Introducing the government-chartered health care cooperative, which is being pushed by Sen. Kent Conrad, the Democrat from North Dakota, as a compromise that can get serious health care reform through the Senate (where opposition to the public option may be insurmountable).

Conrad proposes that the federal government charter health-care cooperatives that will provide a nonprofit alternative to the for-profit health insurance market. It is, in theory, all the benefits of a public plan, but none of that government control.

Note that Conrad name-checks the non-profit Puget Sound Health Alliance as an example of how these coops could successfully compete against larger private health care providers.

I’m interested in hearing from our commenters about whether the Puget Sound Health Alliance is, in actual practice, a shining example of progressive health care. Meanwhile, as the debate over the public plan continues to churn, here’s an important point made by New Yorker writer Atul Gawande in his must-read report from McAllen, Texas (a shining example of out-of-contol health care costs).

Activists and policymakers spend an inordinate amount of time arguing about whether the solution to high medical costs is to have government or private insurance companies write the checks. Here’s how this whole debate goes. Advocates of a public option say government financing would save the most money by having leaner administrative costs and forcing doctors and hospitals to take lower payments than they get from private insurance. Opponents say doctors would skimp, quit, or game the system, and make us wait in line for our care; they maintain that private insurers are better at policing doctors. No, the skeptics say: all insurance companies do is reject applicants who need health care and stall on paying their bills. Then we have the economists who say that the people who should pay the doctors are the ones who use them. Have consumers pay with their own dollars, make sure that they have some “skin in the game,” and then they’ll get the care they deserve. These arguments miss the main issue. When it comes to making care better and cheaper, changing who pays the doctor will make no more difference than changing who pays the electrician. The lesson of the high-quality, low-cost communities is that someone has to be accountable for the totality of care. Otherwise, you get a system that has no brakes. You get McAllen.

What’s he talking about, exactly? Read the piece. You’ll be in good company: after President Obama read it, he couldn’t stop telling other people to read it, too.

Eli Sanders was The Stranger's associate editor. His book, "While the City Slept," was a finalist for the Washington State Book Award and the Dayton Literary Peace Prize. He once did this and once won...

20 replies on “The New Public Option”

  2. Right. I am changing my view on signle payer. We need not just single payer but true socialization — all health care providers are employed by the government only, they get a fucking salary and start treating us to provide actual health, instead of generating extra services to get more $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$4.

    It’s almost time to just start the fucking socialist party to have real health care that works, full gay equality, and other things that these Democrats are too pussy to even stand up for, much less actually enact. Throw in “and we’re going to arrest GW Bush for war crimes” and it’s a go.

  4. Obama sure is “good company”. I wonder how much extra mullah we’d have to work with in every way/shape/form if we killed all the stingy Jews. Oh, that isn’t homophobic bigotry, so it isn’t okay to consider. He can ignore DADT, support DOMA with colossally offensive comparisons, give the Bush administration a “pass GO” card, and bailout a fucking worthless company. But as long as he’s helping us with healthcare, we’re in “good company.”

  5. And Mr Poe you forgot that he’s escalated the war in Afganastan (it worked so well for the Soviets and British afterall) and I’m sure something will ‘come-up’ preventing us from ever leaving Irag…EVER.

  6. @Cato: The difference in Afganistan is that we aren’t trying to take it over. We are systematically killing bad people (and civilians) and trying to add infrastucture and elections. It’s nasty business, but totally different than the Soviet invasion in the 1980s and Brits in early 1900s.

    So not a good comparison.

  7. It’s absolutely no coincidence that the United States has the by far the highest meat consumption in the world (by carcass-weight), by far the highest health care costs in the world, and the 2nd highest rates of obesity in the world (Mexico passed us in the past couple of years).

    Health care costs and meat consumption are extremely closely linked — it is not trivial. We subsidize the product that is making our health and health care terrible. Instead, we should be taxing it and encouraging people to stop destroying their health, like we do with cigarettes and overuse of alcohol.

    Yes, there are other ways to make our health care spending more efficient, such as the real public option that is COMPLETELY NECESSARY. However, health care costs will never be anywhere near as low as the rest of the first-world nations if we have to spend a ridiculous amount of money to keep meat eaters from killing themselves (by mitigating and preventing high cholesterol, high blood pressure, heart disease, strokes, colon cancer, breast cancer, prostate cancer, etc).

    Yet another large peer-reviewed medical study was just published for June 2009 that succinctly summarizes the problem, titled “Red Meat Consumption Linked to Death.” Before anyone wittily mentions that death is cheap, these people are dying from the chronic diseases mentioned above that are extremely costly to treat for years or decades.

    http://www.nursingcenter.com/library/Jou…

  9. Lizzie, I eat more meat than most people in this entire state. I weigh 135 pounds, and I’d lay money that I’m more healthy than you. You are confusing meat consumption with laziness. It’s called physical exercise. I don’t know if you could benefit from it, but I do know you could benefit from mental exercise. Your personal disgust with others meat consumption and your blatant idiocy are extremely closely linked—it’s trivial, though. Whatever.

  10. I read the New Yorker article in question a couple weeks ago. It was a pretty gripping read. It left me wondering if the whole fight over who provides the health insurance isn’t maybe missing the point. In the article he points out that total spending on health care per person can vary by a factor of three from one city to another, and that’s after controlling for various factors like how healthy the population is. There is no indication that the health care is better, or even that people like their health care more, in the expensive cities. If the whole country could be as cheap as the cheap cities, the impending medicare fiscal crisis would evaporate, and our health spending would be more in line with other first-world countries. Weirdly, the cheap health care cities aren’t especially correlated with cheap cost-of-living cities. It seems like a lot of it has to do with the kind of economic incentives that doctors operate under. Are they defacto salespeople for expensive medical procedures provided by companies they have an economic stake in? Then costs will be high. I really recommend everyone read the whole article.

