Rep. Jim Cooper must be one of the few House Democrats who is even remotely satisfied with the way health care reform passed last weekend.
To get approval for the base reform bill that the president has now signed, Speaker Nancy Pelosi was forced to swallow a foul-tasting pill and hustle a 100 percent additive-free Senate bill on the House floor. Her progressive peers looked on as a strong employer mandate and the millionaire’s tax were swept into the dustbin. And they had no guarantee that the Senate would sign off on any of the fixes the House wanted, particularly given the Hatfield-McCoy-esque bicameral feud between the chambers.
Yet while progressives squirmed under centrist compromise, and Blue Dogs from conservative districts writhed beneath an intense populist pressure back home that most buckled under, Cooper was sitting pretty here in Nashville. This moderate Democrat — with no allegiance to the more liberal House bill and an affinity for the restrained, fiscally modest Senate bill — was cool in an undecided hinterland, leveraging himself against the House bill with a deliberately ambiguous position. Meanwhile, doctors were lighting up the switchboards at his office, encouraging him to vote for reform. Then Nashville’s hospitals came out for the Senate bill. It was with registered surprise that onlookers saw the historically conservative American Medical Association offer its support, however tepid.
This turned out to be a no-sweat vote for Cooper.
After casting an initial leap-of-faith vote in November for a House bill he didn’t care for and with an eye toward a Senate bill that hadn’t yet passed, Cooper and his moderates slapped a “deeply upset” House leadership by locking arms with Republicans in a dramatic gambit. So keen is some House Democrats’ loathing of the Senate, Cooper told The City Paper, that they opted to use an awkward parliamentary rule — oft-used by both parties — to append amendments to the Senate bill without actually voting on it.
Cooper believed it would put passage of the Senate bill in jeopardy. And he didn’t care for the reconciliation bill, which he said adds $200 billion to the overall price tag. So Cooper made sure House leadership knew his vote was not, by any stretch, in the bag. Then Cooper, along with moderate Democrats and a whole passel of Republicans, voted to force an up-or-down vote on “deem and pass,” and Democrats abandoned the approach, clinging desperately to waffling moderates.
Now Cooper was free to vote first for the Senate bill, then to oppose the reconciliation bill. Plus, Cooper said, it eliminated the threat that such parliamentary maneuvering could provide ammunition for federal judges seeking to make names for themselves by ruling the entire bill unconstitutional. “It’s not an out-of-bounds technique, but in this divisive environment, we need to keep things straight down the middle,” he said.
Cooper was able to vote for the bill while preserving his stance as a deficit hawk.
In his estimation, punditry has ignored opportunity costs and what they mean when interpreting the cost of doing nothing to curb a $3 trillion-a-year increase in unfunded obligations — Medicare, Medicaid, Social Security. Items in the Senate bill, like insurance exchanges that foster healthy competition among private insurers, curb the increase. A tax on “Cadillac plans,” or insurance plans that cost more than $27,500 annually, does it, too. Not to mention a “bundling” program that would set up a single fee for treating an illness rather than the prevailing pay-per-treatment mode that leads to inefficiencies when health care providers are incentivized to treat more in order to get paid more.
Those are a few things that will cut the cost of this country’s greatest expense — a health care system that is estimated to waste as much as $700 billion a year, according to a Thomson Reuters analysis. And they bend the cost curve Cooper rails about like the sunken-eyed, bearded man blocking the sidewalk, intoning, “The end is near.” Only we are sinking into a hole that could lower the credit rating of the United States, a Moody’s analyst has warned. And the right bend in the cost curve could be just enough to take us down the right fork in the railway split, away from the loss of the AAA rating the world’s richest nation currently enjoys.
Or, as Cooper said, take that $3 trillion in unfunded obligations, divide it by 365 days and see what you get. Answer: $16 billion a day is the opportunity cost of doing nothing. That number alone made his decision to vote for reform an easy one, he said. If people understood that number, he added, it might go a long way toward dispelling the myth that only Republicans are fiscally conservative.
“One of the main things people don’t understand about politics is that opposites attract,” Cooper said. “Only Nixon could go to China. Only a liberal Democratic president like Barack Obama can curb entitlement spending, so we need to let him do that.”
Having, in part, helped to ensure moderate legislation found its way to Obama’s pen Tuesday morning, Cooper is content to let him do just that, his deficit-curmudgeon stripes intact and unsullied, and cries that he’s on the take in this health care town largely silenced — Cooper was paid more by companies seeking to defeat reform than those seeking its passage, according to the Center for Responsive Politics.
Sure, he said, the bill isn’t perfect. Cooper wishes we were paying for the entire insurance coverage expansion by whittling down waste instead of implementing new taxes.
As for the pall of partisanship hanging over the bill, Cooper is unmoved. He estimated there are 20 to 30 Republicans who wanted to vote for health care but feared losing their seats. They’d been maneuvered into a corner by some of the party’s more fanatical factions.
“Sometimes when people tell ghost stories,” he said, “people believe there are ghosts.”