Most of the debate in Congress has focused on whether the health care reform bill should include a public health insurance option that competes with for-profit insurance.  Such a public plan would be run by the government, similar to Medicare, and expand choice while driving down costs.  No surprise, private for-profit insurance is set against any competition with public coverage, and Republicans in the Senate do not want to give Americans the option of choosing public or private.

Sen. Kent Conrad has suggested establishing one or many non-profit health co-ops instead of a public plan, but the idea is hazy.  Will it be regional or state-based, thereby completely defeating the purpose of a national public plan with economy of scale and bargaining clout?  What happens to small businesses above 10 employees?  How will these co-ops fit into the architecture of a National Health Exchange where customers will be able to take their income-based subsidies and compare like-to-like among the private plans?  What happens if you want to join a co-op but can’t afford it?  Despite having answers to none of these questions, too many are looking at this as a possible compromise position.

However, we have plenty of non-profit insurance plans and options already.  They have done little to control costs or expand access, even when they compete effectively with for-profit insurance.  Conrad’s home state of North Dakota has 475,000 people (69% of the market) enrolled in the not-for-profit North Dakota Blue Cross Blue Shield.  It hasn’t helped.  Premiums jumped 74% in the past seven years.

Tell the Senate Finance Committee that a co-op will not reduce the influence of for-profit insurance and expand coverage and, as such, is no substitute for real reform.