The Health Care Co-Op -- Not Quite Dead Yet

Ryan Grim on Huffington Post reports that Sen. Kent Conrad is getting closer to accepting the principles of a public health insurance option – at least the “level playing field” model espoused by Sen. Chuck Schumer.  Make no mistake -- he still thinks his idea of a health care co-op is a winner, but he's trying to find some middle ground between the two ideas.  If I were a charitable man, I would presume that Schumer and Conrad reasoned together in the finest traditions of the U.S. Senate.  Conrad was able to see that his position wasn’t far enough away from Schumer’s to preclude a deal.  They talked it over civilly and believe they have a policy that’s right for the American people.  But either I’m not a charitable man, or I’ve been watching the Senate for far too long.

Here’s what Conrad said after emerging from a closed-door meeting where the two attempted to reconcile Schumer’s public plan with Conrad’s still ambiguous health care co-op:

National structure: I believe to be effective there has to a national entity with state affiliates and those affiliates have to have the ability to regionalize. I think his concern there can be addressed.  Second, he believes there needs to be national purchasing power. I think that's a good point that the national entity would be able to do purchasing on behalf of the state and regional affiliates and on behalf of the national entity itself.

So Conrad thinks he can reconcile a national health care co-op with state health care co-ops, perhaps in some symbiotic relationship where a state administration can somehow pool its purchasing power nationally.  That’s basically gobbledy-gook, and gets us no closer to figuring out if this co-op is a single entity or a network of co-ops, or somehow both and neither simultaneously.  It might make for intriguing theology, but it makes for poor health reform policy.  Schumer wants a permanent board at the national level, where Conrad wants a board that yields to the participants in the co-op – again, seemingly intractable opposites.  And Schumer wants $10 billion for seed money, whereas Conrad wants $3 billion.  They can probably work that out, but my guess is it will have nothing to do with what’s best for the policy.

But one thing’s clear – Conrad is trying to make it seem like he’s closer than, realistically, he can possibly be on reconciling his wacky not-a-public-plan with Schumer’s public plan.  And I think any number of these might be playing as big or bigger a role in making Conrad willing to compromise on his compromise:

• The NY Times poll saying 72% favor a public health insurance option is just one of many showing strong support for the public plan.  This is emboldening pro-public plan Democrats (at least 27 of them on Sherrod Brown’s pro-public plan resolution) and piquing timid Democrats’ interests.
• Schumer, Dick Durbin and Pat Leahy used their campaign funds and email lists to launch their own petition Web site, Citizens for a REAL Health Care Reform and a Public Option.  PS, you’re talking about two of the three most powerful Democratic Senators in that bunch.  Can you say, “support of Senate leadership?”
• The clownish displays of uncordial opening statements and buffoonish amendments in the Senate Health, Education, Labor and Pensions mark-up – clearly, this doesn’t inspire confidence in the efficacious power of bipartisanship.
• Reading between lines of a comment by Schumer, the fact that Senate Finance Committee Republicans are similarly rejecting proposals on the health care co-op, though not in as hostile a fashion as the public health insurance plan.
• Schumer stirring the pot by saying those in support of the public plan just can’t back this co-op:  “Right now, this co-op idea doesn't come close to satisfying anyone who wants a public plan.”
• The House didn’t run in the face of a bad and incomplete CBO score that didn’t even include a public plan – it doubled-down by offering a robust public plan.

I’d like to suggest this substantially changes the calculus for Conrad and others.  Republicans aren’t meeting them halfway.  Democrats are cheered by clear public support for something the president has said he “strongly” believes in.  Ringleaders like Durbin and Schumer are challenging the co-op’s fitness as a compromise openly.  And your committee may be the odd man out in a House-HELP-White House pileup.  I might start slow-walking the co-op too.

Let’s face it – many Senators want to be The Man who rides in on a white horse, snatching a compromise from certain defeat.  But few want to be The Man who’s offering someone no one’s buying, and running afoul of popular opinion and Senate leadership to do so.  The co-op's not dead yet, but it's looking a lot less healthy.

(Photo credit:  shawn.l on Flickr.)