Commentary: Disappointed in Cooper’s vote

Sunday, March 28, 2010 at 11:45pm
Crom Carmichael

Jim Cooper is a smart man and a conscientious member of Congress. There are a number of policy issues where we don’t see eye to eye, but I have always respected his intelligence and believed he was dedicated to doing what’s best, as he saw it, for the 5th District of Tennessee and for the United States.

That’s why his vote on health care “reform” last weekend, and especially his public statement explaining that vote, are so disappointing. Cooper knows as much about our health care system and how badly it’s broken as any member of Congress. He should have been a leader in truly reshaping the system, eliminating its flawed foundations, and reforming the system to create a new paradigm based on personal responsibility, transparency about costs, real options for patients in choosing among health care options, and real competition among providers — which would lead inevitably to lower costs, greater efficiency and higher quality.

Instead he participated in what is essentially a charade that continues the decades-long practice of hiding the true cost of health care from the American people, perpetuating a fantasy world in which “everything will be taken care of, so don’t worry, your personal health choices don’t matter, Father Government will take care of it.” The new “reform” bill leaves in place all the existing players, all the existing ill-advised tax breaks, cumbersome bureaucratic arrangements, and endless paper-pushing people and processes who add no value, only cost and confusion, to the system.

Cooper’s statement explaining his vote is a model of political disingenuousness that makes it clear he understands this but has chosen to ignore it, presumably for political reasons. He touts the fact that lots of hospitals, doctors and medical organizations favor the bill. He doesn’t mention it, but so do the insurance companies. Why might this be? It’s not hard to figure out, and it’s not possible that Cooper doesn’t know. All this bill does is keep the current system and players in place and throw more money at the system, as well as requiring that everyone become a customer. The American taxpayer pays the bill so that insurance companies can have many more paying customers, and hospitals and other providers can dramatically reduce their biggest financial problem: bad debt. Nothing really changes except that the burden on productive America goes up astronomically, incentives to increase utilization remain in place, and all the money-sucking, soul-numbing bureaucratic nonsense that characterizes the current system remains.

What’s different is that we’ve taken a giant step toward the Californication of the United States, spending money we don’t have and making promises we can’t keep. Bankruptcy looms. Cooper knows this. He has in the past been an eloquent spokesman for fiscal responsibility. The Wall Street Journal correctly summarized the situation when it said Cooper’s health care vote(s) have rendered all of his past statements and work toward increasing the fiscal responsibility of the federal government “irrelevant.”

It is all a terrible shame, because he knows better and could have, should have, done everything in his power to push the process in a different direction. How might that have looked?

Let’s start with a quiz. What does a gallon of milk cost at Kroger? What about if you go to a convenience store instead of a supermarket? Do you pay attention to price differences, sales, specials and the like? All of us do to some extent. It’s our money, and if we spend less, we’ll have more for other things. What does this mean to producers and retailers? Obviously, they must find efficiencies and keep prices as low as possible — at the risk of losing your business.

Would your behavior change if the federal government paid your food bill and if it was essentially impossible for you to find out the price of any of the items in the store? Well, that’s how it works in health care. Somebody else pays the bill and nobody knows what anything costs. Would it surprise you to learn that the very same procedure, a CAT scan, varies as much as $1,000 in price at two hospitals in Nashville within two miles of each other? How about the same drug varying more than 100 percent in price depending on where you fill your prescription? It’s true.

That’s the completely unsustainable world Jim Cooper voted to preserve. A world basically devoid of personal responsibility, market competition, price transparency and well-informed free people making decisions about matters important to them and their families. Is it possible to devise a health care system that embraces these American values and also gives every American access to affordable health care and protects families from financial disaster caused by unforeseen health care costs? I believe that it is.

Check back Tuesday morning for my solution.

Crom Carmichael is CEO of Nashai Biotech in Nashville. He is a longtime political commentator for various local media outlets.

20 Comments on this post:

By: govskeptic on 3/29/10 at 7:02

It's the cost of health care that's more important than
anything covered in this "reform" bill. Until competitive
pricing and efficiency begins to take place, cost to
government and insurance companies will spiral
ever upwards!

Our medical education system also has many issues
to resolve. You can't saddle an American educated doctor with
100's of thousands of dollars in education expense and then ask them
to be general practitioners or specialist with ever lower reimbursement
for services.

