I never wanted to be stuck in the middle of this argument. When I started blogging about the co-op plan, I thought it would be a flash in the pan and then I would be able to get back to happier topics like rural transit and local food distribution.
My very favorite thing about cooperatives is that they provide a way for people who share a need and vision to work together, rather than wasting their energy trying to convince those who just don’t want to be convinced. I believe that this is why the ideal structure for a society’s healthcare system would be based on numerous cooperatives, with government playing a minimal oversight role: Rather than constantly fighting in Congress over what services should or shouldn’t be included (and to which sort of family members), we could simply organize with those who share our basic values.
I’ll admit to some bias toward cooperatives, but a key part of my work as a co-op development advisor is to know when a co-op isn’t likely to work. And the more I look at the healthcare reform mess, the more discouraged I become. This discouragement is not from any shortcoming of the co-op model – indeed, I keep finding evidence that co-ops are more likely to succeed than the public plan – but because the overall quality of the debate has bogged down in orthodoxy and bias.
Here’s what finally pushed me over the edge: On Thursday, Jacob Hacker released a heavily-footnoted 16-page paper (with Yale’s name on it!) which dismissed co-ops as the worst possible option, worse than a badly-designed public plan. A co-op plan, he said, is “ugly” and “does not merit consideration.” Having considered this very option for a couple of months, I beg to differ.
Hacker has extensive knowledge of healthcare and he raises some good points, but he has made two severe errors in his haste to dismiss the co-op plan, which remains mostly unchanged since the plan was first mentioned in June.
First, he recycled his unsupported “backup, benchmark, and backstop” objections, which he first cooked up two months ago. At the time, I debunked his attempt to prove a negative with a specific real-world example of cooperatives doing each of the things he said they could not do. I called my critique to his attention, we exchanged a few emails, and I looked forward to seeing how he addressed them in his next writing on the subject.
Unfortunately, it is as though the dialogue never happened, and he once again falsely claims that co-ops cannot do things that they have already done and continue to do.
Second, Hacker erroneously cites Sen. Jay Rockefeller as an authority on health cooperatives:
As Senator Jay Rockefeller, a member of the Finance Committee, has concluded after extensive review of the issue: “What I have to worry about is, are co-ops going to be effective taking on these gigantic insurance companies? And from everything I know from people who represent them, the answer is a flat ‘no.’”
What’s especially interesting about this statement is the date of the source from which Hacker quoted – August 2, which is four days after Rockefeller sent a list of eleven questions about co-ops to the GAO, and three days before the deadline he gave them to respond. His questions were very elementary in nature, including this whopper: “What is the federal regulatory structure for cooperative business arrangements generally?”
At the time he was quoted, Sen. Rockefeller had not completed anything like an “extensive review” and in his letter he essentially admitted his almost-total ignorance of the subject. What’s more, his statement came three days before the National Cooperative Business Association sent him a very patient eleven-page response to another list of 18(!) questions he had sent them. This list included the shockingly basic “What is the formal definition of a cooperative?” which is easily available through the internet.
This was a very odd time for Rockefeller to brag about “everything” he knew, and shows that he is more interested in posturing than in learning about the issue. Rockefeller is a politician and not an expert, and frankly didn’t have any idea what he was talking about. This is like someone claiming to be a surgeon asking you where is your liver. You would be wise to run screaming from the room before letting Dr. Rockefeller come near.
Unfortunately, Hacker missed this, and misused Rockefeller’s words to cast legitimacy on his own weak claim.
It seems that many people have just decided that co-ops are a bad idea, and don’t seem to have any interest in figuring out if they are the least bad idea available. Hacker at least has a good understanding of the industry, but it is troubling that he would publish a report that provides more ammunition for people who just want the co-op plan to go away. I expect better from a paper with Yale University’s name attached to it.
The success of a national campaign of co-op development ultimately depends on the willingness of people to become members. A cooperative approach may still be adopted, and if so it may still succeed; but it will be an uphill battle because of the unsupported and sometimes false claims of supposed experts like Hacker and Rockefeller.
I’m just a peasant with neither a Senate seat nor Yale’s backing. But when people who should know better are making unsupported and false claims, I have to say something even if it doesn’t seem to make any difference.