Start getting prepared -- Co-ops is to Public Option as Boy Scouts is to Marines

[grantcart]

Public Option IS THE COMPROMISE, it is not the 'perfect'


Single Payer is what we really want but a robust public option, particularly given the economic crater that Bush/Cheney has handed us, is the halfway point that we must not receede from.


We have to start confronting and destroying what is going to be the 9th inning attempt to get us to move from a strong Public Option.


They will argue that co-ops will meet all of the objectives of the public option but do so without government bureacracy.


This is not true. If it were true then they would be just as much against the co-ops as they are the Public Option.


Here are some of the reasons that co-ops are not acceptable - many will have more:

1) To begin with co-ops exist only theoretically, there are only a few small co-ops (here is one http://en.wikipedia.org/wiki/Group_Health_Cooperative)while the public option has significant experience in something called Medicare.

2) Cooperatives will be designed in a way to keep them small and a)politically powerless to make real change in policy b)will not achieve the economies of scale to really challenge private care.

3) Cooperatives are based on democratic election by cooperative members, a strong principle for forming governments and policy but an extraordinary weak principle for exercising management in a large bureacracy. ESOPS (not all but most) have a very weak record in competing against private firms in the market because frequently employees would rather have the advantage of the immediate return of higher wages rather than build an organization for higher profits and get the dividend as a stockholder.

4) By definition it is going to be a 'weak sibling'. If it was strong then they would not propose it as a compromise. If co-ops are the same as public option then we don't need to compromise we can stick with the public option. It is an option and for those that cannot stand being associated with a government plan they can pay the additional 38% for getting exactly the same (or even worse treatment).

Now I was in Boy Scouts, Boy Scouts is an organization that I have fond memories of but the Boy Scouts are not the Marines.

Remember "Medical Coop is to the Public Option as Boy Scouts is to the Marines".

When it comes to fighting for our health and the health of our budget and the reduction of our deficits, we are going to have to send in the Marines.

[andym]

1. Nice analogy. K and R nt.

[babylonsister]

2. Isn't there another solution, Wyden's? Oi. nt

[grantcart]

4. That is the charade

Why do we need another solution?


If they propose something that they SAY meets all of the same conditions as public option and they are for it then you can be sure that it doesn't meet all the same conditions.


Public Option. Elections have consequences. Majorities mean something.


The Insurance Companies are not the 'Stakeholders' the people are. No 'weak sibling' compromises.

[babylonsister]

7. So I will say to you what I say to everyone. Wait and see. We could

be surprised. I have been before.

[grantcart]

10. We don't need surprises and we don't need experiments.

Medicare works. Giving the rest of the public an option similar to medicare fixes the problem.


If we accept cooperatives and they do not work we will lose a decade and credibility on changing the system.


Really the conservative thing (strategically, not ideologically) to do at this point is to accept what works well.


There are no repeat no Medical Cooperatives in the US that could serve as a model for a large effective counter balance to the disaster of the 'for profit' health industry.

[babylonsister]

13. What I am saying is we don't know what the final Senate plan

will be. And then, when they get to chew everything over, it might not be co-ops. There will be something, and it won't be the status quo. I really believe that.

[grantcart]

14. But this really is the point - at that point there will be tremendous pressure

Hundreds of billions of corporate profits are going to at stake and they are going to try and do everything possible to cause confusion, create diversions.

This is our weakness, our reasonableness. Almost always when it comes to a negotiated settlement conservatives will get the better result because, well we are reasonable and want the government to work, They don't care and are happy to see it fail.

It doesn't need to be something that we are unfamiliar with.


We know that medicare works. We know that the public option will work. We can cut deals with pharma and the hospitals and with AARP and the AMA. I am not against compromise. But those 'deals' (and I am assuming that we are getting real advantages in the 'deals') will not address anything about the structure of the system and can be addressed in the future.

The public option will offer a profound 'structural change'. Even if there are problems with it as it first comes out it will dispel the myths about the government's ability to provide the proper superstructure for health care and it will develope a constituency that will want it strengthened and expanded. This is exactly what has happened in the other democracies and why every other conservative party outside of the US fights to have their public option 'expanded' and not eliminated, in the exact same way that Republicans no longer fight Medicare but try to present themselves as beneficial reformers.