By: idgaf on 3/29/10 at 7:24

Why does it cost so much?

Because the government which insures about 50% of those that have health care pays at or near cost shifting the burden to those that pay for their own.

Now they want to insure millions more and give them more benifits. A recipe for disaster.

The government is the cause not the solution.

This is yet another welfare program just as the income tax credits was, where you get refunds for money you didn't pay. Its about control. According to the Rev Al you voted for socialism. DID YOU?

By: JDNash on 3/29/10 at 8:15

First of all, these criticisms that the reform did not go far enough on cost control are really tiresome. Yes, the reform could have been MUCH better on cost control. Nevertheless, that is NOT a reason to do nothing. This reform does more than any previous reform ever has. We should all agree that much more can be done. Nevertheless, a vote against this bill was a vote against cost control.

I am not saying that that was people's motivation. I am sure that they were primarily voting against increased spending. But it is very poor reasoning to criticize Cooper for voting for cost control, on the ground that he should have voted for more cost control. Particularly when there is no realistic alternative for cost control on the table and no realistic hope for cost control reform if/when the Republicans take over again.

By: JDNash on 3/29/10 at 8:19

Second, the Californication comment shows a profound misreading of how California got into the position it is in.

Opinion of this long-time California resident: California’s primary problem is that it puts unchageable tax and spend decisions in the hands of the electorate. As a result, you get Proposition 13-type absurdly unsound tax cuts, coupled with spending measures requiring the state government to spend billions of dollars on something, when the voters have no conception of what a billion dollars is or what the trade-offs are.

Whatever the policy implications of the healthcare reform are, the mechanics are nothing like the dynamics of California’s dysfunctional system. The healthcare reform on balance increases taxes, and with respect to the spending, was the result of a year-long extremely detailed hashing out by the people best situated to have a good sense of the spending tradeoffs (i.e., the elected representatives that have to make the spending choices everyday, rather than the only sporadically engaged voters).

And on a policy level, if you want to find a high profile California-style federal decision recently, the Bush Tax Cuts had the hallmarks of California-style governance (i.e., a revenue decrease with little or no thought put into how this will be paid for or how it would affect long term budgets) done to pander to the electorate’s dislike of taxes. (and I don't actually recall, but I would guess that the WSJ were big cheerleaders for that one).

A close second was the Bush Medicare prescription drug benefit. This time done to pander to the electorate’s love of getting stuff for free.

The Healthcare reform, as the Republicans keep telling us, did not particularly pander to the electorate. Rather, over the course of a tough year of negotiations, the measure is self-paid for through tough choices.

That the WSJ does not like the choices made about how to pay for it does not make it California-style. Quite the opposite, actually.

It is an absurd comparison, unless you flip it on its head. Then it is instructive.

By: vechester on 3/29/10 at 8:46

Imagine a law that mandates I as a citizen of this country buy something from a company. AND, regulates that purchase through the IRS with fines and penalties if I don't including imprisonment!

This is unprecedented and unconstitutional! Get ready for a showdown on this.

By: etoft on 3/29/10 at 1:06

JD. You are correct in one point. "[T]here is no realistic alternative for cost control on the table..."

The Democrats removed any reasonable, realistic approach that was placed in front of them, and gave us a incongruous conglomeration that only Dr. Frankenstein could love.

The only solution is to make pricing transparent. First, push back to standard 80/20 plans, so that people are re-connected with the costs. Second, provide for HSA's to cover deductibles and other out of pocket expenses, and these accounts should be able to earn interest.

The only workable govt. intervention would be to possibly provide a tax discount based on the scale of coverage that you purchase.

The free market will work if it is not hamstrung as it is now.

By: Heloise on 3/29/10 at 2:03

Excellent article, Mr. Carmichael. I especially liked the 'Jim's World' comment:
"A world basically devoid of personal responsibility, market competition, price transparency and well-informed free people making decisions about matters important to them and their families."

Jim's World in Washington told me he was making no decision on the healthcare bill until he could read it. (Of course his overlord Nancy Pelosi said it could be read when passed.) Did he expect me to believe that he read over 2,000 pages in less than 72 hours? The Constitution is much shorter. Maybe he should read it too.

