A key feature of the Baucus debacle is of course instead of a public option, health co-operatives, that magical Conradian "medical unicorn" designed to make people think there's a real alternative private insurance. Here's how WaPo describes the provision:
The centerpiece of the Baucus proposal is a series of "exchanges" where people without access to affordable coverage through their employers could apply for government subsidies and choose among a range of private insurance options. The plan would not, as liberals have demanded, create a government-run insurance option to compete with private firms, but would finance the creation of state or regional cooperatives run by consumers -- a concession aimed at winning over Republican lawmakers.
Two points. First, Republicans have already rejected co-ops. Maybe, just maybe, President Sen. Olympia Snowe will deign to approve, but I'm not holding my breath on that one.
Second, "consumer run"? I belong to the largest (and just one of two) health co-operatives in the country, Group Health Co-operative which covers some 600,000 subscribers in Washington and Idaho. It's very consumer friendly--the Web site for ordering refills, setting appointments, e-mailing a quick question to your provider--all very handy and very well done. But I'm not running anything. I'm not consulted when it comes time to set provider payments. I'm not consulted when it's time to determine premiums. There is one terrific feature--Group Health members serve as the Board, and are voted there by other members. But the day to day functions--the money part--is decided by the CEO and the hired executive board. I get no more say in how Group Health is run than I do in how Max Baucus's Finance Committee is run, despite my being a constituent of one of its members.
In reality, Group Health is an HMO, a pretty decent one, but an HMO. And even a Group Health spokesperson, Pam MacEwan, sees that this model would be hard to duplicate.
"We're subject to the market just like everyone else is," MacEwan said....
MacEwan said she thinks the reason that health co-ops haven’t sprouted up across the country is because the market doesn’t generally support the co-op model.
"If we do more for our patients, we don’t get compensated more. In fact we get less money," she said. "There’s a reason we’ve been able to dig in our roots and be able to thrive. But we’ve been going against the grain and what the market rewards."
MacEwan said that while she does believe that the co-op system can be duplicated, "I don’t know that it’s the total answer for health care nationwide."
Group Health only exists now because it was able to get established 60 years ago, when the market allowed it. As good as the Group Health experience has been for many northwest consumers, we're not running the show. The market--the insurance industry, PhRMA, the hospitals and medical equipment manufacturers--is running the show, and would be for any co-operative trying to get established in 2010. Unless Congress and President Obama decide to take that power away.