Behind Those Ferns

If you’ve seen this already you know President Obama is willing to put himself at the mercy of an ironic hipster in order to get the word out about the Affordable Care Act. But what you probably don’t know is that originally health care coops were going to be a big part of this plan. In earlier versions of the ACA, $6 billion in grants was earmarked for the establishment of the Consumer Operated and Oriented Plan (CO-OP) Program, which was intended to foster the creation of qualified nonprofit health insurance issuers to offer competitive health plans in the individual and small group markets.


As many people I know can attest, the roll out with new health plans under the ACA, has had its share of wrinkles, including big problems with the website. But in most states the insurance companies that were affected are who you’d expect: Mega-Insurance corporations like Aetna, Blue Cross, United, etc. And sure while some of these corporations have seen a decline in their net bottom line, especially as costs have risen preparing for implementing the ACA, their top executives, like so many corporate executives, continue to enjoy not just 6 but 7 figure annual salaries. These salaries, btw, are increasing


Mega-insurance companies, whether for profit or non-profit (no income taxes thank you Uncle Sam!), have an incentive to create a net surplus. Even non-profit mega-insurance companies are publicly traded. These standard capitalist business models are run by a board elected by the shareholders who have with the most shares. Basically those who monetarily stand to lose-or gain, the most, run the show. These corporate boards are legally bound to produce profits for their shareholders (in many cases themselves). It is by definition that these business are run to extract profits for shareholders. Healthcare and healthcare related industries are the worlds largest and fasted growing economic sector. There is a lot of profit to extracted, but how much health is there to be had?


Healthcare costs for people in the US are the highest in the world and yet we rank lower than dozens of other countries when it comes to actual health. We have massive infrastructure to manufacture, distribute, and utilize goods “for health care,” as well as armies of healthcare workers to deliver the care, and yet many of us feel that our system is NOT caring, and does not produce measures of health that other countries who spend less do.


So could coops make a difference?


Historically they already have. Canada’s Provincially based single-payer health care system was initiated by Saskatchewan’s Premier Tommy Douglas and former MP under the Cooperative Commonwealth Federation (CCF) (a now defunct socialist democratic party.) CCF was heavily aligned with agricultural cooperatives and the labor movement in Canada. 

Two current examples of cooperative organization around healthcare:


The Health Care Coop Federation of Canada (HCCFC) whose purpose is to promote and support health care co-operatives across the country works to keep members connected both online and face to face, facilitates the sharing of best practices and programs as they are developed by co-ops across the country or internationally,and helps develop metrics needed to demonstrate the co-op advantage and the cost-effectiveness and care-effectiveness of health co-ops.

The International Health Coop Organisation is a voluntary association of consumer (user), producer (provider) and multistakeholders health co‐operatives which seek to provide high‐quality, cost‐effective community health care based on freedom of choice, integration of services, and ethical working conditions.


So then what kind of changes are possible with  the COOP Program under the ACA? Consumer operated? and oriented? WHAT?  And cooperative business structures? where all of the owner/members work together to negotiate costs and services with providers, who might ultimately become their own cooperative business, or gasp! become part of the insurance cooperative! In cooperative business each member gets one vote. Members decide how to handle any surpluses generated by the coop-these could be paid out in the form of patronage shares, which might look like lower premiums for members, or the addition of service, or infrastructure that benefits the coop, which in turn supports and is supported by its members.


What kinds of premiums would we charge ourselves if we knew that we wanted our communities to have health coverage that would be useful, affordable, and that would pay those providing the services, including administration, living wages? What if the powers of the BOD of this coop were in the hands of other cooperative members, elected by the membership, to represent the interests of all members? And what if enough of these coop insurance companies existed to actually force a change in the way insurance companies do business?


There are several reasons that a good number of people who generally know about “these kinds of things” do not know about the health insurance coop option. This short article has good rundown of all the ways in which congress, at the behest of the insurance lobby, has water downed and cut out vital pieces of legislation which would have given the COOP option a better chance to actually succeed. The good news is that in 23 states there are currently coop insurance options. In some states where despite obstacles like a provision that COOP plans could not use any of their government start-up loan money to advertise (!!!????!!!,) people are signed-up and paying lower premiums. Provider networks are working with these coops, consumers are participating in new and meaningful ways in creating the care they need or want.


I’m so glad that POCA is a coop, and as a coop it’s important that we stand in support of other coops. I’d love it if through our coop more people knew about their state coop plan. Visit the National Alliance of State Health Coop’s website to see if the COOP option is available in your state.


Ed Whitfield who works with the Southern Grassroots Economies Project and co-directs the Fund for Democratic Communities said in a recent interview:


“The human capacity to be productive is the opportunity to produce more than we can utilize. We can use that to take care of families, to take care of the elderly, but actually it's used by people as the focus of control.” But if we could place productive capacity “at the disposal of people broadly,” that “could be applied to solving social contradictions, ecological contradictions, and the elevation of the quality of life.


Why doesn't this happen? Because we have forms of ownership that restrict people by cutting off their access to real opportunities to be productive – to build, help and care beyond their own survival or subsistence. “If that's the problem, the process of democratizing wealth has to do with different kinds of ownership, and cooperative ownership is among those forms.”

Author: crismonteiro

I've always thought that I would live to be 100 years old and now that I have an actual idea of what it might be like to inhabit this body for a century I want to be damn sure that Community Acupuncture is around to help me through my days and in the end, on my way. In the meantime, I am passionate about getting shit done, and also having fun.

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  1. BOY-o-BOY big ol’ geography FAIL on my part…including recognizing my own state on that map at the NASHCO site….

    So the states I listed above are the states that DO NOT have COOP options- so I did actually recognize KS, just not that it was color coded to denote that there were not COOPS- OK so without looking at the map here are a list of the states that DO HAVE COOP OPTIONS:

    ME, MA, NY, DE, TN, SC, GA, KY, PA, IL, ID, MI, WI, MT, OR, WA, CO, UT, WY, NV, NM, AZ, CT (I miss labeled RI, CT in a previous comment), NE

    So perhaps confusion about health care coops is abating but I have definitely created more confusion about which states offer them.

    Also- because of the ridiculous limitations put on these health insurance coop options in some states the insurance is actually more expensive than the corporate insurance option!

  2. [And to tag onto a conversation happening inside the forum about how many hours of punking is sustainable- I will say that I did do a 10 hour shift on Tuesday, followed by a Wed. 4 hour shift and saw close to 75 people in those two days… so geographic befuddlement follows if you work too many hours….]

  3. Maryland has it! I got a mailer from them at my clinic and nearly fell out of my chair when i realized what it was. I cannot access it for myself through the clinic without an employee that is not me that works at least 17.5 hrs per week, but I spoke to them on the phone and they were awesome.