3.
There are other, and probably far more important, problems with using Group Health as a model for what the co-op compromise could deliver all over the nation.
Among them: the idea that Group Health provides a structure that can be quickly replicated to great positive effect. Don Mitchell, a retired physician and the chair of the Western Washington chapter of Physicians for a National Health Program, pointed out that it has taken “years” (62, to be exact) to get Group Health to its current level of service and national stature. You can’t just create a bunch of federally-chartered, citizen-run health care concerns all over America and expect them to be high quality on day one.
But perhaps the biggest problem has to do with size. Group Health achieves efficiencies and economies of scale—which in turn lead to cost savings, a Holy Grail of health care reform—precisely because it’s not small.
Size matters quite a lot in cutting health care expenses. That, by the way, is the whole point of the public option: to create a government-backed national health care plan that’s so big it will be able to compete nationwide and bargain for lower costs all over the country, all at once. “Because [co-ops] would be at most state-wide in scope and not be national,” Mitchell said, “they would lack the bargaining clout that a national organization would have in terms of driving down costs vis-à-vis private health insurance companies.”
This is why, even though the Commonwealth Fund recently placed Group Health among the nation’s “shining examples of co-operative health care,” Dr. Karen Davis, blogging for the group, nevertheless described the idea of filling the country with Group Healths as a “difficult” and “uncertain” proposition.
Bottom line: Group Health has found a way to work well in the Pacific Northwest after 62 years of operation. But it’s not the small, easily-replicated co-op that Maria Cantwell and others want it to be. In fact, one important lesson of Group Health ends up being exactly the opposite of what advocates of the co-op compromise seem to want to hear: it takes a big entity with experience in the health care market and significant financial clout to push the industry in the right direction.
An entity like, you know, the federal government—which, under the public plan, would be doing just that at the national level.
The “co-op compromise” is nothing more than a fall-back position after the lobbyists for the for-profit system realized they might not be able to kill a public option outright. It’s a half-measure that is designed to fail. The only credible selling point that Cantwell and others have offered in its favor is that it is more likely to pass the Senate than the bill the American People really want. This is a terrible, circular argument for such a weak compromise.
ZM is right. The Big Pharma and Big Insurance lobbyists are losing the public debate, so they’re trying to trick us into not insisting that we get a single payer national health care plan like two-thirds of American citizens want.
Don’t be fooled.
Insist on what you want – not the bill of goods they’re trying to sell you.
It doesn’t seem weak to me at all. In fact in part 2 Eli is arguing that Group Health is too BIG. How is a bigger Federal solution better? This article fails to answer that entirely. Surely there are reasons to accept a single payer solution besides “Dr. Karen Davis, blogging for the group, nevertheless described the idea of filling the country with Group Healths as a “difficult” and “uncertain” proposition.” Who ever thought nationalized health care would be easy?
The problem is this: There is no comparison between the two options. As I understand it, from this article, GHC is bad, because it is too big and not a co-op, but it’s good because it’s a large enough organization to be cost effective, but it’s bad because it’s 62 years old and it would be difficult to implement similiar organizations elsewhere. This is a very tenuous argument.
How is a single payer solution better in anyway? It would be a larger organization, which would be more cost effective? I don’t know if I buy that, but OK. Because it’s easier to implement? I highly doubt that.
I’m just really confused and this article answered none of my questions.
@3: I’m not saying Group Health is too big.
I’m saying it’s not the type of small co-op that seems to be envisioned by backers of the co-op compromise. (And I’m also saying that Group Health is not even, technically, a co-op).
But size is not inherently bad. As I wrote, the benefits Group Health gets from its size end up helping to make the case for the public plan.
As for the 62 years: The time it’s taken Group Health to get to this point ends up being an argument against the idea that the co-op compromise can work on day one.
Hmm I’m not sure how many people envision GHC as a small, Capitol Hill based co-op. Probably very few.
What was Group Health like 20 years ago, or 60 years ago? Doesn’t the progress made respresent a generally better understand of what is important in a health care co-op? It seems like a pretty incredible lapse in reason to assume that a new, governemnt co-sponsored, co-op would take as long, or even half as long, to implement today. But that’s me making another basely assumption myself. How about some facts?
How long do you presume it woudl take for an effective single payer option to be established, and why do you think it would be less time than regional co-ops?
Eli, in addition to the Gawande article, you should check out The Innovators Prescription and http://www.commonwealthfund.org/Content/…
Both of these offer some pretty good insights into what the components for reform will really have to contain in order to be successful.
