Colorado Democratic representation has been notably lame. The two senators said they would vote for a public option, but haven’t said they’d vote against a co-op either, and none of the representation is on the FDL whip count list in either of the first two columns, even Degette and Polis representing very liberal Denver and Boulder respectively.

And Gov. Ritter sucks too, esp. on union issues.

He is, needless to say, a lying piece of shit.

On a more upbeat note — NOVAKULA BUYS THE FARM!!!!!

No one can truthfully say that coops are as good as anything, nor can they say coops will work well because first of all, there is no plan for how the coops will work and second, there are no models from which to judge them.

This is interesting. When I asked him a week and a half ago he indicated he prefered the public option.

In a word: Bullshit!

Anyone have an email address for Sibelius?

Scarecrow has a very good post on the problems that will arise with a public option.

Conrad’s Blue Cross/Blue Shield Wants to Be Your Local Monopoly Co-op
http://seminal.firedoglake.com/diary/7322

I am probably a more conservative dude here, and as I have said many times, I do not think that a public option is crucial. What can I say -I am a regular middle of the road economists, like Krugman. But anyone who thinks that effective co-ops would mean less ‘government interference’ as defined by the reactionaries and the Blue Dogs is just kidding themselves.

I see very strong regulatory reform as crucial to any plan that is not single payer. Opponents of reform have already announced that they will also oppose strong regulatory reform. I fear the regulatory reform now proposed would not even be strong enough for a public option to work, so it certainly would not be strong enough for co-ops to work as intended.

Obama needs to admit to himself that sometimes compromise is not possible, and sometimes people need strong leadership.

The reactionaries have provided strong leadership to their supporters, too bad it is also extremely manipulative and dishonest leadership.

This is turning into a bad and dangerous joke. The Democrats need to lead for once. They do not seem to know what it means, unless they are also corrupt. In which case, we have to get ready for a very long slog, and work to elect more better Democrats next election.

As was indicated on a earlier thread no one knows what would be the structure of a co-op the only thing that can be agreed on is that it would be more expensive and would not necessarily bend the cost curve. Its advantage is political.

Co-ops as Conrad is construing them will be bought out by the industry within five years. The onliest way that doesn’t happen is if the co-ops are forced to act as gateways into a selected group of insurers.

That’s the model of New Mexico’s State Coverage Insurance. Those who are eligible (there are income qualifications) are brought into the pool, and they get to choose among Molina Healthcare, Presbyterian Healthcare, and Cigna-Lovelace Healthcare “HMOs”. (The scare-quotes are there because except for Presbyterian, these aren’t HMOs in the same sense as Kaiser or Group Health. And even Presbyterian outside Albuquerque contracts with providers rather than having services on-staff.)

Is it better than nothing? Yes. Will it control costs? Not on your life. Will it get to universal coverage? Not without a purchase mandate.

Some of the cripplers that are tossed into the mix: noncompetition provisions (also called crowd-out provisions) that limit the size of the program. Income qualifications: even if you were willing to pay the full premium yourself, you can’t enroll if your income is above 300% of FPL. It funnels the money to contracted insurers on per capita basis, so (except for Presbyterian in Albuquerque) they have every reason to deny you care.

The difference between a real pre-paid cooperative (like Kaiser or Group Health) and a “HMO” like Cigna-Lovelace or Blue Cross HMO options is that a real pre-paid cooperative has physicians on staff on salary. The only costs involved in treating a patient are the costs of supplies. That’s not trivial in a lot of cases, but “HMOs” are paying physicians fees-for-service in addition to the variable costs of supplies. They are also paying providers (hospitals, surgicenters, etc.) for their contributions.

Granted, they aren’t paying full retail for those things, but the fact remains that they have a much larger incentive to deny care than a real HMO does.

If co-ops are the answer, then health care reform was not the question.

Well, he’s in a better place, as they say. I’m sure he’s welcome where he is– he was known as the “Prince of Darkness”. He gets to be with his hero, the senile movie star.

