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Jacob Hacker, Professor of Political Science at the UC, Berkeley, and uber public policy wonk, particularly on healthcare, joined Reps. Raul Grijalva and Keith Ellison today in a press call to release a new report [pdf] reiterating the criticality of a robust public option for meeting the basic goals of comprehensive healthcare reform: lowering costs, and providing higher quality access and care, and guaranteed health security for all Americans.

The comprehensive healthcare reform was proposed by candidate and President Obama, Hacker argues, rested on three pillars: creating more choice for consumers and competition for private insurers through a public option; creating an employer mandate, with affordable options for all businesses to buy in to; creating an individual mandate, again with affordable options. Hacker argues persuasively that without the key pillar of a public option, the structure can't hold. In light of that, Reps. Grijalva and Ellison reiterated the fact that 60+ progressives in the House are committed to not passing a bill without it--either on the House floor or out of conference.

The Hill is reporting today that some of the 60+ members might be "soft" on the pledge (though it doesn't name any of them specifically) and who might be willing to accept co-ops. Assuming that's true, a review of the co-op proposal (such as it is) from Hacker's new report is essential:

So few specifics are available about what consumer health cooperatives would look like or how they would be chartered that a detailed critique is difficult. But that may be just as well, since there is absolutely no reason to think that cooperatives of any sort could do the three crucial things that a competing public plan must do—that is, provide a backup, benchmark, and backstop.  Cooperatives might be able to provide some backup in some parts of the nation, but they are not going to have the ability to be a cost-control backstop, much less a benchmark for private plans, because—like private plans--they are not going to have the reach, authority, or desire to drive broadly implemented delivery and payment reforms or act as a strong public-spirited competitor that discourages private insurers from engaging in practices that undermine health security. As Senator Jay Rockefeller, a member of the Finance Committee, has concluded after extensive review of the issue: "What I have to worry about is, are co-ops going to be effective taking on these gigantic insurance companies? And from everything I know from people who represent them, the answer is a flat ‘no.’"

Consumer cooperatives would have several severe disadvantages. First, they would require building a new set of plans largely from scratch in markets often dominated by one or two powerful insurers. This would mean forfeiting the administrative, economic, and political advantages of building on the Medicare infrastructure to a get a new alternative to private plans up and running quickly. Second, such models would also require forfeiting another major advantage of a Medicare-like public plan: the ability to provide enrollees with a broad choice of providers. The only two sizable examples of consumer health cooperatives, Group Health Cooperative of Puget Sound and HealthPartners in Minnesota, are both health maintenance organizations (HMOs) with restricted provider networks. And they have had decades to become established. New cooperatives would face the same problems breaking into markets that smaller private competitors face in many markets today. Analysts at Oppenheimer, Carl McDonald and James Naklicki, report that "as the co-ops are currently described, we think they would be a big positive for the managed care group, but it seems to us that they would be destined to fail from the moment of creation."

The history of health cooperatives backs up McDonald and Naklicki’s pessimism. Cooperatives of various sorts have been discussed and sometimes created to provide health care in the past. After the Great Depression, the Farm Security Administration encouraged the development of health cooperatives--which at one point had about 600,000 members, mostly in rural areas. But the cooperatives crumbled in the face of physician resistance (including boycotts), the lack of financial wherewithal of the cooperatives themselves, and the eventual withdrawal of government support.

Even today’s remnants of the cooperative movement do not provide the most inspiring of lessons. The only survivor of the 1940s experiment is Group Health Cooperative of Puget Sound. It is a well-regarded HMO, paying doctors on a salaried basis but, unfortunately, is now little different from other nonprofit HMOs, with around a half million members in Idaho and Washington State. By contrast, WellPoint—the nation’s largest insurer and a major force behind the defeat of health care reform in another West Coast state, California—has more than 33 million members.

Finally, and most important, the prospect for cost restraint and quality improvement under these proposals would be limited. Medicare has increasingly out-performed private plans in restraining the rate of increase of health spending while maintaining broad access. A new public plan could draw on Medicare’s experience, as well as the experience of the national VHA system, to improve its cost-control methods and enhance the quality of care. By contrast, cooperatives, if established after a potentially lengthy period of development, would be relatively small and scattered and therefore lack the means to restrain cost increases or drive delivery or payment reforms on a broad scale. (pp. 13-14)

Hacker concludes:

That the two bills under consideration in the House and Senate contain a public health insurance option is considerable cause for celebration. Yet it is no cause for
complacency, because the Senate Finance Committee appears unlikely to produce a bill that contains a true public plan. If, as expected, the Committee endorses federally promoted health cooperatives, they should be understood for what they are: an effort to kill the public plan and, with it, the prospect of an effective competitor to consolidated insurance companies that have too often failed to provide affordable health security.

Cooperatives have been forwarded as a solution to a political problem--how to get Republicans on board--and even in that have proven a failure. They are not a policy solution, and aren't a viable alternative. That's the bottom line, if this reform is going to be real.

Hacker does a good job of reiterating that the public option isn't just a political bargaining chip--that it is absolutely essential part of all of the bills that have thus far made it out of committee (though the House bills are stronger than the Senate bill--check his paper for the details on that) and is an essential part of lowering costs throughout the entire system. We're not just fighting for this to create some kind of political litmus test--we're fighting for this because it's what can work, and work fairly.

Originally posted to Daily Kos on Thu Aug 20, 2009 at 12:52 PM PDT.

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Comment Preferences

    •  We've just begun to fight, this is our line in (11+ / 0-)

      sand. We are not going away, we are not caving in.

      My idea of an agreeable person is a person who agrees with me. Benjamin Disraeli

      by pvmuse on Thu Aug 20, 2009 at 12:54:46 PM PDT

      [ Parent ]

      •  Key point from McJoan, which, if understood, (11+ / 0-)

        should motivate more in this economy to work for public option:

        ... an essential part of lowering costs throughout the entire system.

        People have been mislead into believing that the public option would be wasteful and increase costs.  

        This story should be passed around.

        •  Absolutely -- the p.o. has been portrayed as an (4+ / 0-)

          expensive government run plan, instead of the best possible way of not only providing choice, but also REDUCING COSTS.

          It is critical to realize that in the overwhelming majority of markets, there IS NO COMPETITION AT ALL. This excellent report (pdf) clearly documents that in almost two-thirds of the nation's metropolitan areas, a single insurance company has cornered more than one-half of the market, and in one quarter of metropolitan markets, a single company has 70%(!!!!) of the market.

          There is simply no way of controlling costs in this kind of environment without a nationally available public option.

          The other point that is not emphasized sufficiently is that HR 3200 does not put the public option into place until 2013. That is WAY TOO LATE - it needs to be implemented immediately.

          "But there is so much more to do." - Barack Obama, Nov. 4, 2008

          by flitedocnm on Thu Aug 20, 2009 at 01:28:19 PM PDT

          [ Parent ]

          •  flitedocnm, 2013 is way too late. My unemployed (4+ / 0-)

            young nephew is missing a tooth, needs foot surgery in order to work, and my brother, his dad has NO insurance, has not had any insurance for YEARS.  Exception was when he tried to insure his son by responding to one of those ads that promised exceptionally low premiums, got money from him, then folded.

            Sucks that the Repubs scream for competition but, as your link points out, they with their Blue Dog friends, insure that it does not really happen. Disgusting.

            However, we must not let that freeze us up and keep us for getting change now.

          •  Plus for god's sake (1+ / 0-)
            Recommended by:

            The public option has always been structured as self-supporting.  After initial startup health, it must pay its own way through premiums.  Once again, a point clearly made and routinely ignored.

          •  2013???? So the next Republican president can ` (1+ / 0-)
            Recommended by:

            kill it? If they pass it with that date it will be like not passing anything to most people. Dems will go down big time in 2010 and  2012.

      •  I think that we do more harm than good by (3+ / 0-)
        Recommended by:
        askew, divineorder, littlebird33

        constantly agonizing about the public option.  Obama explained why today.  We are making the public option the main topic of discussion throughout the media. This is where the republicans get their "socialized medicine - government takeover of health care talking points".  

