Debra J. Saunders

There are reasons to support the Medicare bill, passed by the House and the Senate. Poor seniors should get relief they desperately need. Congress should reverse a pending 1.5 percent reduction in payments to physicians who care for elderly patients.

Still, Tom Coburn would have voted against it.

Coburn is an Oklahoma doctor who was elected to the House in 1994. He continued to practice family medicine and obstetrics while he served as a GOP congressman, until 2000 when he chose not to run for re-election, in keeping with his campaign pledge to serve only three terms.

Taking a break from his patients -- and from promoting his new book, "Breach of Trust, How Washington Turns Outsiders into Insiders" -- Coburn got on the telephone to give his take on the bill. As he sees it, the Medicare bill is another big-spending bill from a big-spending GOP-led Congress and a big-spending Republican president.

"It's pretty sad, isn't it? There's not a choice any more about controlling the size of the federal government. It's not Democrat vs. Republican," said Coburn. It's careerist vs. non-careerist -- and the careerists carry the day.

"I deal with seniors every day who have to make a choice between supper and their medicine," Coburn added. He wants the government to do something, but he believes regulators should reduce what drug companies charge American consumers. I doubt his prescription would work -- but at least Coburn's plan wouldn't inflate the national debt.

The bill's $400 billion price tag isn't credible. For one thing, Washington inevitably will expand benefits -- that's why the AARP supports the bill. It's the camel's nose in the tent.

As the bill stands, seniors who earn less than $12,123 annually wouldn't have to pay premiums or deductibles. That's good. But other seniors who enroll in the program would pay a $35 monthly premium, a $250 deductible and a co-payment of 25 percent for the first $2,250 in drugs each year. Seniors would then pay all of the next $2,850 in drug costs -- this gap is called the "doughnut hole," because there are no benefits in the middle -- until they pay $3,600, when Medicare would pick up 95 percent of remaining drug costs.

As the fiscal-watchdog Concord Coalition argues, there's no policy reason for the doughnut hole. It exists solely to keep the tab under a $400 billion limit. Which means, Coburn and the Concord Coalition warned, it's inevitable that Congress will boost benefits and fill the hole.

Debra J. Saunders

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