They say it’s awful hot down there.

If co-ops are the answer, then health care reform was not the question.

Amen!

Note to Ed: You’re in a D+4 district, not a BCBC+4 district.

Actually Ed would be in an Anthem+4 district. BCBS in Colorado was taken private and purchased by Anthem during the 1990s. Not even a co-op. EPIC FAIL.

At least Kent Conrad has a fig leaf.

BargainCountertenor – so the New Mexico plan helps lower income folks, but does nothing for those like me who are middle class and uninsurable due to pre-existing conditions?

Why can’t Obama just say we don’t negotiate with terrorists (we’ve all seen the teabagger tactics at town halls) and just forget about Republican buy-in. Medicare went through without a single Republican vote and it turned out alright.

I’m going to be livid if all I get out of this “reform” is an unfunded mandate to buy my own insurance plan.

I completely agree with your comment. Co-ops weak enough to pass muster with the Blue Dogs will not do anything to reform the current reimbursement system. Unless we go to full very strongly regulated Swiss communism (aka the Swiss Menace). Reform opponents are already signaling they will not accept that. I think that organizations that call themselves managed care, that are really a hybrid of insurers and private provider contractors in disquise are kind of a scam, and are a major source of inefficiency in our system.

So, what is the point of it, other than to capture another market, continue inefficient service, and soak either the enrollee or the taxpayer?

If co-ops were equal to the public option, the insurance companies and the ninnies in Congress wouldn’t be fighting against the option so hard. That seems fairly obvious to me.

to pass muster with the Blue Dogs

Perpetuating this theme misunderstands what is happening. There are Blue Dogs who are not aligned with Mike Ross and company. This way of framing it just lets the Mike Rosses hide their corruption under a veneer of ideology. It also taints folks who shouldn’t be tainted quite yet.

At this point, most Blue Dogs are in duck and cover mode.

“CO -OPS a a political device. even the assholes like conrad who are pushing them dont know what they are. in fact, despite some web rumors their ARE NO CO OPS in existence. For instance “Kaiser permanente” is not a co op. They also have NO IDEA where to begin implementing them. Co-ops are a half assed solution to a political problem NOT the nealth care problem

Fixing healthcare with a co-op is like elk hunting with scattershot.

OK, noted. I hope what you say is true, that would mean there is some hope that they could be brought around with a good plan, should Obama and his people actually propose one and really try to sell it to the voters.

Come on now. Don’t you all understand by now that congress, both dems and rethugs, are owned, body and soul by corporate america? I mean really, isn’t the fact that they can be legally bribed, by “campaign donations” make everyone realize that? Of course they all claim that what the corporations give them in “campaign donations” or as I prefer to call it, bribery has nothing to do with their votes. I cry Bull shit to that. Corruption is corruption whether it be by secret under the table payments or by the oh so public “campaign donations”
Its all very very simple. Follow the money. Then see who voted for or against any bills that whatever corp that bribed tham wanted.
Our republic has been a hollow shell for some time now, the corporations really came out during the gwb years. They will be the ones who decide which bills pass and which do not. Scream, cry, wail, sign petitions, demonstrate. It don’t mean nuttin. Yours, or mine, congress person will vote the way that those who bribed him/her want that person to vote.
The corruption is everywhere and it is massive. It is at every level of govt. from the govt clerk at your local SS office all the way up to the highest levels of govt.
Fact. There is a local Social Security office that will ensure that people who are older relatives of immigrants-over 65, will get qualified for and receive SS payments even tho they have never worked a day in the US. They can get qualified for Medicare. They can not only get Green cards, but can become citizens without ever taking the test or even being able to speak english. And when real written documentation is provided that these things are happening, the agencies will do nothing. Not worth their time. It goes all the way down to the local level where some companies in some locations pay the state unemployment workers to ensure that workers from their companies never get unemployment benefits. We are becoming as officially corrupt as many 3rd world countries. I have found that their are govt workers in the US who will, for a few $$$ will do whatever you want. We-the US-take pride in the fact that our officials are not corrupt. Well, it ain’t true. Corruption can be easily found at every level of govt. As congress sets the tone, so all the rest of govt follows.

