Healthcare cooperatives – pro or con?

Blog sites like the Daily Kos have lit up about co-ops lately. Unfortunately, it is mostly negative response to a health care reform compromise that is seen as undermining our chances at a public plan, or national health care, or whatever progressive solution lies just out of Congress’ reach because the Democrats can’t find the oomph to kick Republican butt.

Even worse, a lot of it is based on conjecture and ignorance of cooperative health care. 

I ask that everyone please stop trying to kill something that you don’t understand. Stop reflexively telling people to call their Senators because you don’t think you like something that you haven’t seen yet. Once you understand the history of healthcare co-ops, and proposal to encourage them (which hasn’t been created yet, as far as I can tell), then feel free to attack it.

Until then, please try to keep an open mind.

My personal opinion from 17 years in the co-op movement is that cooperatives are the ideal approach to providing healthcare to the country, and I believe that something from the Senate is a problematic way to go about reaching that ideal (more on that later). I look forward to reading an actual health care co-op proposal, but expect that I’ll still be ambivalent after seeing whatever Sen. Conrad has cooked up.

Meanwhile, we should look at the experience of an exisiting cooperative.

I recently discovered a gold mine of information about Group Health Cooperative  archived at HistoryLink.org. The seven-part history is particularly interesting, and should give pause to anyone hoping that we can predict the future from the past. The Group Health story is long, complicated, and not always pretty. But it has at least been democratic. And for what it’s worth, Group Health supports health care reform and has a vision for how a co-op can fit into a reformed system (presumably since before it was thrust into the limelight this week).

In spite of many rough patches, Group Health has survived, and often exceeded the quality of care offered by its competitors. Western Washington is not health nirvana, but it “compares well” to the rest of the nation and a recent pilot project has had very exciting results. Of course, this claim comes from a Group Health press release, but Fox News thought it was fair and balanced enough to print verbatim, so make your own judgment about that. I would love to believe it, but I’m not convinced. On the other hand, I doubt that the presence of a large cooperative is totally unrelated to favorable health statistics in its service area. On the other other hand, that doesn’t establish the co-op as the cause of the other factors.

However, if, say, the New England Journal of Medicine were to publish a report by the Rand Corporation, in 1984 perhaps, concluding that Group Health delivered roughly equal care for about 25%  less expense than fee-for-service care, we might have to take it seriously.

G0 ahead, click the link. I dare you.

Considering all this – and discounting all the prognosticators who have somehow already done feasibility studies and concluded that it can’t work because co-ops are “too small to compete with big private insurance companies” (that’s why we need to encourage their growth, silly!) – it seems pretty clear that the cooperative solution has at least an equal chance of success, and deserves serious study.

I’m still not sure whether I want the federal government to launch the next big co-op thing, and I have serious concerns about a federally-led state/regional cooperative 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 too big for the desirable level of democracy. I’m not sure of their co-op development pedigree, but they seem to at least have a relatively sophisticated critique.

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One Response to Healthcare cooperatives – pro or con?

  1. coopgeek says:

    I just heard back from Group Health about that new report I mention, and they said that study hasn’t been peer reviewed so they can’t release it.

    However, they referred me to this study from the Commonwealth Group: http://www.commonwealthfund.org/~/media/Files/Publications/Case%20Study/2009/Jun/McCarthy_Group%20Health_case_study_65.pdf

    I haven’t read it yet, but during a quick skim I noticed mention of another report: http://www.commonwealthfund.org/~/media/Files/Publications/Fund%20Report/2008/Aug/Organizing%20the%20U%20S%20%20Health%20Care%20Delivery%20System%20for%20High%20Performance/Shih_organizingushltcaredeliverysys_1155%20pdf.pdf

    And while looking for that I found a paper on HealthPartners, which has also been mentioned as a model for co-op health care: http://www.commonwealthfund.org/~/media/Files/Publications/Case%20Study/2009/Jun/1250_McCarthy_HealthPartners_case_study_61_for%20PF.pdf

    At first glance, these reports don’t address ownership (private vs. public vs. co-op). However, they do call for integrated systems, which could be built by insurance co-ops as they mature. This system could also be built privately, but I’m not sure that’s what we want. And of course, the government could build it. But that gets us back around to nationalized health care, for better or worse.

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