Remember co-ops, from the horrible, lie-filled health care debate? Co-ops didn’t get nearly the press that the imaginary death panels did, but the idea had supporters:
New consumer-controlled health insurance plans could get seed money from the government to increase competition – and maybe cut prices — under new rules announced Monday by the Department of Health and Human Services.The rules would steer a total of $3.8 billion in low-interest loans to groups such as The Evergreen Project in Baltimore, seeking to launch the so-called Consumer Oriented and Operated Plans. The health department hopes at least one “co-op” will launch in each state and anticipates funding a total of 57 around the country.
The strategy is that new health plans run by consumers – most board members would also have to be plan members — would find ways to improve care, rather than boost profits. The new plans, made possible by the seed money, would also compete with established insurers to drive prices down.The co-ops could “further two of the important goals of the Affordable Care Act, increasing competition and enhancing the voices of consumers in the health care market,” said Steve Larsen, the director the Center for Consumer Information and Insurance Oversight, during a Monday call with reporters to announce the rules.
Here’s The Evergreen Project:
AN AUDACIOUS ATTEMPT TO CREATE SYSTEMIC CHANGE
We know the health care system is broken. It’s the only industry in the country where costs continue to rise, while quality continues to lag. As a country, we’ve taken major steps forward in the last year, but even with reform, too many Americans will remain uninsured or underinsured.
But, what if there was a solution? A solution that reduces costs, while improving outcomes. A solution where informed and involved patients work in tandem with their community physicians. A solution that is built on evidence-based medicine – or simply put, the use of medication and procedures that are proven to work. A solution that fundamentally changes the payment structure. A solution that creates genuine change. Well, that’s why we’re here.
What if? Just answer the question, please.
Okay, maybe not. Here’s a less breathless fact-based report on The Evergreen Project from a local paper that may help:
Pursuing a passion for “health care for all,” Peter Beilenson, M.D., the county’s health officer, is leading an effort called The Evergreen Project to create a new health care cooperative plan with a network of statewide clinics. The co-op would compete with qualified commercial health insurance plans on the new health insurance exchange Maryland is setting up under the federal Patient Protection and Affordable Care Act (ACA).
Section 1322 of the health reform law enables the creation of Consumer Owned and Oriented Plans — co-ops. The ACA encourages that co-ops be statewide or in geographic regions throughout the country.
Under The Evergreen Project, the co-op would comprise a network of neighborhood clinics staffed by “teamlets,” including a primary care physician, a nurse, a health coach or social worker, and a front office liaison who is ideally from the community served. Beilenson said about a dozen states have similar efforts underway, but he believes Maryland is further in its development.
Co-ops would be self-governed by an elected board, but operate within the health reform exchange, under the same rules and regulations for minimum benefits, actuarially equivalent packages and reserve funds.
The Evergreen Project is currently studying the feasibility of launching a co-op plan in Maryland designed for households with family incomes of between133 percent and 400 percent of the Federal Poverty Level (a family of four earning $28,000 to $88,000 annually).Families in this range will be eligible for federal health insurance premium subsidies under health exchanges per the ACA, but many are still likely to find the cost too high, Beilenson said.
I already loathe the word “teamlet”, but other than that, do we hate this? I’d go out of my way to buy into the co-op plan, if one were offered in my state.
General Stuck
With the current level of crazy in the GOP, I suspect they will read “coop” as collective as commie, even though some of them pushed the coop plan, as an alternative to the ACA.
Sounds okay to me, though. Especially if you say it’s okay Kay, you being one of my go to health care wonks.:)
Ron
This looks pretty good, but I guess I’d want to know the costs compared to what I pay for our employer-based health care. Also, would this be only available for people in that 133%-400% range? Or would it be available to higher at a reduced (or eliminated) subsidy?
Kay
I don’t know if it’s okay, Stuck. I just thought it was interesting.
Conservatives won’t demonize co-ops. Their rural constituents use them for electricity, phone service and agricultural storage and marketing needs.
Co-ops, although a commie idea, are Real America :)
It’s just yet another way think-tank conservatives live completely in a fantasy world that is not reflective of conservative districts or constituents.
wonkie
I am a member of a coop and I love it. It’s Group Health. I don’t know how big an organization it is–are there any Group Healths outside of Washigton state? In any case: good service, responsive, the various professionals working with a given patient actual communicate with each other, and they gave me vicodin for a persistant sinus infection! I really appreciated that! Plus they found and removed cancerous cells from my colon…
Dennis G.