The White House,The Senate and The Congress.And the Dems stil can’t get it done.How Fn Pathetic.

At this point the co-op is a nebulous concept. When some sort of plan comes out it will be killed by a CBO analysis if the budget is actually a consideration.

I would be OK with Coops if they are modeled on the VA! As show in this study they do a better job delivering health care than the public sector in almost every measured:
http://thinkprogress.org/2009/…..alth-care/

The VA “outpaces other systems in delivering patient care,” consistently delivering higher quality health care more efficiently. A recent study by the RAND corporation found that “VA patients were more likely to receive recommended care” and “received consistently better care across the board, including screening, diagnosis, treatment and follow up”:

The study also concludes that “if other health care providers followed the VA’s lead, it would be a major step toward improving the quality of care across the U.S. health care system.” The public option — a frequent target of critics who argue that government health care would ration care or provide subprime coverage — would push health providers to adopt some of the VA’s delivery system reforms.

Just saying if they instituted coops using the VA as a model and using their model for charging fees/copay’s we could have a viable alternative to these GREEDY Insurance & PHARMAS Corporations!!
And maybe even meet the desired result of making them go the way of the Dodo Bird!!

This is turning into a bad and dangerous joke. The Democrats need to lead for once. They do not seem to know what it means, unless they are also corrupt. In which case, we have to get ready for a very long slog, and work to elect more better Democrats next election.

I would say we need to elect more and better progressives and better government folks. It certainly would be easier to co-opt the Democratic primary procedure to do this since the two parties have put such high hurdles in the way of third parties. But I think we should dispense entirely with this idea that the Democrats are on our side. As they have proved to us over and over again for the past 8 years, they aren’t.

At this point, most Blue Dogs are in duck and cover mode

Isn’t that the current standard definition for leadership?

Yep, it’s the epitome of muddling through.

Thank you ex-Representative Perlmutter. You really know how to get us to evict you! Just say the word about how you intend to help kill your constituents while you take the cash from the insurance companies! You are a smart man, and know which side your bread is buttered on. The voters will know to take the bread away from you so that you can live on butter.

Ed Perlmutter is a new representative from Colorado…He’s a bit wet behind the ears when it comes to dealing with big, hard, ugly issues like this on a large scale…His first few tries at finesse have obviously failed – miserably..but he seems to keep getting up and going back for another dose. short lesson in using the pointed end of a specialty hammer…ALWAYS start swinging before you go in – never stop swinging while you’re in the fight and NEVER loose sight of why you got in the scuffle to begin with..

Go back again Ed, and tell your constituents ‘Public Option is NOT Co-Ops”…no matter how you try to sell it..If there is no public option, take up the next major issue on your plate….this one is done.

The VA is a national system. The hospitals and all equipment is owned by the VA, the doctors, nurses, techs and etc are VA employees. The VA is a socialist system in the true sense of the word. I have been very pleased with the care I have received at VA facilities. The co-ops are statewide or regional. What happens if you are out of state and are involved in a accident or get sick. How many hospitals would the ambulance have to drive by to find one in which you are covered.

d+4 District linky not working

Kennedy and Byrd should do their party a favor and resign if they cannot show up for a vote on health insurance reform.
Reid should of course be replaced, but at a minimum the pressure should be applied to Conrad and Baucus to follow the party line or kiss their committees goodbye, and Obama needs to send his RNC membership card back.