If we pass a bill that addresses some of the problems but does not address the basic structural problem then we will, in the President's words "kick the can" down the road and face the exact same question 10 years from now but will be poorer for it as the for profit industry continues the greatest legal scam in history. It really is that bad.

We will also forever damage the Democratic Party brand and people will not believe us next time when we say the Public Option is the 'real answer'.

If the final bill does not have a public option then it should not be passed and we should let the Republicans be held accountable for maintaining the status quo. I say this saying that the compromise bill you imagine would probably allow my family to get health care coverage for the first time in 10 years and we need it.

If we don't have the public option in the bill then we should walk away from it and leave the Republicans as the destroyer of reform and the paid sponsors of a corrupt and dying system.

Sometimes you do have to draw lines in the sand and we should push for single payer, the public option is the compromise from which we should not move.

[Hippo_Tron]

15. For the same reason that the Republicans call the "estate tax" the "death tax"

If the word "co-op" poll tests better than the words "public option" then the solution is clearly to legislate a public option and have every senator go on television and call it a "co-op".

[LiberalAndProud]

3. Theoretically ...

could DU form a Co-op? Honestly, would it be possible to work within this new compromise to our benefit?

I am passionate for access to affordable health care. I will take what can be gotten. (and I probably know that last sentence is grammatically disastrous)

[BzaDem]

5. I often agree with your posts.

And you might be right in substance. But in terms of getting something passed, I would not oppose a bill with co-ops if the moderates refuse to vote for a public option. The Democratic party won 60 seats in the Senate and a majority in the house, but that does not mean people who want progressive healthcare reform won 60 seats in the Senate or a majority in the House. I am not going to let the perfect be the enemy of the good (though I would be thrilled if we had enough votes for a strong public option).

[grantcart]

8. I do not believe that coops will offer a real alternative to the profit plans

that are essential a scam on the public.


If coops were an effective foil to the private plans they would not agree to them. Their agreement to them is proof that they are fatally flawed.


I am not against compromise. We can compromise with the AMA, we can compromise with the pharmacuetical industry (although it gags me to do so) but coops will leave in place a super structure that favors private industry and will actually help them by forcing more people to buy service.


This is not letting the perfect be the enemy of the good but allowing compromise to be the midwife to the bad.


It will also undermine future efforts because the public will see that we were wrong about cooperatives so we won't have any credibility about the public option.



BTW can you name a current Medical Cooperative that you think is a viable option?

[BzaDem]

17. The public option that is being considered in the house would most likely have 10-15 million people

enrolled.

That is really not that much more effective than a co-op with that many customers. The public option you want (high tens of millions enrolled) would be able to lower prices effectively through negotiation. But that public option (with open enrollment by anyone) is not even being considered by committees in Congress, much less in Conference.

The truth is, at this point, co-op vs. public option is not the most important part of reform (in the form it is currently being considered in). I still want a large public option, but I know that is not being highly considered.

For me, what is important is getting everyone covered (or, if that isn't possible in 2009, as close to that as possible). Ending discrimination on pre-existing conditions ("community-rating"), a mandate, and subsidies will go a long way in that direction. There are several countries that have either totally private or semi-private highly regulated insurance that covers everyone.

You would be correct that the above ideas (that is an essential part of every plan currently being considered) would not significantly lower costs. But as long as the government guarantees everyone affordable healthcare, it would be the government's job to ensure that costs are eventually controlled. Otherwise, the ever-increasing subsidies to private insurance that the government already guaranteed to its citizens would bankrupt this country. They will no longer be able to avoid the cost problem by not covering everybody (as they are now), since nearly everyone would already be covered. Once we have a guarantee of affordable insurance, Congress' hand will be forced and they will have to enact reforms that lower costs (either through a public option or through Netherlands-like regulation of the insurance industry). And it will be much easier to do so later: with the essential guarantee of affordable healthcare in place (through community rating, a mandate, and subsidies), cost controls can much more easily be pushed through the reconciliation process, avoiding the need for 60 votes in the Senate.

So basically, while I would love to enact a universal guarantee (community rating/subsidies/mandates) and cost controlls (public option) at the same time, I think it is much more realistic to enact the former first, followed by the latter at a later point.

[grantcart]

20. getting everyone covered - without a public option will mean a big payday for the private

sectors.

