- Email: [email protected]
Tom Coburn, MD: a doctor in the house
WASHINGTON WATCH
MICHAEL J. PENTECOST, MD
Tom Coburn, MD: A Doctor in the House Dr. Tom Coburn was certainly not the first physician to serve in the U.S. House of Representatives, but he may be one of the most memorable. In his recent book, Breach of Trust [1], the Republican congressman recounts the story of his stint in the House from 1995 to 2001 representing the second district of Oklahoma. Along with 72 other new members, Coburn was elected in the 1994 revolution when the Democrats lost control of Congress after the failure of President Clinton’s Health Security Act. Behind the leadership of House speaker Newt Gingrich, the “class of 1994” spearheaded passage of the Contract with America within 100 days of taking office. Having honored a self-imposed 3-term limit, Coburn is now back in Oklahoma practicing medicine. His book, like most political memoirs, is part autobiography, part vignettes, and part philosophical reflections. The autobiographical elements of the book are compelling, but not because Coburn is such a unique figure. On the contrary, many practicing physicians will easily identify with this colleague because by any standard, he is a regular guy. No New England prep school background, no Ivy League medical degree, not even a master’s in public policy, for goodness sakes. Rather, Coburn was an Oklahoma State accounting undergraduate with a medical degree from the University of Oklahoma. No boutique Boston, Manhattan, or Washington medical practice here. He was and is a general practitioner and obstetrician in Muskogee, a city of 38,000 in the eastern part of the state.
Starting with page 1, it is clear that this is not a story about a man with lifelong political ambitions who happens to be a doctor. Instead, in June 1994, because of concerns about growing government intrusiveness, Coburn decided on the spur of the moment to run for Congress. He challenged Mike Synar, an 8-term incumbent Democrat in a district that hadn’t sent a Republican to Congress since 1920. And, lo and behold, Coburn won. Like his road to Congress, Coburn’s path to medicine was not a traditional one. In 1975, at the age of 27, married and with young children, Coburn was diagnosed with malignant melanoma. Even after a radical neck dissection, he was given a 20% chance of survival. He credits this battle against cancer with piquing his interest in medicine and deepening his compassion for others. As with many who hear mortality’s clock ticking early, Coburn also became determined to make a mark in life. Increasingly optimistic about his survival 4 years later at age 31, Coburn decided to leave his successful business career with an opthalmic device company and enter medical school. Inevitably tagged with the nickname “Gramps” by fellow students, he completed his studies, settled into practice in hometown Muskogee, and the rest is history. Coburn sprinkles tidbits of gossip throughout the book. Because he is a conservative Christian, none of these are exactly titillating, but many are interesting, behind-thescenes looks at Washington political life. He gained public attention for his tiff with the House Ethics Com-
© 2004 American College of Radiology 0091-2182/04/$30.00 ● DOI 10.1016/j.jacr.2004.02.018
mittee over his weekend “fiduciary” duties. Admirably, Coburn returned to Muskogee every weekend and took call. No showboating but real obstetrics call, delivering babies (over 400 during his time in Congress). The committee ordered him to stop because these children or “clients” might unduly influence him in his legislative duties. Claiming the moral high ground (and no doubt seeing a public-relations bonanza), Coburn disobeyed this edict and continued his practice. The committee quickly backed down. Coburn’s independence and mouth occasionally got him into trouble. After publicly chastising director Steven Spielberg for the nudity in Schindler’s List, he was nearly run out of Washington. Nor was he always steadfast about political stances, having flip-flopped on a bill that limited the growth of federally supported credit unions. As evidence of politicians’ considerable egos, Coburn recounts the little-publicized effort in 1999 of Senator Tom Harkin (an Iowa Democrat) to have the Centers for Disease Control and Prevention named after himself. Neither Republicans nor Democrats are immune from such vanity. At the same time, Pennsylvania senator Arlen Specter had his eye on the National Library of Medicine as a namesake. Both initiatives failed. Confident that their expertise about medicine would be greatly valued, Coburn and two other newly elected physicians, Dave Weldon from Florida and Greg Ganske from Iowa, approached Bill Thomas (a California Republican), the House Ways and Means Health Subcommittee chairman, armed with recommendations. Thomas 381
382 Washington Watch