  11. This is a very bad idea. Non-profits in general should never be assumed beneficent and trustworthy. Some are excellent. However, “non-profit” really just means accounting tricks to make any excess of income over expenses vanish. That can mean ridiculously high salaries and overbuilt facilities, nepotism, etc. Such a “government-chartered health care cooperative” would also presumably be outside the realm of responsibility of regular government review and audits. It would also be vulnerable to all kinds of kickback schemes. No no no. The “public option” is a bare-minimum, last-ditch, line-in-the-sand thing.

  12. #9: Science strongly disagrees with you. People in a normal weight range still develop preventable high blood pressure, high cholesterol, heart disease, strokes, diabetes, colon cancer, breast cancer, and prostate cancer. Having a high red meat consumption still cuts an average of about 5-7 years off your life (controlled for BMI, smoking, drinking, and wealth) — about the same as heavy smoking — and it increases your risk of all of the above chronic conditions.

    There is more evidence that meat (especially beef, pork, and processed meat) is harmful to your health than there was that smoking was harmful to your health 20 years ago. The major difference is, only about 20% of adults smoke and most don’t smoke their entire lives. Over 90% of adults eat red meat and most, unfortunately, develop chronic diseases and die before they quit.

    I just read the published results of another newer large study — amongst people who have never smoked, red and processed meat intake increases your chances of lung cancer by about 250%. Lifelong smoking increases your chances of lung cancer by about 900%. Because of the population sizes of each group, that suggests meat causes much more lung cancer in America than smoking.

    http://cancerres.aacrjournals.org/cgi/co…

  13. A fundamental fact is that the US healthcare system is a tri-plex relationship between the providers, the patient, and the consumer cum bill-payer. think of it as a triangle with each point connected.

    The consumer of medical insurance is the bill-payer not a patient. The patient receives the service, but does not pay the bill. It is a unique economic industry. The employers drive the market, since they represent the bulk of insurance consumers through the purchase of group plans. The single doctor-patient relationship exist within the continum of care, but it is niave to think the bill for the care is not paid by a third party for about 95% of all americans.

    Insurance companies enjoy this status quo arrangement, since the larger the groups, the more dispersed are their risks.

    Co-pays, premiums and deductibles are consumption throttles, not payment for care… in canada longer waiting periods are consumption throttles.

    An insurance Gateway or Exchange or what they call it, will reconginze the individual as a medical insurance consumer. The consumer of group plans currently have the cloat for besting prices vs. the individual. A private, national co-op, with a member elected board, will not work without government involvement, since it would be subjected to the same old status quo market forces.

    Status quo insurance risk being defined by probability of certain percentage of a group needing a large cost medical procedure.

    The single medical patient needs medical care without obstacles. Throttles are necessary to prevent over-consumption but they do need a payer to recieve care. A patient with a job and a job with health benefits have a payer by virture of group belongment. Also, the current throttles are sometimes obstacles to consumption since they preclude even those within a group who lack the financial ability, often due to the lower employement wage levels, to recieve care.

    Yes, such a private plan will not realize “above average returns” due to a higher number of high risk (ie sicker or poorer) members. So, why not let the government accept the finacial risks of paying for the care of some people outside of market forces, while healthier and better employed people can join even great healthcare options which will be available through the retention benefit of a negotiated work/group plans?

  15. Don’t accept half measures.

    Insist – loudly – on single-payer national health care so that if you get the default US citizen plan any doctor has to treat you and you’re covered for anything that covers.

    Nothing less.

    But do it now, they’re wrapping up the discussion probably by Wednesday at the latest – already your pressure has forced the WH to add single-payer to the mix, and if you push more you can get every US citizen covered in a default nationalized plan that every US doctor and clinic and hospital must accept.

    But only if you contact them now. Next week is too late.

  16. There are a number of non-profit health insurance companies. I think Premera might be one of them; I know Kaiser Permanente is one. We can’t really know how they would operate under a health-insurance-for-all system since, up to now, they’ve had to play by the same rules as the for-profit companies. They can’t become a dumping ground for people with preexisting conditions because that would run them out of business. It might be worth an experiment, especially since our crappy pay-to-play political system is not going to allow a true public option, certainly not right from the start.

  17. Kaiser builds Taj Mahal hospitals. My brother pays half his after-tax income to Kaiser and his premiums have gone up around 20% annually for years. They are nothing worth emulating.

  18. I’ve been a satisfied member of Group Health for more years than I can recall. Seems to me that’s the example they should be looking at.

    Let’s turn PolyClinic and all the other such groups into pre-paid health care providers like Group Health. It takes our the middle-men (for-profit insurance companies) whose first loyalty, after all, is to their shareholders; which inevitably puts priority on finding reasons not to pay claims.

  19. Eating meat is the worst possible thing that we could do. Apparently, vegans never ever get sick… unless you count being at higher risk of suffering nutritional deficiencies such as iron, b12, sinc, calcium, and vitamin D deficiencies and having to take pills (wheres the local multi-vitamin tree?) to compensate!

    I’m pretty sure you can’t call it a healthy diet if you have to take vitamin supplements to counteract the deficiencies found in it. Homo sapiens evolved to eat both plant based and animal based foods. Trying to thrive on an exclusively plant based diet is as unnatural as trying to thrive on an exclusively meat based diet. And, in the long run, unless you carefully balance every single thing you eat and take vitamin supplements, both are unhealthy lifestyles.

    But then, that wouldn’t give you an excuse to lord it over other people with how much better you are would it.

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