View Poll Results: County Cooperatives

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    2 20.00%
  • I am a liberal and I do NOT support this proposal

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  • I am a conservative and I do NOT support this proposal

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  • I am neither and I support this proposal

    3 30.00%
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Thread: Getting rid of entitlements or County Cooperatives

  1. #21
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    Re: Getting rid of entitlements or County Cooperatives

    Quote Originally Posted by Harry Guerrilla View Post
    The best way to do it is, cancel out all benefits, except for maybe SSD, for everyone under 35, people would no longer have to contribute but their pay outs will be lowered based on the time away from official retirement age.

    We could also cut Medicare benefits and transfer the savings to shore up SS.
    Subject all people who are receiving SS to an extra 401k/retirement account tax.
    Allow opt outs for those who don't want it and they will not have to pay the tax.
    It's complicated. I don't want to mix the benefits of one program to the benefits of another, so reducing Medicare to fund SS is out.

    I went ahead and removed Social Security as an entitlement we would target with this plan. I am leaving SS alone and I am leaving the SS payroll tax alone. They can deal with it at a later time.

  2. #22
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    Re: Getting rid of entitlements or County Cooperatives

    Quote Originally Posted by reefedjib View Post
    Well, it isn't like the public option since the public option is a direct government program. Co-ops are semi private. There funding comes from public sources, but their operations are private.

    How else can you guarantee universal coverage?
    I support a public option or the co-ops like you proposed. Your right, it is not exactly the same, because yes it will be privetly operated, however, the main idea of it is the same. Its main function would be to control health costs and to provide to those who cannot afford them at the current prices. Its a good idea.

    there was one proposal on the health care reform somewhat similar to yours earlier from senator kent conrad in north dakota. He wanted to make some state level co-ops as a way to compromise with republicans and democrats about a public option.

    Senator Kent Conrad | North Dakota

    Health Care Co-Operatives: Doing It the Right Way

    I think it may have died however because the cbo released a report showing it would have a relatively small impact on the budget defecit.

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    Re: Getting rid of entitlements or County Cooperatives

    I have a few thoughts

    1. I would rather see county cooperatives instead of single counties. My state has something like 140 counties and there is not a critical mass of people for these kinds of initiatives at the local level, unless you are in a metro area. Places like South Dakota would probably need a single entity running these programs for the state as a whole.

    2. During a recession, Keynesian economics contain important policies to jumpstart economies and often counties cannot have a budget deficit, this would have to be changed.

    3. Because of the duplication of infrastructure in administrative functions, I see a very real possibility of taxes going up.

    5. Other than corruption caused by lobbying, I don't really see how this will change much since most of these programs, while funded by the Federal Government, are administered at the local level anyway.

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    Re: Getting rid of entitlements or County Cooperatives

    Quote Originally Posted by megaprogman View Post
    I have a few thoughts

    1. I would rather see county cooperatives instead of single counties. My state has something like 140 counties and there is not a critical mass of people for these kinds of initiatives at the local level, unless you are in a metro area. Places like South Dakota would probably need a single entity running these programs for the state as a whole.
    1. Are you intending to say State cooperatives? Let's say you have a sparsely populated county: it would operate a single outpatient clinic and pharmacy. It would have a small office to distribute healthcare cards. It's administration would likely be one person. YOu could probably go smaller yet and just have the admin and admin office, then let the patients go to out of network doctors or to a neighboring county that actually has a clinic.

    I am hesitant to say that states can determine their own structure to administer this.

    2. During a recession, Keynesian economics contain important policies to jumpstart economies and often counties cannot have a budget deficit, this would have to be changed.
    Why would this need changed? The county won't have to participate in a spending hike.

    3. Because of the duplication of infrastructure in administrative functions, I see a very real possibility of taxes going up.
    I attempted to address this in the proposal. THe state would have an administration co-op. Also, like in the answer to #1, I am hesitant to say that states can determine their own structure to administer this.

    Did you miss a #4?

    5. Other than corruption caused by lobbying, I don't really see how this will change much since most of these programs, while funded by the Federal Government, are administered at the local level anyway.
    The funding and administration will both change. Currently it is funded at the federal level to the tune of $1.314 trillion dollars. It is currently administered at the federal level, although some of that administration may be deferred to the states. By changing the funding to the counties, we remove that funding from the federal budget. Likewise, we lose the administration at the federal level. I don't expect it to save money.
    Last edited by reefedjib; 02-07-10 at 08:17 AM.

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    Re: Getting rid of entitlements or County Cooperatives

    Yeah, sorry I missed 4. It was like 5 am and I have a stomach virus right now, so I may not be completely mentally here.

    My only remaining question is #2. During a recession, we have a choice, either let services suffer or we borrow. I believe it is often better to borrow because increasing desperation and decreasing funds in a recession will often lead to a deeper recession and more suffering. Right now most states and counties have to have a balanced budget. This would have to be changed. So, I am not sure we would be better off overall in terms of overall debt.

