Let's be uncooperative

It's 4 a.m., and I'm sitting here at the keyboard gazing at a blank Word document while coughing so violently -- the result of a really nasty, untreated chest infection -- my first thought was that, before the morning is over, my lungs might be the only thing to go on this page.

But hey, there's one paragraph down. That's a start. And I very much wanted to mull this "cooperative insurance pool" business, versus the vastly more intelligent "public option," that Senate conservatives have concocted. Perhaps if I seize creativity by the throat -- you know, shamelessly lift and steal -- there can be a finish.

So here goes.

As the Washington Post reports, "Senate health-care negotiators said [Thursday] they were closing in on a $1 trillion health-care bill that would be fully funded by tax increases, Medicare cuts and new penalties for employers who do not offer health insurance ... [as well as] by cutting subsidy levels for uninsured people."

As if that last provision, especially, weren't bad enough -- Goodbye, universality -- in "closing in" on the bill, it almost goes without saying that Senate negotiators are choking off a "public option."

But wait. Let's back up. The Democratic Party ran far and wide in 2008 on the specific promise of some loosely defined public option, but a public option nevertheless, because the uninsured, the underinsured and the extravagantly premium-gouged electorate had had quite enough, thank you, of the liberating marvels of exclusively private insurance. So just who are these "negotiators" who now stand athwart the electorate's expectations?

Let's see. There's Senate Finance Chairman Max Baucus, of course, who, as Ted Kennedy ails and Chris Dodd is distracted by elaborate re-regulatory schemes, has pulled off quite the legislative coup by appointing himself health-care reformer in chief. And joining his little junta is what Max calls the "Coalition of the Willing": Chuck Grassley (R-Ia), Olympia Snowe (R-Me), Mike Enzi (R-Wy), Orrin Hatch (R-Ut), Kent Conrad (D-ND) and Jeff Bingaman (D-NM).

Now, let's do keep in mind, as we tally the balance of partisan influence, that it was Democrats who won the aforementioned election. Having dropped that apparently necessary reminder, let's calculate: and in doing so we find, above, including Max, one ... two ... three Democratic senators; and one ... two ... three ... four Republicans.

One must pause to recall another U.S. election in which one party was so thoroughly rejected; and it's empirically impossible to recall any other wholly lop-sided election after which the thoroughly rejected party ruled.

And what, in terms of health-care "reform," are we now likely to see in place of the once gallantly promised -- nay, virtually guaranteed -- public option? Something called nonprofit cooperatives, about which, as Harold Pollack, of the University of Chicago's School of Social Service Administration, wrote in the New Republic: "I do this stuff for a living, and I still don't understand how ... Co-ops would really work."

So, here's the deal, from Max's Coalition: To sell health-care reform, it needs to dumb things down for those resistant to Clintonlike complexities and who are, perhaps, a trifle slower on the uptake. And to accomplish that goal it's going to reject a government-run public plan -- which, as Jacob Hacker, co-director of U.C. Berkley's Center for Health, Economic, and Family Security, also writing in the New Republic, notes is "overwhelmingly popular with Americans, garnering 85 percent support"; is "compelling and simple"; and "would have lower administrative costs" as well as "greater leverage to hold down prices" -- and opt instead for what professional, health-policy researchers "still don't understand": cooperatives.

What they do understand, however, are their experiential difficulties. Again, Jacob Hacker:

[The history of health cooperatives is that] they've been under constant siege from doctors and insurers and eventually largely operated as private insurance plans or weak purchasing arrangements....

Cooperatives might be able to provide some backup in some parts of the nation, but they are not going to have the ability to be a cost-control backstop, much less a benchmark for private plans, because they are not going to have the reach or authority to implement innovative delivery and payment reforms. And so [the cooperative] idea appears to be yet another compromised compromise that cuts the heart out the idea of a public plan choice on the alter of political expediency.

Yet, asks Hacker, is the idea of cooperatives actually an expedient one?

A reform proposal that doesn't have a public plan is bound to cost more (or do less), since a public plan can save money--and save money in ways that the Congressional Budget Office will score. Get rid of the plan, and reform's overall price tag goes up, making it harder to pass. And if reform without a public plan were to pass, it would simply not work as well, or perhaps at all. It would be more likely to run into problems because budget expenditures turn out to be higher, or implementation problems when private insurance doesn't live up to its promises. That could sink reform before it even gets underway. In other words, maybe there's a political risk to including a public plan. But there's also a big political--and policy--risk to excluding it.

Or, in more other words, the Democratic majority-qua-minority is foolishly setting itself up for one helluva justified fall, come 2010 and '12. Because in 2008, there was a clear social contract: You give us guaranteed, universal health care, and we'll give you an enlarged majority.

Until the Congressional Democratic leadership understands that there are some issues -- not that many, but some, such as a public health-care plan -- on which party loyalty is unshakably inviolable, it will find itself forever staring at the prospect or reality of well-deserved minority status.

Well, I made it after all, through the unhealthful ploy of cut and paste. But if you don't hear from me Monday, you'll know America's insufferably broken health-care system got me, along with God knows how many others.