So. The public option has been thrown overboard, and we’re back to co-ops. As I've pointed out previously, the co-op scheme is a weak, nearly meaningless idea that would represent no real alternative to business-as-usual in the health insurance industry.
In the best-case scenario—which is far from guaranteed—the co-ops might have a less corporate governance structure than other insurers and receive federal subsidies for startup costs and more expansive coverage. In the worst-case scenario, they would effectively be private insurance companies operating under another name. And at least some of the initial capital will, in all likelihood, come from members. All the out-of-work Americans who are too poor to buy insurance will appreciate that.
Much is being made of the fact that the co-ops would be non-profits. But so what? Almost half of Americans with private health insurance are currently covered by non-profit plans. As a whole, those plans haven’t proven to be much better or cheaper than for-profit insurers, and they still fail to cover 50 million Americans.
Supporters of the co-ops also insist that they will offer real competition to the private insurers, and bring down costs for their members by giving them bargaining power with health care providers.
In fact, as the State of the Division blog points out, it’s conceivable that private, for-profit companies could get in the back door of the co-op plan. What’s to stop a co-op from actually licensing itself out to a private insurance company—or hiring one to administer its fledging business?