There are only a couple of cooperatives that seem to be working and they are limited geographically.

Also there is no public vs cooperatives, they can continue to have cooperatives, and in some areas - like Seattle they may even outperform the government option. It shouldn't be an either/or compromise.

The other changes that you are talking about are modifying changes that can happen at anytime. Adding the public option - making medicare universally available to anyone who wants it - is a structural change that will lead to more and more evolutionary change as people see and accept the government role in health care and more and more constituents use it and demand more services from it. Just like other countries once there was a government option the people wanted more of it, even conservative parties compete to expand it.

There is a reason that the insurance companies are willing to compromise on the other issues you mention, because once you get down to the details they will be able to manipulate the final bills to their advantage. With the public option they lose the ability to control the game and will be forced to compete.

If we don't get the structural change people will become cynical about health care and there will not be the momentum to add the public option for 10 years.

Rather than compromise with a plan that doesn't go to the heart of the structural problem it would be better to let it die and lay the responsibility entirely with the Republicans who block the change. For me that will mean that I will not get the medical coverage we probably would get under a compromise with no public option.

There's a reason the insurance companies WANT cooperatives.

[BzaDem]

21. What do you mean by "medicare universally available?"

Do you mean for free? For free under a certain income? Subsidized? Available if they can afford it?

Free would be single payer. Anything else we can achieve without the public option.

My main focus is a bill that results in no one's health insurance costs to be above a certain modest percentage of their income. That is my overarching goal. A public option is just one way to achieve that goal. There are countries that achieve that goal without any public insurance plan at all.

If the bill results in no one's medical costs going above a certain modest percentage of one's income, I don't care if the insurance companies twist it to their advantage. If the basic guarantee of "modest percentage of income" was there, the best the insurance companies could due is increase government subsidies. That would certainly be bad. But political and economic realities would force politicians to fix that problem relatively quickly, either with a public option, strong regulation, or through another method (to fix spiraling deficits). The point is that a public option just affects the cost side. It can be dealt with later. What's important is the entitlement side -- that everyone is guaranteed affordable coverage. Once we get the guarantee, it will be much easier for the mechanics to fall into place later, and the insurance companies' day of reckoning will come with it (no matter what ephemeral gains they think they get in today's bill).

If healthcare reform dies, responsibility will not lie with Republicans. We have 60 votes in the Senate and a majority in the house. Responsibility will lie with Democrats, and the media will not rest until that is cemented into everyone's mind. If healthcare reform fails, not only will Republicans make significant gains in 2010, but no one will trust Democrats to lead on healthcare for at least a decade. Our current majorities came in the best political environment in two decades and we will probably not get a better environment for a very long time.

[hfojvt]

43. interesting discussion

I am with the OP though. I am not gonna be happy with health care reform which does not have a public option.

As far as the public, it is kinda hard to tell. Much of the public is gonna be unhappy with anything the Democrats pass. They will be told to be, and they will be told why they should be. Just like people on the left are gonna be told to be unhappy because we did not get single payer (or a public option).

But public option is not the perfect to those who support it. It is the compromise. The question is how much can you compromise before something is no longer good?

Don't let the perfect be the enemy of the good, give up single payer.
Don't let the perfect be the enemy of the good, give up the public option.
Don't let the perfect be the enemy of the good, give up coverage for abortions.
Don't let the perfect be the enemy of the good, give up subsidies for people over 50% of the poverty line.
Don't let the perfect be the enemy of the good, give up increased taxes on the wealthy.

At some point the glass is more than half empty and there's not enough water to wash away the bile that has arisen from everything we are forced to compromise. Instead of a birthday cake we get a bowl of soggy oatmeal and we are supposed to pretend we are having a happy birthday. We are not gonna smile and take it. Our legislative parents are gonna be wearing that oatmeal. Teabaggers are not the only ones who can get mad as hell.

[LastLiberal in PalmSprings]

18. Why is it the GOP passes laws with 51 votes yet the Dems need 60?

We're talking major evil GOP policies here -- the huge tax breaks for the rich and the so-called Medicare drug coverage which was written by the HMOs and pharmaceutical companies, which immediately raised their prices astronomically. Both of those laws were passed when the Repugs only had 51 Senators, and in the case of the drug law they had to keep the vote open for three hours (versus the mandated 20 minutes) until they could cajole/bribe one last senator to vote their way.

