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Has Kent Conrad Solved the Public Plan Problem? An Interview.


(Earlier today, Sen. Kent Conrad, the North Dakota Democrat who chairs the Senate Budget Committee, introduced a "potential compromise" on the public plan: A system of federally-chartered co-ops that could offer a non-profit alternative to the for-profit insurance industry. In this telling, the co-ops preserve the central feature of the public plan -- they're a competitor to the traditional insurance industry -- but are free from the baggage of government control.

I spoke to the Senator this evening about the co-op model, and he said a few things that surprised me. First, his search for an alternative was on behalf of the G-11 -- the key Senate powerbrokers on health care. Second, it proceeded from the premise that the public plan doesn't have the votes. All Republicans are opposed and, according to Conrad, "at least three Democrats." And third, he thinks reconciliation is basically out as a viable option for comprehensive health reform. A lightly edited transcript follows.)

Tell me a bit about your idea for chartering co-ops in the health insurance market.

Maybe it would be most useful to tell you how I got into this. The G-11 group, which is the members of the Senate, Republicans and Democrats, chairmen and ranking members of the key committees, who've been given the overall responsibility to coordinate health care reform in the Senate, asked me 10 days ago to come up with something to bridge the divide between those who are strong adherents to the public plan and those who are strongly opposed.

The co-op structure came to mind because it seems to fulfill at least some of the desires of both sides. In terms of those who want a public option because they hope to have a competitive delivery model able to take on the private insurance companies, a co-op model has attraction.

And for those against a public option because they fear government control, the co-op structure has some appeal because its not government control. It's membership control, and membership ownership.

Also the co-op model has proven very effective across many different models. Ocean Spray in the cranberry business, and Land of Lakes in the dairy business, and Puget Sound in the health care business.

How do you respond to someone who says, this is a terrific idea. More competition is always welcome. But why instead of a public option? Why not do it alongside and let a thousand coverage models bloom?

Votes. The problem is this. If you're in a 60 vote environment in the Senate -- and I believe we are, because I believe reconciliation simply won't work -- if you begin tallying up the votes, I believe that virtually all Republicans are against the public option and some democrats are. So how do you get to 60?

How many Democrats would you estimate are against a public option?

I don't know for certain, but I think at least three, and maybe more.

And why do you think that reconciliation won't work for health reform.

Reconciliation was never designed to write substantive legislation. It was designed solely for deficit reduction. The whole idea was you would change numbers, not policy. You would change numbers on the revenue side of the equation and the spending side of the equation.

And so, the way it works, under current rules, if you're in reconciliation, you have to be deficit neutral over five years. Under the budget resolution, health care can be deficit neutral under 10 years. That's a big difference.

Two, under reconciliation, you're subjected to the Byrd rule. The Byrd rule says that anything that doesn't cost money or save money, or that only costs money or saves money in a way that's incidental to the policy, is subject to strike. The result, for instance, is that all the insurance market provisions are subject to strike. All the wellness and prevention provisions are subject to strike. The Senate parliamentarian said to us that if you try to write substantive health reform in reconciliation, you'll end up with Swiss cheese.

Then let's go back to why this works as a compromise. I understand why it would be preferable for Republicans. But for supporters of a public plan, the key advantage is that the public plan is big. It can negotiate discounts with providers. In the form Sen. Rockefeller offered, it can even use Medicare payment rates. These co-ops don't seem like they'd have that size or weight. How would they compete with large private insurers?

They might have that weight. One option is for a national cooperative. That would give it the heft and weight to compete. But you know, one of the interesting things when we talk to experts is that they say critical mass is probably around 500,000 members. Puget Sound is probably around 580,000 and they compete successfully against much larger entities. The experts tell us that there are probably advantages of size up to a point, but after that point, the law of diminishing returns sets in.

Who would charter these? What is the process? Do I go over to my local health insurance exchange and put in an application?

The way co-ops typically are formed, people who feel they're not appropriately served, or not served at all, band together. They form an organization, elect a board, hire people to do the work, pool their money, and the organization goes forward.

These cooperative entities would provide their contracts through the exchange just like everyone else, be subject to the same rules as everyone else, in terms of reserve requirements, in terms of what kind of contracts they could offer. People would go to their exchange, they'd see the option, and if they liked it, they'd sign up, and then they become one of the members, because every member is an owner. And they would have elections and that elected board would choose the leadership.

Would there be regulations on how many of these there would have to be in each state?

We've not contemplated having that in the health care reform law, but there is clearly an economic requirement in order to have the leverage to negotiate with providers to get competitive rates, you need greater bulk. That's where we believe we need 500,000 lives to be competitive.

