Bell Curve The Law Talking Guy Raised by Republicans U.S. West
Well, he's kind of had it in for me ever since I accidentally ran over his dog. Actually, replace "accidentally" with "repeatedly," and replace "dog" with "son."

Monday, August 10, 2009

Responding to Senator Tom Coburn

The following responds to Senator Tom Coburn's piece in the National Review about health care reform called "10 Questions Politicians Won't Answer." His questions are in italics, response below. [somebody please truncate]

1. Why do we need to increase spending on health care by at least $1.6 trillion and steal prosperity from our children and grandchildren when we spend nearly twice per person what other industrialized nations spend on health care?

• We need to cover all Americans. Nearly 50 million Americans are now uninsured (about 1 in 6) and a great deal of the remainder have wholly inadequate private insurance that will not really cover them in the event of serious or prolonged illness, and that does not sufficiently cover preventative measures, mental health, or other important care issues.
• For 14 years, the Republicans had majorities in both houses and never introduced a single reform effort of any kind. Why the outrage now?
• What a comparison to make! Other industrialized nations have single-payer systems, which Senator Coburn opposes.
• The only workable solution is to spend more up front to cover everyone, then work to reduce the growth of spending over the long term which will narrow the gap with other industrialized countries. Even a single-payer system - which Senator Coburn unwittingly touts as cost effective - would cost more in the short term to implement.

2. What programs will you cut and whose taxes will you raise to pay for health-care reform?

• All of the proposed cuts and taxes are being discussed openly. It is dishonest to aver otherwise.
• The cuts being proposed are to the Medicare Advantage programs, that basically turn insurance companies into Medicare middlemen and run up administrative costs for no better care and. Taxes under discussion are surcharges on incomes over $ 350,000, on cigarettes, and on private health insurance plans that are at the very top end.
• Mr. Coburn wishes to focus on these rather than on his opposition to covering the uninsured, because everything looks worse if you focus on the costs rather than the benefits.

3. What earmarks or pet projects that you have sponsored will you sacrifice to help finance the cost of health-care reform?

• Earmarks comprise less than half of one percent of the budget. This is not a serious question.

4. Will you vote for a public option that requires taxpayer-funded abortion?

• Ah, abortion: Wedge issues and politics as usual.
• No proposal for a public option specifically deals with abortion – that is going to be left to the regulatory process along with the coverage for all other medical procedures.

5. If the public option is so wonderful, will you lead by example and vote for a plan to enroll you and your family in the public option? I offered an amendment in committee to force members of Congress to enroll in the public option. Nine out of eleven Democrats on the health committee who back the public option refused.

• The public option is just that, an option. Nobody should be forced to enroll in it.
• A public option will likely provide equivalent or better care than private insurance companies at a lower price because (1) the participants will have due process rights to challenge claim denials through neutral arbiters, something no private insurance company offers and (2) public option administrators will not be incentivized to deny care in order to raise profits.
• If the public option is as awful as Senator Coburn thinks, nobody will choose it. Let the market decide.

6. Will you vote for a plan that will allow a board of politicians and bureaucrats to override decisions made by you and your doctor? Both the Senate and House bills set up a government-run “comparative effectiveness” board that will make final decisions about treatment and care. In committee, I gave senators several opportunities to accept language that would forbid this board from denying care. All of my amendments were rejected, which suggests that the intent is to set up a board that will ration care, as is done in the United Kingdom.

• Every private insurance plan already has a veto over decisions made by you and your doctor. This would be nothing new.
• A public option will differ from private options in that the decisions about coverage are more likely to be made honestly because (1) they must be made openly and (2) the profit motive will not push denials of care for their own sake.
• What is under discussion is how to limit the scope of coverage in the public option. All plans limit the scope of coverage.
• Use of the phrase "ration care" in this context is a scare tactic.
• Care is not rationed in the United Kingdom. There is not a set number of hip replacements for the nation or some such nonsense. Nobody is proposing that here, either. In Britain, however, free medical procedures is prioritized: elective surgeries such as hip replacements may not be performed ahead of life-saving surgeries. We prioritize too, but we do it by money, not by medical necessity. Which is better?
• Senator Coburn must not know that private health care thrives in Britain. Anyone can pay for any treatment they want there from some of the best private doctors in the world. That will always be true here too. For too many Americans today, this is the only option, and they cannot afford it.