popped their balloons in a hurry, saying, “There is nothing you can teach me about Medicare.” So much for 40 years of practicing medicine. Surprisingly, Coburn has little use for the American Medical Association (AMA), citing the activities of their attorneys and lobbyists on the Patients’ Bill of Rights as being out of touch with the needs of rankand-file physicians and their patients. These feelings were so strong that, immediately after leaving Congress in 2001, he resigned from the AMA. Another casually dropped nugget was the 1964 estimate by the Lyndon Johnson administration that Medicare would cost the federal government $12 billion in 1990. Actual price tag: $110 billion. Unexpectedly, the harshest barbs of the book are reserved for Newt Gingrich and Dick Armey. Coburn quickly rebuts the public image of the lockstep loyalty of the class of 1994 to these two Republican leaders. Rather, he paints a picture of endless rivalry and duplicity between the two, including an assertion that Armey was behind the two efforts to overthrow Gingrich in 1997 and1998 (the latter was successful). Coburn has little use for
either man, and apparently he was not alone. Outward shows of solidarity aside, fellow Republicans in the class had a ditty for Gingrich: “Fire! Ready! Aim!” The political reflections are the strongest part of the book, and here, Coburn’s independent streak shines bright. He despises two fundamental parts of Washington life: careerism and pork. Campaign promises vilifying Washington insiders aside, newly elected politicians begin plotting reelection efforts before unpacking their bags in the Capitol, along with plans to become “insiders” as soon as possible. Coburn, of course, sees term limits as the antidote to this careerism, and he took a 3-term pledge along with many other members of the class of 1994. In one of his best observations, he postulates a strong association between careerism and partisanship. That is, the politician who shouts liberalism or conservatism, right or wrong, is probably aiming for leadership in his or her party rather than championing a deeply held political philosophy. Coburn spares nothing in his criticism of congressional earmarks or pork. Certainly, his gutsiest stand during his 6 years concerned such an issue. The tangle was with
Bud Shuster (a Pennsylvania Republican), the chair of the House Transportation Committee. In the spring of 1998, Coburn alleged that Shuster’s lieutenants offered him and other congressmen $15 million in earmarks to support a particularly pork-laden highway bill. He noisily rejected the offer. After the ABC Evening News aired the story, Shuster marched to the House floor and compared Coburn’s unsubstantiated allegations to those of Joseph McCarthy a half century earlier. Not a friendly exchange. Coburn is a very conservative man, and his views will rankle many. But on the whole, this book is a worthwhile read. Every large medical group or hospital staff has a Tom Coburn: the physician who sees issues in black and white, not shades of gray. When this doctor stands to speak at a professional society meeting, half the group cringes, and the other half quietly cheers. Aggravating, opinionated, bombastic, self-righteous, maybe, but never boring. Long may they live. REFERENCE 1. Coburn TA. Breach of trust: how Washington turns outsiders into insiders. Nashville (TN): WND Books; 2003.
Michael J. Pentecost, MD, Department of Radiology, Georgetown University Medical Center, 3800 Reservoir Road, NW, Washington, DC 10007-2197; e-mail: [email protected].
MICHAEL J. PENTECOST, MD
Tom Coburn, MD: A Doctor in the House Dr. Tom Coburn was certainly not the first physician to serve in the U.S. House of Representatives, but he may be one of the most memorable. In his recent book, Breach of Trust [1], the Republican congressman recounts the story of his stint in the House from 1995 to 2001 representing the second district of Oklahoma. Along with 72 other new members, Coburn was elected in the 1994 revolution when the Democrats lost control of Congress after the failure of President Clinton’s Health Security Act. Behind the leadership of House speaker Newt Gingrich, the “class of 1994” spearheaded passage of the Contract with America within 100 days of taking office. Having honored a self-imposed 3-term limit, Coburn is now back in Oklahoma practicing medicine. His book, like most political memoirs, is part autobiography, part vignettes, and part philosophical reflections. The autobiographical elements of the book are compelling, but not because Coburn is such a unique figure. On the contrary, many practicing physicians will easily identify with this colleague because by any standard, he is a regular guy. No New England prep school background, no Ivy League medical degree, not even a master’s in public policy, for goodness sakes. Rather, Coburn was an Oklahoma State accounting undergraduate with a medical degree from the University of Oklahoma. No boutique Boston, Manhattan, or Washington medical practice here. He was and is a general practitioner and obstetrician in Muskogee, a city of 38,000 in the eastern part of the state.
