Health Care Co-Ops Are Not the Answer

Scale is the big problem

A national co-op could work, assuming it was forbidden to step over the line and get sucked in to the same kinds of problems plagued by private insurers.  A co-op at its best would merely be a non-governmental equivalent to a public option plan.

By proposing regional or state-wide co-ops, though, Congress would be intentionally hamstringing the co-ops against the more powerful private insurers.  I don't dislike the co-op idea in principle, but it must not be handicapped before it gets off the ground.

"I have come to the conclusion that the making of laws is like the making of sausages-the less you know about the process the more you respect the result."  -- Anonymous IL State Rep. circa 1878

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by: Phoenix Rising @ Tue Jun 30, 2009 at 17:08:43 PM CDT

Make the rules the same

If co-ops are legally restricted to certain areas (regional or state-wide, at most) then so should the private insurers.  The flip side is true, too.  If private insurers can operate nationally, then so should co-ops.  And if co-ops are going to have some public funding, then they should be national.  Which brings us back to the public option in a different guise.

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by: dmindgo @ Wed Jul 01, 2009 at 11:44:23 AM CDT

[ Parent ]

I find that Doctors generally are the problem

They are overpaid, in my opinion, and believe that they deserve to be.

Most Medicare recipients have difficulty finding a new doctor to take Medicare.

How about a 5 trillion tax cut for the upper 1% that's borrowed from China  and then invested in China? The Republican platform has legs.

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by: Ray Springfield @ Tue Jun 30, 2009 at 19:09:06 PM CDT

The several doctors of my parents......

....are certainly not overpaid, especially considering the cost of their educations.

There is no problem here in The Medicare Capital of America to get doctors.  Sure, some won't, but most will as soon as they have an opening on their patient list.  

"Collective fear stimulates herd instinct and tends to produce ferocity toward those who are not regarded as members of the herd." -Bertrand Russell

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by: parsingreality @ Tue Jun 30, 2009 at 22:05:31 PM CDT

[ Parent ]

Consider the cost of their educations

Okay, I don't think a doctor pays for an education for an entire career.  If the cost of education is the issue, then once that has been paid off, the doctor's rates should go down.  Not!

If the cost of education is the issue for doctors, then why don't more take advantage of  rural community offers to pay for college if several years are spent in practice in the community?

In rural areas, Medicare patients have a great difficulty in getting and keeping a regular doctor.

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by: dmindgo @ Wed Jul 01, 2009 at 11:49:24 AM CDT

[ Parent ]

In rural areas EVERYone has great difficulty....

Not just Medicare.  

Who knows why doctors don't do what you suggest?  It's their choice.  Regardless, it is an expensive education.

So what do you think is a reasonable income for physicians?  Gross to him or her, personally.  

"Collective fear stimulates herd instinct and tends to produce ferocity toward those who are not regarded as members of the herd." -Bertrand Russell

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by: parsingreality @ Thu Jul 02, 2009 at 14:53:36 PM CDT

[ Parent ]

THe AMA has a strong lobby

The insurance companies co-opt many through incentives to not approve care.

The pharmacuetical comoanies literally bribe them to use the drugs.

So do corporations that deal in workmen's comp. I see them receiving a ton of corporate perks to tow the company line in workmen's comp.

But perhaps I'm being to harsh on them.

How about a 5 trillion tax cut for the upper 1% that's borrowed from China  and then invested in China? The Republican platform has legs.

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by: Ray Springfield @ Wed Jul 01, 2009 at 13:09:47 PM CDT

[ Parent ]

Doctors hate the present system too

They are also jerked around by the insurance companies and have to devote significant resources to getting paid.

Amazon tax? Bad Idea!

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by: DavidThi808 @ Tue Jun 30, 2009 at 22:58:34 PM CDT

[ Parent ]

Critical mass

Doctors, patients, business...heck, even PhRMA looks to be on board with reform. The present system isn't working for anyone except maybe the insurance industry.  

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by: Progressive Promoter @ Wed Jul 01, 2009 at 08:59:35 AM CDT

[ Parent ]

It works for a few

Mostly it works for the insurance industry, and also for large medical chains often associated with the insurance industry; it also works for people like elective plastic surgeons, who are more likely to get paid - and paid handsomely - for their work.

