Comments on Bernard Avishai Dot Com: Cooperatives: The Best Public Option

Israel doesn't have co-ops. It has four giant HMOs...

2009-09-27T13:37:02.000-04:00

Israel doesn't have co-ops. It has four giant HMOs. Basically, it looks like the Clinton system.

They do manage to cover everyone at around 8% of GDP compared to our around 20%, but the WHO ranks Israel's system number 28 -- better than our number 37 but not that much better and certainly nothing to write home about.

Further, the Israeli system involves significant cost sharing. The most recent figure I could find was from 2001, when the average out of pocket cost was 31%. For a major illness or accident, even 1/3 of the bill is potentially bankruptcy-inducing. I also found a reference to a recent survey which showed that 23% of those in the bottom income quintile reported that they avoided treatment specifically because of the cost sharing.

That's certainly better than the US, but I wouldn't describe it as working "just fine."

I asked a friend of mine, who has been following t...

2009-09-17T11:26:39.589-04:00

I asked a friend of mine, who has been following this issue very closely, to read your post and comment. He said though it is full of ideas and references, he felt it uninformed:he gives just these as examples (quote):

Switzerland does have a successful private system, but it achieves fairness and cost control through stringent regulation, which is unlikely to work here (see our recent experience with lack of regulation of the financial markets).

"Private insurers want good prices (generics, etc.) the same way Walmart wants good prices, and public cooperatives will benefit as a by-product."

Everyone negotiates their own deal; just because Wellpoint gets price x doesn't mean the Cooperative will be able to do as well (and, to lower costs, we need to do BETTER).

"Besides, you could establish a buying consortium among healthcare cooperatives ..."

This is specifically prohibited in the Baucus plan! (The plan, I kid you not, is an out-and-out rip-off of the people. It is totally, thoroughly corrupt.)

Progressives generally feel that the best solution would be Medicare (popular, already up and running, more efficient than private insurance) for all. Given that this option was never even "put on the table", our fallback position has been the less elegant and somewhat more problematical "public option". We are fanatical about giving even further ground because we see no other hope for forestalling even more corruption."

(end quote from my friend)

My comment: My understanding is that the "public option" would be a safety net for a small number of people. It is important that it be there to make sure everyone has access. Also I wonder why all these new ideas about how to deliver and manage health care cannot be part of single payer, public option or cooperatives.

Pearlstein's suggestion relies heavily on regulation that, it seems to me, will be hard to get passed given the current realities- not that we give up on that too.

Obama has the promise of being the best president in my lifetime. He has the vision the ability to articulate it in his personally well written speeches but I want to see some spine. Progressives would not be pushing so hard if they did not feel that Obama wants compromise and lets' that be known, before he's even fought the battle for what he believes in.

Shana Tovah

I generally either agree with you or am too uninfo...

2009-09-11T21:32:09.234-04:00

I generally either agree with you or am too uninformed to make an independent judgment. However, I must say that on this topic I do disagree. Coops haven't proven strong enough in the past to compete with private insurance companies. Moreover, the idea of going back to a capitated system in which health care providers must provide care out of a predetermined amount of money is atrocious. We've already been through that and it provides a disincentive to provide appropriate care. If that is what you are suggesting, please re-think this or talk to anyone who has already had experience with this system.

Furthermore, as a psychologist in private practice, I have to say that Medicare is more efficient and pays more for my services than Blue Cross Blue Shield which hasn't raised my rates in at least a decade because they have "no incentive." Meanwhile, they are raking it in. Additionally, while best practices sounds like a great idea, one size fits all is not. In my profession, guidelines for treatment are fine as long as there is still some art to the practice. I assume this is also the case in medicine.

Best regards,
Erica Rapport Gringle
Durham, NC