        The things that people like about the bill are not being talked about at all.  The left, right and the media has made it all about the public option.

        You are drowning out the discussion of the rest of the bill and are scaring to death the very people that you want support from.  The more they hear Public option - the more they think government take over.  Your very passion and anger over it confirms to them that it is government take over.

        Man is equally incapable of seeing the nothingness from which he emerges and the infinity in which he is engulfed. Blaise Pascal

        by Kitty on Thu Aug 20, 2009 at 01:08:28 PM PDT

        [ Parent ]

        •  Well, them's the breaks. (8+ / 0-)

          The public option is absolutely essential to reform, and it's the main point of contention, so naturally we're not talking about the rest of it.

          Not to say we're not fucking it up in a big way. I swear to God, if ever there's been a time when Dem leaders are batshit nuts if they don't hire or at least listen to George Lakoff …

          “If I can't dance to it, it's not my revolution.” — Emma Goldman

          by Jyrinx on Thu Aug 20, 2009 at 01:11:10 PM PDT

          [ Parent ]

        •  By Getting What We Need? (6+ / 0-)

          Insisting on the most essential part, that is under the most threat, from people without legitimate power, who lie to protect what they've stolen and destroyed, is "more harm than good"? How do you get what you need from people who won't give it to you?

          "When the going gets weird, the weird turn pro." - HST

          by DocGonzo on Thu Aug 20, 2009 at 01:17:13 PM PDT

          [ Parent ]

        •  Look. It's people close to (4+ / 0-)

          Obama who have been coming up with these public option trial balloons. We had Rahm last month, Durbin earlier this month and Sebelius recently. If they don't want public option to be a topic of debate then they shouldn't be baiting the left on this.

        •  Kitty, please name 1-2 other parts you see as (1+ / 0-)
          Recommended by:
          We Shall Overcome

          most important to include in talks with others about the Obama Plan.  Thanks.

          •  Here you go (5+ / 0-)

            A major expansion of Medicaid coverage—fully federally funded—for millions of low-income

            working families who currently fall through the cracks

            A regulated marketplace that clamps down on insurance company abuses so people can

            no longer be denied coverage

            Requirements that insurance companies spend more of the premium dollars they collect

            on patient care

            Sliding-scale subsidies so middle-class, working families can afford the coverage they need

            to keep their families healthy

            Limits on out-of-pocket spending, giving Americans real health security and peace of mind

            Much-needed relief for small businesses so they can afford to offer coverage to their


            Improvements to Medicare that will help seniors and people with disabilities afford their

            drugs and their cost-sharing

            Better access to coverage for uninsured children so they can get the care they need Long overdue steps to modernize the system, improve the quality of care provided, and curb unnecessary spending so our American health care system delivers the best possible care

            Man is equally incapable of seeing the nothingness from which he emerges and the infinity in which he is engulfed. Blaise Pascal

            by Kitty on Thu Aug 20, 2009 at 01:24:12 PM PDT

            [ Parent ]

            •  sorry the html got messes up (2+ / 0-)
              Recommended by:
              divineorder, littlebird33

              this was from a previous post of mine here:


                  A major expansion of Medicaid coverage—fully federally funded—for millions of low-income
                 working families who currently fall through the cracks

                 A regulated marketplace that clamps down on insurance company abuses so people can
                 no longer be denied coverage

                 Requirements that insurance companies spend more of the premium dollars they collect
                 on patient care

                 Sliding-scale subsidies so middle-class, working families can afford the coverage they need
                 to keep their families healthy

                 Limits on out-of-pocket spending, giving Americans real health security and peace of mind

                 Much-needed relief for small businesses so they can afford to offer coverage to their

                 Improvements to Medicare that will help seniors and people with disabilities afford their
                 drugs and their cost-sharing

                 Better access to coverage for uninsured children so they can get the care they need Long overdue steps to modernize the system, improve the quality of care provided, and curb unnecessary spending so our American health care

              system delivers the best possible care

              Man is equally incapable of seeing the nothingness from which he emerges and the infinity in which he is engulfed. Blaise Pascal

              by Kitty on Thu Aug 20, 2009 at 01:25:46 PM PDT

              [ Parent ]

            •  Those are all great, but try communicating that (1+ / 0-)
              Recommended by:

              to people - our media is not up to that challenge, unfortunately. And while we try to do that, the right is scaring and confusing people with Death Panels that we also have to dispel. So, we the debate becomes public option - do you want the choice to have one or not ... i think people want that choice.

        •  I have tried to (10+ / 0-)

          explain to people here that all the insurance reforms in the bill, such as eliminating pre-existing conditions clauses, are only being put in there because the insurance industry is being granted a mandate for all Americans to buy insurance. No one seems to be listening. Can I say it again? All these reforms in the bill, the good things in the bill that you talk about, are only in there because the bill also creates a mandate for coverage.

          A mandate, without a public option, is a subsidy for insurance industry profit. It's giving them 50 million new customers. That is why people are talking about the public option, because in light of the rest of the bill and what it does, the public option is actually essential.

        •  True, but it's too late, public option is out (0+ / 0-)

          there. What else is there for the media to spit out, it's what they do, boil it down to some B.S. point they can build a story on ... trying to explain the nuances of health care reform is not the media's thing.

          The choice of a public option along with private plans in an exchange ... this was Obama's point. Yes, a sliver, but an important sliver and one many, many people expect going back to his campaign rhetoric.

        •  The main opposition is from people on (0+ / 0-)

          mdicare. They are scared of the other parts of the bill. They think cost cutting = benefits cutting.

          Surgeons, cardiologists and radiologist are the primary vociferous objectors. Not all but a large proportion. People are profit centers to them.

          We are in a time where it is risky NOT to change. Barack Obama 7-30-08

          by samddobermann on Thu Aug 20, 2009 at 04:07:50 PM PDT

          [ Parent ]

    •  That's really interesting. (7+ / 0-)

      Public option obviously implies choice but if you don't put the word choice in the research you get a very misleading (lower) result. This is really good news I think, and explains a lot.

      "It's like these guys take pride in being ignorant." Barack Obama August 5, 2008

      by thefretgenie on Thu Aug 20, 2009 at 12:56:27 PM PDT

      [ Parent ]

    •  I don't buy it (0+ / 0-)

      As I noted in your diary, the wording on that question is screwy, leading to results that don't polarize at all by party, in contrast to every other substantive question in the survey.

      I hated Lou Dobbs before it was cool.

      by cardinal on Thu Aug 20, 2009 at 12:57:58 PM PDT

      [ Parent ]

    •  Support for healthcare reform collapses without (3+ / 0-)
      Recommended by:
      slinkerwink, irmaly, badger

      the public option; and yet, the public can't have it because the Democrats, who have the WH, Congress, and 60 votes in the Senate, are  blocking it.   Somebody explain to me again why Democrats are the party of working people?  What a joke lie.

      "YES WE CAN" doesn't mean he is going to. ~~Daily Show

      by dkmich on Thu Aug 20, 2009 at 01:05:47 PM PDT

      [ Parent ]

    •  One problem (0+ / 0-)

      The public option isn't medicare-like. It's a co-op run by the government.

  •  Co-op = (4+ / 0-)
    Recommended by:
    badger, Audri, TomP, FreeStateDem


  •  Let's start connecting the term 'Public Option' (10+ / 0-)

    with the term 'American Plan' as Lakoff suggest his diary is a must read for everyone of us engaged in the day-to-day battle for authentic health insurance/care reform.

    No Robust Public Option - No Reelection - No Kidding!

    by dr fatman on Thu Aug 20, 2009 at 12:55:08 PM PDT

  •  Great Job, McJoan! (2+ / 0-)
    Recommended by:
    TomP, divineorder

    Great job in providing more evidence that the co-op cannot accomplish what only a public option can!  Kudos to you!  It's time to remind those in congress trying to "bait and switch" the american people that we're onto their shenanigans.

  •  But...but... (4+ / 0-)
    Recommended by:
    irmaly, badger, pvmuse, griffin459

    he's from Berkeley. They are all socialists there!

