Rob: Well, Dr. Coburn as a lawmaker and as a practicing physician,
what would be your diagnosis of our current healthcare system?
Senator Tom Coburn: We've set up to treat chronic disease rather than to
prevent it; that's number one.
Number two, we're not involved, personally, many times in the cost of our
healthcare.
Number three is, we now have about 50 percent to 55 percent of our
healthcare controlled by the government, which has induced the private market
to start copying it which leads to inefficiency, poor quality, and no
transparency.
The biggest way to fix it is to make us have some personal responsibility,
change the paradigm back to we're going to prevent disease rather than treat
disease.
We'll still treat disease, but our goal, emphasis, has to be on prevention.
Number four is to make sure you can be transparent, make a
transparent decision before you purchase healthcare as to the
quality and the price.
And, you can't do any of that now.
And you have somebody else; we pay the insurance industry 30 percent to
tell us what doctor to go to and what price we'll pay, rather than allowing
a real market, and a transparent market for us to see.
The greatest example of that, if you don't have insurance and you go to a
hospital today, you get charged two-and-a-half times what you would as if
you had insurance.
Well, where else does that work, in a true market based economy where those
with the least ability to pay get charged the highest price?
It shouldn't be that way, and so we have this convoluted system that's
based on the tax code that says your employer can have a tax deduction for
your healthcare, but you can't.
And, consequently we have millions of people who are locked in a job, can't
leave because they either have a health condition or a pre-existing illness
that will keep them from getting insurance somewhere else; so they
stay locked.
So, it's the complete opposite of a market based healthcare system and a
complete opposite of transparency; and it's very, very expensive.
Rob: And, let's expand on that if you would.
Talk about the costs that we're incurring right now as a country, and as
individuals, when it comes to our healthcare.
Coburn: Well, individually, in this country, we pay about 50
percent more than anybody else in the world, for our healthcare.
And, our healthcare is great.
Most of the innovation in the world comes from our private sector healthcare.
But, we should ask ourselves, why it costs 50 percent more in this
country to deliver a product.
And the reason is that there's not a transparency in the market.
Rob: How about as a country.
What's it doing to our country?
Coburn: Well, it's making us uncompetitive.
We have a high burden for healthcare.
Because we've emphasized on treatment instead of prevention, we're going to
carry a heavier load in terms of cost.
We have a less healthy young population, because we've not concentrated on
prevention.
And, the lack of prevention implies greater cost, but also implies
less competitiveness which means we're less able to grow our economy; we have
less capital invested, because we're spending more capital on
healthcare.
And so, the best way to create opportunity for the future is to have a free
flow of capital that's uninhibited by non-market oriented forces in
healthcare.
And right now, it is inhibited, because so many people, you know, we're
losing about one percent per year in the private market as far as health
insurance, because of cost.
Yesterday, it was announced the consumer price index on healthcare
rose six-tenths of one percent.
The core rose one-tenth of one percent.
So, healthcare is rising six times, last month, as fast as everything else in
the economy.
Well, why is that?
It's because there's no market forces to control it, and to allocate the
resource.
So, we can markedly improve quality.
We can markedly improve service.
And we can markedly lower our price if we let market forces help us.
Rob: Now, you have proposed along with Senator Burr, co-sponsor
of the Universal Health Care Choice and Access Act, and I want to ask you
about the word universal.
We hear a lot of the word universal being thrown out now.
How is this proposal, how is it different than a lot of the other proposals
that people are floating, right now?
Coburn: This one says you have personal responsibility.
You have to be accountable.
The government will offer you a tax credit, but you have to buy your
insurance, and here's the credit with which you can buy, and then you have to
make choices.
And you get to suffer the consequences of those choices in terms of how
you purchase.
The numbers that come out of that, basically, are the averages across the
country of which you could buy family insurance.
And, it doesn't raise taxes across the board on anyone; in other words, it
just redistributes the tax break we're giving to corporations, now, to
everybody equally.
And, what it is, is universal access; it doesn't mean universal
care; it means you have the access to money to buy care if you want to.
The government can't make decisions for us based on personal and compassionate
needs.
Any time we try to make the government do that, we fail.
So what this says is, we'll create an opportunity for everybody
in this country to have health insurance for themselves; but, they're
going to have to contribute; they're going to have to participate;
and they're going to have to make decisions that are good for them if they want
to have benefit.
Rob: From a wellness standpoint, a prevention standpoint, is that enough
to have?
Coburn: No, but we have other sections of the bill.
