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Wednesday, March 31, 2010

Senator Tom Coburn, M.D.

Congress's latest final push in its ideological crusade called health reform is shaping up to be an act of historic arrogance and deception. 

For months, the American people have been telling Congress to scrap the current bills. A recent CNN poll found that 7 in 10 Americans want Congress to start over on health care, or quit working on the issue altogether. Yet, the majority in Congress continues to march on in the face of overwhelming public opposition.  

The American people have good reason to be concerned. The bill that may become law in a few days is not a collection of so-called fixes or compromises but the exact bill the Senate passed on Christmas Eve that was filled with backroom deals such as the Cornhusker Kickback. The Senate bill also still contains half a trillion dollars in Medicare cuts, half a trillion dollars in tax increases, job-killing penalties for employers, provisions that will cause premiums to spike, and radical provisions to fund abortion and ration health care. 

House leaders are so ashamed of the Senate bill that they have concocted a procedural process to pass the Senate bill without having a direct vote. In short, they hope to pass one of the most important pieces of legislation in recent history, which will affect one-sixth of our economy, without the public knowing. Even House Democrats are criticizing this charade. Rep. Jason Altmire (D-Pa.), a member of the Blue Dog and New Democrat coalitions, called this process “wrong.” Altmire and other wavering Democrats understand that once the House passes the Senate bill, the Senate will have little motivation to clean up the bill under the arcane and complex reconciliation process.

The fundamental problem with the current reform bill is that it fixes the wrong problem. In medicine, we call this treating symptoms rather than the disease. 

The fundamental problem in health care is cost. Every family knows that cost reduces access. As a nation, we spend twice as much on health care as any other industrialized country, but we aren’t any healthier as a result. A study by Thomson-Reuters shows that one in three dollars in our more than $2 trillion health care system does nothing to help people get well or prevent them from getting sick. If members of Congress focused their time and energy on allocating the health care dollars that are already in the system more efficiently—by reducing fraud and the costs associated with defensive medicine, for instance—we could lower cost and improve access overnight. 

The bill before us, however, fails to do that. Instead, it builds on a broken and bankrupt system. The Senate bill will put 15 million Americans in the Medicaid program, which is bankrupting states and denying care to millions of American. Forty percent of doctors restrict access to Medicaid patients because reimbursement rates are so low. The rest of America will be funneled into the insurance industry the White House has been demonizing.

Supporters argue that the bill will save taxpayers $100 billion over 10 years, but this estimate is a sham.  The numbers Congress gave to the Congressional Budget Office include 10 years of tax increases but only six years of benefits at the back end. This is unjust and deceptive Enron-style accounting. No homeowner would allow a bank to tell them they have to make mortgage payments for four years before they can move into their new home. Yet that is precisely what Congress is telling the American people. 

The bill will also cause health care costs and premiums to increase, not decrease. According to CBO, premiums for families could rise 10 to 13 percent beyond current estimates. The president’s own actuary also estimated that health care costs will increase, not decrease, under the Senate bill. 

Proponents are not only wrong about cost containment but patient choice as well. The fact is the Senate bill takes unprecedented steps to put government bureaucrats between patients and doctors. For instance, the Senate bill creates new comparative effectiveness research (CER) panels that have been used as rationing commissions in other countries such as the U.K., where 15,000 cancer patients die prematurely every year according to the National Cancer Intelligence Network.

The Senate bill also depends on the recommendations of the U.S. Preventive Services Task Force in no fewer than 14 places. This task force was responsible for advising women under 50 to not undergo annual mammograms. Proponents claim the task force recommendations do not carry the force of law, but the Senate bill itself contradicts that claim by declaring health insurance plans “shall provide coverage for” services approved by the task force. 

I’ve treated patients in my own practice who would have had their lives cut short had a government panel been allowed to tell me which treatments I could and could not prescribe. These and other provisions have caused physicians to turn against this bill. For instance, a recent poll conducted by Sermo.com, an online community of more than 110,000 physicians, found that only 1 in 10 physicians said Congress should push the current bills through, while nearly two-thirds of physicians said Congress should start over and work on targeted, step-by-step solutions.

Health reform will only be possible when Congress agrees to listen to reason, and the American people, and defeats a deeply misguided plan that will increase costs, limit patient choices and delay the real reform America needs.

Tom Coburn is a U.S. Senator from Oklahoma. He is also a practicing physician and author of the "Patients' Choice Act" along with Senator Richard Burr of North Carolina and Representatives Paul Ryan of Wisconsin and Devin Nunes of California
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