  •  I think we should have Community Tribal Councils (2+ / 0-)
    Recommended by:
    badger, Fiona West

    CTCs would be empowered to "vote people off" who they deem not deserving of healthcare.  In order to be a member of the CTC, you will have to pay a huge membership fee  and be entitled to any profits generated by medical care received by the community.  The CTC would then function as your typical insurance company and deny care to those in order to turn a profit for CTC members.

  •  Great post, Thanks (3+ / 0-)
    Recommended by:
    irmaly, oscarsmom, FreeStateDem

    There has never been any doubt that there must be a Public Option. Dr. Dean is absolutely right.

    Common Sense is not Common

    by RustyBrown on Thu Aug 20, 2009 at 12:57:17 PM PDT

  •  Public Option for the public's government! (3+ / 0-)
    Recommended by:
    ferg, badger, sharman
    Medicare saved my elderly mothers life with a heart operation, but two of her adult children and grand children have no coverage. None of us could have paid her medical bills after the bypass.

    We worked for the Change President and a Dem Majority. Now we need to make the Public Option happen in Congress.

    Do what ever it takes, letters to the editor, call relatives and friends and ask them to call Congress, JUST DO IT.

    We can.  Will we?

  •  The second its all about Co-Ops (8+ / 0-)

    is the second that Co-Ops becomes the "Nazi Socialist Jidadist" solution.

    The goalposts can always be moved when the people moving them are totally operating in bad faith.

    So embracing bad policy to gain the support of people acting in bad faith is double Epic Fail.

    That that reality hasn't sunk in yet, in 2009, after everything else the Right has done since 2000, is truly scary.

    You can't claim solidarity with people if you also want to bomb them

    by LeftHandedMan on Thu Aug 20, 2009 at 12:58:21 PM PDT

    •  Scary, indeed! (4+ / 0-)
      Recommended by:
      badger, samddobermann, Matt Z, divineorder

      The co-op is the fascist corporatist reich's wet dream.  They know it's doomed to fail and won't touch them.

      I've heard that congressmen are telling Big insurance that "we have your back".

      It's time to find out who these liars are in congress and put them out of a job.  Our hard-earned dollars are keeping them alive.  Time for them to begin representing US or get out of the way for someone who will.

    •  After watching Kent Conrad (5+ / 0-)
      Recommended by:
      ferg, badger, oscarsmom, Matt Z, divineorder

      discuss his Co-Ops idea, I'm also convinced that he will sandbag his own idea the second the usual suspects start demanding it of him. He couldn't really give a compelling reason why they were a better idea. It was all about not wanting to vote for the 'other thing' that was making certain people upset.

      He was about as inspiring to hold the line as a Lieutenant suddenly loudly crying and sucking his thumb at fight sight of a wave of enemy troops come rushing out of the weeds at your position.

      By the time Co-Ops were even up for a vote, they would be facing going down in flames as "too extreme" anyway. Then, strong insurance reform would be "too extreme". Then, weak insurance reform would be "too extreme".

      The opponents of healthcare reform have a goal: nothing. Not Co-Ops. Not Insurance reform. Nothing.

      There is no reason to chase bad reform to please people who want no reform, and there is simply no credible way to blame liberals who came to fight for the best policy considering how important gatekeeping liberalism out of the process to make bad faith players happy was so far.

      You can't claim solidarity with people if you also want to bomb them

      by LeftHandedMan on Thu Aug 20, 2009 at 01:07:40 PM PDT

      [ Parent ]

  •  Dear mcjoan, (0+ / 0-)

    There is so much "opinionating" happening here that I'm frankly perplexed why you didn't "cover"/live blog Obama's forum .  At least he gives us something in real time to parse and freak out about.

    •  couldn't disagree more (6+ / 0-)

      I couldn't disagree with you more.  The coverage of the live Obama forum is being done simultaneously and commented on.  McJoan provides empirical evidence and accurate history of the co-op movement. And since they probably will trade away the public option in favor of a co-op, isn't it critical that we know what these vehicles are all about?

      •  Sorry, larkspurlane, (1+ / 0-)
        Recommended by:

        I totally jumped the shark re the coverage:  my apologies.

        •  It's ok, people are worked up over this (1+ / 0-)
          Recommended by:

          we just need to put that energy to focused efforts, like calling the White House, supporting ActBlue Progressives, FireDogLake, etc.

          CALL the White House at 202-456-1111 and at 202-456-1414

          Let them know that Public Option is non-negotiable.  

          Personally, I told them that Obama was the first presidential candidate in a long time to break my cynicism about the presidency.  I invited them to look up my contributions, my hours of work, and then to tell me to my face that delivering another billion dollar giveaway to insurance companies was "Change I Could Believe In."

          I told them I expected true reform, not wallpapering over the problem. And that I knew this president could deliver, if he'd try hard and get rid of the industry people in the White House.

    •  KOS is able to multi-task (0+ / 0-)

      My experience with KOS is that they multi-task exceptionally well.  I don't get your point exactly.  Is it the "freaking out" aspect that offends you?  I think it's about time that progressives become vocal and begin expressing their view; after all, most of us here spent time and money helping to get this administration into office.  I believe we all have something to add to any discussion and, fortunately, most of us are capable of multi-tasking.

      •  Excuse me: what does multi-tasking (0+ / 0-)

        have to do with freaking out?  Of course kossacks can multi-task, we're also adept at promoting cynical ideology over facts...or in this legislative downtime:  the absence of facts. Can we PLEASE return to how things work and lighten up on the divisive rhetoric?  PLEASE!

  •  rural vs, urban (0+ / 0-)

    Isn't the coop model mainly a rural phenomenon?  Could it work in densely populated urban areas, where the need for good health care is so urgent?

    •  No, not just rural. (0+ / 0-)

      Co-ops of different kinds operate anywhere. The question is only whether this particular health co-op proposal can do what needs to be done and I don't think it can.

      This is not what I thought I'd be when I grew up.

      by itzik shpitzik on Thu Aug 20, 2009 at 01:05:30 PM PDT

      [ Parent ]

    •  It depends on the co-op type (0+ / 0-)

      Yes - you'll find lots of rural utility co-ops, farm co-ops, etc...

      However, on the health care side - a health care co-op actually works better in an urban area just due to the nature of health coverage... you need a higher population (and provider) density.  The few co-ops that do exist and work on the health insurance coverage side are all urban area co-ops.

      I guess everyone's got their own blog now.

      by zonk on Thu Aug 20, 2009 at 01:13:56 PM PDT

      [ Parent ]

    •  In-network vs out-of-network (0+ / 0-)

      There's an article on CNN (I think) about the huge bills people get when they go out-of-network, even when it's because they get emergency-transferred to a major medical center for specialized care.

      Coop may be fine for your primary care, if there's an in-network doctor you like. I just don't see how it gives you access to second opinions (around here, often out of state = Boston), specialists, and most importantly, your choice of physicians. And for those of us who travel occasionally more than 20 miles from home, it sounds like a disaster.

  •  just watched the OFA town hall (2+ / 0-)
    Recommended by:
    ferg, irmaly

    and co-ops weren't mentioned at all by Obama. He did say that a Public Option will be included as one of the plans people can choose from. What's the point of blogging about a possibility thats not even being considered by the administration?

  •  WTF is with the Progressive Caucus? (1+ / 0-)
    Recommended by:

    I hope this is rumor (fingers crossed), but why is it progressives seem to always be the first to fold. We need to get with the program and on the same ball field.

    They don't win until we give up.

    by irmaly on Thu Aug 20, 2009 at 01:02:34 PM PDT

    •  what did they fold on? (2+ / 0-)
      Recommended by:
      divineorder, Jyrinx

      What I saw was a progressive caucus having the balls to stand up to the rest of congress and this white house and state (no, pledge) that if there wasn't a public option in the healthcare reform plan, they would vote it down.  That's chutzpah in my world.

      So, now in reaction to their threat, the Faux Dems (blue dogs) are planning to break it into two bills (ostensibly due to the reconciliation process but we know otherwise).  This would be a "get even" measure precisely aimed at the progressive caucus' threat to vote reform down making Obama experience a huge loss.

