First, definitions:
Public Option (PO) is short-hand for what is usually called in government procurement "Make or Buy".
At NASA-MSC when I was there, we could buy mission-critical GEMINI or APOLLO gear from a defense or other aerospace contractor. Or, we could use our own and the rest of the US-DoD network of government laboratories, arsenals, and weapons-stations to make it ourselves. In fact, we usually bought from the contractor, but we got a good price and maintained quality control. In the case today, the reference is to a Medicare-like plan that is available nationwide if the private plans are not good enough.
Opt-Out is the ability of a state, presumably a "red-state" or "Blue-Dog" state to opt-out of the public option by 2014 and deny its citizens the right but not the requirement to purchase something public -- a plan very much like Medicare.
That has got to be a nightmare for the GOP in Texas. They have railed aginst "Obamacare" while engaging in their own version of "Mediscare". Now, they have to go on the initiative to deny Texans "choice" and "competition" -- what the PO should have been called all along.
Co-Op is a reference to big and old WWII-vintage health maintenance organizations -- not to be confused with HMO's and PPO's we have in Texas now.
These few wildly successful consumer-owned, private co-ops own clinics and hospitals. They hire salared medical and nursing staff. They charge a "capitation" fee rather than a policy premium. They do not otherwise do billing and claims. They are as complex and sophisticated as medicine itself, but they are financially simple and ... not predatory.
Ironically, these big, old co-ops evolved out of what Blue-Cross/Blue-Shield was supposed to be when first envisioned in Texas before WWI and the post-war "Red-Scare" unleashed a reactionary phase of political and economic development in Texas. Yes, we led the nation on progressive policy ... in my grandaddy's day! Now, the two leading examples successful co-ops are Kaiser-Permanente in California and Group Health of Puget Sound in Washington state.
There you have it: This is a populist moment if there ever was one. Texas has the right to opt-out of PO and does not have to create a co-op. It is up to us. We could do the right thing, a beautiful thing -- not condescending charity, a noble thing!
To my mind, the co-op complements the public option. It is the hardest to pull off in any state. But, yes, we can do it.
It will complement many other civic, fraternal, industrial, union, educational, research, and other fine, not-for-profit institutions we have already. It is a private, market-driven undertaking that makes political sense, when one considers that the GOP will be doing Red Scare and Mediscare at the same time: Contradictory Hystrionics! Sweet!
As "Mr. T" says, "I pity the fools!"
For my part, I will try to get something on the 2010 Democratic Primary ballot with a requirement that Democratic primary candidates declare their position or lack of one on "opt-out" and "co-op". |