That’s a lame argument. All the proponents have to do to fix their proposal is decrease the number of the coops and increase their size, I guess. Wow, that would be easy. And that 62 years thing? Get off the PNW “we’re unique” high horse, anyone can copy what Group Death is now, and they won’t have to go through those 62 years of experience. And it’s as easy as creating a single payer from scratch.
Your fnal argument is just that thenational entity would be bigger and thus better, which sorta makes sense, but you know, you haven’t explained anything about why this coop idea would be a bad option, amigo. Lo siento. I mean, Norway and Sweden are about the size of Washington State or Group Health and THEIR plans are “big enough,” right? It all comes down to bargaining power? That’s not much of an explanation of a reason to not go down the coop path.
And you didn’t tell us who is governing Group Health….its customers? a self selecting board? who?
Please add a part 4 that actually explains why this is not a good idea. Thank you.
Just give us a single payer national health care plan as a default for all US citizens and stop whining.
Compelling argument Will. Your single sentence has convinced the entire populace. Single payer national healthcare here we come! What fools we once were to seriously and carefully consider our options!
The point of public health care is to cut costs? The #1 reason for public health care is to make sure everyone is covered for everything. It’s also the reason why conservatives don’t like public health care – they don’t want to pay for other people’s birth control or hormones or AIDS treatment.
It seems like co-ops ARE a good compromise in that regard. In Tennessee, they can provide chapels and unlimited oxycodone and adderall. In Seattle, they can provide emergency contraception and gender reassignment surgeries and acupuncture. I’d rather they provide what I want everywhere, but it’s not going to happen.
How has Group Health been at providing “controversial” treatments? Do they provide health care needs/wants of the minority? Emergency contraception? GRS? Effective cognitive-behavioral therapy? Nutrition? Effective alternative treatments? How do they decide these things?
Maybe I’m naive, but it seems that the government could just provide a central administrative distributor/bargainer to control costs for all the co-ops’ medical supplies and technology development, solving all your concerns in this post.
I’m very pro-co-op if it still covers everyone and addresses these concerns. It’s better than arguing for the next 40 years about whether everyone gets emergency contraception or nobody gets emegency contraception.
PC – Group Health is governed by a Board of Directors who are elected from, and by, the membership itself.
By the people, for the people.. inside a corporate structure that enables GH to get those lower rates. It works.
Group health really isn’t that much cheaper than the for profit insurance system and certainly could not absorb all the under/un-insured we have even in just in the Northwest. Group Health may have a progressive lean based on its history and geographic location but there is no guaranty that would be repeated anywhere else and especially if started now. If you want to see how bad a so called non-profit hospital can be Saint Luke’s in Boise is a good example. They started as a charity and morphed in to a greedy money grubbing major institution that charges almost twice as much as Johns Hopkins while delivering far less. Although they are technically a nonprofit some off their officers make some seriously fat paychecks and some of their doctors also own for profit clinics that a do a lot of business with saint Luke’s and their patients. They also throw their weight around and bully their neighbors like most big powerful corporations. We all know this is a half measure to a half measure which will avail nothing.
BTW – regarding the “Group Death” moniker that has been bandied about – that name was coined back in the 1940’s by doctors of the King County Medical Society, who deemed the Group Health docs as socialists who would somehow threaten to corrupt the bottom line*. So, if you wanna be in solidarity with a bunch of greedy conservative doctors, have at it.
*Source: Walt Crowley’s book “To Serve the Greatest Number.”
Yeah, I have to admit I’m a little lost in all this conversation about how Group Health controls costs. Two years ago I looked into buying an individual health plan – that’s the kind where you pay the premiums yourself – and was shocked to see that Group Health charged more than anyone else and offered less coverage. Why would anyone choose that?
I also wonder about the outcomes of people insured and treated by Group Health. Do they have better outcomes than people who have, say, Blue Shield? I’m thinking about my friend who’s had a hell of a time getting the treatment she needs from them. She has debilitating asthma and, despite her lung capacity being restricted to 40% on several occasions, they have thus far refused to send her to a specialist. This is especially frustrating because when she had regular insurance she saw a specialist right away who prescribed her a series of treatments that actually worked. She’s had Group Health for two years, argued with them ’til she’s (literally) blue in the face, and they still refuse to get her the treatment that has worked for her in the past.
Help me understand why this is a desirable model to follow.
TV Dinner, I am calling bullshit, with all due respect. 1. Patients can self refer to Pulmonary or Allergy – two specialties that handle patients with asthma. 2. If she was not satisfied with her primary provider, she could choose another one.
Well, they’re also socialized countries whose governments subsidize it in return for a high tax burden, so they can afford to do everything to make it work. And it’s not a direct comparison to an American co-op’s situation.
Eli’s getting at the point that a co-op’s resources are inherently limited for the scope of what they have to do.