Kent Conrad's constituents remind him that he actually does represent North Dakota, and not the Village on healthcare reform.
At a health-care forum in this Red River Valley community of about 2,000 people, a woman cited polls that she said show a majority of Americans support a public option for insurance coverage despite efforts by opponents to discredit it as socialized medicine.
"How can you continue to ignore what people want?" she asked....
"I have to deal with reality," Conrad responded. "There aren't the votes to pass public option in the United States Senate."
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Not satisfied, another questioner asked Conrad whether he's pushing co-ops just because that could get the necessary votes or because he believes in the concept.
"In my life experience, co-ops work really well," he said, listing a half dozen examples ranging from small rural electric and telephone cooperatives common in his state to such giants as the Farmers Union, Ace Hardware and the Associated Press.
"It's in our blood. It's in our DNA," he said.
The cooperatives approach also "seemed to have a chance at bridging differences," Conrad said, although "some progressives seem to have forgotten" that the cooperative movement was an important part of the American progressive movement in the early 1900s.
Apparently if it works for North Dakota it works for the nation? At least his constituents pushed back, not that anything will penetrate his own sense of self-importance and his certitude on co-ops. So I guess the experts will have to try to take it on, and convince the rest of his colleagues that they just won't work. Here's one of them, Julius Hobson, talking with Mark Ambinder.
...Is the difference between a "strong" cooperative and a "weak" cooperative simply a matter of scale? In other words -- the cooperative system will be too small unless the cooperatives are of a certain size...with a certain number of people buying into them, and encompassing all types of medical services.
I think it's going to have to be the size. And that's one of the questions I have about the cooperative is: can it acquire enough people to purchase services on the scale that makes it economical? And that part isn't clear to me. The federal government would have to provide seed money. The question is: how much, and how long would that last? Are states such as Montana, and I'm talking people wise, not geography wise, Montana, Wyoming, and North and South Dakota, are they large enough? The answer to that is, probably not. One of the conflicts is that insurance is regulated by states. For a cooperative to work, it would need to be regional. So, who's the regulator? Is the federal government going to be the regulator? If the federal government puts up seed money, would it be willing to let the states regulate? Maybe they can [get] insurance companies to agree to national regulation of health insurance, but I doubt that. One other part to that is, assuming you want the cooperative to be competitive, can it get large enough? If you divide Pennsylvania right in half, you've got two [Blue Cross, Blue Shield companies] that control over 90% of the market. Tell me how a cooperative can compete with that.
There are successful cooperatives like Seattle Group Health. What makes them successful? Is their success replicable?
I'm almost of the option that they are unique because of where they are and when they got started. It's not clear to me that you can duplicate what they have done throughout the country. There are some places where you can do that, if you do it from a regional perspective, you might be able to get enough people. But could you duplicate that in Washington, D.C. or Maryland? Not likely.
That last question and asnwer is key here, because Conrad keeps bringing up Group Health Cooperative (known not so affectionately here in the Puget Sound as Group Death--watch them deny my next claim now!). GHC was started in 1947. There was no other competition in 1947. It did grow out of that progressive movement that Conrad remembers so fondly, and grew to be a key insurance provider in the region. Because it started in a vacuum. And it's grown into just another HMO. The whole point of the public option, we've heard again and again, is having viable competition for the private insurers. There is no indication that co-ops can provide that competition. We're not talking butter, or hardware, or even electricity, and we're not just in North Dakota any more.
The other critical point to keep in mind is that the co-ops are a creation of Conrad's solely to answer the problem of "bipartisan" support. And on the front, they're a dismal failure:
"It doesn’t matter what you call it," Sen. Jon Kyl (R-Ariz.) told reporters on a Tuesday conference call. "They want it to accomplish something that Republicans are opposed to. That is the step towards government-run health care in the country. The president himself said you can imagine a cooperative meeting that definition of a public option."
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In the shorter term, Republicans are working to brand "co-ops" as another toxic "public plan," a scheme to take over health care. Appearing on Fox News Monday, Sen. Jim DeMint (R-S.C.) blasted the Democratic plan, "Now, they — they may try to call it a co-op. They can call it a public option. But you know they are all on record saying they want a single-payer government system. So, any Republican now that helps them pass a bill is helping them pass a government takeover of health care."
Ain't. Gonna. Happen. And yet:
White House press secretary Robert Gibbs said the administration remains committed to drawing Republican support for the bill, particularly in the Senate.
"I don't know why we would short-circuit that now," Gibbs told reporters.