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.