Lies, damn lies and health care reform

When Republican Sen. Tom Coburn warned seniors, “you’re going to die sooner” if Democrats pass health care legislation, it stood out as an memorable, unprovable moment in an opening-week debate over President Barack Obama’s top domestic initiative.

But not the only one.

Across hours of rhetoric, poll-tested charges and countercharges proliferated. Partial truths vied with inflated claims.

Senatorial speech leaned to the earthy.

“It is 2,074 pages long. It is enough to make you barf,” Republican Sen. Orrin Hatch of Utah said of the bill that rested — unsullied — on his desk.

And the discourse approached the level of a schoolyard standoff.

“Her amendment is flawed, mine is terrific,” summed up Sen. Barbara Mikulski, D-Md., speaking of her rival-for-the-moment, Sen. Lisa Murkowski, R-Alaska.

The two sides even disagreed whether private Medicare plans are part of the popular federal health care program for older people. Republicans said they are. Democrats said not.

At least until Sen. Max Baucus, D-Mont., stepped in. “This is a semantic question,” he said. Meaning, evidently, that they are.

“Someone watching this must think we’re on two different planets sometimes,” opined Sen. Lamar Alexander, a Tennessee Republican.

On that, no objection was heard, a rarity in a week in which much was said, little settled.

Philosophical consistency yielded to political maneuvering.

Sen. David Vitter, R-La., supported a requirement for insurance companies to cover numerous preventive services without additional out-of-pocket expenses, including mammograms for women age 40 and older. Then, a few minutes later, he voted to strip the government of any authority over the issue and let insurance companies decide what to cover after consulting with medical groups.

The two votes were consistent, he said in a brief interview, adding that he wanted in both cases “to negate any impact” of a recent controversial task force recommendation for routine mammograms beginning at age 50, rather than 40.

One of the Senate’s most conservative members, Vitter faces a difficult re-election next year, and polling over the summer suggests lagging support among women. Two years ago, he admitted having committed a serious, unspecified sin after his telephone number appeared in the records of a Washington-area escort service that authorities said was a front for prostitution.

Other moments were more classic political thrust and parry.

The bill “is a government takeover of the health care system,” said GOP Sen. John Barrasso of Wyoming, a physician.

“That is a scare tactic,” retorted Baucus a few moments later.

Republicans said the legislation, with $460 billion in Medicare savings over a decade, would cut benefits for older people and siphon off huge sums from the program to subsidize expanded health care for millions of younger Americans. Seeking political gain, Republicans proposed erasing the cuts, thereby forcing Democrats to vote in favor of retaining them.

“If anyone had any question about the Democrat plan to use Medicare as a piggy bank to fund their new government programs, those doubts are now gone,” said Sen. Mitch McConnell of Kentucky, the Republican leader.

Democrats said no guaranteed benefits would be touched and prescription drug coverage would be improved under the bill.

Besides, said Sen. Tom Harkin, D-Iowa, “As we all know, if it were up to our friends on the other side of the aisle, there would be no Medicare. They fought its very creation.” The record shows as much.

But that left much unsaid on each side of the debate.

As the GOP critics presumably knew, but wished to avoid conceding, the bill includes no cuts for doctor care, hospital services or other traditional Medicare benefits.

And as Democrats understood, but preferred not to say, private insurers that provide an alternative to traditional Medicare will almost certainly cut add-on benefits such as gym memberships or vision care.

“There is nothing in the legislation that forces plans to reduce benefits at all, rather than reducing profits,” said Sen. Christopher Dodd, D-Conn., in a sort of a backdoor concession.

Democrats spoke at length about women’s health. More shadowboxing ensued.

Mikulski proposed a change to the legislation that she said repeatedly would insure better preventive health care for women without additional out-of-pocket charges. Perhaps, but precisely which ones aren’t known. That’s because it authorized the government to establish a list of preventive services that insurance companies would have to cover in the future.

Republicans came up with an alternative, after an internal struggle. An early draft would have expanded on a list of preventive services and tests for men and women already in the legislation, at an additional cost of $30 billion over 10 years.

Conservatives within the Republican rank and file rebelled in private discussions, and Murkowski’s final proposal was far different. It dropped a requirement for coverage of screening tests by insurance companies, instead directing them to consult with professional groups such as the American College of Surgeons.

The list of tests that no longer would be automatically covered ran to 45 items, including colorectal screening for people between 50 and 75; HIV screening for pregnant women as well as others; blood pressure screening for people 18 and over; and a hearing check for newborns.

The point, Murkowski said, “is to ensure that we do not have government entities that are making those decisions we as individuals working with our doctors feel is best.”

That was Coburn’s point, jarringly.

“When you restrict the ability of the primary caregivers in this country to do what is best for their senior patients, what you are doing is limiting their life expectancy,” said the Oklahoma lawmaker. “So, for 20 percent of our seniors, this bill is going to be a disaster, but it’s going to save money because you’re not going to be around for us to spend any money on you.”