3.

There are other, and probably far more important, problems with using Group Health as a model for what the co-op compromise could deliver all over the nation.

Among them: the idea that Group Health provides a structure that can be quickly replicated to great positive effect. Don Mitchell, a retired physician and the chair of the Western Washington chapter of Physicians for a National Health Program, pointed out that it has taken "years" (62, to be exact) to get Group Health to its current level of service and national stature. You can’t just create a bunch of federally-chartered, citizen-run health care concerns all over America and expect them to be high quality on day one.

But perhaps the biggest problem has to do with size. Group Health achieves efficiencies and economies of scale—which in turn lead to cost savings, a Holy Grail of health care reform—precisely because it’s not small.

Size matters quite a lot in cutting health care expenses. That, by the way, is the whole point of the public option: to create a government-backed national health care plan that’s so big it will be able to compete nationwide and bargain for lower costs all over the country, all at once. “Because [co-ops] would be at most state-wide in scope and not be national,” Mitchell said, “they would lack the bargaining clout that a national organization would have in terms of driving down costs vis-à-vis private health insurance companies.”

This is why, even though the Commonwealth Fund recently placed Group Health among the nation’s “shining examples of co-operative health care,” Dr. Karen Davis, blogging for the group, nevertheless described the idea of filling the country with Group Healths as a “difficult” and “uncertain” proposition.

Bottom line: Group Health has found a way to work well in the Pacific Northwest after 62 years of operation. But it’s not the small, easily-replicated co-op that Maria Cantwell and others want it to be. In fact, one important lesson of Group Health ends up being exactly the opposite of what advocates of the co-op compromise seem to want to hear: it takes a big entity with experience in the health care market and significant financial clout to push the industry in the right direction.

An entity like, you know, the federal government—which, under the public plan, would be doing just that at the national level.

Last of three parts. Part one here, part two here.