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.”