Reading Up on a Public Option Versus a Health Care Co-op

Over the past week or so, I’ve been troubled by the lack of civility in the town hall meetings. It’s sad to see people shouting down other people who are trying to have a civil discussion on the proposals for health care reform. I’ve been shocked to see videos comparing Obama to Hitler. More ominously, some people have even brought guns in Presidential events, brandishing them in public to flaunt their second amendment rights. Sadly, these displays have had an effect on the opinions of people towards Obama’s health care reform proposals, as support for reform has gone down in the polls.

A debate is necessary because the need for reform for health care is so important for our country. Fareed Zakaria wrote a column in the August 17, 2009 Washington Post in which he states:

“Clearly the U.S. health-care system is on an unsustainable path. If current trends continue — and there is no indication that they won’t — health care will consume 40 percent of the national economy by 2050. The problem is that this is a slow and steady decline, producing no crisis. As a result, we seem incapable of grappling with it seriously.

It’s not as if the problems aren’t apparent to everyone, whatever your political persuasion. Costs are rising so fast that every day more than 10,000 Americans lose their insurance coverage. In 1993, 61 percent of small businesses provided health insurance for their employees. Now only 38 percent do. Larger firms face greater health-care costs. Yet, Americans do worse on almost every health measure than most advanced industrial countries, which spend about half as much on health care per person and have proportionately more elderly people. “

Over the past week, Senator Kent Conrad introduced the idea of a nonprofit health care co-operative as an alternative to the public option plan that has been the centerpiece of President Obama’s health care reform efforts. Senator Kent introduced this plan mainly as a compromise to try to persuade centrist Democrats and Republicans to support health care reform but have serious doubts about a government public insurance option. One must weigh the merits of the co-op plan as compared to the public option plan and see if it meets the goals of helping all Americans receive timely medical care while reducing medical costs so that it doesn’t impose such a burden on the individual and on society. Robert Pear and Gardiner Harris wrote an article in the August 8, 2009 edition of the New York Times examining the merits and possible pitfalls of the co-op idea.

A national co-op idea sounds good on paper. In this plan, the government would offer start up money (estimated at $6 billion) in loans and grants to help doctors, hospitals and other groups to create nonprofit networks to provide health care and coverage. Pear and Harris write that health care experts and economists feel that health care cooperatives could inject competition in some insurance markets around the country. Representative Earl Pomeroy, Democrat of North Dakota and a former state insurance commissioner, is quoted as saying:

“The market here is uncompetitve. A cooperative could provide an alternative source of insurance and some interesting competition for premium dollars. A co-op could operate at lower costs, in part because it would not need to pay its executives so generously as the local Blue Cross Blue Shield plan.”

In learning more about co-ops from this article, I believe the co-ops idea has merit in certain regions, but the co-op plan isn’t strong enough to solve the national problems of our nation. Pear and Harris notes that co-ops would need time to buy sophisticated information technology and to negotiate contracts with doctors, hospitals, and other health care providers. A health co-op in each state would need 25,000 members to be financially viable and at least 500,000 members to negotiate effectively with doctors, hospitals, and other health care providers. Larry J. Zanoni, the executive director of the Group Health Cooperative of South Central Wisconsin, said:

“We are a testament to the success of a health care cooperative. But it took us over 30 years to get where we are today.”

A major flaw that I see in the co-op idea is that it may not work in all regions in the country. The New York Times article mentions the case of Iowa in the 1990s. In the 1990s, Iowa passed a law to encourage the development of health care co-ops. One co-op lasted two years before failing, and today, Iowa has no health co-ops.

Lola Wheeler, a blogger in Everyday Citizen, notes that co-ops in her home state of Kansas do not provide universal health coverage for her state. In her recent blog, she notes:

“If cooperatives worked so well in Kansas, why are so many people that I know in Kansas uninsured, going without healthcare or going broke trying to pay their hospital bills? Why are people dying because they have no access to care? Why are we in crisis in the heartland?”

I’ve read 3 strong arguments in favor of the public option. An editorial in the July 20, 2009 edition of The Nation magazine stated:

“Almost every American knows someone who uses Medicare, and the satisfaction with that program is famously high. From a policy perspective, a public option would serve an essential purpose: if it performed with the efficiency and cost control of Medicare, it would impose discipline on private insurers through competition. In other words, it would set a kind of baseline of care by giving people a choice.”

