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.

-Jeremy

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4 comments so far

  1. Bronwyn on

    Option #3 is far and away the best strategic choice. I would suggest you publicize this on DKos except that I don’t think they even want to acknowledge the possibility of losing right now. A lot of people have a hard time working passionately on a campaign AND formulating back-up plans for what they’ll do if they lose simultaneously.

    But I think that anyone who *can* do that should be doing it–it’s one of the weaknesses of our side in comparison with the far right. Seems like their leaders always have a back-up plan.

    • jeremydc on

      I do want to mention that I actually wrote this post in support of the public option. This isn’t even a backup plan as you put it Bronwyn. Although I do believe what I said and I guess it can serve as a fallback position, it’s primarily a strategic weapon we can wield to de-legitimize these insidious co-ops and help crush the viability of a “moderate compromise” position. Without that crutch to fall back upon, industry apologists will have to state unequivocally whether they stand with the American people or with the murder-by-spreadsheet industry. In such a scenario, I believe the public option passes.

  2. Chris on

    At Netroots the talking point (I think it comes from the White House) was:

    1) take public option out in the Senate.
    2) Keep it in the House version and;
    3) When they go to conference add it and then get the 60 dems to vote for cloture and then vote their conscious or with their donor base.

    I’m not sure people are really buying into that approach.

    During our Wednesday Hill meeting we talked with a staffer that suggested they could chop it up. Passing the controversial stuff with budget reconciliation and the more consensus reforms with 60 votes. (Since we weren’t there to talk about healthcare the name and office of the staffer should stay off the record). This very similar to what the Wall Street Journal wrote today- http://online.wsj.com/article/SB125072573848144647.html

    Arlen Spectre and other moderates have been saying you can’t get everything in through budget reconciliation, which implies that the controversial stuff couldn’t move forward that way. But I never found that very convincing since the controversial aspects are more the type of thing that budget reconciliation was meant to allow to move forward. I guess well have to wait it out with the rest of the country.

  3. Julian on

    Check out Obama’s op-ed in today’s NYT:http://www.nytimes.com/2009/08/16/opinion/16obama.html?pagewanted=print

    It’s decent, but seems to claim that if you already have insurance you can’t opt into the gov’t plan. But once you’re in, you can stay forever even if you change jobs with an employer who provides coverage. Seems unfair to those held captive in a crappy private plan.

    Furthermore, this is not in the current discussion as I understand it. I think Obama needs to sell this, but to do that he needs to be a lot more clear about WHAT he is selling exactly, i.e. provide 5 points that must be included in any bill he signs–and stand firm on them. Then that gives us all something concrete to talk about, i.e. how to best achieve those goals and why they are desirable. Angry idiot minions are more easily marshaled because we were never given anything concrete from the WH. We were just supposed to let congress generate the policy in a black box. And that is a recipe for letting special interests run amok with hearsay.

    This idea does not have to be that complicated. For example, Reich’s summation is clear:
    http://tpmcafe.talkingpointsmemo.com/talk/blogs/robert_reich/2009/07/the-future-of-universal-health.php?ref=fpd


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