The Minimalist Case for Continuing with Health-Care Reform

A democratic congressman explains how if Obamacare is repealed, it will only result in further stalemates on how to fix the system. Returning to the status quo is clearly not an option. 

doctor-615.jpgFlickr/Alex E. Proimos

Almost every economist agrees that the American health care system is unsustainable. Medical care is so expensive that it is busting all of our budgets -- government, business, and personal. Eventually, the medical price bubble will pop.

Repeal is great politics, because it ignites public hatred. It will not automatically lead to improvement, however.

What, then, are the alternatives? In 2010, the federal government started implementing a new approach that will cover virtually everyone with health insurance while encouraging doctors and hospitals to deliver care more efficiently. Health providers are getting some 30 million more paying customers in return for agreeing to waste less money.

It's called, of course, the Affordable Care Act (ACA), or Obamacare. Drafted by congressional Democrats, it bears a striking resemblance to Governor Mitt Romney's state-level reform in Massachusetts, Romneycare. Despite the popularity of most of its components, the ACA is highly controversial (constitutional issues aside) -- and also poorly understood and needlessly partisan.

I like to tell opponents of the ACA that before you criticize the law, state your preference for an alternative, because -- remember -- the status quo is not an option. Republican talk of "repeal and replace" is very heavy on "repeal" and light on "replace." Repeal is great politics, because it ignites public hatred. It will not automatically lead to improvement, however, because passing major health-care reform takes many years -- even decades, if history is any guide. Repeal will almost certainly return us to the status quo, with all of its dangers. Replacement has become virtually impossible now, after the 2012 Republican primaries, because no candidate has offered a constructive alternative.

The Supreme Court should also be wary of overturning the ACA, because, as even Justice Scalia noted, how can you surgically remove parts of a 2,700-page bill without killing the overall reform? Justices can only subtract, not add: their proper restraint in legislating from the bench prevents the construction of a coherent alternative.

So let's cool the rhetoric. As we say in Tennessee, "Any mule can kick a barn down -- it takes a carpenter to build one." Where are the carpenters in either political party?

I am the Democrat who wrote the alternative to Clintoncare (Cooper-Breaux), championed the leading alternative to Obamacare (Wyden-Bennett), and who often votes for Band-Aids that Republicans pretend are alternatives to genuine reform -- association health plans, health savings accounts, interstate insurance sales, malpractice reform, and premium support.

Almost all of these centrist and Republican proposals have failed to become law, except for a few demonstration projects, even when Republicans controlled the White House and Capitol Hill. Most of these proposals never had a chance. Nevertheless, I am proud of working hard for bipartisan health-care reform. As Jefferson said, "Great innovations should not be forced on a slender majority." This is particularly true in health-care reform, because health issues are so intimate and existential.

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I have the battle scars to prove that there are precious few plans that could conceivably pass Congress, other than the one that recently defied the odds, the ACA. To the dismay of passionate advocates, single-payer has no chance, nor does herding Americans into high-deductible plans. Ideologues on the left and right should put their dream scenarios on hold -- let's make the ACA work. America's greatest strength has always been pragmatism.

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Jim Cooper is a Democratic member of the U.S. House of Representatives, serving Nashville and its surrounding areas. More

Jim Cooper has represented Nashville and surrounding areas in the U.S. House of Representatives since 2002. Cooper sits on two House committees, Armed Services and Oversight and Government Reform, and was the lead sponsor of bipartisan legislation to address the issue of the federal deficit. His proposal of a bipartisan fiscal commission became the model for the president's National Commission on Fiscal Responsibility led by Alan Simpson and Erskine Bowles.

A graduate from the University of North Carolina at Chapel Hill, Cooper earned a B.A. in history and economics as a Morehead Scholar in 1975. He received a B.A./M.A. in politics and economics as a Rhodes Scholar from Oxford University in 1977, and a J.D. from Harvard Law School in 1980. Currently, Cooper teaches a course on health policy at the Owen School of Business at Vanderbilt University. He and his wife, Martha, live in Nashville and have three children.

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