This afternoon, Sen. Tom Coburn (R-OK) took a page from the 1965 Medicare debate and argued that health reform would ration care. Coburn insisted that the Medicare Advisory Commission and comparative effectiveness research provisions in the Senate health bill would deny treatments and benefits to seniors, like the Center for Medicare and Medicaid Services (CMS) does today.

In his long-winded speech, Coburn repeatedly invoked his personal experiences as a physician to misinterpret the legislation and scare seniors about the Senate bill:

- “It’s the start of the government practicing medicine. It is the beginning of our seniors to have the government step in between them and their physicians in terms of the physician wanting to do what’s best for that senior and the government saying, ‘no I’ll tell you what you’re gonna have.‘”

- “I have a message for you: you’re going to die soon…When you restrict the ability of the primary care givers int his country to do what is best for their senior patients, what you are doing is limiting their life expectancy.”

- “They’re going to lose the loyalty and primacy of their physician thinking about them. And we’re going to divide that loyalty to where the physician is going to be looking toward the government.”

Watch a compilation:

As a practicing physician and an experienced legislator, Coburn should know that CMS is not in the business of rationing care. Though its coverage decisions, the agency is trying to eliminate waste and fraud from the system, while ensuring that patients receive quality services. For instance, CMS goes through an extensive 9 month process before reaching a coverage decision. The agency confers with a battery of doctors and scientific experts and “the final three (3) months of the Medicare National Coverage Process include a thirty (30) day Public Comments phase, followed by a sixty (60) day requirement to complete the Final Decision Memorandum and Implementation Instructions phase.” In many decisions CMS specifies that the coverage ruling does not apply to patients who are at higher risk for a specific condition and always allows doctors to appeal a coverage ruling on the basis of “medical necessity.”

The new Medicare Commission and comparative effectiveness research provisions lack the authority to make coverage decisions. Page 1005 of the Senate bill states that the Medicare Commission — which is designed to keep Medicare spending in check — “shall include recommendations to reduce Medicare payments under parts C and D, such as reductions in direct subsidy payments to Medicare Advantage and prescription drug plans specified,” but has no authority to make recommendations that deny or lower benefits.

The section on comparative effectiveness research on page 1658 actually states that “research shall be designed, as appropriate, to take into account the potential for differences in the effectiveness of health care treatments, services, and items as used with various subpopulations.” Page 1667 specifically states that comparative effectiveness results should “not be construed as mandates for practice guidelines, coverage recommendations, payment, or policy recommendations.”

Of course, Coburn isn’t the only Republican intent on scaring seniors about rationing. In July, Rep. Ginny Brown-Waite (R-FL) said that “last week Democrats released a health care bill which essentially said to America’s seniors: Drop dead.” Rep. Steve King (R-IA) predicted that “People die when they’re in line [for health care services]” and Rep. Virginia Foxx (R-NC) famously said that the Democrats health care reform would “put seniors in a position of being put to death by their government.”

Sen. Evan Bayh (D-IN), a moderate Democrat who has wavered in his support for health care reform and requested the Congressional Budget Office study of health care premiums, has issued a statement indicating that he is satisfied with the CBO’s findings:

This report alleviates a major concern that has been raised — that insurance costs will go up across the board as a result of this legislation. This study indicates that for most Americans, the bill will have a modestly positive impact on their premium costs. For the remainder, more will see their costs go down than up. Hopefully, we can continue to focus the Senate debate on additional ways to make health insurance even more affordable for all Americans.

Other lawmakers including key moderates Sens. Olympia Snowe (R-ME), Susan Collins (R-ME) and Mary Landruie (D-LA) have expressed concern about the affordability of insurance for small businesses and individuals, but have remained silent about the latest CBO report. Yesterday, Collins said she met “for 45 minutes with Nancy-Ann DeParle, director of the White House Office of Health Reform, to discuss her concerns about the legislation.”

According to the budget office, the overwhelming majority of families, individuals, and small businesses would on average pay the same or less for health care coverage. For people purchasing coverage in the nongroup market, premiums will be attached to more generous benefits than policies available today.

The report also concluded that the small business tax credit would further reduce premiums by 8%-11% for people who will receive the additional subsidy (approximately 12% of people in the small market). Small businesses that buy health care coverage from the exchanges will have the advantages of participating in a larger risk pool and would purchase policies with “lower administrative costs, on average, than the policies those firms would buy under current law.”