      How have they caved?  I'm sure they're just regrouping now to try to find another way to ensure the public option.

  •  Never forget (6+ / 0-)

    Public option was itself a half-assed compromise on the only true reform: single payer. Spam instead of steak, if you will.

    Co-ops wouldn't even have the value of Spam. It would be getting told to eat dirt.

  •  Let's Go Out and Win This Fucking Thing! (1+ / 0-)
    Recommended by:

    I highly recommend reading Femlaw's diary Let's Go Out and Win This Fucking Thing for some clear, effective suggestions on what to do next.

    "I agree with you, I want to do it, now make me do it." -- FDR

    by Nuisance Industry on Thu Aug 20, 2009 at 01:04:13 PM PDT

  •  Absolutely (6+ / 0-)
    Recommended by:
    hester, ferg, irmaly, badger, Matt Z, divineorder

    Public option is not just a slogan. It is a very real policy initiative that is an essential part of reform, especially considering that mandates for coverage are going to be part of the bill. A bill that mandates coverage, with no public option, is nothing more than a subsidy for insurance industry profit.

    •  You nailed it! (1+ / 0-)
      Recommended by:

      That's the core of precisely why the public plan is an essential ingredient in "real" health care reform.  Good job!

    •  Was a public option the belt or the suspenders? (0+ / 0-)

      Obama today, as far as I'm concerned, made the case that there can be no real reform without a public option. He said the health insurance reforms were the belt, and the public option was the suspenders. We lose the public option, and our pants fall down to the floor. He said there will be a public option, and I intend to hold him to it.

      So, wtf is wrong with the Progressive Caucus? We need to prove there is such a thing as a meanass progressive or we'll never get the bubba vote ;)

      They don't win until we give up.

      by irmaly on Thu Aug 20, 2009 at 01:09:01 PM PDT

      [ Parent ]

  •  Yeaaahhh... (2+ / 0-)
    Recommended by:
    badger, samddobermann

    Cooperatives have been forwarded as a solution to a political problem--how to get Republicans on board--and even in that have proven a failure.

    Because let me tell you, being a paraplegic with spina bifida and having a best friend with deathly serious asthma issues and a young sister with a kid, what I'm concerned with is the political gamesmanship of all this. The worry and panic over being fair to Republicans keeps me awake at night.

    Please, please let us solve this huge political problem in a way that's fair to those poor, downtrodden members of Congress.

    "ENOUGH!" - President Barack Hussein Obama

    by indiemcemopants on Thu Aug 20, 2009 at 01:05:32 PM PDT

  •  Some people call it Group Death (3+ / 0-)
    Recommended by:
    badger, samddobermann, figbash

    Lots of people around here are satisfied with Group Health, but there are reasons why it still has a very small market share compared to Regency/Blue Shield in Wash/Ore/Idaho. It is both bureaucratic and restrictive hence the name given to it by disaffected customers who were able to switch out. Of course some people are locked in, if Group Health is not willing to pay for something, good luck getting coverage from someone else in the individual market for those people not covered by employer paid group insurance.

    Co-ops tend to breakdown after they get to a certain size. The Rochdale Principles, on which the modern co-operative movement was largely organized, simply dnn't function once an organization gets to a certain size, a sixe that is well under that needed to get health care bargaining power. I am a life-long supporter of co-operatives and saw exactly this happen to the Berkeley Consumers Cooperative. Founded in 1939 it was a huge success until it decided to go big in the 1960's. Which planted the seeds for its implosion less than two decades later.

    Rochdale principles:
    Consumers Cooperative of Berkeley:

  •  Medicare for All (5+ / 0-)
    It's perfectly obvious that the best health insurance system for America is simply "Medicare for All". Just put everyone in the Medicare system, throw out the Bush era and related handcuffs that prevent Medicare from negotiating with suppliers like for drugs. Take the extra costs and spread them across all the newly eligible people in our taxes, at the same rates. Done.

    The only reason not to is because privateer insurers must keep their cartel's grip on the huge and essential market they've been bleeding to death. The total disconnect between our government and our people, with the government falling heavily on the side of the insurance corps and their corporate allies, shows even more clearly that Medicare for All is the answer. Or they wouldn't have to fight it so hard with so many lies, against such a popular wave.

    "When the going gets weird, the weird turn pro." - HST

    by DocGonzo on Thu Aug 20, 2009 at 01:08:00 PM PDT

  •  My LTTE- referncing my Blue Dog Congressman (0+ / 0-)

    I’ve had some pretty harsh words lately for Ben Chandler because of the way he’s sided with the Insurance Companies against the president’s American Healthcare plan. I think Ben is a pretty smart guy, which is why I’m having a hard time understanding what going through his head.

    It’s obvious to anyone with eyes that we’re in a healthcare emergency when regular people have to give up their homes and financial security just to pay for health problems while the Insurance Companies post record profits. Americans look out for one another; but Insurance Companies only seem to look for new ways to deny coverage so they can maintain their profit margins.

    I don’t live in Ben’s social circle, so I’m just guessing he’s never had to wait while an Insurance Company decides what level of care his family gets based on an accountants say so. I do know I’ve seen people suffer because an Insurance Company bureaucrat overruled a doctor, or delayed a critical test because it didn’t fit in their ‘business model’.  Insurance Company rate increases and claim denials might as well be called what they really are- a private tax on Americans to maintain business profits. And the reality is that the current healthcare crisis isn’t because the American government failed; it’s because the private Insurance Companies failed America.

    I know my doctor cares about my health, but I’m not foolish enough to believe my Insurance Company does. I know what happens to me the moment the Insurance Company stop getting paid, the only concern they have is for my financial ‘health’. But the real worry is that no one knows what an Insurance Company will do if you ever really need their ‘coverage’; and  based on what I’ve seen happen to others, I’m not optimistic. Also, anyone who doesn’t think Insurance Companies currently ration healthcare must never have had to request a specialist or a expensive test- and the corresponding wait  that goes with it while the insurance company accountants decide whether or not they can afford you.

    When I enlisted as a teenager it was in the belief that I was serving my country; not just Kentucky but the ideas and values that made our nation the best in the world. I still believe that, which is why I’m adding my voice to the overwhelming majority of Americans who see the current healthcare emergency and want real reform now- including a Public Option.  I sure hope Ben changes his mind and comes down on the side of us working Kentuckians.

    Man's capacity for justice makes democracy possible, but man's inclination to injustice makes democracy necessary. Reinhold Niebuhr

    by patriot spear on Thu Aug 20, 2009 at 01:08:36 PM PDT

  •  You either think competition works or it doesn't (2+ / 0-)
    Recommended by:
    zonk, divineorder

    If you think it does, then no, a public option isn't necessary because there will already be a national insurance exchange where insurance companies will have to compete against each other (something that is largely not happening now)

    A public option can help push it a long because it would be a plan that would presumably be high quality and low-cost from the start, but necessary? no.

    If you don't think competition between insurance companies will work, then why are we even going through this exercise?  Draw the line at single payer and instead of having a bill with a public option fail in the Senate, have a bill with single payer fail in the Senate.  You get the same result, and then you can feel better about it (and show your true colors while you're at it).

    •  The human greed factor (6+ / 0-)

      It would be great to idealize and dream that these corporate fat cats making millions off our health care dollars give a shit about each of us - you would be dead wrong.  In fact, all they care about are their yachts, multiple mansions, and how much money they're stealing.

      A public option would "force" these fascist corporations who hold a monopoly on healthcare right now to negotiate down their premiums or be driven out of the market by a government-sponsored plan.

      It's the ONLY thing that will work.  But did the White House already cut a deal with Big Insurance?  Yet to be revealed....

      BTW, we did notice that those C-Span meetings with the healthcare negotiators did NOT take place as planned...(ahem).

      •  then let's just declare the US (0+ / 0-)

        a communist state, ban all corporations, and get it over with if corporations are the bane of all mankind.