After the 2006 mid-terms the DNC said that Bush/Cheney couldn't be impeached nor could we get out of Iraq because "we don't have 60 votes." So now they get their 60 votes plus the presidency, and the Dem leadership is saying we can't even consider single-payer because the 60 votes we have aren't the right kind of votes.

We should have started negotiating from single-payer, but Obama and Baucus took it "off the table" without getting any concessions from the Repugs. To accept anything less than a public option now would be turning away from the principles of the Democratic Party. As was said earlier, elections have consequences.

Agreeing to a co-op plan is to let the Repugs win, and win big. They can claim bi-partisanship, but blame Obama and the Dems when the co-ops go under. And they will have succeeded in delaying any consideration of health care reform for another decade, if it ever happens.

[BzaDem]

24. Republican policies like tax cuts can easily go through the reconciliation process

and only need 51 votes in the Senate. Democratic policies such as healthcare are not directly related to the deficit and therefore can't go through reconciliation. The Medicare drug bill actually got many Democratic votes. The cloture vote passed 70-29, so they actually got 70 votes. And as for removal from office after impeachment, that constitutionally requires 67 votes.

[verges]

51. Problem is co-ops won't work.

And when they fail, the Dems will be blamed. The repubs will say that health care cannot be done, and most people will believe it. We won't get another whack at it for 50 years. In twenty years, the failure of coopcare and Hilarycare will strongly resonate and prevent a third attempt. But, if CO-opcare is vetoed, the blame can then be laid at the Repubs doorstep; and we might get another crack in twelve years.

I would really like to see this resolved while I'm still alive. We have to do it right THIS time.

[JimGinPA]

6. K&R

[TheKentuckian]

9. I'm with ya.

While I can't really come up with anything worse than what we have now (and more so, what we'll have in a few years) but we need the Marines to get a real foothold so we can eventually roll in with the Army, Navy, and hit them with the USAF from above.

Hell, we've let this go so bad that single payer might be a half measure. I think it is very possible that we may have little choice than to actually go full on socialized medicine to get a hand on the total expense. Right now, single payer is out of realistic reach and I've been focused on an option but I have some idea of the scope of the problem and KNOW and option is a half measure at best but we have to start to move this and the minds of the people in the right direction and another trickle down market bandaid any further watered down won't even start to slow the train unless luck plays a bigger factor than can be accounted for.

Big insurance will just do some price fixing that gives us a year or two off from the massive increases to lull us to sleep with the co-ops.
They are also prepared for an option and will take short term losses to hobble the program. That means if and when we get it people need to consider it a patriotic duty to go with the option and ride it out while they play their games as they are allowed to join.

The big players will be presenting newer better plans if we pass this but they will resume shenanigans instantly when they can get a puke or a blue dog to start gutting it as a failed program.

Even passing a robust option is only the first step on a long road to getting this under control.

[grantcart]

11. You are right that the public option is only the first step

but it is also the real 'slippery slope'.

Once people see it working and they know that the idiotic rumors (death panels et al) are groundless they will not only use it but demand more and more from it, just like medicare and social security it will build its own constituency.

Cooperatives will not.

[cliffordu]

12. k&r.....

Been busy, sorry I'm late....

[grantcart]

31. tks

[napoleon_in_rags]

16. As a Group Health Member, I have to disagree on some of the things you say.

Group Health care is great, and everything core in my life is from a coop. Food, bank, health care. And the service I get in all of them is better than corporate solutions. Coops for all who want them would be a major step forward.

The issue with backing down here is political though. Sending the message that these HORRIBLE tactics work is extremely perilous, we've been backed into a corner with the public option in that regard.

[grantcart]

19. Apparently GHC is one of two or three functioning Co-ops

They have about 600,000 members. It doesn't seem like a practical approach to guarantee care to everyone and I would imagine that rural areas would be particularly disadvantaged while higher end areas like Seattle and Beverly Hills would gain big advantages.

But here is the real issue - No one is proposing eliminating cooperatives.

Let them compete against the public option as well.

If cooperatives are more efficient then they would crowd out the public option.

What is being proposed is using cooperatives as a way to eliminate the public option.


Private option/Cooperative option/Public option. All are fine just don't eliminate the public option for a weaker alternative.

