the payroll tax extension negotiations, Boehner responded: “All options are on the table.” He added later: “This fight is not going to go away. You can count on it.”