We redirect the vast majority of federal monies, today, that are
being supposedly spent on prevention, but are basically being spent on
bureaucrats, and we put that into a media campaign to educate America about
what they need to know, what they need to know about breast and cervical
cancer, what they need to know about colon cancer, what they need to know
about lung cancer, what they need to know about protecting your skin, what
they need to know about diet, what they need to know about exercise.
We changed the food stamp program; no longer can you use food stamps to buy
something that's going to kill you.
No longer will the school lunch program be designed to raise your cholesterol
and give you coronary artery disease like it is today.
In other words, if we're going to spend money to
help people with nutrition, then the nutrition ought to be
great for you rather than terrible for you.
Rob: I saw you speak to a group of young people, young people training to
be doctors, recently.
And, you asked them what you thought the future of Medicare, Medicaid, was,
and two on one, it was bleak.
Would you agree?
Coburn: It is.
Rob: What do we do?
Coburn: What we need is real competition all the way up, Medicaid and
Medicare.
How many doctors in Oklahoma take Medicaid?
Rob: Fewer and fewer.
Coburn: That's right.
Why is that?
Rob: Because they can't get their reimbursement.
Coburn: Because they can't get a reimbursement that they perceive will pay
their bills, all right.
How many young college students are going into medicine?
Rob: Fewer again.
Coburn : Fewer and fewer.
It used to be 30 percent of Harvard's class went into medicine, four
percent this last year, and you're seeing that across the country.
Why is that?
Because by the time you have 12 years of upper level education and have
somewhere between a quarter and a half million dollars worth of debt, the
economic model doesn't work that you can ever repay the debt.
So, our best and brightest now, many, are choosing not to go into the field
of medicine.
We also know that in about 15 years, we're going to be short 200,000 doctors.
Now how are we going to, we're going to use nurse practitioners and PAs to
pick that up, but that's, they're great physician extenders, but what
happens when the only thing you have is somebody less than a qualified
physician to diagnose and treat you?
So, we better start thinking about the things that have made our country
successful, and that's markets.
If you can see that, if you can have transparency where you can see, here's
the best doctor, and here's his price; and here's the worst doctor
and here's his price or her price.
I don't think I like that quality even though that price is cheap, and here's
this great quality but the price is a little high, I think I can get better
value here.
So we have Americans shopping rather than an insurance negotiating
agent negotiating with somebody in a clinic here about what the price will be.
In other words, we allow consumers to really decide, but you have to
have a transparent market.
It won't work, unless you force physicians and physician groups,
hospitals and hospital groups, accessory medical providers and their
groups, to post quality and to post price.
And there's no reason the price ought to be different to anybody.
Rob: So, no matter what I make and what someone else would make, we'd be paying
the exact same price?
Coburn: Yeah, you ought to be.
You're getting the same service.
You're offering the same amount of money.
Rob: Would there be, under this proposal, would there be people in our country
that would not have insurance?
Coburn: Well, only because they chose not to try to buy it.
And we have in this bill the option for the state, if you have an
irresponsible 27 year old who says I'm riding my Harley, I don't care what
happens, I'm not buying it.
The state has the right to capture that and buy a high deductible policy to
protect the state, employees, the rest of us, from his malfeasance and
irresponsibility.
So, they can capture this high deductible if somebody proves
irresponsible, that they're not going to buy insurance; they can do it,
and it will have a comprehensive exam in it once a year, and a high
deductible policy.
What will happen, here's what will happen, is if we truly have a real market,
deductibles will go up, will incentivize medical savings, and people will
make better choices, and we'll have better competition, better
quality, far better quality, and lower prices.
Rob: This is such a dramatic overhaul that it flies in the face of some
very vested interests.
How does something like this get through Congress?
Coburn: American people have to want it to change.
It's not going to go through Congress, because basically the members of
Congress won't have the courage to challenge the vested interests.
This will be the debate of the presidential campaign, it won't be the war on
terror, it will be healthcare.
And within two or three years, look, the Americans need to know, we're going one
of two ways, we're either going to fix this system, and use a market based
system to fix it, or we're going to have the government run it.
And, P J O'Rourke, a columnist, you've heard me say this, but he's right,
if you think healthcare's expensive now, wait till it's free, and wait till
the government truly gets hold of all of it.
The government has been devastating to its portion of innovation.
It's been devastating to access in a lot of ways, because you have a
bureaucracy that makes us spend one-third of our labor efforts climbing
through the bureaucracy rather than treating patients.
What would happen if our clinic, a third of our employees, instead of
meeting mandates and paperwork were actually helping people?
The cost wouldn't change.
What else would we get?
We would get far better healthcare.
We would get far better service.
We would get far better quality.
But, we don't do that, because we've got a government run system that
mandates what we will and won't do.