In January, as President Bush began his push for Social Security reform, labeling it a crisis, newly seated U.S. Sen. Tom Coburn was, characteristically, already off message.
Asked about his primary legislative concerns upon returning to Capitol Hill after three terms in the House of Representatives and a four-year, self-imposed hiatus back home in Muskogee, Okla., Coburn, a family practice physician, talked shop.
"Healthcare is a big one," the Republican said in a telephone interview. "The cost of Medicare will dwarf us compared with Social Security."
Coburn, who also specializes in surgical obstetrics and allergies, started his first weeks in office already in a flap with the politically balanced, six-member Senate Select Committee on Ethics. Coburn expressed his intention to continue practicing medicine part time in Muskogee-just as he did during his three terms in the House from 1995 to 2001. The clash with the ethics panel remains unresolved.
Senate rules bar members from "affiliating with a firm, partnership, association or corporation for the purpose of providing professional services" and Coburn reportedly was told by the Senate ethics panel that he cannot practice while he is a senator. As a congressman, Coburn sought and received dispensation from the House ethics committee to maintain his medical practice.
"I had another doctor working in it and I worked in it half a day a week or a day every other week," Coburn says. "I delivered 450 babies when I was in Congress in those six years and I can tell you I learned a great deal more about being a congressman by dealing with people at that time, and that's my purpose.
"I can't think of one person who came to me (as an obstetrician) to influence me and how I vote in Congress," he says. "It's not about making money. I've committed to not making anything in medicine. There wouldn't be any income. Once you've paid medical malpractice insurance and nurses and overhead, there isn't any.
"The key to it is maintenance of skill and the maintenance of privileges, but it's also about being able to stay connected to the people of Oklahoma," Coburn says. "When you're a doctor in an exam room, you're not a senator or a congressman. You can find out a lot of things about people."
The only other physician in the Senate, Majority Leader Bill Frist (R-Tenn.), a cardiothoracic surgeon, declined to comment on the ethics committee's decisions but says he understands Coburn's plight.
"I empathize with Senator Coburn's desire to continue to practice medicine. Being a doctor isn't a job-it's who you are as a person," Frist said in a statement. "Balancing our roles as senators and physicians will always be a challenge," something he says will be true for any physician interested in running for public office.
Staying in practice
In a March 18 letter, Ethics Committee Chairman Sen. George Voinovich (R-Ohio) and Vice Chairman Tim Johnson (D-S.D.), said they would not support a change in Senate rules to accommodate Coburn, according to the Associated Press.
Several Oklahoma newspapers have published editorials calling on Coburn to give up the quest, but the senator responded in an open letter to his constituents in mid-April vowing to press ahead by seeking a change of Senate rules to allow him to keep his medical practice open.
"My ambition is to continue to (find) a way in which I can be a citizen-legislator and I can continue to interact with people in Oklahoma," he said in the letter.
In his 2004 bid for the Senate, Coburn easily defeated two-term Democratic congressman and Rhodes scholar Brad Carson, winning 53% of the vote. He holds seats on the Judiciary, Homeland Security and Governmental Affairs, and Indian Affairs committees.
After graduating from Oklahoma State University with a degree in accounting in 1970, Coburn worked for eight years in his family's business, Coburn Optical Industries, as a manufacturing manager. He then entered the University of Oklahoma College of Medicine after the business was sold, graduating in 1983. He did his internship in general surgery at St. Anthony's Hospital in Oklahoma City and completed a residency in family practice at the University of Arkansas at Fort Smith.
Coburn says he stays in obstetrics, despite the medical malpractice expense, because being a part of bringing life into the world "helps keep medicine in balance for me."
When the Food and Drug Administration opposed importing prescription drugs, Coburn campaigned to allow the practice, saying it would lower patient costs while encouraging pharmaceutical companies to spend more money on research and development by restricting marketing and direct-to-consumer advertising. He called for a Justice Department investigation into possible pharmaceutical industry price-fixing but also sought the streamlining of the FDA drug-approval process.
Echoing the language of the Bush administration, Coburn also advocates limiting "frivolous lawsuits" in medical malpractice cases to hold down health insurance costs to employers and consumers and check the growth in the number of uninsured.
Treating the whole system
To fix Medicare, Coburn says what's needed is a holistic approach.
"I don't think we can look just at Medicare-we have to look at healthcare in total," he says.
For example, obesity has been the buzzword for the past few months, but healthcare payments-and as a consequence, much of healthcare delivery-is not focused on the problem, Coburn says.
"I have over 100 patients who have lost over 50 pounds because I made an effort to be involved in their long-term healthcare," Coburn says. "But I lost money doing it. Their diagnosis was their other disease plus obesity, but to have them come back just for obesity counseling-do you know how many insurance companies balk at that?"
And yet, Coburn says, he had been successful with several of those patients in getting them off prescription medication for hypertension and insulin-something that helps explain the approach he'd like to take in reforming not only Medicare but healthcare in general.
"It can be done, but we've got to incentivize prevention," he says. "There is no incentive ... no payment for prevention. The doctors that use best practices, we've got to pay them a premium and the others less." Information technology will help, and not just on the clinical side of the patient encounter but in healthcare administration as well, Coburn says.
"The real fact is, one out of three people in a doctor's office don't do anything to help anybody get well, and we've got to change that," he says.
A social as well as a fiscal conservative, Coburn opposes abortion, except "in the extremely rare case when the life of the mother is truly threatened, such as an ectopic pregnancy in a fallopian tube," according to his responses to a questionnaire posted on the Web site for the 100% ProLife PAC.
Coburn also sides with the Bush administration in supporting health savings accounts but is hawkish on deficits.
"I believe it's a moral issue to not spend our grandchildren's future and we have a $400 billion deficit," he says.
And despite a recent recommendation to the contrary by the Medicare Payment Advisory Commission, "I'm not for a moratorium on specialty hospitals," he says.
"I'm for competition. I don't care who owns it," Coburn says. "If we get into competition on price and quality, quality is going to go up and price is going to go down. If we truly had competition today in terms of diagnostic MRIs, if people went out and competed for ultrasounds and CTs, the price would have to go down. What we have in medicine is price control. Price control never allocated a scarce resource once."
Coburn-first elected in 1994 as part of the "Republican revolution" in which the GOP regained control of the House for the first time in 40 years-lived up to his pledge to serve no more than three terms. He quit the House and went back to practicing medicine in Muskogee in 2001. He has similarly pledged to serve no more than two terms in the Senate.
"The real fact is, one out of three people in a doctor?s office don?t do anything to help anybody get well, and we?ve got to change that."--Sen. Thomas Coburn (R-Okla.)
Birthplace: Casper, Wyo.
Family status: Married, wife Carolyn; three children; four grandchildren
Education: B.S., accounting, 1970; M.D., University of Oklahoma medical school, 1983, Oklahoma City
Previous jobs: Manufacturing manager, Coburn Optical Industries, Colonial Heights, Va., 1970-78; practice of family medicine, obstetrics and allergy, Muskogee, Okla., 1986 to present; U.S. House of Representatives, Oklahoma?s 2nd Congressional District, 1995-2001. Was appointed co-chairman of the President?s Advisory Council on HIV/AIDS in 2002.