Sen. Kent Conrad's co-op model keeps being portrayed--by him--as a "compromise" option on public health. It's not. There's no compromise there between an entirely private model and a Medicare-like public model. It's just something to get all "bipartisany" about, and if it were to gain any real teeth, for the Republicans to oppose.
Robert Reich points this out well:
Nonprofit health-care cooperatives won't have any real bargaining leverage to get lower prices because they'll be too small and too numerous. Pharma and Insurance know they can roll them. That's why the Conrad compromise is getting a good reception from across the aisle, just as Olympia Snowe's "trigger" (which means no public option until some time down the pike, and only if Pharma and Insurance don't bring down and extend coverage a tad) is also gaining traction.
The truth is that there's only one "public option" that will truly bring down costs and premiums -- one that's national in scale and combines its bargaining power with Medicare, and is allowed to negotiate lower drug prices and lower doctor and hospital fees. And that's precisely what Pharma and Insurance detest, for exactly the same reason.
It's all about the bargaining power, and even a national cooperative is not going to be able to compete with the for-profit private insurers if it doesn't have bargaining power. So far, Conrad's proposal does not grant it that bargaining power, the only role of the feds in it is to provide "seed money." If the private insurers, PhRMA, medical equipment manufactures, hospitals, and all of the private entities that are making so much money now in the "system" that we have are going to have any competition, that competition has to have some heft behind it.
And as a political compromise, it's pretty much a non-starter. Here's Ezra:
But it's hard to see it working as a compromise proposal. The fight over a public insurance option is just that: A fight over a public insurance option. The idea's advocates aren't going to find co-ops an acceptable compromise, because, quite frankly, co-ops don't represent what they're looking for: A chance to test the thesis that government is a superior provider of medical coverage.
That said, Conrad is very clear about the genesis of this proposal: The Gang of 11 -- the chairmen and ranking members of the Senate's health-related committees, which is to say, the Senate powerbrokers on this issue -- asked him to build this compromise because they don't think the votes exist to pass the public plan. It's not obvious to me that this idea works as an alternative. But if Conrad is right about the votes, then the question isn't so much about finding alternatives as finding something that will allow liberal senators to vote for a proposal that doesn't include a public plan at all.
Here's some that the Gang of 11 would do well to keep in mind:
House Speaker Nancy Pelosi told the Huffington Post Thursday that a health care overhaul that did not include a public option wouldn't make it through the House because it "wouldn't have the votes."
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Asked by HuffPost if she would allow a reform package without a public option out of the House, she responded: "It's not a question of allow. It wouldn't have the votes."
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Pelosi, during the press conference, also rejected a compromise proposal by Sen. Kent Conrad (D-N.D.) to create private, nonprofit, regional health care cooperatives instead of a national public option.
Pelosi wasn't having it: "Not instead of a public option, no," she said.
As Ryan points out in this story, the 77 member Congressional Progressive Caucus, the Congressional Black Caucus, the Congressional Hispanic Caucus and two-fifths of Blue Dogs all support a robust public option. They managed this week to beat down the idea of triggers, where the Blue Dogs caved. That's in part why Nancy Pelosi can say definitively that the plan has to have a public option. And, by the way, so does the President.
The Senate loves to think it's the only game in town, and for the past several years, it has been. Structural problems and a weak majority on the House side, as well as a Republican president, gave inordinate power to the Senate. That's all changed, and the Gang of 11 needs to start factoring that change into their approach on health care.
For those action inclined--and we've only pushed the ball as far as we have in the House because of action--nyceve and slinkerwink have all the numbers to call.