Back to Basics

By Tom Coburn

Published in Wall Street Journal, Dec. 16, 2009

I recently suggested that seniors will die sooner if Congress actually implements the Medicare cuts in the health-care bill put forward by Senate Majority Leader Harry Reid. My colleagues who defend the bill—none of whom have practiced medicine—predictably dismissed my concern as a scare tactic. They are wrong. Every American, not just seniors, should know that the rationing provisions in the Reid bill will not only reduce their quality of life, but their life spans as well.

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.

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. Medicare, for example, has limited cancer patients’ access to Epogen, a costly but vital drug that stimulates red blood cell production. It has limited the use of virtual, and safer, colonoscopies due to cost concerns. And Medicare refuses medical claims at twice the rate of the largest private insurers.

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.

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.

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.

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.

Other unintended consequences of the Reid bill could wreak havoc on patients’ lives. What happens, for instance, when savvy consumers commanded to buy insurance realize the penalty is the de facto premium? It won’t take long for younger, healthier Americans to realize it’s cheaper to pay a $750 tax for coverage instead of, say, $5,000 in annual premiums when coverage can’t be denied if you get sick.

What we can expect from the government takeover of our health care is already starting to reveal its deadly intensions.

The H1N1 vaccine, purchased by and controlled by the government, was a promise that couldn’t be kept.  There was supposed to be enough vaccine available for all those who were at risk as well as it sounding like for anyone else that wanted the vaccine.  Since early this year the government was telling the public how much of an epidemic the H1N1 flu was going to be and was encouraging everyone to get vaccinated.  But when the time came to pay up the government fell far short of their promises.

The H1N1 is a separate vaccination from the regular annual flu vaccinations.  The regular flu vaccination is controlled by private industry.  Those vaccinations have been produced, distributed and are available at your doctor’s office or clinic for anyone requesting it.  In fact, my family doctor asked at my annual exam if I wanted to receive the vaccination.

However, the H1N1 is a different story.  The vaccine was purchased and distribution is being controlled by the government.  While they promised to have enough to go around they fell far short.  The government is controlling all quantities of this vaccine, including where the vaccines are to be sent and how much.  It is only being distributed to government sponsored agencies, so your doctor probably didn’t even receive the vaccine.  In order to obtain the vaccination you have to go to a vaccination clinic.  Even then, if you are not considered high risk you may be denied the vaccination.  So by the end of this year’s flu season only 25% of the H1N1 vaccine will have been distributed.  The rationing has already begun.

Then this week I read an article from the New York Times about a government task force deciding mammograms for women are no longer necessary until age 50, and then only every other year.  They further decided that self-breast exams didn’t do any good and should be discontinued.  Their recommendation was between 50-75 mammograms should be done every other year and after the age of 75 they haven’t yet decided.  Could this be because they are embracing the ideas of the Obama Czars – that anyone over 75 isn’t worth the cost of medical treatment because they have served their usefulness in society already?

How many people know of at least one woman who is alive today because of early detection and treatment of breast cancer?  How many others hear of the terrible tragedy other women face when the breast cancer was diagnosed in a much later stage and it had spread to lymph nodes or other parts of the body.  Sure, they may not have died from breast cancer, but they died from cancer initially caused from the spreading of the breast cancer.

The American Cancer Society came out against the task forces finding.  Does the government task force know more about cancer that the American Cancer Society?  Shouldn’t this decision be between the woman and her doctor?  No, this is all about money.  The task force says that testing 1300 women to save one life is worth it, but testing 1900 to save one life isn’t.  This is the government playing God.  I’m sure if that life that could be saved were yours or a close family member or friend anyone would agree it was worth it.  What price do you put on a life?  What right does the government have to establish that price?

Rationing and denial of services is what we all have to look forward to if the government takes over control of our health by the proposed health care reform bill passed by the House and under consideration in the Senate.  This is only a sample of what we have to look forward to in the future.  Having health insurance is one thing – getting the actual care of your health is another.  The government is only promising the insurance  – BUYERS BEWARE!

The latest version of the Pelosi/House health care reform is more of the same, and worse.  It includes the same problems of HR3200 including the public option, the health care exchange, mandates requiring everyone to buy insurance, mandates requiring employers to provide insurance, penalties if you don’t purchase insurance, penalties on companies for not providing insurance, government real-time access to your bank accounts…more and more of the same.

I briefly reviewed the 1990 page bill and found some additional measures that were equally disturbing.

The bill is supposed to help those who have pre-existing conditions as well as those with chronic illnesses that may not otherwise be able to obtain affordable health care insurance.  The bill does mandate that insurance companies accept everyone, regardless of their medical history.  However, in a transition period, the government has allocated a specific budget to cover these people and this must not result in a deficit.  If the expenditures are expected to exceed the budget there are three options available to solve this problem:  (1) deny services, (2) increase premiums, and (3) put people on a waiting list.  So those with current insurance issues may find themselves no better off once this plan goes into affect since the bill gives the government the right to ration or deny services and increase the cost of your premiums.

There are over 360 pages in the bill that directly relate to medical treatment in the Native American populations.  This amounts to additional studies, addressing alcoholism issues and a number of other issues.  However, the bill also allows the government to take Indian reservation lands for the purpose of medicine.  The government will make those decisions and it did not appear as if the Native American population would have any control over what lands they chose to take, or if the medical facilities is even necessary for this population.  How far does this abuse of power run?

I recently read articles on the Pelosi/House reform and found that it creates 111 new bureaucratic departments and/or programs…more expansion of government.  The cost of this bill is estimated at approximately $1.2 trillion for 10 years.

