Sen. Kent Conrad's proposal for a cooperative approach to health insurance coverage has created a unique challenge for progressive health care advocates who don't object to the idea but find it inadequate. Hoping not to seem uncompromising on what is health care reform's bipartisan flavor for the day, several high-profile figures began a push-back on Monday, insisting that while Conrad's idea was well intentioned, it simply would not suffice.
"This is a big mistake," former Gov. Howard Dean told the Huffington Post. "These co-ops will be very weak. Many won't have the half-million members that most experts think is necessary to influence the market... Insurance companies will be licking their lips."
"I am very fond of Senator Conrad and think he is a good guy and friend," Dean added. "But I think the basic problem, as the Senate often does, is that they are worried about the internal Senate politics rather than the type of solution the American people want."
For the former DNC Chair, who has become a leading figure in framing the health care reform debate, the co-op proposal could be considered as an addition to a broader restructuring of the health insurance market, not a solution itself.
Such seems to be the line pushed by progressives both in private and in public. "There are so little details about how it would actually operate," one operative emailed. "It is arguably an intriguing idea. But not to replace the public option [but] in addition to it."
Added SEIU President Andy Stern through his active twitter account: "Health Care Co-op is distraction from need for real competition and cost control. Good idea and attempts to avoid important debate on costs."
That said, the politics of Conrad's proposal cannot be entirely pushed aside. Designed to be a third way between the status quo and a government run option, co-ops have earned accolades from some of the Senate's key centrist members. Rather than be run by the public, they would operate as nonprofits, where the insurance coverage would be subjected to those that affect the private industry. Such qualities are endearing to moderate Republicans without being entirely offensive to elected progressives. Conrad himself notes that while the public option might not get through a filibuster, his plan has the votes.
But there are substantive critiques of the co-op proposal, mainly that it won't reach enough people in need and would lack the bargaining clout to help lower costs. And there are political critiques as well -- though not so much with the co-op proposal but with Conrad's internal whip count.
Dean argues that the Senate could pass a public option using reconciliation, the parliamentary maneuver that would allow the proposal to be considered by an up-or-down vote. "There is no problem with doing that. President Bush did it for massive tax cuts. There is no reason you can't use it."