Peter Beilenson was the Health Commissioner for Baltimore for many years and did a great job. He understands health issues for low income working folks at a granular level. I am not surprised that this kind of effort is being launched in Maryland. Nor am I surprised that it is being discussed at a coffee shop in my neighborhood.
This news–along with Senator Mikulski’s recent success in increasing health coverage for women through her amendment to the ACA and Governor O’Malley’s announced effort to push for marriage equality in Maryland–makes me glad to live in a sane State. Would that Washington had some of Maryland’s common sense.
Cheers
RossInDetroit
Community involvement is important in reducing cost through choosing the most effective treatments, but really driving down costs of specific services and products (drugs) requires large scale volume and hefty bargaining power. So far only the largest insurers and the government have that.
WereBear
The thing I like best is “evidence based medicine.” For years now, Europe has been exploring the many alternatives to the Destroy It! paradigm that is fine for germs, but useless for chronic illness.
How much of what we do really works? There’s considerable evidence that every single thing mainstream cardiology recommends for heart disease; from eating low fat to repeated bypass surgeries, is useless at best and dangerous at worst.
This cardiologist is taking a completely different approach.
And I think his results speak for themselves.
I’m not affiliated with him, or know him personally. I just find his approach rooted in actual science, and I think that should be supported.
Mart
Should call it Evergreen Mutual Insurance. Sounds less commie. As long as a not for profit and the board has reasonable compensation; should take twenty percent or so off costs. Could be a step in the right direction.
kay
Should call it Evergreen Mutual Insurance.
Right. I agree. Except it’s not just insurance. It’s a planned network of primary care providers along with the non-profit payment mechanism, which is great.
Hard to scale UP, I imagine, but really, really interesting.
lllphd
back in 2004, when another stolen election confirmed for me and toto that we were not in a democracy anymore, i began exploring how other folks survived outside democracy. my attention turned to gandhi and vaclav havel, the former for his wisdom, the latter for his practicality.
everyone here is familiar with gandhi’s wisdom, but havel’s pragmatism really captured my sense of realistic imagination. bottom line, he described how they were losing their best and brightest to the very public movement, getting gulaged at quite a clip, so they had to think in terms of basic survival and move through life as if the central power didn’t exist. this localized everything. each locality committed to providing for everyone basic food, water, shelter, clothing, healthcare, and education; the ‘common good’, as it were. when they needed something big, like a turbine or a thrashing machine, they would deal directly with the single soviet rep for their locale, who – after all – had to live there amongst them.
eventually, it became quite clear that they could survive adequately without the soviets, who inevitably toppled under the weight of their own pseudo-importance (as evidenced by where all their investments were focused; not dissimilar to where we are now with the ‘rich’ powers that be).
i’ve carried this perspective around with me since, and early on wondered how this would work for health care, as in cooperatives. i mean, we don’t really need insurance; what we need is healthcare itself. forget about the black hole insurance industry sucking all the light out of the room; go back to just taking care of each other.
of course, dealing with the really big issues, like aggressive cancer treatments and all those expensive tests, that’s another matter entirely that requires another approach to our philosophy of health and dying, another rant in itself from which i will spare all of you.
but as for driving down costs through bargaining power in big numbers, ultimately it would be possible for the coops to gang together and do that job. oh wait; sort of like a united front, right? hard to suppress that snark there.
Xecky Gilchrist
The health department hopes at least one “co-op” will launch in each state and anticipates funding a total of 57 around the country.
Again with the 57 states thing! Doesn’t Obummer ever learn?
/wingnut
bkny
Section 1322 of the health reform law enables the creation of Consumer Owned and Oriented Plans — co-ops. The ACA encourages that co-ops be statewide or in geographic regions throughout the country.
how soon before an amendment is attached to some obscure bill revoking this…
Davis X. Machina
Needless to say, one of the last-minute add-ins by House Republicans was the elimination of the mandate in the PPACA. (second paragraph)
Which has dick to do with the debt. And a real prospect of reducing the deficit over time. But it is associated with Obama
They’ll demonize motherhood and apple pie if they have to. Obamacare must die. Even if the wallpaper of your next apartment is ironically repurposed US treasury notes.