That's probably one of the two major items of discussion still remaining here. They're various options for consideration if you will. I offered the G-11 group three models. One is state-based, so every state has one. I don't think that works frankly. In states like mine, the pool wouldn't be big enough. The second would be a national entity. That's probably too limiting as well.

What you probably need is a national entity with state affiliates, and the further flexibility so those states can have regional pools. So in our part of the country, you might have North Dakota, South Dakota, Montana, and Wyoming go together. Out east you might have Maine, Vermont, and New Hampshire together. We're consulting with experts tomorrow about that.

Where did this idea come from? I've done a fair amount of health care reporting, and this is the first I've heard of it.

I guess it came out of conversations in my office after we were asked to see if we couldn't come up with some way of bridging this chasm. Part of it is that we're so used to cooperative structures in my state. They were begun by progressives, they came out of the progressive era. And they're so successful in our state. So I can't really say we came up with some brand new idea. We just thought about our own experience.

What has been the reaction of some of your more liberal colleagues to this?

I think it's fair to say mixed. Those who really want public option because they really want single payer, this does not satisfy their position. Others who really want a competitive insurance model kind of like it. Others who are looking at how you put together the votes are intrigued by it. And on the Republican side, a grudging acceptance that this may be one way to increase competition that does not increase government control.

Let me ask you one last question on that. I understand why this proposal wouldn't satisfy liberals who want single-payer. But why does it arouse Republican opposition? It seems, in a way, to be very small-r republican.

Because they don't...ah, you know, you'd have to ask them. It would just be my surmise on why some of them don't like it. They really don't want a competitive model, at least some of them.

By Ezra Klein  |  June 11, 2009; 6:25 PM ET
Categories:  Health Reform , Interviews  
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Next: Mike Rorty Builds His Own Stress Test


No public plan. If the Federal Employee Health Benefit Program is good enough for Senator Kennedy, then that should be the floor. If a public plan is offered, then as a taxpayer I demand that FEBP be disbanded and ALL government employees must receive the public plan.

Posted by: jhpbriton | June 11, 2009 7:09 PM | Report abuse

As with the public plan, the key question is whether the co-ops would be subsidized from tax revenue to enable them to compete more cheaply than private insurers. This post doesn't address that question.

Posted by: tomtildrum | June 11, 2009 7:10 PM | Report abuse

I'm one of those who is more interested in ensuring competition. If the co-op actually had some weight to throw around, I could support it.

Vanguard, the investment company, is owned by the clients and they do very well.

Posted by: SteveCA1 | June 11, 2009 7:22 PM | Report abuse

This is an awful idea, designed to allow senators to weasel out of a public plan. An ill-defined "co-op" approach is fated to fail, and Conrad, while not the brightest light in the Senate, knows that. I'm giving up--the insurance companies have bought the Congress, and the people's will is irrelevant. We will never get a rational health care system in this country.

Posted by: lowercaselarry | June 11, 2009 8:09 PM | Report abuse

How would these Coops get insurance to those who work for corporations?

Would they only sell to individuals?

Whats to stop them from being bought and turned into for-profit entites just like the many non-profit HMO's that once flourshed?

How does this help us lower overhead in private insurers?

How will this simplify the forms required of physicians by the profit making companies?

How will this lower drug prices?

Will the Coops be forced to take sick people?

How do we know their product will still not be too expensive for many?

And so on.

This is a quarter baked idea purely driven by politics.

We need a government run system like those that work in the rest of the world. Anything else is a pipe dream.

Posted by: lensch | June 11, 2009 8:12 PM | Report abuse

This is not a compromise. This is a complete sell out to the republicans. The coop would be no different than what is currently avaible.

The fact that Republicans have not jumped aboard makes it clear that they have no desire to see health care reform. They will keep moving the goal line until they kill it.

Why not move the public plan and some of the reform through reconcilation then get the rest later? Also the byrd rule can be stop with 60 votes. So it would only be swiss cheese if Democrats vote against the things everyone agrees to.

Finally It is called the consitutional option. Why does no one cover it? You can call a point of order, kill the stupid filibuster rule and move the bill with simple majority. No worries about reconcilation rules. Go back to how the founding fathers wanted the senate run.

Posted by: JonWa | June 11, 2009 8:19 PM | Report abuse

During the campaign, Hillary said that she would allow people under 65 to buy into Medicare or the plan that is available to members of Congress. Why aren't these options being discussed?

Anyway, it's up to Obama to find a way to use reconciliation to implement a public plan even if it means changing Senate rules.

