Thursday, February 25, 2010

Tom Coburn and Paul Ryan rock the Blair House

I became a big fan of Oklahoma Senator Tom Coburn in October of 2005 when he went nose-to-nose with his senior Republican colleague Alaskan Senator Ted Stevens over the Ketchikan "bridge to nowhere."  Dr. Coburn had been in the Senate less than a year and Ted Stevens had been in the Senate since 1968.  After hurricane Katrina devastated the Mississippi and Louisiana gulf coasts in 2005, Coburn offered an amendment to the senate appropriations bill to move $453 million from two Alaskan bridge projects to fund the reconstruction of bridges destroyed by the storm.  Ted Stevens actually threatened to quit the Senate if the amendment passed.  It did not.  But Coburn definitely got my attention as a fearless patriot.

Today at the President's health care summit, Coburn did not disappoint.  Here's a sample of his no nonsense remarks:
The first thing I would do is put out a caution to us, because what I see the Congress doing -- and what I saw this last year -- is us actually performing bad medicine. And that is that we get stuck in the idea of treating the symptom rather than treating the disease. And whether you go to Harvard or whether you go to Thomson Reuters, there are some facts we know about health care in America. And the facts we know is one out of every three dollars that gets spent doesn't help anybody get well and doesn't prevent anybody from getting sick.

The second thing we know is, from the Congressional Research Service, that most of the mal drivers today in health care come from government rules and regulations. The government now directs over 60 percent of the health care in this country. And if throwing money at it and creating new government programs could solve it, we wouldn't be sitting here today because we've done all that, it hasn't worked.

So what I thought we ought to do is maybe talk about why does it cost so much? Because the thing that keeps people from getting access to care in our country is cost. You mentioned Malia and Sasha. The fact is, is with young kids going to the ER, whether they have meningitis or asthma, they're going to get treated in this country. But they may get labeled with a preexisting illness after that, and that's another thing I'd be happy to talk about at a later time. But the fact is, is we know how to treat acute asthma. What we don't do a good job of is preventing children from getting acute asthma. We don't do the good job of prevention.

So when you break down the cost, what we know is 33 percent of the cost in health care shouldn't be there. And how do we go about doing that, and what are the components of that cost? And when you look at, when it's studied, and if you look at what Malcolm Sparrow from Harvard says -- he says 20 percent of the cost of federal government health care is fraud. That's his number.

If you look at Thomson Reuters -- when they look at all of this, they say at least 15 percent of government-run health care is fraud. Well, when you look at the total amount of health care that's government-run, you're talking $150 billion a year. So tomorrow, if we got together and fixed fraud, we could cut health care 7.5 percent tomorrow for people in this country. So what we ought to do is do the Willie Sutton thing; we ought to go for where the money is.

What's the other area? What we do know -- and I'm guilty of this; Dr. Barrasso is guilty of it; Dr. Boustany is guilty of it -- is a large portion of the tests we order every day aren't for patients, they're for doctors. And the reason they're there is because we are risk-averse to the tort system and extortion system that's out there today in health care. And there are a lot of ways to fix that, but I just went through last night -- if you add up what Thomson Reuters, which looked at all the studies that have been done and combined them in -- they say between $625 billion and $850 billion a year of health care dollars are wasted.

So it seems to me if cost is the number one thing that's keeping people from getting care, then the efforts of us as we go after cost ought to be to go to those areas where the cost is wasted. And there's a philosophical difference in how we do that. One wants more government-centered approach to that; I would personally prefer a more patient-centered, market-oriented approach to that. But nevertheless, there's where we can come together, just on those two areas, where we could cut costs 15 percent tomorrow. And that's for everybody in the country.
Representative Paul Ryan's remarks were even more devastating to the Democrats:
Mr. President, you said health care reform is budget reform. You're right. We agree with that. Medicare, right now, has a $38 trillion unfunded liability. That's $38 trillion in empty promises to my parents' generation, our generation, our kids' generation. Medicaid's growing at 21 percent each year. It's suffocating states' budgets. It's adding trillions in obligations that we have no means to pay for it.

Now, you're right to frame the debate on cost and health inflation. And in September, when you spoke to us in the well of the House, you basically said -- and I totally agree with this -- I will not sign a plan that adds one dime to our deficits either now or in the future.

Since the Congressional Budget Office can't score your bill, because it doesn't have sufficient detail, but it tracks very similar to the Senate bill, I want to unpack the Senate score a little bit.

And if you take a look at the CBO analysis, analysis from your chief actuary, I think it's very revealing. This bill does not control costs. This bill does not reduce deficits. Instead, this bill adds a new health care entitlement at a time when we have no idea how to pay for the entitlements we already have.

Now, let me go through why I say that. The majority leader said the bill scores as reducing the deficit $131 billion over the next 10 years. First, a little bit about CBO. I work with them every single day -- very good people, great professionals. They do their jobs well. But their job is to score what is placed in front of them. And what has been placed in front of them is a bill that is full of gimmicks and smoke-and-mirrors. Now, what do I mean when I say that?

Well, first off, the bill has 10 years of tax increases, about half a trillion dollars, with 10 years of Medicare cuts, about half a trillion dollars, to pay for six years of spending.

Now, what's the true 10-year cost of this bill in 10 years? That's $2.3 trillion.
If, as Politico reported this morning, the President's objective for today's summit was to alter the political atmospherics by portraying the Republicans as heartless obstructionists devoid of real health care reform ideas, then in my view, today was an abject failure.

Oh, and for what it's worth, the Democrats had the microphone today more than twice as long as the Republicans.

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