        And since when did a "monopoly" get defined as "several companies competing against each other in an exchange."  What, you now have to have a public option for something not to be a "monopoly?"  Boy, I sure dislike my fast food monopoly where I don't have a choice of a fast food public option.

    •  They wouldn't HAVE to compete. (4+ / 0-)

      They'd just collude to keep prices as high as they want them. And we couldn't actually get all Teddy Roosevelt on them and trust-bust their asses because they're exempt from antitrust laws.

      So, as DeFazio says, the exchange will only work if we enforce antitrust laws and/or provide a public option.

      “If I can't dance to it, it's not my revolution.” — Emma Goldman

      by Jyrinx on Thu Aug 20, 2009 at 01:16:36 PM PDT

      [ Parent ]

      •  well, I'd agree with the (0+ / 0-)

        yanking the exemption from anti-trust laws unless someone can give a really good reason why there is one to begin with.

        •  The problem then is that (3+ / 0-)
          Recommended by:
          badger, samddobermann, divineorder

          antitrust laws aren't ever enforced these days. And besides, in most areas there's an effective oligopoly, such that implicit collusion would work just fine; the barriers to entry for a health insurer are pretty massive (need a big risk pool to make it work), so the insurers can just jack up prices with a wink and a nod to each other.

          “If I can't dance to it, it's not my revolution.” — Emma Goldman

          by Jyrinx on Thu Aug 20, 2009 at 01:20:31 PM PDT

          [ Parent ]

          •  well, thus the exchange (0+ / 0-)

            which, if I understand it correctly, is on a national scale.  So if you have some state oligopoly, then you can look to the national insurance exchange.

          •  That's exactly it (3+ / 0-)
            Recommended by:
            samddobermann, oscarsmom, Jyrinx

            The public option is a continuous enforcement mechanism that doesn't depend on who's the AG or Secretary of HHS or controlling Congress or the White House, once it has enough members.

            It becomes another "third rail" of politics, like Social Security or Medicare. When 20 or 30 million voters (or many more) are relying on the public plan to keep them healthy - including large numbers in red states - it will become relatively immune to defunding or hollowing out its benefits because of the political reaction that would cause.

            Nothing's perfect or permanent - even SS was under attack by Bush and the GOP (and they failed big). But it's a much more robust mechanism than insurance regulation (AIG?) or enforcing anti-trust laws.

            Je suis Marxiste, tendance Groucho

            by badger on Thu Aug 20, 2009 at 01:29:01 PM PDT

            [ Parent ]

    •  you clearly didn't read the article (1+ / 0-)
      Recommended by:

      I'm on Twitter. I'm also a part of the FDL team on health reform.

      by slinkerwink on Thu Aug 20, 2009 at 01:27:21 PM PDT

      [ Parent ]

    •  What competition? (0+ / 0-)

      Aren't health insurance companies exempt from antitrust laws?

  •  co-ops are supposed to be a political compromise (6+ / 0-)

    but I still don't know who wants them. Conservatives don't want them. Liberals don't want them. Moderates don't know what the hell they want. This is a compromise to nowhere.

    Does anyone know of any politician that wants them?

    Of course you'd say have the brainpan of a stagecoach tilter!

    by gooners on Thu Aug 20, 2009 at 01:09:15 PM PDT

  •  The problem is (4+ / 0-)
    Recommended by:
    badger, oscarsmom, Matt Z, divineorder

    Publicly funded healthcare is objectively, measurably, indisputably more efficient and less costly.

    A public option will further demonstrate that, and potentially make single payer inevitable.

    Which is why it cannot and will not be allowed by the people with political clout in this country.

    The debate isn't about ideology. There shouldn't even be a debate. The solution is obvious.

    But we won't get it, because the politicians don't work for us.

  •  Pimping my co-op diary one more time. (1+ / 0-)
    Recommended by:

    I agree that this half-baked co-op model is not the way to go.

    But what this co-op debate has revealed also is how little most people know or understand about co-ops, so that info is in the diary as well as my opinion and background in the cooperative movement.

    Co-ops: good, health care co-ops: bad

    This is not what I thought I'd be when I grew up.

    by itzik shpitzik on Thu Aug 20, 2009 at 01:10:58 PM PDT

  •  But here's the thing... (1+ / 0-)
    Recommended by:

    I'm fairly sure ALL of the potential bills that came out of House Committees don't really have a public option -- it's more of a public last resort (I might be forgetting one of the early marks).

    I know I'm very much on the lonely side of this debate here -- and I also want to make it clear that I DO support a public option... I just don't think it's the centerpiece, the tie that binds, the "if not, then the bill's crap" that most of my fellow kossacks do.

    My primary issue with the way people are presenting this -

    1)that it's the KEY to cost containment... It's not.  Especially as it would arrive in virtually any bill, it's simply NOT going to be in much direct competition with private plans.  It's also not likely to be able to use the same reimbursement rate formulas as Medicare.  There's almost certainly going to be a modifier.  Finally - unlike Medicare, which is universal based on age - the public option is also unlikely to have the same administrative overhead advantage that Medicare has simply because there will be a greater burden placed on beneficiary eligibility.

    2)That nothing else can possibly work as well to satisfy a mandate.  I support a 'public option' because I think it's the easiest way to satisfy the mandate needs... but there are all sorts of possibilities where it might not be the BEST.

    Coming from a job that's very much on the wonky side of health care policy (specifically, Medicare and Medicaid... I've been accused 3 times now of being an insurance industry plant or employee) -- I'm more interested in the national, macro effects and policy behind a bill.

    It's not that I don't see the strong need for the help 50 million Americans need who have no coverage, nor the 10s of millions more who are undercovered, nor the rest of us suffering under the weight of premiums, rescission, etc.

    It's not that I'm an especially big fan of private insurance, to say nothing of the inevitable problems with a for-profit scheme and fat cat exec salaries.

    It's just that I think a lot of people here are really overselling the effect of a public option and overestimating what it's going to do for cost containment, coverage, and improving our national outcome scoring on health issues.

    There's a symbolic aspect to a public option - put one in place, and you can prove that our nation won't go to hell in a handbasket and perhaps lay the foundation for creating a true single payer system... but in the context of this specific bill, I just we could discuss it more rationally, rather than the generally dismissive attitude people with a different POV bring (I find it ludicrous, for example, that an excellent source of information like Ezra Klein has become virtually persona non grata because he's more lukewarm on the need for a public option).

    I guess everyone's got their own blog now.

    by zonk on Thu Aug 20, 2009 at 01:10:59 PM PDT

    •  Answer this question (5+ / 0-)
      Recommended by:
      irmaly, badger, oscarsmom, divineorder, Jyrinx

      for me, please. All four bills that have emerged from committees in Congress have a mandate that all Americans buy health insurance. The Senate bill has a $750 yearly fine if you don't buy health insurance. Tell me then, how is this NOT a subsidy to private health insurance companies if this bill does not create a public health insurance plan?

      That is my question. If you really want rational, honest debate, please answer that question for me.

      •  Just as a different option (0+ / 0-)

        And not one I'd especially support --

        A modified Part D plan.   All of Medicare Part D is essentially privatized insurance, with more restrictive regulatory limits on premiums, and the like.

        I'm no fan of Part D - it ought to get a real overhaul - but strictly from a beneficiary perspective, it doesn't work as badly as many might have feared (the exceptions, of course... if you fall into the donut hole, or your medication needs change and you're stuck with a formularly that doesn't work anymore).... but from a beneficiary perspective, most seniors who haven't fallen into the donut hole are relatively happy with their plans, particularly some of the better plans like the AARP sponsored one.

        I'm not saying I'd negotiate it this - as I said, I do nominally support a public option - but a mandate that flows solely to privatized insurance could be forced into the private carriers as a "loss leader", or "revenue neutral leader"... In other words, you could structure the legislation in such a way that basically makes private insurance provide a zero profit policy (in fact - many of the international models -- the Swiss, the Japanese -- do precisely this), and then this serves a springboard for the carrier to sell an enhanced or additional coverage option.

        Item 1) above --

        There's this false idea that just because Medicare is not for profit and has lower administrative cost rations than private insurance -- a public option is just going to magically pay for itself via premiums.