Posted by: newjersey_lawyer | June 11, 2009 8:43 PM | Report abuse

This sounds suspiciously like Hillary's health alliances proposed in the early 90's. BTW the Federal Employees Health Benefit Progam is not a single plan. It is composed of quite a few plans including Blue Cross/Blue Shield and several plans which are closed to all but employees of certain agencies. Each has different benefits and different costs. The advantage is that plans can be changed once/year with no preconditions.

Posted by: hc01 | June 11, 2009 8:44 PM | Report abuse

How can he say, "they might have that weight"??? They will NEVER have the weight needed to compete against insurance companies, which are practically monopolies at this point. There are 3 companies that own 2/3 of the entire industry. That is the problem, consumers have no choice right now. This idea of a co-op is just a cop out! Senators who know what is right, but who don't have the courage to stand up to Republicans yelling "Socialism!". Grow a pair, and do what is right for your constituents. A public option is the choice Americans deserve!

Posted by: chandler02 | June 11, 2009 8:51 PM | Report abuse

Germany's sickness funds originally functioned like co-ops, with member elected boards. Of course, they are highly regulated, don't compete with private insurers, and everyone is in one.

If Puget Sound is a co-op, what is to prevent co-ops from already entering the market? What exactly would this proposal do differently?

The comment on opposition by 3 democrats was revealing. The issue is not are they opposed to the idea, but would they filibuster the entire reform plan in order to deny people choice and stop meaningful competition.

Posted by: kjacobs9 | June 11, 2009 8:56 PM | Report abuse

The Obama takeover of the US healthcare system is dead on arrival...

Posted by: Phil6 | June 11, 2009 9:02 PM | Report abuse

All the Blues started out as non-profits, but currently are just as bottom-line driven, ruthless, and consumer unfriendly as the for-profits. And look at federally chartered banks and the mess we are in. I am very skeptical and agree with a previous commenter who says this looks too much like a sell-out to Republicans. We don't really need sixty -- we just need 51.

Posted by: hollandbj | June 11, 2009 9:05 PM | Report abuse

I see the lunatic fringe is already in residence.

In truth this is not a bad model, and sounds a great deal like France's. There it is far easier to go to specialists (one thing Americans believe is in the Constitution as one of the Bill of Rights) and costs are still far lower than the current US system. It still ensures universal coverage, but people have a minimum level of coverage (currently 80%) required, with options to buy more, which means excellent care for everyone.

Setting up a centralized buying mechanism to buy drugs would further reduce costs.

Posted by: copperred | June 11, 2009 9:45 PM | Report abuse

Unless there is a public plan I view the entire effort as a waste of time.

I have worked in the private sector my entire life. Why does the government insist on forcing me to have health insurance with a private, for-profit company through my employer?

I want an affordable option like a government plan in the name of freedom if nothing else.

Right now the free market, "flat earth" folks keep thinking the magic of the market place will fix health care. Wake up! You might as well be waiting for Santa Claus.

Let's have a real choice, let those who want to have a government plan have the opportunity to pick one!!

Posted by: NoMercy | June 11, 2009 10:22 PM | Report abuse

Up to this point I have not been a fan of the coop but this interview shows it to be a better idea than I thought. If it can bridge the chasm it would be preferable to sacrificing the public option altogether (which is what the Republicans want).

Conrad does make a good point about the 500,000 member mark. It is true the big 5 (Aetna, BCBS, Cigna, Humana, UHC) have membership greatly in excess of that.But their membership numbers are national and healthcare is local. So if the coops are local/, Texas has a coop with 500,000 members...that could be competitive with the commercial insurers.

Lensch...I think it is fair to assume that all the other aspects of reform would continue to, exchanges, no underwriting, no pre-ex, community rating,etc. I would assume the legislation would be written such that coops could not be bought and turned for profit (I would insist on that). Also, the standardized form issue---huge red herring--the industry has already standardized the forms and claims are largely electronically submitted (their recent letter notwithstanding)

I can give you reasons why this won't work. But I can also see where regional coops would generate enough competition that it might work. The theory of this whole exercise is that competition will lower costs (of course, single payor is probably the best model, but the reality is we have this patchwork system we are working from and not a clean sheet of paper)

Posted by: scott1959 | June 11, 2009 10:25 PM | Report abuse

NoMercy....after working for years in the healthcare field I tend to agree that relying on the free market in healthcare is a pipe dream. But I go back to the original objectives: universal care and cost control. This proposal would accomplish universal coverage. Health IT and CER will start controlling costs. Universal coverage will eliminate a huge portion of the cost shift that distorts and inflates costs.

This ain't perfect. Nothing will be. We will be working on this for the next 10 years to get it right. Heck, even those countries with great systems work on theirs every year. Healthcare is incredibly complex.

