Jim Cooper's presentation at Naked Hospital 2010- "Unpacking Health Care Reform"

1. Unpacking Health Care Reform
Congressman Jim Cooper (TN-05)
May 24, 2010
Congressman Jim Cooper
Aug. 26, 2010

2. Who is Jim Cooper?

3. My favorite
animal

4. Published in You get your
2006 to warn favorite
Americans of company’s
our true debts annual report;
why not your
favorite
country’s?
© Jim Cooper 2008. All rights reserved.

5. A “Blue Dog” Democrat, a Centrist
#5 on Speaker Pelosi’s bad list
#3 on Tea Party’s bad list

6. Questions about Health Care
1. Can we afford it?
2. Is it too radical?
3. Is it big government?
4. Is it worth it?

7. What works?
• 40% behavior
• 30% genetics
• 15% social conditions
• 10% remedial health care
• 5% environment
Steven A. Schroeder, M.D., We Can Do Better – Improving the Health of
the American People, New England Journal of Medicine, 357:12, p. 1221,
Sept. 20, 2007.

8. Entire health bill could have
been two words:
Diet and exercise

9. U.S. health care BEFORE reform
25
20
Private Health
Millions of Americans
15 Insurance:
160 million
10
5
Uninsured: 47 million Medicare:
44 million
Medicaid: 60 million
0
5
15
25
35
45
55
65
75
85
95
5
10
Age Cohorts

10. A typical life story
25
20
Private Health
Millions of Americans
15 Insurance:
160 million
10
5
Uninsured: 47 million Medicare:
44 million
Medicaid: 60 million
0
5
15
25
35
45
55
65
75
85
95
5
10
Age Cohorts

11. U.S. health care BEFORE reform
25
20
Private Health
Millions of Americans
15 Insurance:
160 million
10
5
Uninsured: 47 million Medicare:
44 million
Medicaid: 60 million
0
5
15
25
35
45
55
65
75
85
95
5
10
Age Cohorts

12. U.S. health care AFTER reform
25
20
Private Health
Millions of Americans
15 Insurance:
182 million
10
5 Uninsured: 15 million
Medicare:
44 million
Medicaid: 75 million
0
5
15
25
35
45
55
65
75
85
95
5
10
Age Cohorts

14. Timetable for Health Reform
Look for adjustment
legislation annually

15. Total Elderly
http://www.worldmapper.org/display.php?selected=6

16. Private Health Spending
http://www.worldmapper.org/images/largepng/214.png

18. What is right amount of care?
Physician Patient Business
Professional Ideals: Hippocratic Oath: Survival Instinct: Optimization:
Everyday goal Do no harm; Get well soon; Marginal cost =
Patient comes first Right to health marginal benefit
care? Scarce resources
Ideal in economic $1.00 of care = Zero $1.00 of care = $1.00 of care =
terms benefit $0.10 of benefit $1.00 of benefit
Ideal stated $-0.01 of harm is $0.09 of care is not $0.99 of care is not
negatively not worth it worth it worth it
Greatest fear Don’t lose patient Don’t pay retail Don’t waste $$$$

20. 1. Can we afford it?

21. Cost of delay: ~$8 billion a day?
Costs more to argue
than to solve the problem!

23. Health
Private Health
insurance

24. CMS Actuary Report 4/22/10

26. We must slow the rate of growth
of health spending by 1% or 2%
In Washington, that means
“cutting spending”

27. Moody’s
• “If no policy changes are made, in 10 years from now
we would have to look very seriously at whether the
U.S. Treasury bond is still a triple-A credit.”
• “The U.S. rating is the anchor of the world’s financial
system. If you have a downgrade, you have a
problem.”
• Medicare and Medicaid are the “cause of major fiscal
pressures.”
– Steven Hess, Lead Analyst for U.S., Moody’s,
Jan. 11, 2008 (Now the outlook is much worse!)
© Jim Cooper 2008. All rights reserved.

28. “Preserving debt
affordability at levels
consistent with Aaa
ratings will invariably
require fiscal
adjustments of a
magnitude that, in
some cases, will test
social cohesion.”
- Moody’s Report, March 2010

29. Health reform slows Medicare growth
1. Reform bill “cuts” Medicare spending growth
by about $50 billion annually (largest
Medicare cuts ever!)
– If you want more, support more, not less
2. U.S. health care is wasting $700 billion
annually
– It is possible to cover everyone and save money
– But we’ll have to watch it like a hawk!

30. Cost of
health
care reform

31. Key Budget Tools
Entitlement reform: Fiscal Commission
Pay-as-You-Go: 1990-2002, restored 2010
Discretionary Spending Freeze: Obama Budget
– The least we can do; I support 5% cuts
4. Stop digging deeper holes
– “Fun” deficit spending: SGR, AMT, Estate Tax, etc.
5. Adopt accrual accounting for federal gov.
6. Stop all “earmarks,” not just to corporations

32. Upcoming vote on Medicare doctor
pay will have more deficit impact
than all of health reform
$300 billion over 10 yrs.,
$4.2 trillion for permanent fix

33. 2. Is it too radical?

34. Baby
kille
rs!
th ls!
ea ne
D Pa

35. Affordable Care Act is not radical
• Similar to Richard Nixon’s 1970 health plan
• Similar to Republican health plan in 1990s
– Dozens of Republican Senators supported it
• Obama adopted the central plank of McCain’s
health reform plan of 2008
– Scored by CBO to lower deficits
• Similar to Howard Baker, Bob Dole, Tom
Daschle principles for reform in 2009

36. "I like the bill"
- Bill Frist,
at American Hospital Association April 2010
“It's an important step. The provisions related to
changing provider payments are significant in terms
of their potential for reducing spending growth...”
- Mark McClellan,
former head of Centers for Medicare and Medicaid under
President Bush, a day after the bill passed.

37. Repeal?
Improve
?
Hospitals,
AMA,
Nurses,
Nuns,
AARP,
Phrma

38. 3. Is it big government?

39. Reagan Clinton

40. We
Need
Cuts

41. Opposites attract:
Only Nixon could go to China

42. but barely
touched it
as President.
Bush made
© Jim Cooper 2008. All rights reserved.
it worse!

43. Only a liberal can reform entitlements?

44. 4. Is reform worth it?

45. Wyden-Bennett
Cooper-Breaux

46. Voted for
Senate
Health Bill
Voted against
Side Car
(reconciliation)
Biggest
Medicare
“cuts” in history,
plus Cadillac tax

47. Senate Health Bill Side Car
High
Net-
Worth
Taxpayers
Cadillac Tax
Deloitte, Prescription for change ‘filled’: Tax provisions in the Patient Protection and
Affordable Care Act, March 23, 2010

48. Thomas Gryta,
WSJ, April 13, 2010

49. TN is in the Bottom Quintile
Ranking from data collected January 2, 2009 – December 30, 2009

50. Tennessee is not
on this list! Yet!

51. So is this
good medicine?
You decide