Health Care Co-Operatives: Not a Viable Solution

With the Public Option now officially in doubt, suggestions regarding health care co-operatives are becoming talking points again. Critics point out that we already have health care cooperatives that have done very little to lower health care costs. Proponents point to success stories about how co-operative arrangements lead to better health care.

In theory, co-ops offer many positive qualities. Market forces rather than governmental agencies determine services and payment levels. There is an incentive for health care providers to work efficiently and effectively since “profits” are re-invested into the co-op. Proponents also see co-ops as a competitive alternative to established insurance providers. By making patients part owners, patients theoretically become more interested in making appropriate health care and life style choices in order to keep costs down.

Implementing and managing co-ops is another matter. Many different – and sometimes contradictory – goals are in play: businesses and investors need to make money, patients want choice and excellent healthcare, government – or rather, taxpayers – cannot continue footing the bill for escalating health care costs. In essence, co-ops are just delaying the health care debate and pushing it further down the ranks rather than tackling the thorny issues at a national level. Just providing seed money from Washington does not help with addressing these issues.

I don’t know anyone who doesn’t think that our current system is broken and that we need to do “something.” For better or for worse, we live in a society in which money and profit play a key role when it comes to allocating health care resources. We need to find incentives that fairly balance contradictory needs and encourage responsible behavior by everyone – from patient to provider to business to government.

Unfortunately for health care reform, responsible behavior is very subjective and very much influenced by one’s philosophical and spiritual way of thinking. Hence the problem: what appears as good and prudent medical care to me may appear wasteful or gold plated to someone else. Using different words to say the same thing: what appears as irresponsible, greedy or callous behavior to some is viewed as prudent business and appropriate health care by others.

To my way of thinking, the ideal solution lies in finding ways in which patients and doctors can discuss appropriate approaches to health care on an individual basis. This means paying doctors for consulting with patients and not just for administering procedures. It also means that patients need to take responsibility for their health. Healthcare ultimately is a deeply personal experience, subject to many factors that cannot be legislated. Socio-economic, lifestyle, philosophical and spiritual issues need to be taken into consideration as necessary.

This does not mean that society is required to pay for everything – but creating an environment in which everyone receives support when facing a devastating calamity is a worthwhile undertaking. Health outcomes research along with frank discussions about quality of life and the value of extending life for a few weeks are necessary and we should not let ourselves be swayed by those who use these topics to sow fear.

All this is a long way of saying: the idea of health care co-ops sounds appealing because in theory they allow for individual patient-doctor discussions and thus informed decision making. Given their track record and the huge hurdle to entering the market place, the skeptic in me believes that they will just muddle the water without solving our health care crisis.

Additional Reading

Neither Quick Nor Easy

By THOMAS L. GREANEY

August 18, 2009

http://www.thehealthcareblog.com/the_health_care_blog/2009/08/neither-quick-nor-easy.html

Health Care Cooperatives–An Old New Idea–So What’s a Blue Cross Plan?

Health Care Policy and Marketplace Review

June 12, 2009

http://healthpolicyandmarket.blogspot.com/2009/06/health-care-cooperatives-old-new-idea.html

Health Co-op Offers Model for Overhaul

New York Times

July 6, 2009