        Nothing could be further from the truth.

        As everyone knows, Medicare is basically funded by your under-65 payroll taxes, and then you get benefits when you retire.   It's got a trust fund because for most of its existence -- there were more people paying in than receiving benefits.

        That the equation has flipped - more beneficiaries than payers - is only part of the reason that Medicare has 8 years of solvency left without adjustment.

        The other big part - the one that good progressives aren't supposed to talk about - is on a strict payroll deduction to benefit ratio, we don't pay for ourselves... meaning - what I'm paying in Medicare deductions now is NOT actually going to cover the expenses I'm likely to draw as a beneficiary... never has, probably never will.

        A "public option" isn't going to have the Medicare benefit of a positive payor/beneficiary ratio.  It never will.  Especially once you account for the necessary subsidies (fully support that) -- a public option is immediately going to need funding beyond what it can reasonably expect to get via premiums.

        I guess everyone's got their own blog now.

        by zonk on Thu Aug 20, 2009 at 01:31:58 PM PDT

        [ Parent ]

        •  I would have to (0+ / 0-)

          study the details of the bills, but I don't think there are any provisions that force insurance companies to give consumers zero-profit policies, under this new mandated coverage. It's all for-profit, with government subsidies for consumers to buy the for-profit plans. That's why they are talking about non-profit co-ops, because even some conservatives realize there should be some type of non-profit alternative. That's really what I want is a non-profit alternative that works.

          I get your point about a public plan potentially having funding issues, because it is supposed to be funded by premiums. But aren't insurance companies funded by premiums? A public plan would operate like an insurance company, just with less of a profit motive. Another thing is Medicare costs more because those older patients need more expensive care. Many of the public option patients would be younger, healthy people who are not expensive to insure, so it would have lower costs.

  •  GAO Report in 2000 says (3+ / 0-)
    Recommended by:
    badger, oscarsmom, divineorder

    They don't win until we give up.

    by irmaly on Thu Aug 20, 2009 at 01:11:56 PM PDT

    •  This was outed yesterday..... (2+ / 0-)
      Recommended by:
      badger, Jyrinx

      And there is no doubt left to the imagination that a co-op is like gutting the bills entirely.

      Just ask BC/BS - they were originally a co-op that failed.  Ask them for the details....

      •  each BC/BS was separate; they were not coops (0+ / 0-)

        they were non-profits. They didn't fail; they were so good the wanted to get the profits. So through a complex system they became for profit. A few have remained non profit.

        We are in a time where it is risky NOT to change. Barack Obama 7-30-08

        by samddobermann on Fri Aug 21, 2009 at 02:32:28 AM PDT

        [ Parent ]

  •  Co-op that could buy Fed Insurance? (0+ / 0-)

    What about a creating a bill that would mandate allowing co-ops to purchase Fed type insurance?  In other words, create a public option through the "free" market?  I doubt Republicans will vote for this bill even with a public option, they're just gaming the system to water it down as much as possible and then vote against it.  If it passes, it will suck and people will blame our side.

  •  It is notable who is proposing the PO, (0+ / 0-)

    and his exclusive use of anecdotal 'evidence' to 'prove' that it will work.

    Whatever could his motivation be?

  •  What little research I've done on co-ops (2+ / 0-)
    Recommended by:
    slinkerwink, Jyrinx

    proves them to be an unacceptable replacement for the Public Option in a comprehensive reform bill. We need to make sure the Congress critters understand that we understand this.

    Redeeming the time, because the days are evil. ~ Ephesians 5:6

    by 99 Percent Pure on Thu Aug 20, 2009 at 01:13:50 PM PDT

  •  I think the policywonk argument for the (1+ / 0-)
    Recommended by:

    public option is relatively weak. The problem with it is that its proponents can't really go too far with the argument that it will effectively compete with private insurance, because they are at the same time providing assurances to centrists and Republicans that it will not compete with private insurance.

    I think the better argument is just to bold-facedly say that it's immoral to force people through the employer- or individual-mandate to buy health insurance without a way to do so without lining the pockets of insurance executives. It's also a basic progressive value that if something is societally valuable and not everyone can afford it, it's the government's role to step in and provide it.

  •  Lest we forget the GAO did a study of health co- (1+ / 0-)
    Recommended by:

    ops in 2000 (five different versions of co-ops, in fact) and found all of them ineffective in costs or outcomes.  Next time that moron Kent "I'll Co-Op This Legislation" Conrad talks about health co-ops people need to remind him of the 2000 General Accounting Offices report.

    •  or laugh in his pathetic face. (0+ / 0-)

      Either technique will do but there's no fool like an old (bought and paid for) fool so Kent Conrad goes his merry, idiotic way in supporting co-ops.

      He was told to "find an alternative" to the public plan by Rahm....end of story.  He made it up out of thin air.

      He's nothing more than a corporatist "stoolie".

      •  I don't know if he pulled it out of thin air (0+ / 0-)

        because there have been co-ops with varying degrees of success as far as getting people covered goes.  Massachusetts is supposed to have something like a co-op. However one thing they have been proven NOT to do is lower health care costs.

  •  I have only one thing to say to this: (1+ / 0-)
    Recommended by:

    Go Bears!

    I'm not part of a redneck agenda - Green Day

    by eugene on Thu Aug 20, 2009 at 01:16:14 PM PDT

  •  A strong month for the DNC (1+ / 0-)
    Recommended by:

    The Democratic National Committee just reported raising $9.3 million in July, substantially raising its fundraising game and one-upping the RNC, which raised $6 million last month.

  •  Public Option or nothing. (3+ / 0-)
    Recommended by:
    oscarsmom, Matt Z, divineorder

    Single Payor would be better, but just maybe a public option could eventually become a single payor. No way a Co-Op will do anything substantial. It might even make things worse.  

  •  Great job, McJoan. (2+ / 0-)
    Recommended by:
    divineorder, polar bear

    Coops are nowhere.

    Obama was his most supportive in a long time on the public plan option today.

    All of us, working together, make a difference.

    He wants the "left of the left" on his side.

    They "prefer an America where parents will lie awake at night worried if they can afford health care their children need."

    by TomP on Thu Aug 20, 2009 at 01:17:31 PM PDT

  •  The Uninsured Congressman (5+ / 0-)

    Rep. Steve Kagen is a democrat and a doctor — and he explains why he has opted out of a generous health insurance package offered to lawmakers. Until his uninsured constituents are able to have access to something similar, he’ll be uninsured.

    The link brings up their player to listen to todays short discussion with the Congressman.

    This one should be in the Leadership, and not only as to Healthcare, he actually seems to understand his roll as a rep.!!

    "The wise man points to the stars and the fool sees only the finger - and discusses it 24/7 on cable and am radio."

    by jimstaro on Thu Aug 20, 2009 at 01:17:53 PM PDT

  •  Let's "go for the gusto" & demand single payer (2+ / 0-)
    Recommended by:
    oscarsmom, divineorder

    I think if they're going to separate the bill on us to claim victory, then it's time to go out and demand single payer to be back on the table.

    There's more than one way to skin this cat.

  •  What Snowe is telling Mainers & Mainers are (0+ / 0-)

    telling Snowe is at this link:

  •  No public option = No health care reform. It dies (2+ / 0-)
    Recommended by:
    Randomfactor, oscarsmom
    •  The Bauchus Death Panel (0+ / 0-)

      The real death panel in all this ironically has been the Senate Finance Committee and it's Chairmen Health Mafia shill Max Bauchus. It's killing health reform.

      "It's better to die on your feet then live on your knees" E. Zapata

      by Blutodog on Thu Aug 20, 2009 at 02:47:56 PM PDT

      [ Parent ]

      •  Working Hand In Hand With Obama (1+ / 0-)
        Recommended by:

        Baucus is working with Obama and Obama is basically ignoring everyone else. Yes, it is killing healthcare, but that was the plan. Obama has been using "bipartisanship" as an excuse to take out everything the corporate lobbyists don't want while giving them their goodies. Glenn Greenwald and FireDogLake have written up about how Obama is trying to out-corporate the corporatist Republicans...apparently Obama and Emanuel want to kill of the Republicans by being more in the pocket of the corporations than the Republicns are and thereby starving Republicans of oxygen (campaign cash).

