J.C. Moore Online

Current events from a science perspective.

Healthcare co-ops are now being promoted as a way to keep government out of healthcare. They might be effective at doing that but it is questionable whether they would be effective at providing health care reform. Most people don’t know about healthcare co-ops because they are not really an option for their healthcare. Senator Kent Conrad (D-ND) has proposed a co-op system in which the government would provide $6Billion in seed money to doctors, businesses and hospitals to form the co-ops. Eventually the co-ops would have to become self-supporting with premiums paid by members. Senator Conrad should be commended for his effort to find a bipartisan compromise but health care co-ops will do little to bring about health care reform.

 During the depression, the Farm Security Administration encouraged the development of rural health cooperatives, and at one point, they had about 600,000 members. Unfortunately, few co-ops survived after the FSA removed its support in the late 1940s. One that did is the Group Health Cooperative in Washington State and it is an example of a successful co-op. It has its own hospitals, hires its own Doctors at salary, and tightly manages its costs and membership. It took eighty years for the co-op to get where it is today and it is unlikely that a start up co-op could achieve the same success in a short time. When the seed money runs out, new co-ops would likely disappear and we will have spent $6Billion with little to show for it. Many health care co-ops have gone bankrupt. An example is Sunkist Growers , once a licensed insurance co-op that covered about 23,000 people. It fell into insolvency because claims outpaced income in 2001 and it left employers and medical providers holding the bag for about $11 million in unpaid medical claims.

Some healthcare co-ops negotiate with private insurance companies to provide insurance for their members. Their advantage is that they provide group insurance rates to small businesses, farmers, and individuals who might otherwise have difficulty negotiating favorable insurance rates.  Their disadvantage is that their rates, co-pays, network providers, and pre-existing condition policies are very much like any other private insurer. One such company is the Farmers Health Cooperative in Wisconsin which cooperates with Aetna and functions much like a PPO.  It has been successful because its members are reasonably healthy people. Co-op health care has mostly been successful in such small demographic niches. Jamie Court, president of Consumer Watchdog, says that “if co-ops attract high-risk people, who would otherwise go uncovered, it could bleed the co-op’s funding dry.”

Government is already providing health care. It is a strange spectacle to see Medicare recipients, Veterans, Congressional Representatives, and Senators decry socialized medicine when they, in fact, benefit from public subsidized health care. Would they be willing to put aside their present health coverage and go on a co-op system? I think not!  The Health Care Reform Bill, H.R. 3200, is a reasonable bill and it should not be replaced by a health co-op system unlikely to be successful.

Research Credit: Barbara Moore

Dr. Dave Janda, an orthopedic surgeon and author, has written a letter that has been widely circulated by those opposed to the health care bill (H.R. 3200). The letter is a bit incendiary for a doctor.  Dr. Janda’s  comment about end of life counseling is: “After each American turns 65 years of age they have to go to a mandated counseling program that is designed to end life sooner.”  That is really a distortion of the document.  The bill requires your health care provider to provide information on end-of-life counseling but does not require that you go or that you end your life right away. Dr Janda’s claim that the bill is “FASCIST” (caps his) seems to be in conflict with others who claim that it is socialistic. Isn’t that the makings of an oxymoron?  Highly paid specialist may be one of the losers if the bill passes so I do not think Dr. Janda can be seen as unbiased.

  Medicare may be socialized medicine, but those on it pay about $120 a month and most of their medical bills are covered. An unemployed person or someone who retires before 65 may pay $400 for full coverage up to $800 for family coverage.  It is very difficult to change companies or coverage because of pre-existing condition clauses.  The alternative is a catastrophic health care plan which costs about $200 a month and covers 80% of all costs over $7,000. A major illness really hurts, both physically and financially.  I was recently charged $6,300 for a CAT scan but the provider wrote off $5,500 for my insurance company.  If someone on catastrophic coverage or an uninsured person had the same procedure, they would pay the full $6,300.  It doesn’t really seem fair.

 There is also a concern that there is going to be very few general practitioners in the future unless something is done about their compensation.  Many medical students choose specialties because that’s where the money is. The general practitioner pool is now  being made up more and more of foreign educated doctors. That brings me to the health-care bill before Congress.  It may have a few warts but it certainly appears better than what we now have and it would certainly correct a lot of the problems. The main arguments against the bill seem to be a little ill conceived:

 1) it will lead to socialized medicine.  Medicare, Medicaid, the VA, the Army, the Navy, the Air Force, the Marines, all federal employees, your congressional representatives, and your senators are all on socialized medicine. You don’t see them scrambling to get off.

  2) it will ration health care services. The services are already effectively rationed by the high costs and by insurance providers.  Poor people with no insurance have no healthcare at all which is about as severe as rationing can get.

 3) it requires end of life counseling.  Ministers, lawyers, doctors financial advisors, tax consultants, and hospice worker all do end-of-life counseling.  It is irresponsible to your family for you to die without planning for your demise. The bill requires that you be provided information about this counseling but does not require that you die.  To his credit, Senator Johnny Isakson (R-GA) proposed this reasonable idea and he has really taken it on the chin for it.

 4) it will run doctors out of business. We now have a shortage of general practitioners and it is getting worse. The bill provides for increased compensation for general practitioners and incentives to get more medical students to go into general practice.

5) passage of a reasonable bill will hurt the Republicans in the next election.  Possibly! Sen. Jim DeMint (R-SC) said that if Republicans can defeat health care reform it would be President Obama’s “Waterloo” because it would “break him.”  Sen. Jim Inhofe (R-OK) thinks that if the GOP can ‘Stall’ or ‘Block’ Health Care Reform, it will be ‘A Huge Gain’ for the 2010 Elections. Hmmm! Statesmanship at it’s best.

 The Health Care Bill is available at http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-BillText-071409.pdf  (1018 pages). There is a Library of Congress summary at http://thomas.loc.gov/cgi-bin/bdquery/D?d111:1:./temp/~bdwSmj:@@@D&summ2=m&|/bss/111search.html