7. If you support a “comparative effectiveness” board, what qualifies you, as a politician, to practice medicine? Have you delivered health care to a single person, much less entire classes of people you claim to represent, such as the poor, the uninsured, or children?

• Right now, private insurance companies are allowed to deny care and set limits without any input from medical professionals at all.
• A public board will be at least as well chosen as the private insurance company boards. In a public board, however, the decisions must be made openly and will not be subordinated to the profit motive.
• The board will be composed of medical professionals, not politicians. Politicians should not practice medicine. For more on this issue, see Terri Schiavo.

8. How will a government-run public option perform better than other failing government programs, such as Medicare, Medicaid, and Indian Health Care?

• Does Senator Coburn also oppose Medicare, Medicaid or Indian Health Care? If not, what is the argument?

9. If increasing spending on health care was the solution, why hasn’t it worked yet?

• Nobody is proposing just increasing spending. This is not a serious question.

10. Are you more committed to doing reform right or quickly? Would you consider backing a thoughtful alternative to the public option? If so, which one?

• Let's be honest. Senator Coburn is opposed to all reform. For him, nothing will ever be "right."
• Republicans defeated reform in 1994 and kept if off the table for 15 years. Nothing about this is quick.
• Nearly fifty million Americans lack health care and most of us are only a paycheck away from losing our health insurance. People regularly die from lack of adequate health care in this country. Millions suffer from grossly inadequate treatment because they cannot afford proper medical care, or because their insurance plans are too restrictive to cover their needs. Millions cannot afford the medicines they are prescribed even when they can get to see a doctor. Most Americans' access to health insurance, even if they have insurance, is severely limited by inadquate funds or HMO and PPO networks. Health care costs are the number one cause of bankruptcy in America today. There is no more time to waste.


Robert said...

Question number 5 is also misleading. The amendment passed, and the Senate version of healthcare requires all congresspeople and their staff to be enrolled in the public option.

But it is still a stupid question, since he constantly implies government cannot run a healthcare system and yet all members of congress and their staff and federal employees and seniors and Indians and some Social Security and COBRA are all healthcare systems run by the government.

LTG - thank you for your reply but I fear you wasted your time.

Pombat said...

We finally saw the Daily Show episode with Bill Kristol last night (aired 27th July I think - we have some catching up to do!), with the best bit being when Kristol says that the military should definitely have the number one healthcare system in America, having been going on about how gov't can't run healthcare. Jon Stewart couldn't believe his luck, and of course immediately pointed out what he'd said. Not that he'd agree to it then though :-)

I'm most interested in the senator's reference to the UK in number 6 - it's amazing how someone like me can live in a country for a good quarter century or so, and still not realise things like the 'fact' that healthcare is rationed there. Sounds like I'm lucky to have gotten out!

And in seriousness, somehow plenty of people from countries such as the UK need to get airtime in the US - just some little spots interviewing them about their healthcare systems, their experiences of them, and their thoughts about the US system - I guarantee you that if you explain the US system to a European who's unfamiliar with it, you'd get a most telegenic shocked reaction...

limo said...

ya i agree with Robert's comments fifth question is misleading..
and why you don't include your family. why???????????

Raised By Republicans said...


I agree that the Republicans' mischaracterization of British, French, and other public health care systems is infuriating. I really wish that someone who is better at marketing than I am could figure out a way to counter all that misinformation.

The Republicans already have adds with disgruntled Canadians complaining about how they were denied some life saving experimental procedure and had to come to the US to get it. The foreign testimony theme seems to be a favorite of theirs.

Anonymous said...