Starting with page 1, it is clear that this is not a story about a man with lifelong political ambitions who happens to be a doctor. Instead, in June 1994, because of concerns about growing government intrusiveness, Coburn decided on the spur of the moment to run for Congress. He challenged Mike Synar, an 8-term incumbent Democrat in a district that hadn’t sent a Republican to Congress since 1920. And, lo and behold, Coburn won. Like his road to Congress, Coburn’s path to medicine was not a traditional one. In 1975, at the age of 27, married and with young children, Coburn was diagnosed with malignant melanoma. Even after a radical neck dissection, he was given a 20% chance of survival. He credits this battle against cancer with piquing his interest in medicine and deepening his compassion for others. As with many who hear mortality’s clock ticking early, Coburn also became determined to make a mark in life. Increasingly optimistic about his survival 4 years later at age 31, Coburn decided to leave his successful business career with an opthalmic device company and enter medical school. Inevitably tagged with the nickname “Gramps” by fellow students, he completed his studies, settled into practice in hometown Muskogee, and the rest is history. Coburn sprinkles tidbits of gossip throughout the book. Because he is a conservative Christian, none of these are exactly titillating, but many are interesting, behind-thescenes looks at Washington political life. He gained public attention for his tiff with the House Ethics Com-
© 2004 American College of Radiology 0091-2182/04/$30.00 ● DOI 10.1016/j.jacr.2004.02.018
mittee over his weekend “fiduciary” duties. Admirably, Coburn returned to Muskogee every weekend and took call. No showboating but real obstetrics call, delivering babies (over 400 during his time in Congress). The committee ordered him to stop because these children or “clients” might unduly influence him in his legislative duties. Claiming the moral high ground (and no doubt seeing a public-relations bonanza), Coburn disobeyed this edict and continued his practice. The committee quickly backed down. Coburn’s independence and mouth occasionally got him into trouble. After publicly chastising director Steven Spielberg for the nudity in Schindler’s List, he was nearly run out of Washington. Nor was he always steadfast about political stances, having flip-flopped on a bill that limited the growth of federally supported credit unions. As evidence of politicians’ considerable egos, Coburn recounts the little-publicized effort in 1999 of Senator Tom Harkin (an Iowa Democrat) to have the Centers for Disease Control and Prevention named after himself. Neither Republicans nor Democrats are immune from such vanity. At the same time, Pennsylvania senator Arlen Specter had his eye on the National Library of Medicine as a namesake. Both initiatives failed. Confident that their expertise about medicine would be greatly valued, Coburn and two other newly elected physicians, Dave Weldon from Florida and Greg Ganske from Iowa, approached Bill Thomas (a California Republican), the House Ways and Means Health Subcommittee chairman, armed with recommendations. Thomas 381
382 Washington Watch
popped their balloons in a hurry, saying, “There is nothing you can teach me about Medicare.” So much for 40 years of practicing medicine. Surprisingly, Coburn has little use for the American Medical Association (AMA), citing the activities of their attorneys and lobbyists on the Patients’ Bill of Rights as being out of touch with the needs of rankand-file physicians and their patients. These feelings were so strong that, immediately after leaving Congress in 2001, he resigned from the AMA. Another casually dropped nugget was the 1964 estimate by the Lyndon Johnson administration that Medicare would cost the federal government $12 billion in 1990. Actual price tag: $110 billion. Unexpectedly, the harshest barbs of the book are reserved for Newt Gingrich and Dick Armey. Coburn quickly rebuts the public image of the lockstep loyalty of the class of 1994 to these two Republican leaders. Rather, he paints a picture of endless rivalry and duplicity between the two, including an assertion that Armey was behind the two efforts to overthrow Gingrich in 1997 and1998 (the latter was successful). Coburn has little use for
either man, and apparently he was not alone. Outward shows of solidarity aside, fellow Republicans in the class had a ditty for Gingrich: “Fire! Ready! Aim!” The political reflections are the strongest part of the book, and here, Coburn’s independent streak shines bright. He despises two fundamental parts of Washington life: careerism and pork. Campaign promises vilifying Washington insiders aside, newly elected politicians begin plotting reelection efforts before unpacking their bags in the Capitol, along with plans to become “insiders” as soon as possible. Coburn, of course, sees term limits as the antidote to this careerism, and he took a 3-term pledge along with many other members of the class of 1994. In one of his best observations, he postulates a strong association between careerism and partisanship. That is, the politician who shouts liberalism or conservatism, right or wrong, is probably aiming for leadership in his or her party rather than championing a deeply held political philosophy. Coburn spares nothing in his criticism of congressional earmarks or pork. Certainly, his gutsiest stand during his 6 years concerned such an issue. The tangle was with
Bud Shuster (a Pennsylvania Republican), the chair of the House Transportation Committee. In the spring of 1998, Coburn alleged that Shuster’s lieutenants offered him and other congressmen $15 million in earmarks to support a particularly pork-laden highway bill. He noisily rejected the offer. After the ABC Evening News aired the story, Shuster marched to the House floor and compared Coburn’s unsubstantiated allegations to those of Joseph McCarthy a half century earlier. Not a friendly exchange. Coburn is a very conservative man, and his views will rankle many. But on the whole, this book is a worthwhile read. Every large medical group or hospital staff has a Tom Coburn: the physician who sees issues in black and white, not shades of gray. When this doctor stands to speak at a professional society meeting, half the group cringes, and the other half quietly cheers. Aggravating, opinionated, bombastic, self-righteous, maybe, but never boring. Long may they live. REFERENCE 1. Coburn TA. Breach of trust: how Washington turns outsiders into insiders. Nashville (TN): WND Books; 2003.
Michael J. Pentecost, MD, Department of Radiology, Georgetown University Medical Center, 3800 Reservoir Road, NW, Washington, DC 10007-2197; e-mail: [email protected].