RalfW
I know its not quite the same thing, but it sounds a lot like Health Partners in Minnesota. By state law, we don’t have for-profit insurance plans here (but a major – and seemingly icky – for profit health insurer is based here, I’m not sure how their employees are covered!).
Anyway, Health Partners has a board elected by it’s member-customers, and while I think it tends to make a surplus which it invests to buffer future claims, it isn’t trying to skim off 3% (or more) for shareholders.
They used to be an awful HMO when I was first enrolled as a worker benefit back in about 1997. But they eventually ditched the HMO model and run their clinics competitively, still under the Health Partners name. It can be a tad confusing, your HP insurance can be used (nearly) anywhere in MN and isn’t direclty linked to the HP clinics.
But I’ve found them to be very easy to work with. I had day surgery on my knee and the whole thing was handled seamlessly and with a minimum of fuss
Granted, I have a Cadillac post-COBRA plan that costs out the butt. I am in effect trapped in that plan till ACA lets me shop for another more affordable plan with guaranteed issue. I can manage the rising premiums (inflation plus age bracketing is starting to really kick in), but if the GOP ever manages to fuck up ACA, I’ll eventually hit a premium level that is just unsustainable.
RalfW
Unfortunately, Davis @12 is probably right. The GOP doesn’t just hate Obama because he’s black. They hate him because he passed a massive, potentially effective New Deal add-on that could cement the Dems as actual, y’know, helpers of average people (and even poor people! Gasp!+pearl clutch).
So of course ACA has to be damaged as quickly and stealthily as possible. Not a frontal assault. That failed as optics as well as in fact.
But worse is to nibble away at it, so that it appears to still be the law, while all the good stuff gets ripped out in amendments to other bills. Double win – a decent law becomes shit, and everyone is bewildered why Obama’s signature win now sucks.
In this context, it is critical that people like Al Franken (and others, of course) keep paying attention and that the Senate remains in Dem hands to edit out the evil.
Dolbia
Wonkie – yes, Group Health is AWESOME. My only gripe with them is that the waitlist for mental health appointments can be long, but even then I can normally see my shrink within a month.
Davis X. Machina
@RalfW: The GOP imperative is the same now as it was in ’93 and ’94, when Clinton was pushing his HCR plan, and Gingrich and his troops set out to kill it.
There will be no more de novo social provision in this country. Ever.
Getting rid of SS would be nice — but probably not do-able. Undermine it instead. Medicare has to go. Granted, right now it might even have to be expanded to buy some votes (Part D)[1] — but that might take some time, and demographics might do that for us anyways.
But step one — no new social provision — that is a die-in-the-last-ditch position.
[1]Medicare part D, and the attempt at SS privatization, emerged more-or-less simultaneously… why?
ruemara
As a co–op member, shopper and volunteer; I, for one, welcome our new co–op overlords.
It will be interesting to see how this model works, but I’d sign up for it.
burnspbesq
I’m in the process of shopping for health insurance right now, for the first time ever (I’ve always had employer-provided insurance before, but I’m taking a very hard look at getting off the BigLaw treadmill and going solo).
All I’m prepared to say so far is “yikes!” I won’t have difficulty getting coverage for my family (even though all three of us have pre-existing conditions), but it’s going to be expensive and won’t cover as much as my current employer’s plan.
2014 can’t get here soon enough.
Fucen Pneumatic Fuck Wrench Tarmal
its a great idea.
especially if it reaches into communities where the only practical access to health care is the emergency room. where, and here is my latest peeve, the use of ambulences as taxi service to otherwise relatively routine appointments, because there isn’t any other way, to get someone who may need just a little more help than usual, or can’t be reasonbly brought in normally.
because of my mother, and my odd middle aged reliability, i have taken to the task of helping some other wise independent seniors, with some of the less routine things they need to be independent. which of course they prefer, and saves costs on the health care system.
shocking when old people’s pcps are telling them to go to the er and have the ambu bring them in, for more or less routine things. its the last mile so to speak in health care, and terribly inefficient.
boss bitch
Didn’t remember any love from the left for co-ops during the health care debate.
OzoneR
I never really understood what the left’s problem with co-ops were.
Fucen Pneumatic Fuck Wrench Tarmal
@OzoneR:
when you want single payer, which i still do, its hard to argue for co-ops. but since single payer will require cons and con leaners to be as despised as liberals were in the 80s, and is probably a decade away from being “serious” co-ops are a way of getting the health care to the people.
