Co-Ops: Let's Do This, If It's Done Right

Jillian Bandes
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Posted: Aug 18, 2009 11:55 AM
A health care co-op has long been branded by conservatives as another word for government-run health care. But as the public option flounders, and Republicans have room to suggest alternatives since their fight to defeat Obamacare has seen success, the idea of a co-op has been tossed back into the ring. The NYT even reports that some Republicans have become amenable to the idea, though the general consensus seems to be that this sort of thing could never get off the ground.  Chris Good at the Atlantic thinks that's unfortunate, and that it's mostly the fault of Republicans.
The idea is that co-ops (whether it's one national co-op, state co-ops, or a national co-op with state affiliates) would serve the same function as government-administered health insurance, in that they'd operate as non-profits and perhaps utilize some added bargaining power or lower payment rates, thus forcing for-profit insurance companies to drive their own costs down, out of sheer economic necessity, once they had to compete with a non-profit that had some consumer cost advantages.

But it would do so specifically without being a government-run plan--and that's the line both Reid and the RNC blurred.
Good blurs the line between a government-run plan in name and a government-run plan in practice. If the government gets involved in co-ops like the Senate Finance Committee seems like it wants to, Uncle Sam would have a big say in what goes on in these programs and co-ops would probably be just as much of a boondoggle as a public option. Furthermore, large cash outlays for such a plan are going to be met with nothing but skepticism while budget issues are so critical -- and won't help the cause of distancing the co-op idea from the public option idea.

In addition to the prospect of substantial government involvement and hefty subsidies needed to establish the programs, there are other concerns.
  • no promise that those with pre-existing conditions or without health care would benefit
  • a long lag-time for such a system to actually work
  • regional disparities
  • no promise that the incentives for employer-based coverage would be changed
  • problems like dropping coverage based on technicalities in times of crisis could still exist
But say these things were addressed as a push for co-ops was made. I'd be amenable to whatever new legislation was being pushed. It's difficult to imagine such crucial reforms making their way into legislation at the same time such a huge co-op system would be hashed out, but if they were, it would be the perfect opportunity for Republicans to put their money where their mouth is and support real reform. But Obama is supremely reluctant to acknowledging opposition to his ideas and the Democrats have done nothing but push their desire to ram a plan through as fast as possible. So while Republicans might seem hard to work with, Democrats are just as much at fault.

Here's hoping for a two-pronged approach: first, the Dems completely restructure their attitude towards health care reform, and actually open themselves up to new co-op ideas -- some of which may very well be branded as conservative. Second, Republicans acknowledge this change in approach, and move from town halls full of opposition to Obamacare to pushing for a real, workable solution to the health care crisis.