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    Re: Getting rid of entitlements or County Cooperatives

    Quote Originally Posted by megaprogman View Post
    Yeah, sorry I missed 4. It was like 5 am and I have a stomach virus right now, so I may not be completely mentally here.

    My only remaining question is #2. During a recession, we have a choice, either let services suffer or we borrow. I believe it is often better to borrow because increasing desperation and decreasing funds in a recession will often lead to a deeper recession and more suffering. Right now most states and counties have to have a balanced budget. This would have to be changed. So, I am not sure we would be better off overall in terms of overall debt.
    Ok, that what you mean. I did address this in the proposal on page 6. I talk about establishing intragovernmental loans, so the fed can borrow from the market, which the state/county cannot do, and then extend it to the state/county.

    The problem with this on reflection is as you say, states and counties need a balanced budget. It should not incur debt.

    An alternative may be to allow the fed to borrow money and then give the money to the state/county as a "bailout" - no debt incurred by the state/county.

    I hope you feel better.

    You claim to be a Very Conservative Democrat? What's that? Blue Dog?
    Last edited by reefedjib; 02-07-10 at 09:09 AM.

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    Re: Getting rid of entitlements or County Cooperatives

    Quote Originally Posted by reefedjib View Post
    I hope you feel better.

    You claim to be a Very Conservative Democrat? What's that? Blue Dog?
    Thanks. Especially since I have a job interview tomorrow for something that could possibly get me 20k per year more. I need to recover fast

    I am not registered with any particular party, but I am actually liberal, I just forgot to change it.

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    Re: Getting rid of entitlements or County Cooperatives

    Quote Originally Posted by megaprogman View Post
    Thanks. Especially since I have a job interview tomorrow for something that could possibly get me 20k per year more. I need to recover fast

    I am not registered with any particular party, but I am actually liberal, I just forgot to change it.
    You should be a Whig! If you are in Georgia, they have a strong chapter running. (GMWP - Home)

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    Re: Getting rid of entitlements or County Cooperatives

    Quote Originally Posted by drz-400 View Post
    Quote Originally Posted by reefedjib
    Well, it isn't like the public option since the public option is a direct government program. Co-ops are semi private. There funding comes from public sources, but their operations are private.

    How else can you guarantee universal coverage?
    I support a public option or the co-ops like you proposed. Your right, it is not exactly the same, because yes it will be privetly operated, however, the main idea of it is the same. Its main function would be to control health costs and to provide to those who cannot afford them at the current prices. Its a good idea.

    there was one proposal on the health care reform somewhat similar to yours earlier from senator kent conrad in north dakota. He wanted to make some state level co-ops as a way to compromise with republicans and democrats about a public option.

    Senator Kent Conrad | North Dakota

    Health Care Co-Operatives: Doing It the Right Way

    I think it may have died however because the cbo released a report showing it would have a relatively small impact on the budget defecit.
    Thanks for the link from the Heritage Foundation! I learned a lot and it seems that what I am proposing is specifically a GSE, a government-sponsored enterprise - like Fannie Mae, since the "Co-op" would be taking government subsidies.

    Let me talk specifically about the Healthcare "Co-op", since that is the larger of the two I am proposing.

    The Heritage link on Health Care Co-Operatives never actually states what a co-op is. It is a bit of a political piece in it's own right. They never actually say that a co-op is a member-owned and operated organization. They talk about how they are used to concentrate purchasing power for their members.

    Quote Originally Posted by Heritage
    The co-op concept is also longstanding and widespread in the insurance sector, where it is known as a "mutual" insurance company.
    Quote Originally Posted by Heritage
    When it comes to health care, a group that "organizes" coverage provided by insurers could be structured as a co-op, and a company that provides insurance could also be structured as a co-op. Both could be present in the same market.
    Quote Originally Posted by Heritage
    In the case of cooperative or mutual insurers, while they are a longstanding feature in most other insurance markets, they are not found in today's health insurance market. Instead, current health insurers are organized either as stockholder-owned companies or as non-profits operated (at least in part and at least in theory) for charitable purposes beyond simply selling health insurance. There is a reason for this, as discussed below.
    Quote Originally Posted by Heritage
    If Congress wants to provide Americans access to health co-ops, it would need to make it possible for an institution to combine tax-exempt (non-profit) status with mutual insurance status, something health plans cannot do today. Congress should allow mutual health insurance companies to form based on the credit union model. Under this model, Congress would simply grant non-profit status to mutual insurance companies, justified by the "member benefit" they provide.
    Now, in talking about a GSE model, where the co-op receives subsidies:
    Quote Originally Posted by Heritage
    A health insurance GSE, with its close relationship to the government, would tilt the market playing field and open the door to political manipulations--both of which would ultimately harm consumers. It would also create unjustifiable and unaffordable taxpayer exposure to financial risk.
    The article does not go into why these may be true. I think that since our co-ops are not federal, that that changes the picture.