I guess I’m focused personally as much on the cost issue and the impacts for the wider economy as I am on the quality or accessibility and affordability of service. How will co-ops effectively contain the exploding system-wide costs and reduce the 50% or so of healthcare spending that is reckoned to be outright wasted? According to the CBO, industry-wide costs (already at 16% of GDP) will spiral to 37% by 2050 – a disastrous scenario for the country.. forget about individual affordability or even universal access. Healthcare is literally bankrupting the country. OECD average is something like 9% of GDP and we’re already 50% higher than that.

Here’s my question (and, yes, I am asking it rhetorically), How will decentralized and multiple co-ops contain industry-wide and systemic costs without providing a competitive single point of competition from a government agency large enough to negotiate effective price control of insurance costs, service costs, and pharma costs?

We have to remember that this isn’t just about quality of service and care, and universal access. It’s also about saving the whole bloody economy from these insurers. Co-ops might (and I’m being incredibly generous here) solve the former problem but they do nothing for the latter. As such, they are worse than worthless.

This is the real reason why Big Insurance likes the co-ops. ’cause they do nothing to stop them from raping the country. In the case of their style of healthcare reform, that rape will just be extended (by the mechanism of the co-ops) from raping consumers and businesses to raping the government and taxpayers. This is their wet dream of a compromise.

True but if The Co-op is national that would remedy that issue. But seriously a Public System Modeled after the VA would do much better than the fucked up mess we have that masquerades for the ”Health Care System” we now have!!

I’m in complete agreement, Hugh. I might take it a step further and say that all of our representatives (term used loosely) in government are not on our side.

d+4 is not necessarily correct. Perlmutter won the district when his predecessor republican Bob Beauprex ran against Ritter in 2006. It was considered a toss up for Obama in 2008.

i really don’t think BC/BS and Aetna are thinking national co-op. They’re thinking decentralized local things. Depending on how its structured, a true national taxpayer-funded (or PPP) co-op would be basically the same as PO. So they won’t allow it. The whole point here is to scr*w us, not to solve the problem of rethug opposition by simply giving the same thing a nicer name. If we think co-ops can be turned into something we can live with – if we think big insurance will let us do that – I think we’re fooling ourselves.

Grand Junction CO is known for is being a trailblazer in cooperative health care. Doing something right and doing it with private nonprofits and insurance companies.

There’s the hospital, there’s the the local non-profit insurance company — which have partnered up to create cooperative health care. In doing so, they have created various clinic and palliative-care programs that vastly lower the expenses to the government-run Medicare system.

It’s proof that it can be done and done without government assistance.

If you’re going to monkey with the health-care market it’s best to do it at as local a level as possible. A major reason why cooperative health care appears to work in Grand Junction is that the community is intimately involved in their health-care decisions. The area has one of the country’s highest rates of health savings account usage.

In Grand Junction, better health care is about helping individuals make better decisions and letting the community set its own standards and find its own solutions.

I did some quick research on the Grand Junction, CO system and it sounds like they’re doing some good things there. But I suspect their system wouldn’t work everywhere. I notice they have something like 40 percent of the market — I doubt that would be the case in many places and without that kind of market share there’s no way they could compete with the big insurance corporations.

I don’t know that it’s a co-op per se, but it’s definitely a not-for-profit system. The article I read said the city runs it, although I couldn’t find any details about that in the rest of the article. But if it’s government-run it’s clearly not the same thing as the co-ops being proposed in the Senate.

And I’m sure a similar thing could be replicated in areas the insurance giants just aren’t interested in, but I doubt it could stand up to hard-ball competition.

I agree with ya Blub… I was just saying how the VA system does so much better than anything else in our country and would be a good model to base what we really need and that is Single Payer!! Anything else is just a sell out to the establishment!! Gee I have heard that somewhere before!!

We need regulations similar to what exist in those socialist hellholes, Switzerland or Netherlands, IMHO.

You can read about them here. Scroll down to find individual countries. Warning, big pdf files, so best to download rather than read in browser.
European Observatory on Health Systems and Policies
HiT country profiles
http://www.euro.who.int/observatory/Hits/TopPage

The answer to health insurance/health care reform lies not in another expansive national entitlement, but within communities who citizens are empowered and engaged. That is the lesson to be learned from Grand Junction CO.

