Health Insurance Co-ops: Now we're going into new fields

There is no proposal, no text from which we're working, just the idea of a health insurance co-op, where a group of people "own" the co-op and have options to voice their opinions and the direction of the co-op based on that "ownership."

Typically, such co-ops, in this consumer as owner state do not provide a magic solution to the lack of access to affordable quality coverage but instead provide something less, but at least there is health insurance.

Still, throwing around old concepts with the label "new" accompanying such ideas is ridiculous and for the listener becomes as silly as watching the new generation of "hippies" telling those who lived through that era what being a hippie really means.

So why hasn't this concept of the health insurance co-op caught on before?

Here are some questions:

Who owns the co-op? Is is consumers with a common interest, such as farmers or is it a group of professionals such as physicians, or is it a hospital itself? This group, as owners, has the power to dictate the direction of the "insurance" and the problems with all these examples already exist. Further, ownership models where physicians have a percentage of interest, hospitals have a percentage of interest and administrators have a percentage of interest have also occurred. Listening to all the guesswork, without government involvement and support and OVERSIGHT, it doesn't work for consumers. Issues of conflict of interest arise constantly where physicians refer patients to their own hospitals.

Conflict of interest is a major concern. It is well established that separate interests are WHY we are in this mess, insurance companies seeking profitability have INCENTIVE to erode benefits and eligibility and to raise premiums and co-pays. Physicians have an INCENTIVE to over test and over charge for profit. Consumers have an incentive to grab at cheaper rates without sufficient knowledge of what their medical services experience will be when they get sick. The GOVERNMENT is most influenced by VOTES, gross numbers of citizens who support the government or don't. In the process we watch billions of dollars being spent by the insurance industry and the medical services providers to LOBBY the government because IT WORKS. As consumers we stupidly (and I've carefully selected that word) buy into the NO BIG GUVMENT mantra which leaves us OUT of the significant part that government already plays in this industry. In Health Insurance Co-ops, FAILURE to adequately address the real life experience of conflicts of interests through LEGISLATION and RULES will leave consumers less powerful than ever to battle their "own" insurance company. Administrative costs will go up after YEAR ONE, that's a prediction based on reality. Coverage will go down after year TWO as government dollars are fazed out or reduced. Ownership percentages will shift and consumers will own LESS of their own co-op. How do I dare to predict this? Because this is what happens in the stakeholder game of health insurance...playing to the traditional FEAR of government which is a phobia based on the non real notion that if we ignore government every other stakeholder will and the FEAR of no coverage which has tweaked the cheap gene in humans to our survival's detriment as we BELIEVE that thirty choices of provider for exams will help us at all when we need an oncologist for cancer and find there are two providers.

Co-ops and government money: Governments contributing to these organizations will either become STAKEHOLDERS who support reduced coverages that jump on the cheap three wheeled bandwagon of wellness rather than care for the sick, or will provide "bailout" type dollars, an ongoing stream of government money with little oversight requiring permanent government funding or corruption.

Will the Co-ops REALLY have the power to negotiate a better rate of insurance companies for their members than the government? The only edge that small co-ops will have at a negotiating table will be what they're willing to give up because they represent a less diverse group of people than any "national" group. So, farmers can negotiate for coverage of accidents from machinery and give short shrift to other health services needs that the national government cannot do without alienating some Americans. But do you really believe that smaller co ops are better able to make a deal with health insurance companies than the government? Compare the benefits they offer their members with the benefits offered the members of Congress and if you still say yes, clearly there are other issues influencing your decision. This "issue" is the same one that seems to leave all the big mouths jumping on the go it alone bandwagon from DEMANDING that their non-pro-national health insurance representatives OPT OUT of the cushy government benefits they enjoy year after year. Further, if you examine the Massachusetts health co-op hybrid sort of offering you'll see that MA GAVE AWAY the bargaining tool in a valueless hope that continued "competition" would ultimately force health insurers to modify their rates lower...so far, MA is in the hole on that one.

The continued REFUSAL to address controls and oversight over physicians and insurers will prevent progress from ANY proposal. If you smoke you pay more, if you are old you pay more and if you get sick, welcome to the gift of higher premiums that keeps on giving. And it's not just you. In the last five years have you, your parents or grandparents had cancer, or have your grandparents, parents or yourself EVER suffered a heart attack...these are the real questions that come out. A mandate that everyone be offered health insurance without a LIMIT on what can be charged for such insurance (remember until recently the right to COBRA included the cost of 102% of premium which kept many from using COBRA). Without meaningful limits on physicians pay which currently includes defensive medicine costs which the consumer carries in the real dollar cost of over testing, means that no matter what label we smack on something the issues will be the same: Less cost only obtained by less coverage.

In our current environment a national health choice is the ONLY means we have of negotiating lower costs: If this insurance doesn't provide me with affordable rates of coverage after I have my cancerous mole removed then I will choose the national option. It won't be great because of the lack of firm mandates on physicians and insurers, but it will be better. Ultimately, mandates on insurance companies and providers will be the ONLY way left to manage costs. Ultimately, you can weed out any ill person into a special group but ultimately, an insurance industry that only provides insurance to the healthy will erode their own profits as the healthy realize they don't NEED insurance and that when they NEED insurance it will not be there.