An Egghead Talks 

A schooled health care mind shares his thoughts

A schooled health care mind shares his thoughts

Fifth District Congressman Jim Cooper may know more about health care policy than anybody in Tennessee. Aside from his credentials as a former adjunct professor on the subject at Vanderbilt University's Owen School of Management, Cooper offered a competing proposal to the Clinton administration's failed universal health care plan in the mid-'90s. The Scene this week talked with Cooper about Gov. Phil Bredesen's TennCare reform proposal.

What are your thoughts about the governor's proposal?

Well, first of all, it's the only proposal. And I think the governor's gotten a bum rap. I think he's a very caring, decent and capable person who bleeds when anybody in TennCare is cut. But he's doing the best he can under difficult circumstances. He inherited almost all of these problems, and until somebody comes up with a better solution, his is the only one on the table. The Tennessee system has been out of whack for a long, long time, and Gov. Bredesen just has the sad duty of being on the job when the bills come due.

You're an expert on pharmaceutical costs. Is there anything a single state can do in negotiating drug prices and drug availability in the context of a Medicaid program like this?

There is. There are really two issues here. One is—and this is a strong-sounding statement, but I think I can back it up—we're almost bankrupting ourselves in an effort to poison ourselves. Tennesseans are on more medications than people of any other state. In fact, we're on so many medications that it's impossible for anyone to prevent those medications from interacting in our bodies in a way that is poisonous or harmful.

The first and greatest issue is to try to be as healthy as other states by reducing our overmedication because Tennessee has been victimized by drug companies worse than any other state. It's not just that we're taking more medicine; we're taking more brand-name medicine, the most expensive kind. We have swallowed whole the sales pitch of every major drug company in America....

The second problem has to do with getting drugs at a discount. Several states, especially New England states and Northern plains states, have done everything from attempting to buy medicines from Canada to being very tough with the pharmaceutical companies. And certainly Tennessee can do plenty of that. But you can't put all the monkey on the back of the pharmaceutical companies. Tennessee doctors and Tennessee patients and Tennessee loved ones have swallowed whole whatever medicine they've wanted to sell us.

Unquestionably, the greatest short-term savings can come from a more intelligent purchase of pharmaceuticals, and the governor is working hard on that.

How will Tennessee absorb this, given that Tennessee doesn't have the kind of public health infrastructure other states have outside of their Medicaid programs?

Now, it is true that we have few MCOs (managed care organizations) and that MCO infrastructure has been relatively weak, but the primary reason for that is underpayment on TennCare from the first day it was started. No major MCO outside of Tennessee has bothered to participate because they knew it was a poorly set-up program. And the primary technical reason for that is, when TennCare was started, no actuarial study was done to determine the proper reimbursement level until six years, I think it was, after the program was underway. They picked a number—and I forget now exactly what that number was, but it was something on the order of $100 per member per month—and it turned out they picked wrong. But that was the number that happened to fit the state budget at the time.

Do you foresee any kind of perfect storm in the future when TennCare can go back to covering uninsurables and a larger population of the poor? Is this the best we're going to do?

As I said earlier, it's the only plan, and I've been trying to follow this very closely. I think the governor has a good heart, he's got a sharp mind, and he's doing the best that he can. As I say, there have been a lot of critics and very few performers.... It's easy to pretend that this is someone else's problem, but this is the problem of everybody in Tennessee....

Has the governor brought you in on some of these discussions?

Oh yeah, and I was involved in some of the earliest efforts to get Gordon Bonnyman and the governor together.... The governor is doing the best that any human being can do.... Previous governors have tried to increase revenue, and that's clearly not possible now, so what's the governor going to do? He's honest; he ran on a no-tax platform. People get the government they vote for. As I recall in that election, no one ran on a tax-increase platform. If someone does want to run on a tax-increase platform, they're welcome to do so.

Is Gordon Bonnyman really as unyielding as the governor has characterized him to be?

I like Gordon. I have worked with him well in the past. I want to continue to work with him well in the future. I think right now he's wearing several hats, and as an attorney for the class he has very little leeway. I think it's very hard for him to take that hat off because he's just one person and he can't suddenly be a public policy advocate because a lawyer is supposed to be loyal to his clients.... I'm not faulting Gordon. I think he's an outstanding public servant.... I do think he's won decisively the public relations battle here, and I think that's a little one-sided because as great as Gordon is, he's not perfect and doesn't claim to be.

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