    Quote Originally Posted by Heritage
    Health care cooperatives can work as private entities in a private market and give another choice to families, but they have to be done right. Here are several principles that must be a part of any co-op model:

    1. Cooperatives must be voluntary, open to individuals who choose to freely join together without coercion or restraint, and controlled by its members, not the government;
    2. Cooperatives must be viable on their own and must not receive anti-competitive government support in any form including assumption of risk, "start-up" capital, or continuous subsidies to the organization--which would turn them into government-preferred public plans;
    3. Health plans must be selected only by a co-op's members, not the government;
    4. Competitiveness must be based on the member strength of the cooperatives and not on any favored status, including government subsidies, access to government pricing, coverage or coding decisions, or regulatory intervention;
    5. Any necessary regulation to keep a level playing field among health plans must be reserved for the states;
    6. State reforms should open doors to competition, including the competition that cooperatives would bring; and
    7. All individuals--including those who receive public subsidies and individuals eligible for Medicaid or SCHIP--should be free to join cooperatives of their choice.
    Here is how the Healthcare Co-ops, I am proposing, fare on these principles:
    1. It is controlled by it's members and is voluntary
    2. FAIL - we accept continuous subsidies to pay for uninsurable members
    3. It is member-controlled
    4. Given the subsidies, it is unclear how that affects competitiveness
    5. indeed it is
    6. it should - we should open the door to competition across state lines
    7. indeed they are. Only those with private healthcare are not free to join


    The problem we are facing, as I see it and others have mentioned, is that the elderly, those with pre-existing conditions and the poor are all uninsurable. With a straight co-op, the membership premiums would be through the roof. So how do we insure them? It is a community problem, as the community ought to care for them, therefore, local taxes are used to insure them. This meets the set of criteria:

    1. Necessity: Healthcare is a necessity for a well functioning society, designed along the lines of education.
    2. States’ Responsibility: Each county will implement their own healthcare coverage.
    3. Coverage: Everyone is covered - no exclusion for pre-existing conditions.
    4. Affordability: Co-pays and a maximum outlay.
    5. Choice: You can choose the doctors, specialists and drug companies you do business with.
    6. Competition: Drug companies, hospitals, research labs, equipment/device companies all compete.
    7. Portable: Healthcare services can be utilized away from your home county.
    8. Funding: Property taxes at the county level forms the baseline. State income tax and consumption tax allows the state to assist targeted counties. Intragovernmental loans should be available from the federal government to bridge recessions. Per doctor co-pays of $50, with a maximum amount per year. Assistance for the poor can be provided.


    especially numbers 1, 3 and 4.

    I feel comfortable continuing to call my proposed organizations, Co-operatives, even though they receive government subsidies. This is because they are member-owned.
    Last edited by reefedjib; 02-07-10 at 10:10 AM.

  10. #30
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    Re: Getting rid of entitlements or County Cooperatives

    I did a little more research into what defines a Co-op. Wikipedia is my friend!

    First a link on Co-ops: [ame=http://en.wikipedia.org/wiki/Cooperative]Cooperative - Wikipedia, the free encyclopedia[/ame]

    Then a link on: Consumers' cooperative - Wikipedia, the free encyclopedia

    Finally a link on the: [ame=http://en.wikipedia.org/wiki/Rochdale_Principles]Rochdale Principles - Wikipedia, the free encyclopedia[/ame] of what defines a Co-op.

    These principles are:
    1. Voluntary and open membership
    2. Democratic member control
    3. Member economic participation
    4. Autonomy and independence
    5. Education, training, and information
    6. Cooperation among cooperatives
    7. Concern for community


    Based on this list, Healthcare Co-ops
    1. Unsure - If membership is defined as all homeowners, then membership is mandatory. If membership is defined as all Co-op customers, then membership is voluntary for all the poor, elderly and those with pre-existing conditions.
    2. How do members vote? Depends on who the members are.
    3. Capital is reinvested - facilities are purchased and staff is hired. "developing their co-operative, possibly by setting up reserves, part of which at least would be indivisible".
    4. This is the interesting one - funding is external.
    5. Definitely!
    6. Definitely! Cooperation between neighboring counties is a must.
    7. By it's very essence.


    While the answer to the first one is important to define, the fourth item is most interesting given the funding model. The fourth item states:

    Quote Originally Posted by ICA's Statement on the Co-operative Identity
    According to the ICA's Statement on the Co-operative Identity, “Co-operatives are autonomous, self-help organizations controlled by their members. If they enter to agreements with other organizations, including governments, or raise capital from external sources, they do so on terms that ensure democratic control by their members and maintain their co-operative autonomy.
    So the question of membership becomes doubly important. If the membership is defined as a tax-payers, or property tax payers, then the members are the funding source.

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