Yutsano
@burnspbesq: Sorta OT, but you may end up getting a client because of me. And not because I’m a big ol’ IRS meanie. :)
OzoneR
Where the hell was this argument in 2009?
FlipYrWhig
@ OzoneR : If you have one precisely-defined goal, anything less than that goal is capitulation or selling out, even (especially?) things that get you closer to the goal than the status quo, because doing those postpones the Big Goal even further. I don’t really see the wisdom in that, but self-described “activists” do it rather a lot. It’s sort of like complaining that every play from scrimmage should be a deep pass.
gwangung
I.e., incrementalism is no true strategy to use.
Boy, they must have HATED Bill Walsh and loved Al Davis…
FlipYrWhig
@ gwangung : LOL Al Davis, exactly right.
kay
It never got any real air because 1. the debate sucked because conservatives wouldn’t stop screaming (because their objective was to shut down all rational debate) which they did, and 2. the complaint was the co-ops would be too small to be effective (co-ops are not a new idea in health insurance).
That’s a fair question, by the way. The only reason this physician thinks he can compete (long-term) on price is because he’s addressing the cost of buying health care along with the cost of buying health insurance.
Martin
Honestly, it was out there (and promoted by Obama) but was sacrificed by Hamsher and the kill-the-bill folks who needed to cast all insurance solutions other than single payer and public option as wasteful, for-profit operations.
The mandate allows for non-profit insurers like currently exist, like co-ops, like self-insurers (some states with strong public hospital systems offer this – CA does), and for states to build their own public option or single payer systems like VT is considering. But all of that had to be demonized by the left in order to make the case for a national single payer or public option system. That’s not to say that those wouldn’t be fine things to have, but they decided to trash otherwise good solutions that could have been implemented under what Congress was likely to pass in order to swing liberals toward a bill that, honestly, was never going to be supported by senators that represent states that headquarter large national insurers (Lieberman, Nelson).
AAA Bonds
Well, there’s nothing wrong with cooperatives. I bank at one, in fact. But they’re not universal health care, which is the baseline of civilization.
AAA Bonds
@burnspbesq:
Do it.
Corner Stone
@Martin:
She’s pure evil you know.
And more powerful than AAPL’s cash on hand.
OzoneR
Which is true and all, but they would have been a huge improvement and were certainly passable in 2009. Maybe I looked at this differently because I don’t support an immediate change to single payer, because I think it would be a shellshock at first, but rather think it needs to be implemented gradually (like starting in the states, thank you Vermont), so I was more amicable toward the idea of a co-op.
Glen Tomkins
You need a full-spectrum solution
It’s relatively easy to organize the delivery of patient care more rationally than the present non-system from the patient end. But that end of the business, primary care, isn’t where the low quality and excessive costs in our non-system come from. They derive from the fact that the lack of system results in the overuse of highly invasive and expensive specialist interventions, compared to addressing problems earlier and at a lower level of care. We need to think more, especially ealier and at lower levels of care, so that we end up needing to do less at the high end.
But if you do more at the primary care level, primary care is going to be more expensive, and it’s going to be more expensive right up front. The benefits of that extra effort would be slow in showing up even if we compensated medical skull sweat as well as we do medical intervention — but we don’t. We stand the surgical maxim on its head, and reward measuring once to cut twice, rather than measuring twice so as to need to cut only once. And even if we surmounted those hurdles, in order to provide medical care, you need to be able to offer the full spectrum, you need your primary care to be able to integrate into specialty care that smaller, because better-picked-over, stream of patients it does end up sending off to the specialists. That end of the spectrum still holds a veto over all your good work on improving quality and holding down costs at the primary care front end, because if there’s a mismatch between your front end and the specialty intervention end, the high cost stuff still ends up being overdone and misdirected.
I volunteer in a free clinic myself. We provide quality primary care, better than people get who have insurance, because we have no corporate master pressuring us to compromise care in order to maximize profits. But at the end of the day, some of the people I work up actually are going to end up having cancer, and eventually some of my diabetics are going to end up needing dialysis no matter how clever I am and compliant they are at working to prevent that. My free clinic, and the Co-Ops, need surgeons and oncologists and nephrologists and all the other specialists, and all the services available at their hospitals and dialysis centers, and if we don’t have their services available in a manner coordinated with what we have done at the front end, the result is neither high quality nor low costs.
Co-ops won’t be a force for improvement unless they encompass the whole spectrum of medical services.