Cooperation

So the latest "alternative" to public healthcare is based on a Co-op model in Seattle; run as a non-profit with a board elected by the insured. That way, the desire for votes keeps the board focused on the patient's well-being. Doctors, working at clinics owned by the Co-op, are paid a salary rather than per-procedure with bonuses based on quality care. According to the NYT,

Patients are assigned a team of primary care practitioners who are responsible for their well-being. Medical practices, and insurance coverage decisions, are driven by the company’s own research into which drugs and procedures are most effective.

[snip]

A number of company officials acknowledged that it is Group Health’s ability to directly manage its doctors that really drives innovation. The cooperative structure’s primary contribution, they said, is to create a consumerist ethos that keeps the company focused on patient care.

“There’s a kind of accountability to the patients in our system,” said Scott Armstrong, president of Group Health. “And when you bring the principles of a cooperative to bear, patients feel responsibility for holding the system together and for their own health.”

Of course, to set this up on a national scale with universal coverage, we'd need an organization large enough to collect votes from every citizen, and for the resulting "board" to oversee career administrators to actually run the behemoth. About $7.5 million has been raised by the Seattle clinic, one would suppose that extrapolating that nationally would cost upwards of a trillion dollars. Who in the world could raise that kind of money?

If only there already existed an entity that could answer to the patients (that is, the American citizens) that was large enough and already experienced in being run by elected officials, and had some kind of research capabilities in medicine and drugs. Huh. Maybe we could create one. Now, I now what you are thinking - why not just use the Federal Government? But then, you see, patients might have primary care physicians assigned, and doctors would be directly managed by the very group paying their salaries. And they'd make decisions on procedures and coverage based on their own research. Plus, in order to get that accountability to patients, the government would have ultimately answer to the people, and the people would have to bear the responsibility of holding the system together. And we know that's never going to work. What kind of government would that be?