Sen. Coburn Sends GOP-Approved Lies To The Wall Street Journal

December 17, 2009 11:00 am ET

The evening of December 16, 2009 - the same day he tried to force a lengthy delay of a vote to fund our troops - Sen. Tom Coburn (R-OK) wrote an op-ed that appeared in the Wall Street Journal.  As usual, Sen. Coburn relied on GOP-approved talking points instead of anything resembling factual information.

Dr. Coburn Disingenuous About Doctors' Influence Over Patient Care

Sen. Coburn: "My 25 years as a practicing physician have shown me what happens when government attempts to practice medicine: Doctors respond to government coercion instead of patient cues, and patients die prematurely. Even if the public option is eliminated from the bill, these onerous rationing provisions will remain intact." [Wall Street Journal, 12/16/09]

Doctors are not always permitted to respond to patient cues - their decisions must fall in line with what private health insurance corporations allow.

Americans Face Denials For Coverage From Insurance Companies Every Day.  Americans are already facing the denial of treatments from their private insurance companies, according to the Wall Street Journal. As Diane Archer, director of the Health Care Project at Institute for America's Future argued in the New York Times: "As any doctor will tell you, when a private health insurance plan delays or denies a physician-recommended service, it is deciding who gets care and what kind of care people get." [Wall Street Journal, 9/25/08; New York Times, 5/8/09]

Insurance Bureaucrats Stand Between Americans And Their Doctors.  Dr. Howard Dean said on MSNBC: "Right now there is a bureaucrat between you and your doctor, and it's that private health insurance bureaucrat." [MSNBC, accessed 6/17/09]

Rather Than Waiting In Line, Americans Simply Do Not Get Care. As Ezra Klein argued in the Los Angeles Times, "although Britain and Canada have decided that no one will go without, even if some must occasionally wait, the U.S. has decided that most of us who can't afford care simply won't get it." [Los Angeles Times, 4/7/09, emphasis added]

Many Americans Have Been Priced Out Of Health Care.  As Ezra Klein wrote on his blog: "If you look at waiting times, you'll see that relatively few Americans wait more than four months for surgery, which helps folks claim that America doesn't ration care, and makes our system look pretty good on the waiting times metric. Here's what they don't tell you: When you look at who foregoes care, the international comparisons reverse themselves. About 23% of Americans report that they didn't receive care, or get a test due to cost. In Canada, that number is 5.5%." [Ezra Klein blog, The American Prospect, 12/5/08, emphasis added]

"Twenty Percent Of Americans Say They Have Delayed Or Postponed Medical Care, Mostly Doctor Visits, And Many Said Cost Was The Main Reason." According to MSNBC: "Twenty percent of Americans say they have delayed or postponed medical care, mostly doctor visits, and many said cost was the main reason, according to a survey by Thomson Reuters released on Monday." [, 4/20/09]

Sen. Coburn Shamelessly Lies About Medicare Council

Sen. Coburn: "For instance, the Reid bill (in sections 3403 and 2021) explicitly empowers Medicare to deny treatment based on cost. An Independent Medicare Advisory Board created by the bill-composed of permanent, unelected and, therefore, unaccountable members-will greatly expand the rationing practices that already occur in the program." [Wall Street Journal, 12/16/09]

Independent Medicare Advisory Council will NOT make decisions about the care patients receive.

IMAC Would Have Jurisdiction Over Updating Medicare Payment Rates. According to Politico: "The proposed five-member Independent Medicare Advisory Council would be charged with making two annual reports dictating updated rates for Medicare providers including physicians, hospitals, skilled nursing facilities, home health and durable medical equipment." [Politico, 7/15/09]

IMAC Is Specifically Excluded From Recommending Changes That Would Affect "Free Choice By Patients."  Page 7, line 20 of the Independent Medicare Advisory Council legislation reads: "(2) EXCLUSIONS. - In exercising its authority under paragraph (1), the Council may not recommend any changes to the following aspects of the Medicare program: (A) Provisions under section 1801 prohibiting federal interference and provisions under section 1802 providing for certain specified beneficiary protections and free choice by patients." [Subtitle - Independent Medicare Advisory Council, via, accessed 8/25/09]