[napoleon_in_rags]

29. Its true, GHC is geographically dependent

They save a lot of costs because we get our care at this big computer connected GHC building, which has all the goodies for most medical care. Of course we're covered if we need to go to hospital proper (like ER) and I think certain specialists get outsourced if we need them. But the fact that its non-profit and centralized geographically (for each area, my big building is in Lacey, other ones in Seattle and so forth) is what gives us the most value. I'm not sure if you could get the same amount of value just be non-profit insurance for rural doctors.

[grantcart]

30. Ironically it is being advanced by Senators from rural areas

They probably think that it will work for them like some of the old farm cooperatives.

[napoleon_in_rags]

32. It might, to be honest. The real question is why not have a broad spectrum of options?

Including coops and public options? Choice is good, well see what works out by experimenting.

[grantcart]

33. as stated above, absolutely agree to coops being an option

No one is suggesting that option be taken away.

Coops are being advanced as a substitute for the public option, which it can never fill, no matter how well it might work in a particular setting like Seattle.

Public/Private/Coop what they are trying to do is eliminate the public option.

[napoleon_in_rags]

36. You may be right or wrong, but Francis Bacon must be quoted:

> In the year of our Lord 1432, there arose a grievous quarrel among the
> brethren over the number of teeth in the mouth of a horse. For
> thirteen days the disputation raged without ceasing. All the ancient
> books and chronicles were fetched out, and wonderful and ponderous
> erudition such as was never before heard of in this region was made
> manifest. At the beginning of the fourteenth day, a youthful friar of
> goodly bearing asked his learned superiors for permission to add a
> word, and straightway, to the wonderment of the disputants, whose deep
> wisdom he sore vexed, he beseeched them to unbend in a manner coarse
> and unheard-of and to look in the open mouth of a horse and find
> answer to their questionings. At this, their dignity being grievously
> hurt, they waxed exceeding wroth; and, joining in a mighty uproar,
> they flew upon him and smote him, hip and thigh, and cast him out
> forthwith. For, said they, surely Satan hath tempted this bold
> neophyte to declare unholy and unheard-of ways of finding truth,
> contrary to all the teachings of the fathers. After many days more of
> grievous strife, the dove of peace sat on the assembly, and they as
> one man declaring the problem to be an everlasting mystery because of
> a grievous dearth of historical and theological evidence thereof, so
> ordered the samewrit down.

Its exactly like this. The simple way to see which system is best is to LOOK at them in action, which means allowing people the public option, so they can see which care they prefer.

[WHAT]

38. My experience with Group Health...

reinforces your claim of "geographic dependency". I really liked the culture of Group Health and thought they gave good care because of the consistency built into the record keeping because even if you saw another doctor they knew where you were at because documented care was accurate and accessible to any of the providers...I can't imagine triple MRI's on the way it was set-up, or three different prescriptions for the same drug. However, when I had to have radiation 5 times a week for 6 weeks, there was a dilemma. The nearest location this specialized care was available to me was Seattle, an hour and a half drive away, minimum...twice a day.

I almost didn't do it just because of that road-block.

So, Group Health is really good within a high density area where the most people can be helped the most effeciently...but it's difficult to acquire specialized care if you live in a weird geographical area.

I'd like to see the good things about Group Health, accurate and efficient documentation resulting in consistency of care, incorporated into a public option where geographic location wouldn't limit access to care.

[napoleon_in_rags]

41. I think some of that is coming no matter what.

I'll bet the money and time they save from their model is just astounding, you sit in the room and your test results come up on the screen, nobody goes anywhere. Or your test results come online. If I want to talk to my doctor about any number of small things, I just go online and email him, Or I call one of the nurses from the 24 hour center. That's just plain old fashioned efficiency, which everybody agrees we need. They're using 21st century information tech for medicine.

Some treatments will always be geo-dependent, because the equipment is expensive. But yeah, if they could come up with ways to minimize that, we'd be in good shape. I think a lot of that deals with an open standards based information system. There really shouldn't be a reason why GHC shouldn't be able to outsource a treatment to a local hospital near you, so long as as they are using the same information standards, so the local hospital can instantly pull your records from GHC, and send test results back to GHC seemlessly. IF the hospital they are outsourcing to has efficiency standards which are as good, there shouldn't be much of a cost differential between the local hospital and doing it themselves.