Posted by: scott1959 | June 11, 2009 10:34 PM | Report abuse

So let me get this straight. Conrad acknowledges that health insurance co-ops already exist. So his "compromise" is to offer nothing new. His compromise is to keep the market exactly the same

Posted by: JonWa | June 11, 2009 11:12 PM | Report abuse

If you think a non-profit health insurance company that accepted everyone would better serve the interests of consumers then start one. Nothing is stopping you. Raise the capital and start it. If tons of money can be raised to lobby for healthcare reform then there should be ample capital for such an effort. Just don't use any taxpayer money and don't expect any preferential treatment from the Government. Why doesn't someone just do this? Why does it have to go through the Government?

Posted by: fallsmeadjc | June 11, 2009 11:21 PM | Report abuse

I'm impressed. I'd like to see someone bang out the details of this.

Also, reading the comments, it occurred to me that any new option would be, essentially, a new company (be it gov't, non-profit, whatever), and, therefore, wouldn't have a balance sheet groaning under the weight of pensions and health insurance premiums for retirees.

That is, the lack of a need to pay as high a price for health insurance FOR THEIR EMPLOYEES could make the public plan administrator stronger than their competitors.

And they'd probably be able to pay more and poach good employees away from the notoriously poor paying bigger insurance companies.

Oh sweet sweet irony.

Posted by: ThomasEN | June 12, 2009 12:27 AM | Report abuse

JonWa...Healthcare of Puget Sound is not really a coop, Conrad is stretching it a bit there, I believe. It is largely owned/influenced by Kaiser.

Fallsmeadjc...if you started such an insurance company...and you are right, there is nothing stopping you (other than you needs tons of money) the current environment all the sick people would joi n your plan. You could not charge high enough premiums to offset this adverse selection. That is why we need regulation to have ALL insurers waive underwriting and pre-existing conditions.That is not an argument for a public option, that is an argument for regulatory reform. The argument for the public option is lower cost due to lower overhead and more favorable bargaining power with providers.

ThomasEN...good observation (but the insurers have all hacked away at their retiree medical obligations just like every other employer. Working for one of them gets you no favorable treatment)

Posted by: scott1959 | June 12, 2009 12:36 AM | Report abuse

This is a great interview, Ezra. I learned more about this idea than in any of the other sources I have read. I am intrigued by it because of its opportunity for more local and member control. Lots of questions remain, which I am sure will come out in the next few days. Please stay close to this issue and keep us all informed.

Posted by: LindaB1 | June 12, 2009 1:25 AM | Report abuse

Who is Conrad to fatuously claim that there won't ultimately be the votes for a public option at this early point in the process?

If either Republicans or Democrats want to filibuster a public option, Reid and Obama better have the guts to let them to do it so that these self-interested fools have to face the wrath of the majority of the public who want it. Votes will almost certainly change under the pressure of that attention.

Posted by: newjersey_lawyer | June 12, 2009 7:38 AM | Report abuse

Explain to me why state-based coops are any different from the high-risk pools which were supposed to provide "group leverage"? But which currently have prices way beyond the average consumer?? Anything that is state-based leaves the average American at the mercy of local politics, which in my case (KS) leaves me out of luck for any affordable coverage.

Posted by: aka3000 | June 12, 2009 8:05 AM | Report abuse

This is a horrible idea. Creating even MORE "corporations" for providing insurance will not solve the problem!!!

One of the biggest problems out there is not only the limited options you actually have to select from, but huge variety that the actual health insurance companies offer!!! Have you ever noticed that if you switch jobs, the plan looks absolutely nothing like the old one you had, and you have no idea what in the world is being offered???

They use every trick in the book to befuddle and confuse you into thinking new Vanilla is different than old Vanilla (it isn't, both options still suck!), or that new Vanilla is actually the same as old Chocolate (prob not, you're getting screwed).

This will HUGELY exacerbate this problem!

We need to simplify this process, not make it more tedious and confusing!!! I'll say it again, this co-op idea is horrible!!! It makes it even more confusing, from a very pityful 2 choices to how many?? 30??? 50??? When has the general public really been able to figure out which is actually the best option???

And it eliminates the advantage of public option: cost savings associated with a very large pool.

I am about ready to give up here... If Obama or some big-shot Senator does not step in to demand a moderate-to-robust public option, this whole thing will have accomplished very little in terms of fixing the system, and reducing costs.

Yes, more people will be ensured, but so what? If we just keep adding people to a broken system, it will just make things that much worse.

Democratic Senators are a joke. Sellouts to my employer (large health insurer), those doctors who only care about their bottom line and not their patients, and their many lobbyists.