"I have come to the conclusion that the making of laws is like the making of sausages-the less you know about the process the more you respect the result."  -- Anonymous IL State Rep. circa 1878

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by: Phoenix Rising @ Wed Jul 01, 2009 at 09:22:37 AM CDT

[ Parent ]

Both our long time family doctor

and a specialist to whom he referred me last year were Obama supporters and not only would they go for a public option,  they'd be fine with a good single payer system. Wonder if it's a coincidence that they are both also the kind of doctors who are happy to spend as much time as it takes with you, patiently answering all of your questions, incuding ones you might not have though of yourself, and explaining all options.  

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by: BlueCat @ Wed Jul 01, 2009 at 11:43:26 AM CDT

[ Parent ]

You pay their costs...

Medical malpractice insurance, medical school bills, facilities and equipment costs, and enough staff to handle the work load of arguing with insurance companies to be paid on services performed in good faith.  And, yes, someone to handle the Medicare claims - which I understand are significant but relatively painless once completed.

"I have come to the conclusion that the making of laws is like the making of sausages-the less you know about the process the more you respect the result."  -- Anonymous IL State Rep. circa 1878

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by: Phoenix Rising @ Tue Jun 30, 2009 at 23:39:32 PM CDT

[ Parent ]

Depends on the specialty: depends on the location

Denver
Physician - Emergency Room Total Benefit $320,702
Physician - Family Practice Total Benefit $224,168
Physician - Generalist Total Benefit $207,169
Physician - Obstetrics/Gynecology Total Benefit $336,672

Grand Junction
Physician - Emergency Room Total Benefit $247,328
Physician - Family Practice Total Benefit $173,570
Physician - Generalist Total Benefit $160,632
Physician - Obstetrics/Gynecology Total Benefit $260,346

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by: Danny the Red (hair) @ Wed Jul 01, 2009 at 13:26:13 PM CDT

[ Parent ]

I have no problem with those incomes.

Other than dermatologists, they are on call 24/7.  Even as part of a group, they may be called if the first doctor needs to know more or ask another question.  They have to be (or should be) experts, not only on the biology at hand, but dealing with people and their many personalities and ways of interacting. They have to run a business, overseeing many employees, even with a manager.  

As far as I'm concerned, they earn every nickel.  

"Collective fear stimulates herd instinct and tends to produce ferocity toward those who are not regarded as members of the herd." -Bertrand Russell

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by: parsingreality @ Thu Jul 02, 2009 at 14:57:53 PM CDT

[ Parent ]

Do you see a problem

...with the Government being both a regulator and a participant in the public option scenario?

"Kevin and I will keep them out somehow -- even if we have to redefine what the peer-review literature is!"  

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by: Laughing Boy @ Wed Jul 01, 2009 at 11:52:54 AM CDT

Depends on what your goal is...

If you want to keep the current scenario where private insurers are sending lots of money to their top executives, and putting 30%+ towards administration, then having government being regulator and insurer at the same time is a problem.

If the public option is supposed to be cost-efficient, then it has no need to ensure that it out-performs the private plans through biased regulation - it will (assuming all the good things we Big Government types take for granted) win out simply because it has a lower overhead, as Medicare and the VA have shown.

Any functional, cost-saving reform is going to significantly alter private insurance practices.  Removing rescission, pre-conditions, and creating easy-to-understand plans with open rates will do that; having a public option driving the private plans into action will ensure it, IMHO.

"I have come to the conclusion that the making of laws is like the making of sausages-the less you know about the process the more you respect the result."  -- Anonymous IL State Rep. circa 1878

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by: Phoenix Rising @ Wed Jul 01, 2009 at 12:10:20 PM CDT

[ Parent ]

Not at all. It works in every other country. And Medicare.

"Collective fear stimulates herd instinct and tends to produce ferocity toward those who are not regarded as members of the herd." -Bertrand Russell

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by: parsingreality @ Thu Jul 02, 2009 at 14:58:30 PM CDT

[ Parent ]