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Congress considers Conrad's cooperative proposal for health care

Suddenly, Sen. Kent Conrad's co-op model for health care reform has taken center stage. But is it the answer, the compromise key to achieving some degree of health care reform? Or is it "a great mistake," as former Democratic National Committee C...

Suddenly, Sen. Kent Conrad's co-op model for health care reform has taken center stage.

But is it the answer, the compromise key to achieving some degree of health care reform? Or is it "a great mistake," as former Democratic National Committee Chairman Howard Dean has said, a retreat from meaningful reform that includes a "public option" for coverage?

Or is it, as ardent foes of public option fear, a way to win Senate approval of a bill that later, through legislative maneuvering, would emerge with public option firmly in place?

Though the signals were mixed, the White House appeared to indicate over the weekend a willingness to consider Conrad's cooperative proposal as an alternative to public option.

Providing a government-run alternative to private insurance has been a key part of President Barack Obama's plan to overhaul the health care system, ensuring access for people unable to find or afford private insurance.

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But in recent weeks, it has become a primary target for people who thronged to town hall meetings to denounce it as "socialized medicine," a government takeover that would lead to bureaucratic delays, rationing of services, federal funding for abortions and even "death panels" to lower costs by restricting access to health care for the old and infirm.

"I want to do something," a frustrated man from Fargo said at a town hall meeting hosted in Mayville last week by Sen. Byron Dorgan, D-N.D., "but I'm not sure the government should be in charge. Government may have a role to play, but it's not good at running a business."

At a town-hall-style meeting Saturday in Grand Junction, Colo., Obama defended the idea of a public option but said it was just a part of his effort to control costs and make the delivery of health care universal and more efficient. Sunday, Kathleen Sebelius, the health and human services secretary, said on CNN that the public option was "not the essential element" for reform. She mentioned the co-op approach as a legitimate alternative.

"What's important is choice and competition," she said. "And I'm convinced at the end of the day, the plan will have both of those."

Conrad himself, appearing on Fox News Sunday, repeated his assessment that public option is a non-starter.

"The fact of the matter is, there are not the votes in the United States Senate for the public option," he said. "There never have been. So, to continue to chase that rabbit, I think, is just a wasted effort."

Conrad's plan

Conrad, who will be in Grand Forks today to dedicate a new Veterans Administration clinic and in Mayville to discuss health care with community leaders, outlined his cooperatives plan on his Senate Web page June 30 and at a health care roundtable two days later at Altru Hospital in Grand Forks.

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He would create private, consumer-owned, nonprofit cooperatives to join employer-offered plans and private insurance as consumer choices, restraining costs and covering more of the uninsured.

In his seminal "History of North Dakota," the late UND professor Elwyn Robinson identified "radicalism" as one theme of that history, and the rise of cooperatives "the most important expression" of that theme. With co-ops, farmers and others made "a determined effort ... to control the markets in which they buy and sell."

The cooperative idea came to the region with immigrants from Europe, but it has lost most of its onetime "foreign" or "radical" sheen and has settled comfortably into the mainstream.

"Similar to the electric, telephone and farm cooperatives across America, these health care cooperatives would operate as nonprofits owned by the consumers and could deliver better health care outcomes for lower costs," Conrad said.

"We have seen cooperatives thrive in this country, from the rural cooperatives we are familiar with in North Dakota to major companies, including Land O'Lakes, Ace Hardware and the outdoor retailer REI. And we have a working model with Group Health, a Washington state-based health care cooperative with more than 500,000 members."

The co-ops would require $3 billion to $4 billion in initial support from the government, he said during the Grand Forks meeting, but they would operate independently from Washington.

They would have to maintain financial reserves sufficient to cover unexpectedly high claims, just as private insurers are.

Republicans, who say a public option would cause employers to drop private coverage, gave Conrad's proposal some initial credibility by not dismissing it out of hand.

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"If it can be presented as an entirely private-sector operation and is like co-ops we know generally in the Midwest, I think it's got some possibilities," Sen. Charles Grassley, R-Iowa, said.

Conrad acknowledged at the Grand Forks meeting that some in his party remained committed to public option.

"People have to realize they can't all have their way," he said.

A big mistake?

The clash over public option has brought nationally-produced, campaign-style TV ads to North Dakota and other states represented by moderate Democrats, hoping to recruit citizens to persuade them either to support or oppose public option.

"Do you trust Washington -- with your life?" asked one anti-public option ad, part of a $1.3 million campaign backed by groups favoring more limited government.

From the beginning, Democrats most keen on passing a public option have discounted co-ops as inadequate.

"This is a big mistake," Dean, the former governor and presidential candidate, told the Huffington Post Web site in mid-June. "These co-ops will be very weak. Many won't have the half-million members that most experts think is necessary to influence the market. Insurance companies will be licking their lips.

"I am very fond of Senator Conrad and think he is a good guy and friend. But I think the basic problem (is that senators) are worried about the internal Senate politics rather than the type of solution the American people want."

Sunday, Sen. John D. Rockefeller IV, D-W.Va., said a strong public option remains "a must" and "the only proven way to guarantee that all consumers have affordable, meaningful and accountable options available in the health insurance marketplace."

Dean has suggested that the Senate, where Democrats have 60 votes, could use a procedure called reconciliation to advance public option even if the proposal fails to win enough votes from moderate and conservative Democrats to pass on its own. The House bill is expected to pass with public option included.

The Service Employees International Union, one of the strongest backers of public option, dispatched organizers to North Dakota to work with others to build grassroots support for it. In an

e-mail urging people to call Conrad, the coalition instructed people to "remember to stress the need for a public plan option for health insurance to improve affordable access for the uninsured and to increase competition in the health insurance market."

The union's president has dismissed the co-op idea as a "distraction," and local organizers held a rally outside Conrad's Grand Forks office to urge him to support public option.

Jacob Hacker, co-director of the Center for Health, Economic and Family Security at the University of California-Berkeley, wrote in the New Republic's online edition that the proposed co-ops won't have the reach to control costs or set standards for private insurance providers.

"And so Conrad's idea appears to be yet another compromised compromise that cuts the heart out of public plan choice (public option) on the altar of political expediency," he wrote.

Reach Haga at (701) 780-1102; (800) 477-6572, ext. 102; or send e-mail to chaga@gfherald.com .

Related Topics: HEALTHCARE
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