Current Medicare Payment Commission "Is Too Rife With Politics And Special Interests." Politico reported: "The current Medicare Payment Advisory Commission, or MedPAC, established in 1997, already serves to make recommendation to Congress on Medicare spending. Many of its ideas have been incorporated in the current health reform bill, but MedPAC is only advisory and critics contend that the current system is too rife with politics and special interests." [Politico, 7/15/09]

As A Practicing Physician, Coburn Should Be Aware Of The Benefits Of CER

Sen. Coburn: "Section 6301 of the Reid bill creates new comparative effectiveness research (CER) programs. CER panels 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. CER panels here could effectively dictate coverage options and ration care for plans that participate in the state insurance exchanges created by the bill." [Wall Street Journal, 12/16/09]

CER Council "Will Not Recommend Clinical Guidelines."  The published guidelines for the Federal Coordinating Council are very clear about the decisions its members will make: The Federal Coordinating Council For Comparative Effectiveness Research "will not recommend clinical guidelines for payment, coverage or treatment." [, 3/19/09, emphasis added]

Comparative Effectiveness Research is NOT rationing.

Comparative Effectiveness Research Is The Comparison Of Medical Treatments.  According to the Washington Post's Steven Pearlstein, "comparative effectiveness research" refers to "research done by doctors and statisticians who troll through large number of patient records to determine, for any particular disease, which treatments work best." [Washington Post, 2/13/09]

CER Studies Examine Both The Treatments And Diagnoses Of Diseases.  According to a December 2007 report released by the Congressional Budget Office titled Research on the Comparative Effectiveness of Medical Treatments: "studies can examine not only treatments for health problems but also different procedures to screen for the presence of a disease."   [, 12/07]

CER Supplements Physicians' Knowledge To Ensure The Best Treatment Is Provided To The Patient.  David Dale, MD of the American College of Physicians, testified in a House Ways and Means Committee hearing: "The availability of valid, comparative effectiveness data supplemented by the physician's clinical experience and professional knowledge, helps ensure that an effective treatment choice is made-one that meets the unique needs and preferences of the patient." [American College Of Physicians' Statement for the Record, 6/12/07]

Applied Properly, CER Empowers Patients To Make The Best Choices For Their Own Medical Care. In a post at, Michelle Andrews wrote, "This is good stuff, not only for the medical establishment but also for patients, who are increasingly expected to play an active role in managing and paying for their healthcare." [, 3/23/09]

Sen. Coburn Must Have Been Absent The Day The Senate Passed The Mikulski Amendment

Sen. Coburn: "Additionally, the Reid bill 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. The administration claims the task force recommendations do not carry the force of law, but the Reid bill itself contradicts them in section 2713. The bill explicitly states, on page 17, that health insurance plans 'shall provide coverage for' services approved by the task force. This chilling provision represents the government stepping between doctors and patients. When the government asserts the power to provide care, it also asserts the power to deny care." [Wall Street Journal, 12/16/09]

Senate Passed Amendment To Ensure Women's Care Would Be Determined By The Patient And Doctor.  NPR reported: "The 61-39 in favor of the Mikulski amendment would expand coverage of women's health care, allowing the government to require insurers to cover preventive care and screenings for women at little or not cost to them...Mikulski said that under her amendment, women would never be forced to forgo a mammogram based on a task force recommendations. Instead, they would make a decision with their doctors and would have 'universal access' to the service, she said." [, 12/3/09, emphasis added]

Sen. Coburn Skipped The Section That Increases Payments For Doctors

Sen. Coburn: "If the bill expands Medicaid eligibility to 133% of the poverty level, that too will lead to rationing. Because Washington bureaucrats have created a system that underpays doctors, 40% of doctors already restrict access to Medicaid patients, and therefore ration care." [Wall Street Journal, 12/16/09] Current Legislation Increases Payments To Doctors To Keep Them In Practice. reported: "Lose your own doctor? Many people experience that today, if their employer changes insurance plans, if they change jobs, or if they become uninsured for any reason. Wait longer for care? Given the shortage of family doctors, which is only expected to worsen, we can expect wait times to increase even if the system remains untouched. Pending overhaul legislation aims to ease that, in fact, by increasing certain payments to physicians and making other adjustments to encourage training of primary care physicians." [, 9/9/09, emphasis added]

