Conrad Co-opts Health Care
Posted on June 17th, 2009
by Lewis McCrary |
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Senator Kent Conrad (D-North Dakota) is stirring up his fellow Democrats by suggesting that perhaps Washington shouldn’t grant itself a monopoly on providing health insurance. Conrad proposes that the inevitable health care reform set up a system of nonprofit insurance cooperatives (co-ops). It is thus far sketchy on details, but according to an outline released to the press,
the “consumer health cooperatives (co-ops)” would operate “at the state level or regionally” to “provide a non-profit, non-government, consumer-driven coverage option in every state to deliver maximum value for consumers.” “The democratic nature of co-ops could encourage increased quality and appropriate utilization and could help foster care integration and other delivery system reforms,” [...]
- Co-ops would be required to be non-profit
- Co-ops would provide a coverage option for individuals and micro-businesses (< 10 employees)
- All exchange rules and state laws that apply to other plans also would apply to co-ops
- Strong governance standards would be required to ensure a strong consumer focus and democratic structure.
When I hear the word cooperative, I imagine myself banding together with my neighbors to create a community-based solution. But Conrad’s approach is not the kind of organically emerging network of local civil society organizations that many conservatives could endorse. Such a decentralist approach to filling the gaps in health care could never come from a top down Washington plan that requires “strong governance standards” (and most likely a large regulatory bureaucracy). Conrad envisions co-ops of at least a half-million people. This seems far too large for a genuinely “democratic structure,” for example far exceeding the number of “consumers” provided for by another (albeit tax funded) locally controlled institution, the average local school board.
But while Conrad’s version of health co-ops would likely result in heavily regulated companies chartered by Congress (along the lines of Fannie Mae), his proposal is useful in shifting the debate away from plans resembling single payer. This has caused most of the Left to denounce Conrad’s plan as a “cop out,” and “more like capitulation than compromise.” This crackup among the Democrats—a distraction from their long planned Washington takeover of the health care sector—creates an opening for the Right. Conservatives should articulate that state control of health care is only the exchange of one monopoly for another, and encourage policy that enables both individuals and local communities to create flexible and effective solutions for increasing access to health care.
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“…his proposal is useful in shifting the debate away from plans resembling single payer…”
In what way does a multi-payer environment in which one participant is a government-chartered company resemble single-payer healthcare?
Are you even aware that the so-called “public option” would create precisely the same relationship for mainstream healthcare that exists in Medicare via the Medicare Advantage program?
I said “resembling single payer” because it appears that the strategy of some is to start with a large public plan controlled by Washington and incrementally move the country toward single payer. Jamie is correct — Conrad’s approach is most certainly not single payer. As Jamie points out, it suggests multiple chartered companies, as opposed to say, HHS running the whole show. I argue that the scale and federally-regulated nature of these Conrad Co-ops would make them undesirable, but the idea at least shifts the debate away from a single public plan administered in Washington, or “Medicare For All.”
With regard to Medicare Advantage, which refers to using private HMOs as agents of the federal government, this seems far worse than the Conrad option. It centralizes the flow of dollars and turns private insurance companies into something like defense contractors.
[...] development plan. I couldn’t help but notice, however, that The American Conservative has chimed in on the need for co-ops to be grassroots, and voiced concern that the proposed cooperatives will be [...]
At the risk of ticking off absolutely everyone:
I live in a jurisdiction where there is a dual system of essentially public healthcare for all, with competing private insurance companies that you can basically pay for better rooms and doctor service. It’s far from perfect - there are too many administrators and consultants who think the system is for their benefit - but I would far prefer it to the American system. This isn’t petty chauvinism: in terms of value for money, I do believe that Americans pay far more even after taxes. Other Americans I know who have said this to those in the US tend to get the noses bitten off of them nonetheless; a combination of resentment and misplaced national pride, I think.
I do appreciate that many liberals can be a goddawful annoying bunch in how they glorify everything that is European and supposedly leftwing; I also understand the intellectual arguments by classical liberals. The plain and simple fact, however, is that when it comes to voting with my feet when having babies and raising a family, I would prefer my current home than the US - simply because of the potential medical costs that I have seen reduce other people having families to near ancient-mesopotamian debt-bondage.
I don’t know the particulars of this Democrat’s plan, but I wouldn’t be quick to write it off as a solution or starting point: I can’t agree that either the current American system or the mainstream conservative ideas on this hold any attraction or value for me whatsoever - from a purely family-values perspective, even. All corporations and current incorporated co-ops are creatures of the state to an extent anyway, being required to comply with certain governance rules. This idea seems to have more in common with David T. Beito’s studies on Mutual Aid societies, than either Republican or Democratic ideas at least.
The concerns about democracy being difficult at large scale are well-founded, but there are ways around this. Cooperatives often organize in multi-level federations, so that many decisions are made at the local level. It is admittedly unclear that the proposal would allow for this, but still worth noting.
Italy has several cooperative federations, which range in size up into the millions and engage in many enterprises. Better still, they provide a way for people to work with those who share their values, rather than against those who don’t. For example, the Catholic cooperatives ( http://www.confcooperative.it/C3/Homepage%20English/default.aspx ) split off from the secular-socialist co-ops ( http://www.legacoop.it/history.aspx ) in 1919 and they manage to coexist reasonably well.
This strikes me as an excellent and libertarian way to deal with divisive issues like abortion or definition of families; people have a choice of voluntary and democratic systems, and choose whichever best meet their needs and values. Incidentally, it also fits in with Christian teachings much better than using the state to impose morality.
[...] development plan. I couldn’t help but notice, however, that The American Conservative has chimed in on the need for co-ops to be grassroots, and voiced concern that the proposed cooperatives will be [...]