[quiller4]

40. 600,000 Co-op members but over 2,500,000 subscribers

One need not join the Group Health Co-op as a voting member in order to subscribe to a Group Health policy.

[quiller4]

45. Remember members and subscribers are different-you can buy into

Group Health without becoming a voting co-op member and the number of individuals with Group Health coverage is about 10 times the number of Co-Op members.

[grantcart]

50. all good points and again GHC seems to be the only medical cooperative

that is having this kind of benefit.

But cooperatives are not a substitute for the public option


Private Option/Public Option/Cooperative Option - just don't take the public option out.

[Dawgs]

22. Don't worry. Any bill that doesn't include some sort of public option will never pass in the House.

I can almost guarantee this to be true.

[grantcart]

28. the problem is when the reconcile the senate and house bill

There will be big pressure on the progressives to be 'reasonable' and fold, after all "cooperatives will bring all the benefits of a public option".

In order to help the House we need to 'spike' this argument now.


Co-ops are not a substitute for public option.

[Freddie Stubbs]

23. Some Boy Scouts grow up to be Marines

[grantcart]

25. and the public option can grow to single payer

but the cooperative 'compromise' is a trap, a blind alley.

After the cooperatives prove to be only successful in certain areas where hundreds of thousands of people will join in a efficient geographic area and we start complaining and pushing for the public option they will try and fiddle with coops to make them a little mroe effective.

It will become the foil against public option.


After I left scouts a new scout leader was brought into my troop he committed suicide when he was investigated for committing crimes (he was a deputy sheriff).


When you need marines you don't send in a bunch of boy scouts and hope that some of them will eventually make it and possibly solve the problem.


We need the marines now.

[Better Believe It]

26. Public Option is to Single Payer Medicare for All as Boy Scouts is to Marines

Could also say that! Certainly in the case of the watered down public option that is now being proposed.

:)

[grantcart]

27. Yes but I believe that the public option is simply a path

(and the only realistic one) to single payer.


Medical Cooperatives are not a path to the public option or single payer they are a dead end alley that will be used to foil real change.


Even a compromised public option will be a major step forward because it will eliminate the mythology (death panels etc) about government involvement in universal health care and it will build a constituency that will insist on strengthening and expanding it (in the same way social security and medicare has).

:D

[Better Believe It]

34. The "public option" currently proposed isn't worth spit.

And the House "public option" will only get weakere and worse, if it even stays in the bill, once the Senate gets their hands on it in conference.

As currently written the public option will only cover around 10 million people in 2019, won't go into effect until 2013, won't be allowed to pay Medicare rates, won't provide better benefits at lower premiums than private health insurance policies and will be required to play "on a level playing field" with private insurance companies!

Well, if the public insurance can't provide better benefits at a lower cost premium, why in the world would anyone want it?

[OwnedByFerrets]

35. K and R

[grantcart]

37. thks

[quiller4]

39. Group Health is anything but small and has plenty on influence

on Washington State health policy. That isn't to suggest that I think co-ops are the way to go.

[grantcart]

42. Unfortunately that is not true

First Group Health is apparently the only functioning coop that is having any impact.


Second it is having a significant impact in a very small area, apparently has only two facilities that would cover about a 50 mile square radiance.


For people living in Wenatchee or Spokane or anywhere outside of that very small area it has no impact.


This is the problem with coops - even if they are well organized and provide a great service (which Group Healh apparently does) they are marginalized by geography.

[quiller4]

46. Group Health owns 26 facilities in Washington and contracts

with an additional 30+ to provide service in 23 Wasington cities and 4 cities in Idaho. One of its largest facilities is in Spokane.

[grantcart]

49. and it should be an option that is included -- it is not a substitute for a public option

[grantcart]

44. Cooperatives will not be enough

[billyoc]

47. You don't get it, when Sebelius says no public option, the field is cleared to get rid of co-ops!

So don't bother getting used to the idea of co-ops, they'll be gone by Friday.

[grantcart]

48. You must have missed the point of the thread

I would be happy with no coops if there is no pubic option.


In any case the Whitehouse has announced that Sebelius mispoke.

http://politics.theatlantic.com/2009/08/administration_official_sebelius_misspoke.php