congressman jim cooper- "unpacking health care reform"
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Jim Cooper's presentation at Naked Hospital 2010- "Unpacking Health Care Reform"TRANSCRIPT
Unpacking Health Care Reform
Congressman Jim Cooper (TN-05)
May 24, 2010
Congressman Jim Cooper
Aug. 26, 2010
Who is Jim Cooper?
My favorite
animal
© Jim Cooper 2008. All rights reserved.
Published in
2006 to warn
Americans of
our true debts
You get your
favorite
company’s
annual report;
why not your
favorite
country’s?
A “Blue Dog” Democrat, a Centrist
#5 on Speaker Pelosi’s bad list
#3 on Tea Party’s bad list
Questions about Health Care
1. Can we afford it?
2. Is it too radical?
3. Is it big government?
4. Is it worth it?
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.
Entire health bill could have
been two words:
Diet and exercise
U.S. health care BEFORE reform
0
5
10
15
20
25
5 15 25 35 45 55 65 75 85 95 105
Medicaid: 60 million
Medicare:
44 million
Private Health
Insurance:
160 million
Uninsured: 47 million
Mill
ion
s o
f A
me
rica
ns
Age Cohorts
A typical life story
0
5
10
15
20
25
5 15 25 35 45 55 65 75 85 95 105
Medicaid: 60 million
Medicare:
44 million
Private Health
Insurance:
160 million
Uninsured: 47 million
Mill
ion
s o
f A
me
rica
ns
Age Cohorts
U.S. health care BEFORE reform
0
5
10
15
20
25
5 15 25 35 45 55 65 75 85 95 105
Medicaid: 60 million
Medicare:
44 million
Private Health
Insurance:
160 million
Uninsured: 47 million
Mill
ion
s o
f A
me
rica
ns
Age Cohorts
U.S. health care AFTER reform
0
5
10
15
20
25
5 15 25 35 45 55 65 75 85 95 105
Medicaid: 75 million
Medicare:
44 million
Private Health
Insurance:
182 million
Uninsured: 15 million
Mill
ion
s o
f A
me
rica
ns
Age Cohorts
Timetable for Health Reform
Look for adjustment
legislation annually
Total Elderly
http://www.worldmapper.org/display.php?selected=6
Private Health Spending
http://www.worldmapper.org/images/largepng/214.png
What is right amount of care?
Physician Patient Business
Professional Ideals:
Everyday goal
Hippocratic Oath:
Do no harm;
Patient comes first
Survival Instinct:
Get well soon;
Right to health
care?
Optimization:
Marginal cost =
marginal benefit
Scarce resources
Ideal in economic
terms
$1.00 of care = Zero
benefit
$1.00 of care =
$0.10 of benefit
$1.00 of care =
$1.00 of benefit
Ideal stated
negatively
$-0.01 of harm is
not worth it
$0.09 of care is not
worth it
$0.99 of care is not
worth it
Greatest fear Don’t lose patient Don’t pay retail Don’t waste $$$$
1. Can we afford it?
Cost of delay: ~$8 billion a day?
Costs more to argue
than to solve the problem!
Private Health
insurance
Health
CMS Actuary Report 4/22/10
We must slow the rate of growth
of health spending by 1% or 2%
In Washington, that means
“cutting spending”
© Jim Cooper 2008. All rights reserved.
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!)
“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
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!
Cost of
health
care reform
Cost of
health
care reform
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
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
2. Is it too radical?
Death
Panels!
Baby killers!
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
"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.
Repeal?
Improve
?Hospitals,
AMA,
Nurses,
Nuns,
AARP,
Phrma
3. Is it big government?
Reagan Clinton
We
Need
Cuts
We
Need
Cuts
Only Nixon could go to China
Opposites attract:
© Jim Cooper 2008. All rights reserved.
but barely
touched it
as President.
Bush made
it worse!
Only a liberal can reform entitlements?
4. Is reform worth it?
Cooper-Breaux
Wyden-Bennett
Voted for
Senate
Health Bill
Voted against
Side Car(reconciliation)
Biggest
Medicare
“cuts” in history,
plus Cadillac tax
Deloitte, Prescription for change ‘filled’: Tax provisions in the Patient Protection and
Affordable Care Act, March 23, 2010
Senate Health Bill Side Car
Cadillac Tax
High
Net-
Worth
Taxpayers
Thomas Gryta,
WSJ, April 13, 2010
TN is in the Bottom Quintile
Ranking from data collected January 2, 2009 – December 30, 2009
Tennessee is not
on this list! Yet!
You decide
So is this
good medicine?