Swapping employer based health care for federal government based health care does not solve the current problems (cost, access), it will only exacerbate them. As long as control is centralized, corruption will continue, and freedom and efficiency will erode further as we see elite technocrats replace insurance company bureaucrats as the arbiters of the terms and conditions by which we all receive care.

Empowering individuals by allowing them the greatest access to markets and greatest control over health care costs will create a dynamic system that will best serve the needs of individuals.

Imagine being able to buy coverage through a company, on your own, perhaps in another state, that promotes and covers holistic, natural or alternative medicine outside of the corporate/government complex. Imagine being rewarded for choosing and maintaining a healthy lifestyle with lower premiums. Consider paying more out of pocket for smaller expenses in order to be guaranteed coverage for catastrophic illness or chronic disease later in life.

This CANNOT be done by the government imposition of a ‘one size fits all’ universal, single payer system but only through a dynamic, free market that can adapt and conform to the needs and desires of the consumers they serve.

The VA succeeds because it serves a finite class of citizens. Taxpayers gladly, willingly pay additional taxes in order to reward the sacrifice made by our enlisted men and women and their families.

Also, the military is an autocratic institution, the VA is too. How many Americans are willing to accept a system even more authoritarian than the employer-based model we have now?

Again, real reform, real choice and competition involves empowering individuals and creating smaller, dynamic communities and delivery systems (both geographic and virtual) to better respond to the needs of all health care consumers.

A dynamic, free market that can adapt and conform to the needs and desires of the consumers they serve? GM and Ford served their consumers with exploding Pintos and ditch-magnet Corvairs in their free market days. Only government imposition produced safer vehicles. Yet, somehow the free market magic will work with the “consumers” of health care in a free market?

It is incorrect to frame the debate free of government intervention. Government has a role to play in PROMOTING the general welfare, and that includes consumer protections and industry regulation, But that is not what Democrats and the President are proposing.

Self-reliance and independence are at the core of the American spirit, and the inability to understand these core values by some liberals confounds me. The fundamental feeling that a person is responsible for him/herself should be central to any government policy. Trusting the American people to make decisions in their own self interest is paramount in creating a government that is responsive without being intrusive.

When did adhering to deeply held principles become “working against our own interests”? My interests may overlap or intersect with yours, but only up to a point. Trying to impose a top down, one size fits all health care system on the most diverse, independent population on the planet cannot succeed. Legislating equality of outcomes is IMPOSSIBLE in health care.

“within communities who citizens are empowered and engaged”

may I suggest that you cut this ridiculous ideological BS, which I care not a dollop about, and tell us how you intend to solve the hard-number cost crisis, which is everything here. I want to know how you intend for a status-quo-based system to reduce costs in a healthcare system that now has about 50% waste and costs about 17% of GDP and has been forecasted by Republican analysts during the last president’s term to account for 37% of GDP by 2050, down to about 9% of GDP (comparable to the highest end of the rest of the developed world). Unless you have a plan to make this happen, I don’t care to listen to anything you or your ilk have to say about this issue.

I agree Blub… indie is barking out his ass on this! The Insurance Companies hae had long enough to make sure all citizens had decent health care and look at what we have today!! Sky rocketing costs and massive profits for the industry, and we have 50 million who can’t get regular health care coverage, which forces them into emergency rooms when they are the sickest!!
It is high time these blood suckers went out of business!! Why are we the ONLY industrial country who spend so much and get so little for that expenditure!!??? We rank below Costa Rica in Health Care WTF!!

Empowering individuals by allowing them the greatest access to markets and greatest control over health care costs will create a dynamic system that will best serve the needs of individuals.

This is hilarious. It means absolutely nothing, but sounds fantastic. Nice work!!!