Both House And Senate Bills Include Measures To Support Doctors.  According to a study conducted by the Commonwealth Fund: "The House and Senate bills include a number of provisions to increase primary care payment rates under Medicare and Medicaid, cover effective preventive services without patient cost-sharing, and support community and employer prevention and wellness programs.  These provisions could begin to change the orientation of our health system toward primary care and away from specialty care, counter the impending shortage of primary care providers, and lay the groundwork for more fundamental payment reforms." [Commonwealth Fund, November 2009]

Sen. Coburn Needs Someone To Read Medicaid Analyses To Him

Sen. Coburn: "Medicaid demonstrates, tragically in some cases, that access to a government program does not guarantee access to health care. In Maryland, 17,000 Medicaid patients are currently on a waiting list for medical services, and as many as 250 may have died while awaiting care, according to state auditors. Kansas, the home state of Health and Human Services Secretary Kathleen Sebelius, faces a Medicaid backlog of more than 15,000 applicants." [Wall Street Journal, 12/16/09]

Sen. Coburn, apparently in need of someone to read the article to him, misinterpreted the Maryland data.

Maryland Medicaid Data Wrong Due To Provider Error And Fraud.  The Baltimore Sun reported: "Auditors also found that a list of about 17,000 individuals waiting for services might not be accurate. The waiting list, used to determine budgetary needs, included the names of at least 250 who were deceased, according to a departmental review. Auditors also found that some providers billed for services for dead clients, including one who paid more than $70,000 for care of a client who had died five years earlier." [Baltimore Sun, 12/9/09]

Without reform, state budgets will suffer.

Cost Disbursement For The Uninsured Places A Strain On State Budgets.  According to the Kaiser Commission on Medicaid and the Uninsured, "most uncompensated care is financed through a variety of federal and state programs" including Medicaid, Medicare, the Veterans Administration, and Community Health Centers.  "Finally, there is some 'shifting' of costs to the privately is highly unlikely that much of the cost of the newly uninsured can be shifted to private payers particularly in light of the likely decline in rates of employer sponsored insurance.  Thus most of these costs that we project will put pressure on providers, as well as states and localities to fund the increased costs.  If they cannot provide additional funding, access to care for the uninsured is likely to fall." [, accessed 1/14/09, emphasis added]

Sen. Coburn Ignores MIT Analysis Of Senate Legislation

Sen. Coburn: "OMB Budget Director Peter Orzsag's belief that mandatory health insurance will become a 'cultural norm' is bureaucratic naivete that will produce skyrocketing premiums and reduced care for everyone. My state's own insurance commissioner, a Democrat, recently confirmed this concern to me in a letter noting that 'the result will be higher insurance rates due to a higher percentage of insured being higher risk/expense individuals.'" [Wall Street Journal, 12/16/09]

Gruber: Senate Bill Lowers Premiums And Improves Coverage.  In his analysis of the Senate health care bill, MIT economist Jonathan Gruber wrote: "It is worth noting that these savings are all in addition to the more generous benefits that these groups will receive through the exchange compared to the non-group market...So not only does the Senate proposal lower premiums, it does so while also improving coverage."  [Gruber, "The Senate Bill Lowers Non-Group Premiums: Updated for New CBO Estimates," 11/27/09, via Politico; emphasis added]

"Most People Covered By Big Employers Would Gain More Protections Without Major Changes."  The Associated Press reported: "Most people covered by big employers would gain more protections without major changes. One exception would be those with high-cost insurance plans, whose premiums could rise as a result of a tax on insurers issue the coverage."  [Associated Press via Canon City Daily Record, 11/30/09]

Gruber: Senate Bill Will Cause Premiums For Low Income Americans To Drop Thousands Of Dollars.  Politico reported that MIT economist Jonathan Gruber found "that people purchasing individual insurance would save an annual $200 (singles) to $500 (families) in 2009 dollars. And people with low incomes would receive premium tax credits that would reduce the price that they pay for health insurance by as much as $2,500 to $7,500." [Politico, 11/28/09]

Gruber: "Reform Will Significantly Reduce, Not Increase, Non-Group Premiums."  In his analysis of the Senate health care bill, MIT economist Jonathan Gruber wrote: "the key point is that, as of now, the most authoritative objective voice in this debate suggests that reform will significantly reduce, not increase, non-group premiums."  [Gruber, "The Senate Bill Lowers Non-Group Premiums: Updated for New CBO Estimates," 11/27/09, via Politico]