The Consumer Operated and Oriented Plan program could have given progressive health policy wonks first-hand experience with how hard running an efficient, solvent insurance company can be.
That could have done a lot to help the United States deal with looming long-term care finance crisis.
The Great Depression gave both Democrats and Republicans an understanding of the value of stable banks.
World War II helped members of both parties understand the need for a strong standing military and the need for the country to build strong alliances with other countries.
Starting, running and (in many, many cases) burying CO-OPs could have given the kinds of theorists prone to thinking of money as icky a gut-level understanding of the need for insurance programs to make the numbers of work. They could have learned that promising people wonderful, necessary services is only genuinely good for their welfare … if you have the resources to provide the services. If you promise to provide the wonderful services and can’t, because of issues that were at least close to being under your control, you’re a creep. If only, for example, the current leaders of Venezuela had received and understood this lesson.
Using the CO-OPs as a school to spread that idea throughout the Democratic health policy community could have been helpful as Congress starts to wrestle seriously with the idea of what will happen when the baby boomers start turning 85, and the country has to figure out how to allocate whatever long-term care resources it has as fairly and humanely as possible, with as little chaos as possible.
Instead, what CO-OP program really taught progressive Democrats: If you have anything to do with starting a program associated with the Democrats, the Republicans will run after you with scissors and try to chop you in two.
The most important practical lesson for the high-level Democrats in the Obama administration seems to be that they should do anything humanly possible to sidestep questions from the Republican members of Congress, because Republican members of Congress will do something awful with any information they can extract with a direct answer to a question.
This message came through clearly last week, as I was watching a House Oversight subcommittee hearing on the ACA CO-OP failures and other ACA problems.
Rep. Jim Jordan, R-Ohio, the subcommittee chairman, tried over and over again to get Kevin Counihan, the head of the agency that oversees the CO-OP program, to admit that deaths of about two-thirds of the CO-OPs, and the fragile state of the remaining CO-OPs, made the CO-OP program a failure. Counihan repeatedly avoided calling the program as a failure.
Of course, this was like watching a scene in a horror movie in which a monster knocks a city down, then asks the mayor why the city looks so bad. The obvious answer: “Because you knocked it down!”
Obama administration hemmed in the CO-OPs with absurd regulations, such as requirements that they could not get any of their board members from traditional insurers, and that they could not sell their plans to any for-profit or nonprofit organizations, ever.
The Republicans then proceeded to knock the CO-OPs down by changing the terms of the ACA programs that could have helped the CO-OPs survive. The Republicans slashed funding for the CO-OP program itself and for the ACA risk corridors program, which was supposed to buffer insurers against unexpected problems with pricing and claims that might occur during the first three years of ACA health insurance exchange system operations.
Many Republicans loathe everything about the ACA, and they will say that they actions they took are about all they could do to block the Obama administration from setting up a terrible, controversial program in an arrogant way. They will say that a program like the CO-OP program would have died quickly, anyway, even without the funding changes.
And those seem like reasonable arguments, but I think the Republicans worked against their own true interests, by wrecking a chance to educate Democrats about insurance economics. All that they really taught their political opponents is that the way to cope with brutal gridlock is to be sneaky.
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