I wonder just how much money Conrad got from them on donations... oh wait, I guess I do know... why am I not surprised???

We're not buying cars or radios here. We're dealing with what amounts to the most direct safety net for people's health and economic well-being. Don't believe me there? Try getting a bad disease and let me know how well you do financially when your crappy insurance doesn't cover things, or you get dropped for pre-existing conditions.

We're dealing with peoples livelihoods here.

And btw, if a Public option is so bad, why do the Senators and Congressmen all use their public option? Why can't we buy into it??? Shouldn't they be buying Blue Cross or Aetna or Cigna or something???

Posted by: JERiv | June 12, 2009 9:14 AM | Report abuse

aka3000...the state based high risk pools get the worst possible health risk signing up because (a) the insurers cherry pick the healthy due to underwriting, etc, and (b) only those who are really really sick will pay the extraordinarily high premiums.

Under reform, underwriting and preexisting conditions rules would not exist, plans would be be community rated, so the cherry picking would stop. Therefore, the cherry picking would stop and risk could be spread better throughout the system and we would not just have the sickest of the sick in the high risk pools. We would not have a situation as we do in my state (NM) where we have 400,000 uninsured and only 25,000 in the higgh risk pool.

Posted by: scott1959 | June 12, 2009 9:36 AM | Report abuse

JERiv....I appreciate your disgust. One point: Congressman do not have a public option, never have. The benefit program they are enrolled in is a series of health plans offered by Aetna, BCBS, etc. There is not a public option in the way that is being discussed in healthcare reform.

Posted by: scott1959 | June 12, 2009 9:41 AM | Report abuse

What do you think Ezra? Is this an honest attempt at a second best reform in the face of intractable politics? Or is this a pet proposal from a politician looking to get his name on something? The fact that Conrad also wants to use the upcoming CBO estimates of cost instead of shelving them for OMB's suggests the latter, even if there are good reasons for him to do so.

Posted by: MrGoodKnight | June 12, 2009 9:53 AM | Report abuse

Ridiculous, the knots we're willing to twist ourselves into and the bureaucracies we're willing to create to keep from creating a simple public option. The GOP can go hang if they don't like it.

Posted by: csdiego | June 12, 2009 11:05 AM | Report abuse

I don't know that I think of it as a 2nd best option. I think it's maybe the equivalent of saying a public option is a no-risk contract and the coop option is a risk-contract, i.e., greater risks but potentially greater rewards in the long run.

Think of it this way, if a public option was able to identify billions of dollars in new efficiencies and all the disparities like McAllen, TX were washed away, it's not like those savings would jump into our pockets. They'd most likely vanish into the ether of the federal deficit/debt. If these coops realized new efficiencies and savings, and they were regional, there could be nimbler new projects like gym memberships, nutrition programs, bicycle subsidies, really, whatever a progressively minded (citizen-run) board of directors thought to be helpful.

Posted by: ThomasEN | June 12, 2009 11:20 AM | Report abuse

This sounds a lot like HMOs gone bad. This requires a great deal of personal organization and know how. It leaves tremendous room for knowledgeable shysters to take advantage in the set up and operation. You wouldn't have access to your own doctor anymore because the pricing wouldn't work unless doctors joined it and they won't if they can make more elsewhere. Why can't Americans buy into Medicare? Medicare works pretty well in this country for millions of people and it covers more than my expensive insurance policy covers. This would take years to implement and before it ever reached everybody, it would die a slow death and we'd be at zero again. We need a real, and timely and widely available plan. Now. We need a public plan. If Obama keeps doing his town halls and if we all pitch in and help, we'll get what we need. Ben Nelson was one of three dems firmly against, but due to carefully targeted pressure, he's backed up quite a bit. We need to organize pressure from campaign contributors to the democratic House and Senate members. They'll help if they're going to lose their jobs over this. Obama hasn't quit or given up and we mustn't either. This is important for the sake of individuals, the economy and national security. Insurance rates have doubled in the last nine years. Many went up a third THIRD this year. Obama said it could reach one dollar out of every three of federal money if we don't act now. This is another money grab just like the Wall Street junk was. Stand up and fight.

Posted by: karela | June 12, 2009 11:25 AM | Report abuse

One thing I don't see covered in this article is the issue of mobility. Americans move across country for their jobs (or to search for new ones)...what happens if you're in a local co-op and there's no co-op where you move to? There is no guarantee these will be established nation wide.

I think this is a cop out for the public plan that 79% of Americans want (according to recent polls). For those Senators who vote for this plan, perhaps the American public will finally see it's time for them to OPT OUT of their jobs!