This morning, Senate Minority Leader Mitch McConnell (R-KY) dismissed the weeks of mark-up in both the Senate Finance and HELP committees and the months of public hearings surrounding health care reform and criticized the Senate health bill for failing to incorporate Republican ideas into the legislation. McConnell called on the Senate to support Sen. John McCain’s (R-AZ) amendment to “start over from the beginning and craft a bill that they [the American people] can actually support…then we could start over.” Watch it:

As it turns out however, many of McConnell’s ideas for how to start over are already incorporated in the Senate bill. McConnell hasn’t read the legislation:

MCCONNELL ASKED FOR – ENDING JUNK LAWSUITS: “We could start over and end junk lawsuits against doctors and hospitals that drive up costs, something the majority didn’t find any room for in their 2,074-page bill. Not a word about controlling junk lawsuits against doctors and hospitals.”

SENATE BILL – DEMONSTRATION PROJECTS FOR TORT REFORM: While malpractice is not a major contributor to rising health care costs, the bill expresses the sense of the Senate that health reform presents an opportunity to address issues related to medical malpractice and medical liability insurance, states should be encouraged to develop and test alternative models to the existing civil litigation system, and Congress should consider state demonstration projects to evaluate such alternatives. [pg. 1858-1859]

MCCONNELL ASKED FOR – WELLNESS AND PREVENTION: “Then we could encourage healthy choices like prevention and wellness programs, something that the majority somehow couldn’t squeeze into their 2,074-page bill.”

SENATE BILL – INVESTS IN WELLNESS AND PREVENTION: Title IV of the health care bill addresses wellness and prevention. The bill invests $15 billion in a Prevention and Public Health Investment Fund to provide an expanded and sustained national investment in prevention and public health programs to improve health and help restrain the rate of growth in private and public sector health care costs. [pg. 1134 - 1266]

MCCONNELL ASKED FOR – POLICIES ACROSS STATE LINES: “Then we could lower costs by letting consumers buy coverage across state lines, something the majority must have overlooked in their 2,074-page bill.”

SENATE BILL – POLICIES ACROSS STATE LINES: Starting in 2016, states may form ―health care choice compacts to allow for the purchase of individual health insurance across state lines. Once compacts have been agreed to, insurers would be allowed to sell policies in any state participating in the compact. [pg. 219]

MCCONNELL ASKED FOR – END WASTE, FRAUD AND ABUSE IN MEDICARE: “Then we could address the rampant waste, fraud, and abuse, something our friends didn’t think was important enough to seriously address in their 2,074-page bill.”

SENATE BILL – ENDS WASTE, FRAUD AND ABUSE IN MEDICARE: Subtitle F of Title VI of the health care bill would reduce the waste, fraud, and abuse in the Medicare and Medicaid programs. Section 6508 specifically requires “States to implement fraud, waste, and abuse programs before January 1, 2011.” [pg. 1783-1791]

This morning, Fox News ran a chyron alleging that the new Congressional Budget Office report on premiums concluded that the Senate health care bill won’t lower health care premiums:

The report actually concluded that on average, premiums would substantially decrease for the majority of Americans purchasing coverage in the individual market and maintain or lower premiums in the small and large employer markets. In fact, almost all of the ledes in today’s newspapers echo this interpretation:

- “The Congressional Budget Office said Monday that the Senate health bill could significantly reduce costs for many people who buy health insurance on their own…” [NYT, 11/30/2009]

- “As the Senate opened debate Monday on a landmark plan to overhaul the nation’s health-care system, congressional budget analysts said the measure would leave premiums unchanged or slightly lower for the vast majority of Americans, contradicting assertions by the insurance industry that the average family’s coverage would rise by thousands of dollars if the proposal became law.” [WP, 11/30/2009]

- “On average, 134 million Americans insured through large employers will see no rise in premiums and may pay 3 percent less than they would if Congress failed to pass a health-care overhaul plan, the nonpartisan Congressional Budget Office said yesterday. Subsidies also will lower costs as much as 59 percent for 18 million people buying their own insurance.” [Bloomberg, 12/1/2009]

Fox News anchor Stuart Varney further questioned the report by arguing that Americans won’t see any savings because the health care bill won’t cut payments to Medicare Advantage or subsidize coverage. “Those are the assumptions on which everything is based. If those things happen, yes it will be deficit neutral and your costs will be stable,” Varney said.