Health Inc.

Health Co-Ops Explained

The only co-op we have any experience with is the New York variety for apartment living. Even in the little Brooklyn building where we used to kick back, the vetting process for prospective shareholders was daunting, including in our case a separate interview of our dog. She passed.

A pediatrician from Group Health Cooperative checks a patient.

A pediatrician from Group Health Cooperative checks a patient. Stephen Brashear/GroupHealth hide caption

itoggle caption Stephen Brashear/GroupHealth

So what's the deal with these health co-ops, suddenly the hot alternative to the administration's controversial proposal for a government-sponsored public plan in health overhaul? We point you to a prescient piece from late June by NPR's Joanne Silberner.

She took a look at HealthPartners, a Minnesota-based co-op with 1.25 million members. The folks insured by HealthPartners also own the non-profit company. Any money left over each year gets plowed back into care.

HealthPartners directly employs hundreds of doctors and dentists, owns and operates scores of clinics and even has its own hospitals, including nonprofit Regions Hospital in St. Paul, Minn. But the majority of care paid for by HealthPartners comes from doctors and facilities that contract with the co-op, just as they might with a for-profit insurer.

Sen. Kent Conrad, a North Dakota Democrat who's a champion for the co-op approach, told Silberner:

[They] have some of the strengths of public option in that they are not for profit and will provide competition for the insurance companies. On the other hand, it meets some of the objections from others who don't want a government-run plan, because co-ops are membership-run and membership-controlled, not government-controlled.

While HealthPartners is being held up as a model, some co-ops have failed because of conflicts between their goals and those of doctors and hospitals, Silberner reported. The providers of care in some co-ops wanted more money, autonomy or better facilities than the co-op was willing to provide.

Update: Not everyone thinks co-ops are such a hot idea. Robert Lasziewski, who runs a health-care consulting firm, told Silberner today that they're "the single dumbest idea I've heard in 20 years of being in Washington and working on health-care policy."

Lasziewski says it takes a lot of money to start any kind of insurance company these days, and new co-ops would need piles of dough to get rolling. Plus, in many markets the co-ops would be facing some very successful nonprofit competitors, like the conventional Blue Cross/Blue Shield plans, that have been around for decades.

On Monday's All Things Considered, Conrad says he figures it will take about $6 billion to get co-ops up and running in every state. And he says he can find the votes for co-ops, but can't pin them down for a government-run plan. Here's a snippet of Conrad talking with NPR's Robert Siegel about the vote calculus:

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