Posted by: treetracker | June 12, 2009 12:13 PM | Report abuse

Honestly, they'll go to any lengths to try to slime the American public into believing that they are actually elected officials instead of purchased clowns. I hope the public isn't as stupid and Mr. Conrad thinks we are.

Posted by: technoir | June 12, 2009 12:14 PM | Report abuse

Senators, read my lips. If there is no public plan there will be hell to pay for the Dems. As a life long Dem I will vote against any Democrat who opposes it and contribute/speak out publicly against their re-election. Yup, might mean a Republican majority again, but I will be that angry. I have seen the lists of contributions from the insurance industry to these Senators and it tells the whole story. If the Democratic Party is going to turn against the people then it is time they go. Too bad. I had such hopes.

Posted by: tarryh | June 12, 2009 12:31 PM | Report abuse

Congress represents Congress. Why is this so difficult for many Americans to understand? There is ONE major political party(The American Corporate Party)that has two-wings:The GOP & the Dems. The GOP is wholly owned by Corporate America & the Dems are mostly owned. "We the People" is a phrase to be used on national holidays in speeches.

Posted by: allen11 | June 12, 2009 12:39 PM | Report abuse

I live just north of North Dakota and see Conrad's warm and fuzzy campaign spots when he is out wooing voters. But it is hard to warm to his performance on health reform. Whose side is he really on in this debate?

Posted by: atkiwildwood | June 12, 2009 12:49 PM | Report abuse

All this legislative posturing and compromise is a cover for the fact that Congress is selling out to private HMOs. If they really wanted to, they could offer a public health option and find the votes to push it through. There is clearly no will to do it. Private HMOs do own Congress.

Contact Conrad's office directly to provide feedback:
Phone: (202) 224-2043
Fax: (202) 224-7776

Posted by: pixiedust1 | June 12, 2009 12:57 PM | Report abuse

He is in their pockets.

Here is the link to his top campaign contributors.

Posted by: jelly450 | June 12, 2009 1:05 PM | Report abuse

The opposition to reforming our healthcare system is absolutely astounding. It is obvious that our elected senators priority is to get re-elected and that the insurance industry is a major player in finaning their campaigns. To hear some of these feeble fear tactics that are being employed to oppose single payer or even a public option are disgraceful. I will never accept the arrogance of these career politicians. The country has gotten in the mess it is today is due to excessive greed. Never did I believe that this would be led by the elected officials of our country. So go ahead and accept your bribery and watch the USA become a third world country!!!!

Posted by: txfred | June 12, 2009 1:29 PM | Report abuse

My God, this Conrad is a coward. No guts, no vision, no principles. Polls continue to show Americans back a public option by wide margins, yet he doesn't have the votes? The only way he doesn't have the votes is if the senators opposing a public plan aren't representing their constituents (other than the insurance and big pharma lobbies). Show some backbone! Stand up and do what's right - for once in your life, senator(s). The only reason America's the only industrialized country without universal coverage is your lack of guts. Get with the people on this or get tossed out of office.

Posted by: jef305 | June 12, 2009 7:42 PM | Report abuse

If the Dems can't institute real health care reform by offering a non profit public plan then kick them out.

The public plan is a deal breaker. If anyone on the Hill looks beyond the bribes and the next election, s/he knows, or should know, that the only way to sustain health care and protect the long term economic and social health of this country is to remove all of the profit motive. Profit health care has to go.

For a change, elected officials need to put aside their selfish financial interests and do something that is right for America. I honestly don't believe we have much time to get our house in order, yet there are politicians who are willing to let the whole ship go down for their own short term gain. Shame on them.

Posted by: sandyfeet | June 12, 2009 10:41 PM | Report abuse

No to profit health care! It is killing us. This should not be hard. The U.S. government already directly funds sixty percent of health care and private employer based health insurance is sustained with lucrative tax breaks. The U.S. government spends more per person on health care than the UK, and Britain covers everyone.

It doesn't make economic sense to fund a profit driven private health care industry that pays hundreds of millions to CEOs who maximize profits by denying care.

Posted by: sandyfeet | June 12, 2009 10:55 PM | Report abuse

We need a public option. Those of us who agree need to organize and stage some kind of event(s) to make it clear to Congress and the White House that we are serious about health care reform. I worked hard to elect Pres. Obama but if he fails to push a real public option, I will sit out the next election or better yet, work to elect a 3rd party candidate who will push for a public option for health care

Posted by: marya1 | June 12, 2009 11:52 PM | Report abuse

After decades of trying to bring health care to all citizens, this is the solution - everyone has to buy insurance!? NO! To get health care costs down the for-profit insurance companies have to be taken out of the equation.

