The Healthcare reform bill currently under debate in the US Senate emphasizes the role of nonprofits in the provision of affordable care. The bill lends federal support and subsidy to nonprofit member-run healthcare cooperatives, which would compete with private insurance companies. The bill also relies on the establishment of a “private, nonprofit Patient-Centered Outcomes Research Institute” to conduct research on the comparative clinical outcomes of medical procedures.
The nonprofit health co-ops were conceived as a way to lower healthcare costs for many Americans, while still maintaining a private system. The Senate bill does not include a public option – the co-ops would be subsidized by the government but privately run and controlled. As there are currently fewer than 20 nonprofit healthcare cooperatives in the United States, co-ops would need to be created in order to meet the needs of the population and fully replace the public option.
This initiative is similar to one that emerged in the New Deal era, which critics point out was not very successful. Most of the co-ops created in that time disbanded when they lost government subsidies. Nevertheless, proponents point to the Group Health Cooperative of Puget Sound, which was established in 1947 and which functions basically as an HMO.
The nonprofit research institute, meanwhile, is a way that decisions regarding the effectiveness (and cost-effectiveness) of procedures can be made, without the determinations being directly in government hands. It lends a sense of objectivity to the policies on which procedures will be favored over others, and grounds what is otherwise a very emotionally-charged debate in scientific evidence.
While the outcomes of the Senate bill remain to be seen, the evolving role of nonprofits in the healthcare debate could have a profound impact on how the system is ultimately configured. The Senate bill, it seems, sees the nonprofits as a neutral third party – not the government; not the private sector. It may be a compromise that works.
