I read this article in The Hill, a congressional newspaper, and a question kept coming back to me. Did Senator Conrad purposefully seek to delay the passage of health care reform with his leading questions of the CBO director, Elemendorf, during the congressional hearing on health care reform? It seems that he did. Here are the relevant excerpts below:

"Under questioning from Conrad, Elmendorf delivered a bombshell, testifying that healthcare proposals drafted in the House and by the Senate’s Health, Education, Labor and Pensions (HELP) Committee would not curb healthcare spending, as Obama has envisioned, but instead add to federal spending.

“It was devastating,” Sen. Ben Nelson (D-Neb.) said of the effect of Elmendorf’s assessment. 

Conrad said he suspected Elmendorf would give the answer he did, but wanted to hear it so that his colleagues would understand the real impact of the legislation they are considering.

“I did not know what his answer would be; I suspected that’s what his answer would be,” Conrad said. “I suspected that was the answer but I didn’t know for sure because I’m not an expert on the House bill.”

Senator Conrad has been trying to push his co-op proposal for a long time to replace the public option. While at face value, co-ops seem like a good policy idea, but in reality, they’re not. We have electric utilities here in this country that began as co-ops, but they were taken over when they became privatized. What’s to stop Blue Cross Blue Shield from taking over a health care co-operative and privatizing it? 

Jacob Hacker explained the drawbacks to the co-operative proposal by Senator Conrad over at The New Republic when it was first floated weeks ago.  For those of you who may not be familiar with Jacob Hacker, he’s the one that came up with the idea of the public option as a way to bend the cost curve, keep the insurance companies honest, and provide quality and affordable health care to Americans. Here are excerpts from Hacker’s article in the New Republic:

Cooperatives of various sorts have been discussed and sometimes created to provide health care in the past. After the Great Depression, the Farm Security Administration encouraged the development of health cooperatives–which at one point had about 600,000 members, mostly in rural areas. But the cooperatives crumbled in the face of physician resistance (including boycotts), the lack of financial wherewithal of the cooperatives themselves, and the eventual withdrawal of government support. 

Even today’s remnants of the cooperative movement don’t provide the most inspiring of lessons. The only survivor of the 1940s experiment, Group Health Cooperative of Puget Sound, does continue to operate as a tightly managed health maintenance organization, paying doctors on a salaried basis. It is well regarded, and indeed, was found to be remarkably efficient by the RAND Corporation as part of a famous 1970s analysis of the effect of insurance cost-sharing. Unfortunately, it’s now little different from other nonprofit HMOs, with around a half million members in Idaho and Washington State. By contrast, WellPoint–the nation’s largest insurer and a major force behind the defeat of health care reform in another West Coast state, California–has more than 30 million members.

And that’s the story of purchasing cooperatives writ large. They have been hard to establish or extend, and when they have been established, they’ve been under constant siege from doctors and insurers and eventually largely operated as private insurance plans or weak purchasing arrangements.  It is hard to see how any sort of decentralized cooperative model could do what a public plan can do.

Senator Conrad wants nothing more than to push his health care co-operative plan, whether it’s a national co-operative or state-based co-operatives, into the final health care package. He’s like Senator Ron Wyden in this way, seeking to put their imprint on the final package, regardless of whether it might be good or bad policy for Americans. Senators like Conrad don’t have the interests of their constituents, but rather the interests of private insurers when it comes to allowing them to game the system in any way they can such as setting up co-operatives in which private insurers can later take over.