Likewise, just as disturbing is those people who truly believe that this type of government takeover of the insurance industry is the only way they will be able to obtain health insurance.  They don’t want to even consider any other options that may allow them to be covered but not destroy the health care coverage 83% of the population currently has and likes.  They further expect this coverage, because of the public option, to be FREE; they are not expecting to contribute anything to their health insurance costs.  Nothing is free – you will be paying for insurance premiums, co-sharing costs as well as an increase in your income taxes.  If you don’t wake up now you could find yourself facing a huge medical/insurance bill you will be required to pay.

Behind the scenes in the real world anticipation over the new bills has already made an impact on the insurance industry.  A health insurance agent was at a recent party we attended and she is all for this new mandate, her mouth watering at the prospect of making lots of money from all the policies she will be selling.  As long as the private market can compete with the public option she will make a fortune, as she gets a commission not only when she sells a policy, but will continue receiving that commission as long as you renew your policy – and she may not have to do a thing.  This bill will make her a rich woman.  On the other hand, her ex voiced his opinion at her enthusiasm and stated that all this was at what expense to us.  He understood the consequences.

Another tip of the hand came when it was open enrollment time for my daughter.  Her options had been greatly diminished in health insurance coverage.  Option A would give her a set office visit cost of $30/visit, a $750 deductible and she would be responsible for 40% of her medical bills.  Option B would have given her a set office visit cost of $35/visit, a $1500 deductible and again she would be responsible for 40% of her medical bills.  For this reduction in coverage she would enjoy a minor increase in premiums.  Yes, she can say she is “covered” by health insurance but with the deductibles and cost-sharing responsibilities she cannot afford medical care or treatment!  This is from a very large insurance company, so one has to ask if this is the direction we can expect the government plans to be heading.  Is this the type of coverage that may be offered in a basic insurance plan?  If so, then although the government could claim more people would be insured, it would not necessarily mean people would be able to obtain medical care or treatment because they may not be able to afford it.

While the House healthcare bill does little or nothing to decrease medical costs and is anticipated to actually increase insurance premiums, one has to wonder what the real motives are behind the bill.  Is this just a bill to grant the government more control over our lives and denying us personal freedoms…with more government expansion?  With insurance agents waiting in the wings to jump at the vast money making opportunities, whose interests – or special interests – were really in mind?  Does being insured actually make medical care and treatment affordable…or will the cost of the insurance policy and cost-sharing expenses make it even more unaffordable?

Time is running out.  The House is expected to start debate on this issue this week.  The people spoke this summer at Town Hall meetings.  Did Congress get the messages?  It is time we remind them.  Call, write, fax and email your representatives before it’s too late.  The life you save may not only be yours but the country.

If you think it was bad in August with the possibility of facing fines for not buying health insurance, it has gotten worse. Now we find out if you don’t buy health insurance you could be fined an additional $25,000 and face a year in jail. Jail time for not purchasing something because the government tells you it’s required! This is outrageous. You will notice Congress and government employees are immune from this system.

Here is John Shadegg explaining this new twist to the bill.

Did I miss something in the new health care reform proposals?  When did the democrats’ proposals provide free office visits, free medications and free medical procedures to everyone?

I recently had a conversation with a friend that has a pre-existing medical condition and is very concerned about being able to obtain affordable health insurance.  He is currently insured and is paying what I would consider a very reasonable price for his monthly premiums (less than $200/month).  He must also take medications that run about $2000 per year.  Understandably he is concerned about health care issues.  He indicated a friend of his is on some government insurance plan (he didn’t specify which one) and that this friend is able to obtain all of his medical and dental treatments and medications at no cost to him.

It seems that some people in favor of the democrats government run proposals are assuming that this health care is somehow not going to cost them anything, other than maybe a monthly insurance premium.  They assume the cost of office visits, medical treatments, medications and dental services are going to be provided free of charge.

I read H.R. 3200 and have heard the reviews on the Baucus bill.  Nowhere would I interpret these bills as providing free medical and dental treatments for all, with the only obligation being a monthly insurance premium.  People with certain income levels could qualify for government assistance in paying for the monthly premiums and co-pays, but it certainly did not come with a free price tag.  In fact, I read some reviews on the Baucus bill indicating the co-pays and other costs the consumers would have to pay would actually make health care less affordable to middle-class Americans.

Until the health care reform became an issue, I assumed that once someone retired and was on Medicare that those medical premiums would also be free.  I found out otherwise when talking to my parents.  When on Medicare after you retire you pay a monthly insurance premium, which is taken out of your Social Security check to cover your Medicare health insurance.  Further, you continue have out-of-pocket expenses, like cost-sharing, for medical treatments received.  If you are on the government medication system you also continue paying a portion of the medication.  My grandmother was paying out of her own pocket $1200 a year for her medication and she was on Medicare and had a secondary medical insurance policy.

So you have to wonder if those in favor of the government health care actually understand the consequences of the program.  The government program would not be a free system – you will be paying for premiums, co-pays, and cost-sharing.  You will further be paying to supplement those who cannot afford insurance and the cost of medical treatment.  If you think your premiums and cost today are high, they will only go higher with government controlled plans.  As a bonus to the higher costs you will have no choice but purchase these plans because now it becomes a law that you must have insurance.  If you don’t, you will be penalized by the IRS, and may also face imprisonment.

So, before jumping on the government control bandwagon, look at the other proposals being offered.  Every plan wants those with pre-existing conditions to be covered at costs within reasonable limits of a regular policy.  Every plan wants to provide insurance coverage to all that don’t have it.  No plan offers free insurance, free medical, free dental or free medicine to all.  Do you want the government controlling your medical treatment and care, along with mandatory requirements, higher premiums and higher taxes?  Or do you want patient choice?

I urge everyone to really understand the bills being proposed – read them!  The concerns out there are very real.  This is your future – your life!  Nothing the government provides is free, and the health care reform is no exception.