Art Hackett:
Congress is heading home without floor action on health care reform. One of the big stumbling blocks is known as the public plan, this would be a government-run option similar to the current Medicare coverage for those over 65, intended to provide an alternative for those who can't find private insurance coverage they like or can afford. For some members of the U.S. Senate, the public plan is a deal breaker. As an alternative, Sen. Conrad of North Dakota is exploring a network of cooperatives, like the cheese and feed co-ops Wisconsin farmers have been dealing with for decades. As it turns out, Wisconsin already has a number of health care cooperatives. To explore how they might work in the context of national health insurance reform, Bill Oemichen of the Cooperative Network joins us. His organization runs co-op care. Also with us is Robert Kraig of Wisconsin's Citizen Action. They feel co-ops are no substitute for the public plan. Greetings to you as well. Bill Oemichen, your group operates a co-op that allows agricultural business to buy health care almost as if they are one big business. Is that what Sen. Conrad is contemplating? 

Bill Oemichen:
We're not certain what the eventual bill is going to look out from the U.S. Senate and the House of Representatives. We're proud that Wisconsin has the most health care cooperatives of any state in the nation, and we have cooperatives that have been in existence for over 30 years and been very, very successful. The cooperative that we founded, the Farmers Health Care Cooperative has provided quality health insurance for farmers. We think cooperatives are part of the health care reform equation. What we've always said, if someone has a better idea or mousetrap, we're all for it. We'll wait and see to see what kind of cooperatives are formed by the federal legislation.

Art Hackett:
The concept of a co-op is still somewhat murky in terms of health care reform, but the public plan, do we know exactly what that would be? 

Robert Kraig:
That's the political football as well that's changing into various versions. But the idea is to create real competition for private insurers. Ninety-four percent of markets there is a monopoly. As President Obama has said and Russ Feingold, we need something to keep insurance companies honest, to keep prices down, to keep them from discriminating against people with preexisting conditions. And also to give people another option so they don't have to be on the role of the insurance companies.

Art Hackett:
So why wouldn't co-ops work as that other option?

Robert Kraig:
We think co-ops should be part of the national health care exchange. People should be able to choose between private, nonprofit, co-ops. But we don't think they will do what the public health care option does and therefore it's unfair to put them in as the replacement.

Art Hackett:
What could a public plan do that a co-op couldn't?

Robert Kraig:
Well, it could create something large enough to create an alternative to the large for-profit company and to give people another choice and to create a benchmark so that if they start raising prices again or trying to discriminate against people with preexisting conditions, people would have somewhere else to go. It's also critical because it costs the least amount of money. So $75 billion come from having a strong public health insurance option. We estimated in Wisconsin we save $1.2 billion more a year if we have a public health insurance option. So we think we need that desperately. But co-ops would also be an excellent option for people. People should have as much control and choice as possible.

Art Hackett:
Would the presence of a public plan cause problems for the Cooperative Network co-op care as you're currently running it?

Bill Oemichen:
The one concern we have is if there's a substantial public subsidy, that would be difficult for us to compete with. But with the other cooperatives, there is quite a bit of evidence to say that when these co-ops are created, they created a lot of competition along with that and especially for farmers here in the state it's reduced in many cases the health insurance premiums that they pay and it's also substantially increased benefits. We think it can potentially have that impact on the federal level as long as cooperatives are created the right way. We're voluntary associations of people coming together to try to do something together that they couldn't achieve separately.

Art Hackett:
While there are some co-ops that provide care and provide insurance, you buy your insurance through a large private insurance company.

Bill Oemichen:
There's a lot of different models. In the Farmers Health cooperative, yes, we buy our insurance through Aetna. Group Health Cooperative, I'm a member here in south central Wisconsin, there I'm buying insurance from Group Health Cooperative, but I get access to clinics of Group Health Cooperative. That's a model we like very much, where they employ the physicians. GHC just got an award as the eighth highest quality health care institution in the nation. Health Partners up in Minnesota has received a number of awards as the highest quality health care provider in Minnesota.

Art Hackett:
I think I heard both of you say that you could live with a public plan and co-ops existing side by side on this exchange. But there may come a point where it's co-ops or no health care reform at all. If it boils down to that, what does Citizens’ Action of Wisconsin say?  

Robert Kraig:
Since we don't think co-ops can do the role that public health option can do. They can't get up to scale in order to provide everyone in the country an option other than the for-profit private insurance, it would be very problematic. We wouldn't have a way to keep the insurance companies honest. When we pass the bill, get to lobby against it year after year after year. Also, we wouldn't get the cost savings we need. We need to change the medical delivery system and you need the transparency and the nationwide pool to do that.

Art Hackett:
Bill, you want to put something in real quick?

Bill Oemichen:
Well, just we think this is one option in the national health care debate. When I testified in front of the committee earlier this year, we said if you want to bring the consumer interest together with insurer interest, cooperative is the way to do it.

Art Hackett:
Thank you both and I suspect we'll talk about this again probably in September when the legislators come back from their break.