Archive for August 19th, 2009|Daily archive page

Co-ops or Nothing?

The White House seems poised to abandon its insistence on a public option and cave in to industry interests at the expense of the American consumer. They have very recently reiterated that they continue to support the measure, but that support grows squishier and squisher by the day. I’m not ready to write any postmortem for the public option, because I think Senate progressives have more fight in them on this matter than is commonly acknowledged. I also think Reid, Baucus and Conrad put themselves in serious danger of losing their powerful posts if they fail to deliver a public option to the American people (note: I’d be willing to bet Schumer was the “unnamed Senator” quoted in support of Harkin’s idea).

But for a second, for strategy’s sake, let’s hypothetically assume the public plan is dead. At that point, what do supporters of meaningful health care reform do?As I see it, we have 3 major alternatives:

1) Accept the co-op plan, swallow our disappointment and get back into the trenches to push the remaining provisions that would still be a major step in the right direction.

2)Drop our support for the remaining reforms altogether and continue pushing for the public option.

3) Push to remove the co-op plan, on the premise it would be a waste of provide a false sense of competition to the murder-by-spreadsheet industry and blunt the calls for further reform.

I believe option #3 is the strategically correct one, for two basic reasons. First, regional co-ops are a waste of time and $. We tried that already in America: it’s called Blue Cross Blue Shield. The BCBS regional groups were founded primarily to function as non-profit entities, but ultimately were forced by market competition to adopt the practices of a for-profit insurance company: restricting coverage, excluding pre-existing conditions, charging exorbitant premiums and, of course, paying massive salaries to their executives. Even those that have retained their non-profit status function as if driven by the profit motive. There is absolutely no reason to believe that Conrad’s co-op plan would not meet exactly the same fate, completely fail to drive down costs, and piss away gobs of money in the process. Indeed, Blue Cross themselves may be the prime beneficiaries of this program; the various affiliates are apparently seeking to change their legal framework to that of a “non-profit cooperative” to take advantage of all that prospective federal largesse.

Second, co-ops would serve as a foil for those seeking to rein in murder-by-spreadsheet  industry excess. You can just see the apologists crow a couple years down the road when nothing’s changed: “Give it a few more years! The co-op effect hasn’t really kicked in yet!” And as politicians continue to drag their feet at the request of health care profiteers, millions will continue to find comprehensive care unaffordable or downright impossible to get. On the other hand, without any sort of pretend competition and an individual mandate bringing more people into the system, the calls for a government-run plan will grow ever louder. Letting the private insurance industry continue to run amok could lead to a strong public plan or even single-payer a few years down the road, when the current system completely breaks down and the Medicare Trust Fund dips into the red.

So I believe we should make this case quickly and loudly to dispel the notion that the cooperative framework is in any way a reasonable compromise position. Let us know in the comments if you’re interested in pursuing this effort.