Now that the public option for national healthcare seems to be on the table as a negotiating point, a new idea (championed by Republicans) has emerged as a compromise: health care cooperatives. These are organizations that unite healthcare consumers with their hospitals and doctors to spread the risk through a diverse pool of members, lowering overall healthcare costs, and providing negotiating power to its members. One model that has been put forth is Group Health Cooperative in the Puget Sound region of Washington State [1]. The Newshour also provided some information about what it means to be a healthcare cooperative [2].
All of this got me thinking about the national healthcare debate, and since I love compromise so much (it’s an art, really), I decided to weigh in on this discussion. I love the idea of a cooperative that empowers its members and provides a huge lever arm in negotiating healthcare costs. So here is my proposal for a cooperative healthcare system.
I propose a national healthcare cooperative, or NHC. The NHC is an organization, governed by a board of trustees, that can be opted into by any person anywhere in the U.S. In order to provide enough negotiating power, a cooperative needs at least 1/2 million members, but with over 300 million U.S. citizens it should be no problem to find at least 1/2 million people interested in doing this.
A cooperative is governed by a board of trustees, elected by members of the cooperative. As GHC says of itself, “Today it is one of the few health care organizations in the country governed by consumers. Its 11-member Board of Trustees — all health-plan members elected by other members — work closely with management and medical staff to ensure that the organization’s policies and direction put the needs of patients first.” I propose we also have a board of trustees for the NHC, a group of elected members put there by the consumers in the cooperative. In fact, given the diversity of consumers in different regions of states and the nation as a whole, it’s important that views from each region be represented fairly, by population of the cooperative, on the board. It makes sense to divide states into districts, based on population, and allow each district to elect a member to the board.
The election process should be governed by a charter, a constitution that briefly outlines the terms of service of board members, the election process, etc. I propose that the NHC have a national charter that so describes the procedure of electing the board members, as well as the rights of the consumers in the cooperative.
Once we have the NHC framework and board established, we can then determine the membership by a census every decade or so. The census will update the size of the membership, giving solid demographic information for use in leveraging companies when providing drugs, etc. Of course, the NHC shall be a non-profit organization; apart from the salaries of the bureaucrats who will be needed to run the system and those of the board members (which shall be modest by proportion to their service to the nation), any profit over cost shall be returned to the consumers in the form of health credits or healtch cost breaks – perhaps in the form of a yearly check, right around tax time to make everybody feel good.
In fact, this NHC idea is not far from Kent Conrad’s proposal, which briefly says, ” . . . he has proposed a system in which the government would offer seed money (he’s suggested $6 billion) . . . to form the co-ops. Eventually the co-ops would have to become self-supporting with premiums paid by members . . . the cooperative . . . might be a national entity with state-level affiliates.”
I can certainly see an easy mechanism of yearly collection by which NHC members pay into the cooperative for the benefit of all members.
I know, I’m being snarky. But seriously, don’t we already have an elected board at the nation level who can direct a bureaucracy to negotiate on behalf of its members to reduce healthcare costs? Don’t we already have a governments, of the people and by the people . . . er . . . consumers?
[1] http://www.ghc.org/about_gh/co-op_overview/index.jhtml
[2] http://www.pbs.org/newshour/updates/health/july-dec09/coop_08-17.html