        •  What's in it for us? (0+ / 0-)

          That would be politically stupid because if it ever can be proven Obama will lose the base and he'll have more problems then starving GOPers for cash. Hell he'll be no better then the GOPers so what's the deal?

          "It's better to die on your feet then live on your knees" E. Zapata

          by Blutodog on Thu Aug 20, 2009 at 06:43:22 PM PDT

          [ Parent ]

  •  President Obama Should Feel Ashamed For (2+ / 0-)
    Recommended by:
    badger, BenGoshi

    trying to fool us into thinking co-ops would be a public option.  Not even close.

  •  Co-Ops can workd fine, if... (0+ / 0-) also mandate that they be not-for-profit...and ban all for profit health insuers.

    You can give the current health insurers the option of converting to provider/member-owned not-for profit co-ops.

    But, profits are banned.

    •  Actually, Blue Cross Blue Shield in ND (1+ / 0-)
      Recommended by:

      is non-profit, and it would qualify as a non-profit co-op under the proposed Senate legislation.

      I'm on Twitter. I'm also a part of the FDL team on health reform.

      by slinkerwink on Thu Aug 20, 2009 at 01:30:34 PM PDT

      [ Parent ]

    •  While non-profit would be nice (0+ / 0-)

      it's the fact that co-ops are private entities that screws them. They're funded initially by the government - like Fannie Mae, Freddie Mac and other GSEs. They're regulated insurers, like AIG. If large enough to be effective, they'll be too big to fail, meaning the government will either let their policy holders lose all their premium payments and possibly die, or the government will spend more billions to bail out failed private entities.

      Co-ops are the mortgage backed securities of health care.

      Je suis Marxiste, tendance Groucho

      by badger on Thu Aug 20, 2009 at 01:35:46 PM PDT

      [ Parent ]

  •  Glad finally getting the FP attention this... (0+ / 0-)

      . . . deserves.

      Been diarying on Conrad's Craptacular Coops since several few weeks ago (actually, before this linked one).


    "Unseen, in the background, Fate was quietly slipping the lead into the boxing-glove." -- P.G. Wodehouse (via Bertie Wooster)

    by BenGoshi on Thu Aug 20, 2009 at 01:26:24 PM PDT

  •  I belong to a health co-op... (8+ / 0-)

    ...and I am being priced out of it.  I work full-time for the State at a public hospital and my health insurance is going so high next year it will be like not having any insurance.  I'll have a $750 deductible even though I am a member of the working poor and support a child on my meager salary.

    When I first started the co-op insurance was free.  It's gone up about 400% in the last three years alone.

    We need Medicare for EVERYONE!

    •  This happened to a retired county worker friend (1+ / 0-)
      Recommended by:
      Matt Z

      of ours in a Republican ruled county in SE Texas. Raised and raised the premiums and decuctibles and lowered policy limits until it was almost worthless.  He dropped it  and went without.

  •  It just occurred to me. OFA is the DNC. I knew (0+ / 0-)

    there was something I didn't like about them.

  •   A dissenting view in defense of co-ops (2+ / 0-)
    Recommended by:
    zonk, FreeStateDem

    All of the objections made are based on the idea of small, regional co-ops. What progressives should be calling for is a large national co-op for health insurance, which would address all of these problems.

    1. the idea that a co-op will be too slow to start up doesn't make a lot of sense because the current House bill wouldn't be implemented until 2013, which is plenty of time to get a co-op system going. I think a co-op could be set up faster than the public plan.
    1. "such models would also require forfeiting another major advantage of a Medicare-like public plan: the ability to provide enrollees with a broad choice of providers." The fact that two small existing co-ops use this model is no reason why a national co-op would have to.
    1. The past failure of small co-ops is no reason to expect that a national co-op would fail.
    1. A national co-op would not "lack the means to restrain cost increases or drive delivery or payment reforms on a broad scale."

    As I noted in my diary today, if progressives push for a strong national co-op, we will be more likely to succeed (since all of the attacks have been aimed at a government-run plan), we will have a better system than a constrained public plan, and we will have an institution less vulnerable to political corruption from the next Republican administration.

    Yes, the idea of co-ops came up as a political compromise. But it can be turned into a great idea.

    Obama Politics (

    by JohnKWilson on Thu Aug 20, 2009 at 01:33:19 PM PDT

    •  Agreed (0+ / 0-)

      There was a very good diary here on the Seattle based Group Health plan.

      I guess everyone's got their own blog now.

      by zonk on Thu Aug 20, 2009 at 01:40:43 PM PDT

      [ Parent ]

    •  If we were able to get a "strong" national co-op (2+ / 0-)
      Recommended by:
      Egalitare, FreeStateDem

      in the final bill as opposed to small/regional co-ops, and if it were just as good as a robust public option would be, the Republicans and the Blue Cross Dems would be just as opposed to it.  They want reform to fail, and they're not going to get behind something if it actually offers the prospect of successfully reforming the system.

      -7.12, -7.54 / "Health care reform will never take place until Rahm Emanuel is strangled with the entrails of Frank Luntz." - Diderot

      by Big Tex on Thu Aug 20, 2009 at 01:46:58 PM PDT

      [ Parent ]

    •  Amateurs vs professionals (1+ / 0-)
      Recommended by:

      "Coop" has that nice fuzzy you-and-your-neighbors feel to it. Bunk, but that's the appeal.

      A national coop by definition would be just another huge non-profit (like our friends at Blue Cross used to be). It is no more a real co-op in terms of governance than a mutual insurance company is. There are not going to be warm fuzzy town meetings to talk about, say, whether to cover gender change surgery, or how high your co-pays should be.

      I just don't see why this is an advantage over letting younger people buy into Medicare, which to me is the simplest solution.

    •  I don't see how we can possibly reduce costs (0+ / 0-)

      By creating yet another private, publicly-funded entity.  We'll be getting screwed on both ends, and how will they possibly compete with the other companies enough to bring prices down?

      Profit and the middleman need to be taken out of the equation altogether!

      Save the parrots: Drink shade-grown coffee!

      by oscarsmom on Thu Aug 20, 2009 at 02:14:52 PM PDT

      [ Parent ]

    •  A series of Seattle sized or larger... (0+ / 0-)

      ...along side a Public Option you can probably sell to most of us. If people want to chose the Puget Sound model, so be it. But it is likely to actually be used only in a handful of places which are densely populated enough to get both a critical mass of enrollees and enough physicians willing to be part of an community experience.

      But as someone has already posted, the GOP has already declared Co-ops as "goverment healthcare by a different name." They are only interested in securing our well over 47 million uninsured (and BTW many millions of underinsured) as new enrollees for Big Health Insurance, subsidized by the Federal Government.

      And they'll blame us for increasing the deficit because of it.

      Medicare: Government-run Health Care since 1965

      by Egalitare on Thu Aug 20, 2009 at 02:27:04 PM PDT

      [ Parent ]

  •  The Hacker report is excellent. (2+ / 0-)
    Recommended by:
    samddobermann, flubber

    On page 5, it points out what I consider to be a crucial consideration (emphasis added):

    The versions of the House bill approved by the House Ways and Means Committee and House Education and Labor Committee contain a Medicare tie-in that has two crucial characteristics:

    1.  Providers participating in Medicare would automatically be considered participating providers in the new public plan, although they would have the right to opt out.
    1.  Initial payments to providers would be set at Medicare rates plus 5 percent. After three years, the Secretary of Health and Human Services could adjust rates. But during the crucial start-up period, the public plan would be able to piggyback on Medicare’s payment methodology.

    These are good provisions. They would be even better if they included an explicit protection of providers’ rights to join the public plan. Private plans (at least those that participate in the exchange) should be prohibited from setting as a condition of participation in their networks that providers not join the public plan.