Then, after the bill was passed, to add insult to injury, Jim's World sent me an email that said how this bill would save us money and help us all out (including students who need college loans!! ) etc. etc. And I have a bridge for Jimbo to buy right down from Government Motors. And a foreclosed house for sale down from car dealership, and some debt bonds . . . and the list grows with Jimbo in his job.

If Cooper expects us to go willingly down the path of a socialized government, good luck. He should look for a job in the private sector because he's going to need one come November. I've had it with blue dogs, yellow dogs and just plain dogs who want to chew up my Constitutional rights and dump on my hard-earned savings. I'm not going to just vote for someone else. I'm going to actively work against his campaign!

By: JDNash on 3/29/10 at 3:41


It is ridiculous to blame Democrats generically for taking all alternatives off the table. Democrats have been trying to work on this problem for generations. The Republicans killed reform in 1994 and have been ignoring it ever since then.

There were a huge number of alternatives on the table over the last year, most offered by Democrats, and they worked through and chose some.

By definition, in order to pass a bill, eventually you have to take all other options off the table. And you are left with one option -- the bill that gets passed.

I agree with you that one should employ the market forces as best one can. I am a huge fan of the power of smoothly-functioning markets. But the neither the healthcare primary market nor the healthcare insurance market are remotely smoothly functioning. And I don't think that there are any simple fixes for that, unfortunately.

I don't agree, for instance, that 80/20 goes far enough to create a proper market. It does nothing at all to make the health INSURANCE market competitive. And I am not convinced that having one party (you) with only 20% in the game who gets all the benefit of a procedure, along with another party (the insurer) who gets none of the benefit and pays 80% of the cost. And in a context where the patient really has no way rationally to assess the costs and benefits of a given procedure. This would continue to be a seriously screwed up set of incentives in the market A single payer system would actually allow a much more smoothly-functioning market on the healthcare primary side. I am sure you don't want that, though.

Ideally, the patient would pay 100% of the costs and would have all the information he/she needs to make the decision. Then a pure market would be great. Obviously a pipe dream, though.

So I am afraid that Frankenstein is going to have to do. Unless you want to throw up your hands with some half-assed, oversimplified miracle cure. Dr. Republican's Stupefying Mysterious Miracle Elixir!

By: pswindle on 3/29/10 at 7:28

And you think that you are not paying now. Everytime someone goes to the emergency room, you are paying for it. That is the reason that the insurance premiums go up and up and they pay less and less. Somthing had to be done, and I thank Rep Cooper for helping. If everyone pays something it will not all be on our backs, as it was, we pick up the whole tab. My parents said they some said that #SS and Medicare would break the Nation. I've got news for you that was done under Bush and Cheney.

By: idgaf on 3/30/10 at 5:51

If you think you are going to insure 30 million more people for less money you are delusional.

I don't know who you think will pay for subsidising people making up to 80,000 for a family of 4, and there will be many freebes.

By: sidneyames on 3/30/10 at 6:06

idgaf said "This is yet another welfare program just as the income tax credits was, where you get refunds for money you didn't pay. Its about control. According to the Rev Al you voted for socialism. DID YOU?"

No, I did not. idgaf, I'm not sure where the Obamaites have their heads buried. He has now made insurance mandatory, so everyone will have to purchase something from AN insurance company. I'm looking at investing some money in insurance company stock. It is BIG BUSINESS and Obama is a big business man. He is George Bush's twin brother in his philosophy of BIG BUSINESS.

Pswindle, Get your little pea picking head out from up your butt. The past is over. Get over it. 10 years from now, you and all our country will be wishing we had a leader who could lead, cut costs and get our country back.

Obama wants us middle class to be dummied down and poor. The rich will survive and he's RICH. I bet his retirement portfolio has insurance company stock in it.

By: rldavenport@com... on 3/30/10 at 6:57

Finally, a reasoned and rational discussion on this topic in this forum between people on both sides of the issue instead of the irrational name-calling by many who refuse to deal with other people's arguments and insights. Please continue in this vein!