A strong argument was made in the July 1, 2009 edition of The New Republic:

“… the history of American health care is replete with examples of insurers- like all industries- trying to maximize thier profits, often in ways that leave Americans without the financial protection or medical care that they need. In the mid-twentieth century, it was the entrance of for-profit insurers to the market that set off the chain of events that led to the situation we have today- a situation in which people who have pre-existing medical conditions frequently cannot afford to buy coverage on their own. And, in recent decades, it was the transformation of managed care into a for-profit industry that left Americans with medical needs at the mercy of insurers that sometimes made clinical judgments based on profits and loss.

…In this sort of world- the world of American health care as it exists, rather than how it seems in some idyllic conceptions- the case for a public insurance plan is strong. Very strong. Government can decree that its insurance program provide coverage to anybody who seeks it- and that it cover all necessary medical services, without secret gimmickry to wring profits from treatment denials. The government can offer coverage cheaply, by taking advantage of its bargaining power and economies of scale. And, insofar as the goal of reform is to reduce the cost of care in the long run, by attacking the medical habits that encourage excessive or ineffective care, the government can make sure the public plan pays for services in ways that promote the most effective treatments.”

An editorial in the August 19, 2009 San Jose Mercury News strongly advocates the public option plan:

“A public option would utilize the government’s immense negotiating and buying power to drive down rates. Medicare operates with just 8 percent overhead and cares for the vast majority of senior citizens of this country. Why isn’t that the theme of town hall meetings

There’s nothing wrong with establishing co-ops across the nation to help small businesses and individuals get coverage, as the Senate proposes. But they will not substantially affect costs. And without bringing down costs, health care reform- even if it brings coverage to every American- will fail.”

I agree the most with the Mercury editorial. Co-ops in an of themselves are not bad. And the co-op idea shows a commendable thinking outside the box on the part of the Senators trying to craft a difficult health care bill. The example of Iowa in the 1990s, though, shows that co-ops may not be able to cover all citizens in all regions of the nation and compete with well intrenched insurance companies. It seems to me that the public option will do a better job than co-ops of dealing with the problems in our national health care crisis.

Onto more personal news, some of my Everyday Citizen cartoons have been selected for inclusion in the San Francisco Cartoon Art Museum’s Monsters of Webcomics exhibition, and will be featured in the Virtual Gallery along with a wide array of webcomics from around the globe. This historic exhibition will include over 100 artists, making this one of the largest exhibitions in the Cartoon Art Museum’s 24-year history.

Monsters of Webcomics opens to the public this Saturday, August 8, and will run through December 6 here at the Cartoon Art Museum in San Francisco.

You can find the full press release for the exhibition here: http://cartoonart.livejournal.com/29650.html Additional information about exhibitions and events can be found at LiveJournal (http://cartoonart.livejournal.com), Twitter (@cartoonart), on MySpace, and at the museum’s Facebook “Fan” page and “Causes” page.

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About angelolopez

I’ve wanted to be an artist all my life. Since I was a child I’ve drawn on any scrap of paper I could get a hold of. When I went to San Jose State University, I became more exposed to the works of the great fine artists and illustrators. My college paintings were heavily influenced by the humorous illustrations of Peter De Seve, an illustrator for the New Yorker magazine. I also fell under the spell of the great muralists of the 1930s, especially Thomas Hart Benton and Diego Rivera. I graduated with a degree in Illustration. Since my time in college, my goal has been to be a successful children’s book illustrator. I’ve illustrated 3 books: Two Moms the Zark and Me by Johnny Valentine in 1993; Night Travelers by Sue Hill in 1994; and Cherubic Children’s New Classic Story Book Volume 2 for Cherubic Press in 1998. I’ve painted murals for Lester Shields Elementary School in San Jose, the Berryessa branch of the San Jose Public Library, and Grace Community Church in Los Altos. I’ve had a few illustrations published in South Bay Accent Magazine and I will have an illustration published in the January/February issue of Tikkun magazine.
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