  •  Single payer off the table now PO off the table (5+ / 0-)

    The table is growing smaller and smaller, now it's COOPS on the table and soon they will be off the table, then it will be a Mandate and on the table and without anything but Private Ins. as an alternative we'll find the table has suddenly grown as large as America won't we. When it's stuff the Ins. Mafia wants the table is endless but if it's something they hate and fear it's they not us who seem to control the table size is it?

    "It's better to die on your feet then live on your knees" E. Zapata

    by Blutodog on Thu Aug 20, 2009 at 01:40:15 PM PDT

  •  For a look ... (1+ / 0-)
    Recommended by:

    ... at one hopeful co-op under Kent's plan, see my recent post on the monopoly insurer from his home state, Blue Cross Blue Shield of North Dakota.

    Don't like pimping my own diary, but it seems on point and the post is scrolling off rapidly.

  •  Drop GOP provisions from final bill! (1+ / 0-)
    Recommended by:

    Dems tried to encourage bipartisan bill(s)--all they received in return were shouters, gun nuts, and legislative obstruction. GOP is party of NO. They have NO ideas and No clue. Let's get real reform without them!

  •  Silly question here (2+ / 0-)
    Recommended by:
    oscarsmom, OleHippieChick

    ...but since we already own 80 percent of AIG, couldn't we just split off a chunk of it, call it the public option, and run with it?

    I remember jokes about that when AIG was bailed out, but now I'm starting to wonder if it isn't really possible...

    The Shrub Has Been Uprooted. Time to plant anew.

    by Randomfactor on Thu Aug 20, 2009 at 01:40:43 PM PDT

  •  A brazillion dollars for guns, (3+ / 0-)
    Recommended by:
    oscarsmom, Matt Z, polar bear

    none for butter.
    They get the goldmine, we get the shaft.

    Hit the Easy Button:
    Medicare for All Americans!

    by OleHippieChick on Thu Aug 20, 2009 at 01:41:19 PM PDT

  •  Nothing less than a robust public option. (2+ / 0-)
    Recommended by:
    oscarsmom, Matt Z

    We've surrendered enough.  This is our line in the sand.

    -7.12, -7.54 / "Health care reform will never take place until Rahm Emanuel is strangled with the entrails of Frank Luntz." - Diderot

    by Big Tex on Thu Aug 20, 2009 at 01:48:30 PM PDT

  •  I consider myself pretty well informed, but (1+ / 0-)
    Recommended by:

    could someone please, in simple terms, explain the difference between a coop and a private plan?

  •  Call the White House again: (0+ / 0-)

          1.  CALL the White House at 202-456-1111 and at 202-456-1414 with the talking points below!      

           They have to know that you're unhappy, and that YOU WILL NOT accept health care reform without a strong, robust public option as essential cost containment to make health insurance premiums affordable, otherwise it'd just be a mandated bailout of the murder-by-spreadsheet industry.

              Regional co-operatives are unacceptable since they will NOT be competitive in order to bring down your insurance premiums! They will not provide a strong deterrent to the murder-by-spreadsheet industry. It's why Republicans such as Rep. Shelby are now making noise about why regional co-operatives are okay because they know this.

              After all, Blue Cross Blue Shield started out as a regional co-operative too. Then it got privatized, taken over by people from private insurers, and premiums started rising with no end in sight. That's not the kind of health care reform we need from regional co-operatives.

       courtesy of Eve & Jane

    Their lines are busy.  Keep them busy.

  •  "Medicare for the rest of us" (2+ / 0-)
    Recommended by:
    Crazy like a fox, Matt Z

    I don't understand why anyone is proposing setting up a second public plan, rather than allowing the under-65s to buy into Medicare (at sliding scale rates). The infrastructure is already in place, the regs have already been written, you're just adding younger (healthier?) people to the same pool.

    The question for the loonies at town halls should be: Are you on Medicare? Are you OK with it? So why don't you want to let me have it too? Whether they think Medicare is "government" or not doesn't matter -- just open it up to the rest of us.  

  •  Have to ask the question... (0+ / 0-)

    In many ways the public option as I have seen described is a National Health Insurance Cooperative.

    Federally chartered National Health Insurance Cooperative started with federal seed money.  A national governing board consisting of certain public officials (HHS secretary?), member elected people, and possibly a couple appointed positions.  The ability to negotiate reimbursement rates with providers and drug companies.  Probably some sort of regional infrastructure to deal with provider negotiations more locally within nationally set guidelines.

    It does not deal with the create whole new infrastructure problem described in the diary.  Perhaps Medicare could provide some initial infrastructure to get things going or something...

    And, it is definitely not fleshed out in any way because I know very little about what it takes to set up an insurance company. Nor the fact that cooperatives are just a red herring to gut health care reform.

    But, I mention this idea as more of a call their bluff.  "Fine, you want to compromise with cooperatives.  Shove this cooperative up your ***.  Oh, you are against cooperatives too?  So, you clearly are not in favor of any really reform."

  •  Key point (0+ / 0-)

    Cooperatives have been forwarded as a solution to a political problem--how to get Republicans on board--and even in that have proven a failure. They are not a policy solution, and aren't a viable alternative. That's the bottom line, if this reform is going to be real.

    "Mr. President, I'm not saying we wouldn't get our hair mussed." General Buck Turgidson

    by muledriver on Thu Aug 20, 2009 at 02:51:50 PM PDT

  •  Great Orwells GHost! (0+ / 0-)

    The comprehensive healthcare reform was proposed by candidate and President Obama, Hacker argues, rested on three pillars: creating more choice for consumers and competition for private insurers through a public option; creating an employer mandate, with affordable options for all businesses to buy in to; creating an individual mandate, again with affordable options

    Candidate Obama was strongly opposed to an individual mandate.  Repeatedly.  Publicly.  In all his published plans.

    It wasn't any fucking "pillar" of his plan, he was against it.

  •  On a Complicated Subject... (0+ / 0-)
    Jacob Hacker speaks the truth.
  •  OFA person made a snide comment about a (0+ / 0-)

    Public Option sign at a Town Hall meeting.

    Why aren't these people on board?  They are being very passive toward the Public Option.

    Hopefully, MoveOn and other organizations aren't putting OFA in charge of the fight.

  •  The co-op proposal (0+ / 0-)

    is equivalent to proposing a open co-op general stores to compete with Walmart. The well-established infrastructure, market share and buying power of  Walmart easily crushes smaller competitors.

  •  This is the same old misinformation (0+ / 0-)

    Hacker raises some very good points, but I found it very disappointing that he started by recycling almost verbatim his unsupported "backup, benchmark, and backstop" scheme, which I debunked when he first said it two months ago.

    And speaking of old information, the Sen. Rockefeller quote that you cite is from here: (says Hacker's footnotes)
    It is from Aug 2, which is before the National Cooperative Business Association wrote an 11-page response to Rockefeller's list of questions to the GAO. Rockefeller had just sent his inquiry a few days earlier, and was still waiting for a response by his deadline. This is an odd time for him to issue this proclamation on "everything" he knows, and suggests that he is more interested in posturing than in learning.

    Co-ops may not be the best approach, but lets avoid jumping to conclusions and making unsupported claims.

  •  Be nice is someone in the press asked Conrad... (0+ / 0-)

    "Everyone has their own pet ideas on how to best to do Health Care Reform.  You're a big proponent of Co Ops and as one of the powerful swing votes you might be able to force a concession that chooses Co Ops over the Public Option the President is in favor of.  The danger with that is if your program -- if the Conrad Co Ops don't work at controlling Health Care Costs -- are you going to admit you screwed the pooch on this one?"

    Maybe reference his coming election in 2012 in some way.  The general message being, wouldn't it be safer to pass the President's plan instead of sticking your own neck out there for your pet idea?

    Scare-a Palin: Democratic Fundraiser of the Century

    by Steko on Thu Aug 20, 2009 at 05:39:21 PM PDT

  •  I am always impressed with the quality... (1+ / 0-)
    Recommended by:

    ...of your work, mcjoan. Thank you.

    HR 676 - Health care reform we can believe in - national single-payer NOW.

    by kck on Fri Aug 21, 2009 at 08:37:27 AM PDT

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