By: Tull on 3/30/10 at 8:34

Rep. Cooper has spoken at numerous Vanderbilt Medical Center events about the federal defict and how it was out of control and something must be done and this was when Bush was president. Since Obama was elected he has not been the champion of fiscal responsibility and when he voted for this bill it was a betrayal of the people he was elected to represent. It is time to get poeple in office that represent the wishes of the people I had respect for Rep. Cooper but I will not vote for him ever again.

By: oyharward on 3/30/10 at 9:06

You don’t have to worry about Congressman Cooper. He, without any hesitation, voted for ObamaCare on the first round and then on the conciliation Rep. Cooper was most likely instructed by President Obama, Speaker of the House Pelosi, and Sen. Harry Reid to support this ObamaCare legislation. Rep. Cooper failed to listen to his constituency who was telling him to vote no. He even supported to force taxpayers to pay for abortions, cut Medicare and Medicaid payments to physicians, etc. Now Cooper will have to face his constituency in November.

When you look at Rep. Cooper’s Web, he shows many issues on the children. His voting record is leading America down the road toward Socialism, destroying the basic freedoms which have made America so free and open throughout our entire history.

Oscar Y. Harward

By: Slappy on 3/30/10 at 9:50

JDNash, not being able to pay for something is EXACTLY why you should DO NOTHING. You don’t buy a car you cant pay for [or perhaps you do…] so why do you think then that it is OK to institute a system of healthcare that WE cant pay for?

Healthcare is NOT an entitlement or a RIGHT, it can be a lot better but not this way.

We are spending our children’s money here with willful abandon. It is a disgrace that we are up to our necks in national debt and our creditors are starting to baulk at the idea of extending more…that should be a sign to become fiscally conservative.

I cant get past the logic that 6 years expense divided over 10 years of income is an honest of balanced budget AND don’t think for a minute that it wont cost a whole lot more than has been projected.

You say that these people are in the best position to make MACRO economic decisions…perhaps by virtue of their positions only. Most of these people don’t have a basic understanding of economics. They are in government because most would never really cut it in the private sector.

By: pswindle on 3/30/10 at 9:57

The GOP has nothing else to offer , but they can throw around the word, Socialism.
Do you consider SS and Medicare Socialism? If so, you should refuse to accept it.

By: oyharward on 3/30/10 at 10:06

AT&T said ObamaCare will cost them $1 Billion, John Deere’s ObamaCare cost is expected to be $150 Million. Caterpillar says ObamaCare will cost them $100 Million. Folks, this is new taxes on businesses. The list to businesses suffering increased future financial costs from ObamaCare will expand. These additional costs are passed on to consumers purchasing their products and/or using their other services. Elevating costs produces higher unemployment and inflation, again weakening existing and new jobs. America needs lower taxes and more jobs for (y)our economy to recover. As you hear other businesses in the Tennessee 5th. Congressional District and others throughout America having more layoffs, you can call Congressman Cooper and thank him for supporting by President Obama, Speaker of the House Pelosi, and Sen. Harry Reid in damaging our economy.

Congressman Cooper will now pay the price in November for his vote on damaging our US economy. It was Congressman Cooper who decided to vote against his own people and support Obama, Pelosi, and Reid.

Oscar Y. Harward

By: Slappy on 3/30/10 at 10:54

pswindle, Social Security is bankrupt and Medicare will be the same way in 4-6 years...SO what exactly is your point?

The FACT is that government [regardless of who is running it] could not even successfully manage to organize a p*ss up in a brewery - and you trust them with something as massive as YOUR healthcare??? Good luck with that sunshine - or should I say God help us!

By: pswindle on 3/30/10 at 1:47

You take away SS and Medicare and we will be a country of poverty. SS and Medicare is all that some have. That is what is wrong with most of the countries of the world, only the rich have and that is that. Where would this country be without SS and Medicare? It has saved many from going hungry and some from ever going to the doctor.

By: Tull on 3/31/10 at 9:28

I don't for the life of me understand the logic of cutting Medicare to pay for free health care for illegal aliens, welfare moms with multiple kids, people that can work and won't. My father payed into the system for 50 years and now his benefits gets cut to pay for people that have not contributed a dime! I don't have a problem with helping people that need help but not at the expensive of people that did the right thing all there life. This bill encourages people to not try and make a better life by hard work it will create a generation of people dependant on the goverment (our money). This thing will snowball into the largest entitlement EVER and will be the downfall of our economy.