The insurance companies are dancing in their board rooms about this. If co-ops are required to take all applicants they will get the sickest of the sick and all the people the insurance companies refuse to insure. They will never be able to compete on price and benefits because they will pay out too much to their otherwise uninsurable members.

To insure their members these co-ops are supposed to act like large employers to negotiate rates with the insurance companies, but haven't employers been screaming for years that their health care cost are out of control? How will this help? When I worked for a major corporation I could never have afforded the same health care as a private citizen - so how am I supposed to afford it from a co-op no matter how good a rate they negotiate with the insurance companies?

If the Republicans and three Democrats want to scuttle the single-payer and public plan options then I say let them. Americans will deal with them in the 2010 and 2012 elections. As desperately as we need a single-payer system quickly, now is not the time to fold our hand on a Republican bluff.

Posted by: JCharles1 | June 13, 2009 3:18 AM | Report abuse

Co-ops or other not-for-profit health insurance plans could achieve everything a public plan could achieve, IF two critical reforms are implemented:

1) Require health care providers such as drug companies, hospitals and doctors to charge everyone the same price for a particular service. This would allow small insurers to compete on an even playing field with giant insurance companies, just as a giant public plan could. This would maximize competition among insurers and allow easy entry into the market. This reform would have broad public support, because of the widespread outrage that providers charge individuals without insurance double and triple the fees that they charge insurance companies.

2) Require all insurance plans to offer at least an austere minimum package of benefits. (As with most approaches under consideration, we should also require insurance companies to accept all applicants at the same price, while making the companies happy by requiring everyone to buy insurance.) If we are to subsidize the old and sick while we are young and healthy, then the low-cost plans to which the young and healthy will gravitate must offer enough benefits to meet the minimal needs of the old and sick. Otherwise, the plans that offer real benefits will fill with the old and sick, and their skyrocketing costs will drive the young and healthy to plans that are cheap because they offer no real benefits. The minimum package of benefits should be low-cost enough that the public is willing to subsidize people who can't pay for it , but it should provide minimally decent care, because the minimum plans are likely to dominate the market eventually. We are on a path now that that our current minimum plan, no insurance at all, is on the verge of dominating the market.

Posted by: Ned_Kennington | June 13, 2009 10:59 AM | Report abuse

The real answer to the health care crisis in this country is single payer. A public option is a poor second. Co-ops is a plan to distract us while they do nothing. Any public option should become the insurance for all members of the government. They should get what we get. There is no other reason to support the Democratic party than to get this done. If they can't do it, it's time to support a third party. I donated the maximum amount to Obama both in the primary and the election to get this done. That money will go to another party next time. No more excuses. Anyone who votes against this should be targeted in the next election. If we can't support the citizens of this country on matters of health and well-being over the profits of corporations, then we are not a democracy.

Posted by: pac999 | June 13, 2009 12:25 PM | Report abuse

I agree pac999, the compromise is a public plan. If the opposition doesn't want that, the Dems better use their numerical advantage to steam roll the naysayers under. If guys like Conrad, Baucus, Reid et al can't cut it, they should start looking for the DC law firms they want to go to.

Posted by: catlbob | June 13, 2009 4:00 PM | Report abuse

The idea of a alternative public insurance program or Coop to run in tandem with private insurance is a singularly bad idea. First of all, it will leave most of the $500 Billion of savings (from high overheads of private insurers, compliance costs pf physicians, and high drug prices) we would acheive with Super Medicare for All (HR676) lying on the table. It will simply add extra cost. It will also add yet another pool of high risk individuals, the sick and the poor, to the mix. We should be striving for larger pools, not adding new ones. Of course a single payer system has the largest possible pool. Because this alternative program will inevitably wind up with those people unwanted by private companies, it will also be extremely expensive even with the cost savings of a public plan.

Also if the alternative public plan takes people with pre-existing conditions, many more people will self insure since they can avoid paying until they get sick. They would be terrible.

We need Super Medicare for All

Posted by: lensch | June 15, 2009 8:34 AM | Report abuse

Coops start when a group of people pool their money. Huh?? Who has money to pool in some start up? I would want to see if it were a success first. The only ones interest are the now 50 million (less 5 million idiots, max) without coverage. Many are the sickest of the sick; a significant number of backlogs of ailments to be treated and DON"T HAVE any money.

And instead of, let's say for every 1000 employees to do all the management and contracting with an army of providers we have, what 500 in each state. Hmmm, 500 x 50 = 25,000 new government (coop) employees. That'll save money.

Who's going to head up these coops? Have elections? Goody another set of pols to be bought. Ah, but there will be an Inspector General's like office. I mean 50 of them.

