Health Care Reform

Floor Speech

By:  Thomas Coburn
Date: March 20, 2012
Location: Washington, DC

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Mr. COBURN. I, thank the Senator. The reality is we are committing malpractice. Let me describe what I mean by that. In medicine, when a patient comes in, listening is a very important aspect. In fact, there is the axiom in medicine that if you listen to your patient, they will tell you what is wrong with them, completely. The more time you spend, the more effective you are at gaining it. The reason that is the axiom in medicine is because you do not want to treat symptoms of a disease, you want to treat the real disease.

All of America recognizes that we had some difficulties in being competitive and also with access in terms of health care. We know our health care is good, but it is too expensive. As a matter of fact, it is more expensive than anywhere in the world. But we do know some things about that. We know one out of three dollars we spend in health care in this country does not help anybody. It does not help them get well. It does not keep them from getting sick.

The problem with the Affordable Care Act is that it almost always treats the symptoms rather than the underlying disease. Let me give some examples. I have practiced medicine. I have been a physician for almost 30 years. When I have a contract with a private insurer, they are going to renew that contract in the next year on whether or not I am efficient and effective in taking care of people who have insurance with them. There is no motivation at all in the Medicare Act.

The underlying problem with our $2.6 trillion is that we all think somebody else is paying for our health care. So I am a practicing physician. I have no motivation not to spend Medicare dollars and avoid the axiom of listening to the patient because maybe the short-term remuneration for my services is low, so I need to see more people. So we have addressed the symptoms of the disease but not the real disease.

The real disease is that we, on both the purchasing and providing side, are not responsible with the available dollars in our economy. When we always assume someone else is paying for it, we cannot get there. We do not have the right incentives. Consequently, when we treat symptoms we actually make it worse.

What are we seeing? What we are going to see is the government jump between the doctor and the patient to make the symptoms worse. We are going to have an IPAB board, which is not coming yet, but it is coming. We are going to have an innovation board--not patients, not doctors--not patients making these decisions but somebody in Washington making the decisions. So the very capability of utilizing that one axiom of medicine, having the freedom to listen to the patient and then acting on what we heard rather than acting on the basis of rules and regulations coming out of an autonomous nonpersonal body in Washington that is going to tell us what we are going to do.

Let me give a great example. In the Affordable Care Act is the money and the incentive to put everything online. Now, by itself that sounds smart. What do the first studies show on the basis of that? The first studies show that when a doctor has online available diagnostic tests versus the doctors who do not, they order 18 percent more tests then the doctors who do not.

In other words, if something is easy to do, we do more of it, and so here is the first--this just came out 2 weeks ago--the first set, when people were looking at radiographic tests such as CTs, MRIs, CAT scans, chest x-rays, ultrasounds, they get the results. They get the results faster. Without the patient being there, without reading them, they automatically order 18 percent more tests.

Well, our problem in our country was we were ordering too many tests. We have all of the incentives to order tests rather than listen to the patient, and now we set up a system where we are going to order more tests. That is what the first study shows. We are going to give hundreds of millions of dollars to doctors to have an IT system put in their offices so we have an electronic medical record. Well, what are we seeing from the first examples of that? Other than in isolated cases where it is a very refined product, such as Mayo Clinic or Cleveland Clinic or even at the VA, what do we find? People fill out the paperwork, check the boxes, but they do not check it in relationship to the patient. So when the next person looks at the electronic medical record, they do not look at all of the garbage that is there that does not mean anything--but, oh, it might because there is too much information now in terms of the computer screen.

So what is happening? We are doing duplicate things that were not done before. So the impact of the health care bill--just in terms of taxes, does anybody think health insurance premiums are not going to rise enough to offset whatever the increased cost is for the medical loss ratio? They are going to make money. Businesses are going to make money. So if we put a medical loss ratio at 15 percent, what is going to happen is they are going to live within that, but the premiums are going to go up so they can do what they need to do.

Blue Cross-Blue Shield Oklahoma knows my practice parameters. They know what I am good at, what I am efficient at, and what I am not. They are not going to give up that knowledge of whether or not I should be doing a test by simply saying the Federal Government put in a medical loss ratio. They are going to raise premium prices, which we are already seeing in Oklahoma.

So when we continue to treat symptoms instead of the underlying disease, we do not solve a problem; we actually make the problem worse. That is why you get sued as a physician when you miss a diagnosis of a disease, and what I will tell you is Americans are at ``dis-ease'' about health care in our country. But we have committed malpractice in our approach to it because we are treating the symptoms and not the underlying disease.

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Mr. COBURN. The IPAB stands for the Independent Payment Advisory Board. They are a group of individuals who will decide what we pay for and what we do not pay for in terms of health care. They will also decide how much we pay.

Once those 15 people are in place, if they are wrong, people will have no ability to challenge it in court. They have no ability to see their work product and why they decided on what they did. They have no ability to cut off their funding. In other words, they are an autonomous nondemocratic function whose whole goal will be to control costs.

Well, there are lots of ways to control cost. I call it the ``sovietization'' of the American medical industry. They are going to control costs. Well, we know how that works. We have already seen it. It is called NICE in England, and we are seeing a revolt. As a matter of fact, in England today they are talking about reforming their health care system and going in the opposite direction of what we are doing because what they know is the rationing of care based on a value of 1 year of life per individual is the way they make that decision.

So if Senator Johanns is 78 years old and has a broken hip and bad diabetes and bad heart disease, they look at the value of what his life expectancy is with that and then the cost of fixing his hip. They say: You are not worth it. So in England they do not fix your hip. Well, that is called rationing.

The fact is it is not bad by the word; it is a loss of liberty. It means people no longer have the ability to decide themselves what will happen to them, and somebody autonomously, very distant from them, makes the decision for them.

IPAB is not the worst--the innovation council. What will not happen that the innovation will not allow to happen? I have a story of a patient--and I will just give an example. Not IPAB, not innovation, but we are also going to have the Preventive Services Task Force that is going to make recommendations on screening.

I want to give an example. This is a true story. I will not use her name, but a young lady came to me with a breast lump. I did the standard protocol, best practices on her. It showed to be a simple cyst, and the point I am making is about the art of medicine, not the science of medicine because everybody gets hung up on the science, but nobody ever talks about the art.

I had an uncomfortable feeling about this cyst. So I aspirated it. It was inflammatory carcinoma of the breast. In other words, had I followed the protocols that are going to be recommended by IPAB and the best practices, I would have never aspirated it.

Well, this patient is now dead. But she lived 12 years. A delay in diagnosis on inflammatory carcinoma would have given her less than a year to live. Because I did not follow what the standard protocol was but followed my history and my knowledge of the patient and my feeling, I diagnosed her early. She got to see her kids get married; she got to see a grandchild. That never would have happened.

So what is coming with IPAB and the Preventive Services Task Force is people making decisions that are not in the room with the doctor and the patient, and that is the biggest danger of the Affordable Care Act: that we are going to take the ability of patients and doctors to make choices and give that choice to a government bureaucrat.

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