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If you really think, given this country’s make-up today, that you can get 60 Tom Coburns in the Senate to where you can actually cut the spending enough and reform the entitlements where you wouldn’t have to have it and you could get the government down to 15 percent of GDP, I’m all for it. But if that’s the case, I have a whole bunch of spoiled land in Oklahoma I’d like to sell you for $10,000 an acre. Because there’s no truth to that.
The fact is, our Founders made this country where if you’re going to change something, you have to do it based on compromise. And we’re going to have to increase revenue. That doesn’t mean increased tax rates. Actually, the increased revenues will come from the dynamic effect of lowering the rates and broadening the base and getting some of the $2.6 trillion that’s sitting on the sidelines right now in businesses, invest it, and that will create jobs.
reason: Entitlements are where the big money is, right?
Coburn: A lot of people say that, you know, a trillion dollars a year in discretionary spending is big money, especially when 30 to 35 percent of it is waste, fraud, or duplication. If it’s 35 percent, that’s $350 billion a year, that’s $3.5 trillion. If you truly ran the government efficiently—and that’s not talking about things that are done outside of the purview of the enumerated powers—if you did that, you’d cut another $150 billion, and that’s $5 trillion over 10 years. Then if you fix entitlements.…
reason: You’re talking about changing eligibility ages and things like that. But how do we fix Medicare? Medicare is something that gives essentially free or reduced price health care to seniors irrespective largely of income. Is that something we should be doing?
Coburn: The question is, is it constitutional? I would have to say it’s outside of the enumerated powers. So is Medicaid. Social Security, if you wanted to create a system where the Social Security actually was set up independent and people could put their funds into it, and they could do it, that’s all constitutional. You can do that. But the point is that if they were all self-financing, we wouldn’t have any of the problems with it.
reason: So what’s your best fix for Medicare?
Coburn: You can’t fix Medicare unless you fix health care. And the best fix is to let free-market forces work on health care. What Sen. Richard Burr [R-N.C.] and I have proposed is the Seniors Choice Act, where you have a premium support system, and you connect purchase with payment and allow individuals to be involved. There are great corollaries in the private sector. And even our private sector doesn’t have real market forces.
reason: How do we get to that market-based system? I know that you agree that markets have delivered great increases in productivity and service and treatments in every aspect of our lives. They can do it in medicine, you’re a doctor, you recognize that. But how do we get there? Because the resistance is humongous, it seems, toward moving to a system where the patient is actually in charge of spending money.
Coburn: How you get there is to contrast what’s going to happen if you don’t change. And the question you ask a senior that’s on Medicare today is, do you want Medicare not to change knowing that your children and your grandchildren will have a markedly lower standard of living if we don’t change it? That’s how you get there.
You have to have transparency in outcomes and quality in medicine, which we don’t. Unless you’re a doctor. I mean, I often ask the question, why do only the doctors know the bad doctors? Why isn’t there a transparent market in terms of quality and service? If you want to get a complicated operation, do you really want to go to somebody who does it twice a year or 200 times a year? Which place do you go?
reason: If I created a system to rate doctors publicly, like Rate My Professor for doctors, would that be allowed?
Coburn: Sure it would. You have consumer reports out there right now. You could have consumer reports on health care. Here’s the problem in health care: People in health care don’t want transparency because we have a system that pays based on the more you do, the more you earn, rather than the quality of outcome and prevention. Market forces aren’t perfect. But I guarantee they’re better than what we’re doing right now. And when you have a Medicaid system where the outcomes are worse than if you have no insurance at all.…
reason: Which is stunning. Medicaid is not just an inefficient program, it’s actually a disastrous program.
Coburn: It’s a low quality program that says you have access when really you have no access or you have access to inferior quality. So there’s ways to fix all that.