If I hear one more of these bastards talk about stealing prosperity from our children and grand children, I'm gonna puke and then start shootin'! What, are all of the "real Americans'" kids never gonna have a health problem? More over, it is probably the people who are complaining the most about health care reform who actually need it the most. Have you seen the dis-rupters at the meetings? They are mostly all obese, probably smokers (I'm projecting, I know), diabetic, kidney, lung and heart issues, are on meds paid for by Medi-care...we are already paying for those obese, unhealthy bastards who are complaining the most!! Jesus, shut them the fuck up. And like Obabma said today, UPS and FedEx are running fine, it is the US postal service that has problems...a government option is not going to hurt anybody or steal prosperity from anyone. Future prosperity has been stolen by deregulation...not by taxes and entitlement programs. RBR...the only real marketing program I can think of is to tell them to Fuck Off!...that is the kind of language they understand. These people are bullies and it is time to call the bluff for God's sake.They need to shut up, go the doctor and get some more meds like Prozac or some other chemical that they love, that we have to pay for, maybe Rush can get the a RX for Oxi-cotton. WW

Pombat said...

They'd never answer the question "so what healthcare plan are you on?", with the follow up "ah, that's a government plan, would you like to keep it?", would they?

wild bill said...

In his recent article in National Review online, Senator Tom Coburn writes that the health-care bills moving through Congress will dramatically increase the deficit and cause millions of Americans to lose their health insurance," and that the "independent Lewin Group estimates that 114 million Americans will be forced to give up their current health-care plans as the government-run plan puts everyone else out of business." Mre. Coburn also asks "Why do we need to increase spending on health care by at least $l.6 trillion and steal prosperity from our children?"

Let's look at the actual facts according to the Lewin Group study that has been widely cited by the GOP critics:"The Act would reduce the number of uninsured by 32.6 million people without significantly increasing national health spending. The overall increases in spending for the newly insured would be roughly offset by reductions in provider payments and administrative savings for those covered under the plan." Premiums under the public plan "would be up to 30 percent less than private insurace plans if Medicare payment levels are used. Due to this substantial cost advantage, we estimate that up to 119 million of the 171 million people who now have private employer or non-group insurance coverage would move to the public plan."

The average saving uder the public plan compared to private insurance would be $2,148 for families and $1,100 for individuals. According to the Lewin study, "Benefits provided under the public plan are the same as the Blue Cross/Blue Shield Standard Option offered to members of Congress and federal workers under the FEHBP."

I beleive that if the howling mobs showing up at the public forums would shut up and listen, they might figure out that saving $2,150 per family and getting the same benefit package is not something to scream about (except for joy). No one would be "forced" into the public plan; people would freely choose to save money. duh.

The total government increase of $1.042 trillion over TEN YEARS (CBO) or $1.22 trillion (Lewin Group) would be entirely offset by premium savings to consumers under the public plan.The "dramatically" increased budget deficts would be between $226 billion over ten years (CBO) or $55 billion over ten years (Lewin), a deficit of $22 billion to $5 billion a year(with the new spending largely offset by a tax on families making over $350,000 a year).

By comparison, the GOP rammed a prescription drug benefit through Congress in 2003 that is now estimated to add $525 billion to the budget deficit over the next ten years--up to ten times the deficit added by the health reform act. The GOP also increased annual federal spending ONE TRILLION DOLLARS between 2000 and 2007, and reduced the tax base to 15.1 percent of GDP in 2009, the lowest level since 1950 (down 5.8 percent of GDP since 2000, when we had a surplus of $240 billion). The GOP borrow and spend crowd should stand in front of a mirror and howl at themselves.

Doing nothing is not an option; insurance premiums grew 122 percent over the past decade compared to inflation of 29 percent, and are projected to grow 94 percent over the next decade to an average of $23,842 per family, and up to an astonishing 38 percent of GDP by 2050. Unlike the public plan, this will actually cause millions to lose their insurance as employers opt out, while adding a TRILLION dollars over ten years to the deficit (the annual tax subsidy for premiums would go from $260 billion in 2009 to an average of $360 billion a year.

Doctor Coburns says the "entire stratey of public-option proponents depends on misdirection and subterfuge." I would suggest that this best describes his deceitful essay in National Review.