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ROBERT SIEGEL, host:

From NPR News, this is ALL THINGS CONSIDERED. I'm Robert Siegel.

MELISSA BLOCK, host:

And I'm Melissa Block.

Now, to the debate over health care. In a few minutes, we're going to hear from two doctors who've been practicing for more than 30 years about how the system has changed in that time.

First, to one idea that's been floating around Capitol Hill: health care co-op.

SIEGEL: Co-ops have several ardent boosters there, among them, Democratic Senator Kent Conrad of North Dakota. Co-ops would be an alternative to a government-run health insurance plan, that's what the administration prefers, and it's an idea that's been met with a lot of skepticism on Capitol Hill. There already are a handful of health care co-ops around the country, so the institution has a track record.

NPR's Joanne Silberner visited one of the oldest to see how it works.

Unidentified Woman #1: Hi, George.

Mr. GEORGE FELL (Member, HealthPartners): How you been? Hi, there.

Unidentified Woman #1: How are you?

Mr. FELL: I'm fine.

Unidentified Woman #1: Good.

JOANNE SILBERNER: George Fell has stopped by a pharmacy in a suburb of Minneapolis. It's owned and run by a non-profit health insurance co-op called HealthPartners.

Unidentified Woman #2: Any questions? Any...

Mr. FELL: Nope.

Unidentified Woman #2: Okay. And (unintelligible).

SILBERNER: He's picking up five prescriptions today for himself and his wife.

Unidentified Woman #2: Receipt's in your bag.

Mr. FELL: Thank you.

Unidentified Woman #2: Thank you. Have a good day.

Mr. FELL: Have a good day. Bye.

Unidentified Woman #2: Thank you. See you later, George.

SILBERNER: Fell has been a member of HealthPartners for 27 years.

Mr. FELL: I like my pharmacy and I like my doctor, and I don't want to change.

SILBERNER: Fell says he doesn't think much about HealthPartners being an unusual type of insurance company. But it is, says board member Jack Gherty.

Mr. JACK GHERTY (Director, HealthPartners): You own it and you operate it, and you use it, and you get the benefits from it.

SILBERNER: You own it means that the 1.25 million people who have HealthPartners insurance, mostly Minnesotans, own the company. They vote for directors like Jack Gherty from among their members. And the board of directors selects the CEO, at the moment, Mary Brainerd. Brainerd says one of the special features of HealthPartners is how it handles complaints.

Ms. MARY BRAINERD (CEO, HealthPartners): Our dissatisfied members have recourse to a committee of our board directly to resolve any issues that they have with the organization.

SILBERNER: Tom Brinsko is chairman of the board, and he's been on more than a dozen appeals panels. He remembers one issue in particular: how a couple was trying to conceive a child. They'd used up all the fertility treatments allowed under their plan.

Mr. TOM BRINSKO (Chairman, HealthPartners): I'll just never forget how sincere and how much they wanted a child, and just were not having the success that they desired. The committee really struggled with that. And quite frankly, we overruled.

SILBERNER: They got the extra session. Members don't always get what they want. There are denials, too. The bottom line is unlike the case with for-profit or standard non-profit insurers, co-op members really control the company. They could even kick out CEO Mary Brainerd if they didn't like her policies.

Ms. BRAINERD: Oh, sure. Absolutely. Yeah, they could.

SILBERNER: CEO Brainerd says her company is in the black and plows profits back into things like electronic health records. It saves money with its lower administrative costs, six percent, half that of the average private insurer, and by focusing on preventive care. Co-op approach has fans among health economists, such as Karen Davis, who heads the Commonwealth Fund.

Ms. KAREN DAVIS (President, Commonwealth Fund): The co-op system can make a difference. It is making a difference in those areas where they currently exist. It'll take a long time to get there more broadly in the nation, but we have models of care that currently work.

SILBERNER: She says they'll need help: seed money to start with and some way to guarantee low doctor and hospital fees, maybe a national board. That's where some Republican legislators and free marketeers get nervous.

Michael Tanner, with the libertarian Cato Institute, says there's nothing intrinsically bad about co-ops, as long as the government is not involved. His nightmare for co-ops is this.

Mr. MICHAEL TANNER (The Cato Institute): Washington's appointing the directors and officers where it is subsidized by the taxpayers, where the Congress directs the way it practices insurance. And I don't think free market people would support it.

SILBERNER: But that's not Senator Conrad's vision. He wants the plans to be owned and run by members, not by the government. That question about how much the government should be involved is at the center of not just the co-op issue, but the entire debate over redesigning the health care system.

Joanne Silberner, NPR News.

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