In Boston two hospitals, Mass General & Brigham Women's, big "brand names" called Partners, got together to raise their fees by 30% and got a deal with Blue Cross. When another Insurance company balked, the unHospitals refused patients with that insurance. They caved. Yet on many measures these hospitals rank lower in treating people. They are good for very high end specialized care but not so for run of the mill hospitalizations.

See the Boston Globe series.

"Private insurance data obtained by the Globe's Spotlight Team show that the Brigham, Mass. General, Children's Hospital, and a few others are, on average, paid about 15 percent to 60 percent more than their rivals by insurance companies such as Blue Cross Blue Shield of Massachusetts and Harvard Pilgrim Health Care. The gap is even more striking for many individual procedures, which can be two or three times more expensive in one hospital than in another."

There is no way any coop could take on such practices.

They are not working on improving care, taking care of patients not able to pay, or even updating their own facilities. They are building an empire all over Mass. They are driving the smaller and community hospitals out of business.

Posted by: sam_dobermann | June 15, 2009 2:48 PM | Report abuse

First of all, everyone has to have healthcare insurance.
If everyone has healthcare insurance, individual premiums can be lower.
Second: It is a shame that companies earn a fortune by squeezing ill people or people with so called preconditions out of health insurance. It is a shame and it should be forbidden that companies are living on the expenses of people who need health insurance. As long as this is the case, it is only natural, that payments will be denied and that people with preconditions have to pay a fortune or do not get any health insurance at all. This is a system immanent flaw! Please recognize that! Health insurance should only be allowed to be offered by nonprofit companies, only nonprofit companies will not have to choose between profit and payment for medical causes. There are countries with mutual health insurance companies, and these companies are supervised by representatives of the insured people (not by politicians, but by with secret ballot elected people). Our Forefathers only could survive with solidarity, the times we now have are asking for solidarity again! Do not leave anyone behind. Are you happy knowing that there are people being sick and living in tents or cardboard boxes like they do in India, but here in the United States? How far have we come?

Posted by: Bluebee2010 | June 15, 2009 3:05 PM | Report abuse

Any plan that avoids significant government control of healthcare should be considered seriously because any way you look at the situation, medical care, procedures, drugs, etc. have inherent costs associated with them. Nothing is free and you will not get "free" healthcare just less of it and substandard healthcare. Nurse, doctors, lab techs, etc. all have to be paid. There are significant costs in running a doctors office, clinic, or hospital (maintenance personnel, clerical, utilities, etc.) Even at bare bones expense, medical care is high tech and expensive, especially if you want to seen, treated, or operated on in a timely manner. Tort reform alone would save hundreds of millions of dollars per year. But malpractice lawyers have more clout in Washington than healthcare personnel and hospitals ever will. The cost of a public plan will be extremely expensive to taxpayers alone. Why else to you think Walmart, General Mills and the car industry are supporting it with $$$$$,----they want taxpayers to foot the bill for their employees health insurance. There will be mass offloading to the public plan which will decrease competition and cause rationing of healthcare. I think most of us do not want to wait 3 months for a CT scan, 6 nmonths for elective surgery, or not be eligible for certain drugs or treatments at all. Why do Canadians and Europeans come here for medical procedures I wonder? All of this will be controlled by the government and not the individual. More taxes will be necessary to pay for it and everyone will suffer, but it will be too late to roll back the entitlement program then. Medicare and medicaid will be bankrupt in the near future. I hope a public plan will be not follow along in their footsteps. Americans need to wake up and really look at the facts before emotionally signing on to something they may not want once they get it. Socialized medicine bankrupts countries finances (i.e. taxpayers) pure and simple.

Posted by: deliaasmith | June 17, 2009 4:40 PM | Report abuse

I'm 24. I suffer from major depression.I looked into switching insurance, and found that if I left my current insurance company, I would not be able to find coverage for any price. I'll have to move out of the country if they don't pass this, as my monthly payments have reached $900/month, not including prescription drug co-pays or the specialists they don't cover. (Normally, there's no reason you need a doctor who's the best. You only need a doctor who's good, because normally, they have a clue what they are doing. You break an arm, they use a splint, etc. If you suffer from severe treatment-resistant mental illness, they don't even know why or how many treatments actually work, so if you want to have a real chance at getting better, you need a great doctor, not just a good one.)

This bill does nothing. Requiring insurance providers to sell me insurance has no effect on the price of that insurance. The companies will raise their rates. Maybe they'll offer to sell me healthcare for a million dollars a month. Then, all the sick people will go to the co-ops, and they will fail. I and everyone else will be SOL.

Posted by: vim876 | June 19, 2009 1:02 PM | Report abuse

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