Monday, August 24, 2009

National Health Care Cooperative Option

Hal Pepinsky
August 24, 2009
In a 1984 book, Myths That Cause Crime that I wrote with Paul Jesilow, we offered a range of proposals for building public safety through democratization of public life. One proposal was to give tax credits to subsidize worker/patient owned cooperatives. Members would elect a board from among themselves, who in turn would hire management and staff. Each member would have one vote. Staff would be salaried. Profits and deficits to be recovered by increases in membership fees would be evenly distributed among members. The co-op would in turn contract coverage for larger services such as hospitalization. Thus would primary medical care be democratized. This would avoid the problem Adam Smith warned against, of allowing the invisible hand of the free market to be overtaken by oligopolization of for-profit corporations whom the state licensed to limit their liability for wrongdoing to the amount they and absentee strangers invested in the business. Quite a sweet government deal for limiting liability by incorporation. Investors have the luxury of walking away whenever it suits their personal interests, which sometimes gets known as corruption or more timidly, influence peddling.
Now comes North Dakota Democratic Senator Kent Conrad to propose subsidizing health care cooperatives as a compromise between a public option and no change. Brilliant, just what I advocated in 1984. But now I see a problem I didn’t see then, the problem of transportability.
There is nothing wrong and everything right about local staff/patient local ownership of health care delivery. That is the kind of substitute I want in place of placing my primary care in the hands of private or public gatekeepers. But in the United States, the poorest among us especially move far and wide. If coops remain purely local (there being no more reason to put them out of business than other private insurers), the problem arises of what happens when you leave the area covered by the co-op.
I propose that a national co-op be established where all member fees and profit/loss shares would be constant regardless of where one lived. Once registered locally, one would be entitled to vote for and be on the local board. Wherever you lived or worked, under this plan you would be entitled to whatever co-op services were available elsewhere.
Sure, I’m just dreaming, I’m being utopian. Still, my vision of an ideal gives me a framework for evaluating strengths and weaknesses of various proposals. This morning on NPR’s “Morning Edition,” Cokie Roberts introduced the radio public to the idea that getting any compromise “reform” through Congress will open the door to doing greater things. Okay. Meanwhile, I’m trying to keep a clear eye on the way in principle I think daily life, including our health care, might conceivably be democratized. Who knows what parts of the whole we might have the wisdom to put into practice as time passes. Love and peace--hal

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