House Majority Leader Steny Hoyer (D-Md.) is threatening Senate Majority Leader Harry Reid (D-Nev.) and President Barack Obama with a legislative smackdown over plans for a long-term fix for doctors’ pay under Medicare that isn’t paid for.Hoyer, backed by Speaker Nancy Pelosi (D-Calif.), is demanding the Senate approve pay-as-you-go legislation as a prerequisite for passing a bill increasing doctors’ pay.“The American public is rightfully concerned about the fiscal posture of the United States,— Hoyer said, citing polls showing most Americans are worried about the record deficit.Hoyer said he told White House Chief of Staff Rahm Emanuel on Thursday and Obama directly on Monday that statutory PAYGO had to be part of any deal on the “doc fix.—Hoyer also said he talked to Reid about the issue last week and expects to talk with him again this week.Hoyer and Pelosi sent a letter earlier this year demanding statutory PAYGO as a precursor to consideration of a doc fix and relief from the estate tax and the alternative minimum tax, all of which Democrats are likely to pass without complying with PAYGO principles.“All of them understand where the Speaker and I are,— Hoyer said.The doc fix, which would cost about $245 billion over the coming decade, would ensure that doctors get increases in their reimbursements instead of a large scheduled cut. Democrats have been considering divorcing it from the larger health care reform legislation so they can claim that the health care bill does not add a dime to the deficit. But Democrats also have been eager to maintain the support of the American Medical Association and doctors for the larger health care reform effort.Hoyer also said he believes a $500 billion transportation bill proposed by House Transportation and Infrastructure Chairman James Oberstar (D-Minn.) needs to be paid for, but he wouldn’t comment on what taxes should be raised.Hoyer has been fighting a sometimes-lonely battle for more fiscal discipline within the Democratic Caucus. He was one of just five Democrats to vote against a bill preventing an increase in Medicare premiums for wealthier seniors. And he has long supported a fiscal commission to address the long-term challenges of the country, but Pelosi has repeatedly put the kibosh on that idea.The agreement with Pelosi on statutory PAYGO was the main fiscal responsibility plank that Hoyer and fiscally conservative Blue Dog Democrats extracted during the negotiations on this year’s budget.