HYPOCRISY AT THE TOP

One
of the greatest moments during my year on Capitol Hill was the late evening
discussion of the health care bill in the US Senate Committee on Health,
Education, Labor and Pensions, in July of 2009. Such discussions are called
mark-ups and it is the time that amendments to the majority’s proposed legislation, most importantly those from the
minority, are considered,
discussed and voted upon.

Senator
Tom Coburn (R-OK), a family physician, offered an amendment to the bill. He
proposed that if the “public option” (government provided health insurance for
all, essentially Medicare for everyone) was included in the bill, all of the
Senators and their families would have to use it instead of the Cadillac private plans they
currently enjoyed, paid for by the taxpayers.

Senator
Coburn stared at Senator Jeff Bingaman (D-NM) across the large tables arranged
in a square. Senator Bingaman was leading the mark-up at that point. Bingaman
and the rest of the Democrats on the committee blanched at the thought of
having to receive the same health insurance as their constituents. Aghast, they asked
Senator Coburn why?

“Because
we are leaders,” came the answer.

Tom
Coburn is a staunch Conservative and I lean a bit more to the left than he
given my northern liberal up-bringing. But that was the moment that I became
Senator Coburn’s undying supporter, for I had come to Capitol Hill to see
someone act like the senators of my childhood and he just had.

A
month or so later, toward the end of my fellowship, Senator Coburn’s staff
arranged a 15-minute meeting for me with him—just one doc to another. We
discussed the state of health care reform and his objections to the Democrat’s
proposals. He told me about his own experiences as a private physician. He was most proud of delivering over 5000 babies. He posed with me for a picture that
a staff member took. I treasure that meeting and the autographed two-shot that
hangs on my wall that Senator Coburn signed before mailing it to me.

More
than anything, I cherish the courage of a member of the Senate standing up for
his principles and that this member was not only a senator, but also a
physician.

That
was 2009. Unbeknownst to most Americans, functionally, Dr Coburn got his wish.
The members of Congress and their staffs are supposed to use the exchanges
available to them to gain health insurance, as they are no longer covered by
government-issued insurance. As an op-ed in the Wall Street Journal on January
6, 2014 demonstrates, the President and the Office of Personnel Management
(OPM) managed to find a narrow crevice through which members of Congress (and their staffs) could wiggle and
gain employer-based subsidies similar to what most employees of
large institutions or companies (e.g., UT System employees) get. That means
part of their health insurance premiums are paid for with pre-tax dollars.

As
Senator Ron Johnson (R-WI) points out in this op-ed, this was explicitly NOT
what Congress intended in the law and to show how serious he is, he is suing
the government in US District Court in his home state. He is angry that the
President and his administration is allowing and encouraging Congress to break
the terms of his signature piece of legislation by giving the members and their
staffs arbitrary waivers from the terms of the ACA. And he’s right! And it’s
not the first time that the President has skirted the terms of his own bill. He
did so when he delayed the employer mandate last year.

According
to what I learned in DC, the President does not have the power to pick and
chose which of the terms of a signed law he will enforce and which he will not.
If he wants a change, he has to go back to the Congress and request revisions
to the law in the form of new legislation.

This
brings us to another president with a similar problem—the selective adherence
to institutional law. The conflict of interest waivers granted to Dr. DePinho
and presumably his wife (I have no idea on that one) were and are outrageous,
yet, as far as I can tell, they are still in place allowing him to skirt the
COI rules the rest of the faculty must obey.

In
both the case in Washington and the one in Houston, the executives involved are
undermining their own credibility for foolish purposes. For President Obama, if
the ACA is so good and the passed law requires the use of the exchanges by the
members of Congress and their staffs without pre-tax subsidies, why try to get
around the law? The guess is that once the members found out the implications
of their handiwork, they weren’t so happy. Those unintended consequences can be
brutal.

Similarly,
by acting the way he has since coming to Houston, Dr. DePinho has significantly
weakened his relationship with the faculty. Neither Senator Johnson nor the MD
Anderson faculty can see the purpose of putting rules in place and then
behaving as if they don’t exist.

Senator
Coburn had it right in 2009. We do the right thing: “because we are leaders”.
And when we don’t, we aren’t.