Crazy proposals

by Henry Farrell on November 17, 2004

Nick Confessore makes a self-described “crazy proposal”:

bq. Imagine an endeavor under which the official Democratic Party sponsored a non-profit health-insurance corporation, one which offered some form of health insurance to anyone who joined the party — say, with a $50 “membership fee.” Since I’m not a health care wonk, I don’t know how you’d structure such a business, or what all the pitfalls might be, or even if such a thing is possible or desirable. But I can think of some theoretical advantages. The Democrats could put into practice, right away, their ideas for the kind of health insurance they think we all ought to have. They could build their grassroots and deliver tangible benefits to members. Imagine a good HMO, run not for profit and in the public interest, along the lines the Democrats keep telling us all existing HMOs and health care providers should be run.

I don’t know enough about health care to comment on whether this would work or not as a policy (I’m somewhat sceptical, but can’t give good reasons for my scepticism). I will note, however, that this is how European Social Democrats (and the Christian Democratic parties who sought to imitate them) generated mass appeal in the late nineteenth and early twentieth centuries. In the days before the welfare state, they provided an enormous variety of services to party members including health, life insurance etc etc. While Confessore’s idea may or may not be crazy, it’s by no means ridiculous.



abb1 11.17.04 at 6:43 pm

This is something the unions should do, not political parties.


Dick Thompson 11.17.04 at 6:56 pm

Unions only serve a minority of the people who have no health insurance. The extension of unions to those people (unemployed and employees of small businesses) would be controversial enought to offset the gains.


nihil obstet 11.17.04 at 7:11 pm

I like the idea. In fact, there are a lot of services that people need that are very difficult if not impossible to negotiate for on an individual basis. Ideally, the government would help, as in many European countries, but in the U.S. social services have been declining rather than broadening. Political parties are large enough and stable enough to become an organizational basis for those of us who want social services and can be a demonstration to the rest.


doctorwes 11.17.04 at 7:17 pm

Private sector union density in the US is down to the single digits. So a party-based system does make more sense.


Lindsay Beyerstein 11.17.04 at 7:22 pm

A lot of Republicans would join for the cheap health insurance and vote Republican anyway. Worse, these new members could sabotage the Democrats in our own primaries by nominating right-wing candidates.


LizardBreath 11.17.04 at 7:31 pm

I think abb1 makes an excellent point — Thomas Geoheaghan has an essay in last week’s Nation saying pretty much the same thing, that unions should be allowing anyone to join, rather than merely workers for whom the union is a collective bargaining representative, and then providing them with services.

I’m not sure how I feel about doing the same thing through a political party. Doesn’t it have an air of direct vote-buying?


President Jackass 11.17.04 at 7:44 pm

An interesting idea. The downside for the Dems would be if it went wrong: they would then be associated with failure.

Thinking about it, what have they got to lose? They should go for it.


messenger 11.17.04 at 8:08 pm

All this nit-picking and agonizing about what tactics the Democratic party should employ next strikes me as incredibly naive, full of childish optimism.

You are like some French aristocrats calmly discussing half-hearted concessions and stratagems with a false feeling of security, even as the Terror is on its way. The ground rules will have changed so fundamentally by 2008, that all these current discussions will appear “quaint” and “obsolete” (like the Geneva Conventions, according to your AG Gonzalez.)

There will not be anything like a level playing field for Democrats then, and maybe never again. Of course this sort of thing is often clearer to see from a distance, but surely by now even you guys ought to have enough clues to get some inkling of what is in store. Probably even worse than I can imagine.


pblsh 11.17.04 at 8:11 pm

If the Democratic party stands for government sponsored, single-payer health care for at least the portion of citizens who choose to opt into it, how does this idea demonstrate that commitment? It seems to me as though it is saying to the country we ought to continue to have the private system we already suffer under. How would this be any different than the other not for profit HMOs that already exist? The need for change in health care in the US isn’t rooted in the need for not for profit alternatives.

What does the party know about running an HMO? I fear they already have more than they can handle trying to run a political party. And I suspect the Republicans would love to see the party bankrupt itself trying to be something other than a viable political party. Nick is well-meaning here, I know, and I appreciate the impulse to put proof to the party’s ideas. But it’s a good thing that this one isn’t going to fly in any way, shape, or form.


Thomas 11.17.04 at 8:11 pm

A fantastic idea.

Perhaps they could offer doctors medical malpractice insurance as well, since they assure us that the reason that premiums are high is because insurance companies gouge. They can demonstrate the truth of that assertion and move the medical establishment into the Democratic party in one move.

And perhaps they can do something about ‘redlining’ in the banking game. All these banks refusing perfectly good opportunities to make money. The Democrats could start a bank focusing on that underserved market.


sennoma 11.17.04 at 8:14 pm

I liked the idea, but I think Lindsay just sank it. I can’t see a way around that. Nuts.


Desert Donkey 11.17.04 at 8:14 pm

abb1 beat me to it. I was having the same thought the other day. Unions could build their ranks by offering such services first, then building upon that membership role to expand the businesses they negotiate contracts with.

One of the unions’ biggest problems is that the negotiate into positions that benefit their members, but that may work against new entrants (two tiered contracts for instance). By expanding the membership first maybe this would improve the universality of bargaining strategy.


Tassled Loafered Leech 11.17.04 at 8:15 pm

This idea is frought with peril. How do you select for pre-exsisting conditions? If you don’t, every one with full blown aids is at your door. If you do, you’re PR is shot.


Jason Kuznicki 11.17.04 at 8:17 pm

Messenger — They said the same thing about the Republicans after Watergate, but they bounced back too. Sure, it took a while, but it’s far to early to give up on the Democrats for good.


asg 11.17.04 at 8:27 pm

A lot of Republicans would join for the cheap health insurance and vote Republican anyway.

Isn’t the whole point of this proposal to increase support for the Democrats by inducing Republicans to join and then persuading them to vote Democrat?


Cranky Observer 11.17.04 at 8:28 pm

> This is something the unions
> should do, not political parties.

The AFL-CIO did extensive study of developing affinity-based services in the late 80s/early 90s, and implemented some. None of them worked out very well, nor did they attract many new members or stem membership decline.

The problem with heath benefits specifically is that without a total redesign of the system (aka – gasp – Hillarycare) the union would just end up being a very small insurance company in a sea of very large and experienced sharks. Not a formula for success.



BigMacAttack 11.17.04 at 8:32 pm

But the problem isn’t that evil insurance companies are seeking profit or a lack of insufficient buying clout or that insurance admin costs are economies of scale.

Most of the problem is here –

You are in the doctor’s office. The doctor has no incentive to not treat you in the most expensive way.

You have no incentive to not ask for the most expensive treatment.

And your HMO does not have the power to deny you the most expensive treatment. (At least not always.)

See your government doesn’t pay for your treatment, so it has no reason not to demand that you get any free treatment you want.

In Europe this is not the case.


Warbaby 11.17.04 at 9:06 pm

The miniscule set of people in the Democratic party who would approve or disapprove this scheme have approximately the same regard for the future of America as Vidkun Quisling had for the future of Norway.

Mind you, it’s a good idea. I just don’t think the senile ruling in-group is capable of doing anything other than self-interested thimble-rigging.

It is a good idea. Christianity got its start partly as a burial insurance society. Planned Parenthood did the same sort of shift, but without broadening their client base and are now dropping out of the health provider business.


Marcus Stanley 11.17.04 at 9:08 pm

Sorry, but this is a crazy idea. Leech has it right — under our current system insurance companies survive by selecting the right kinds of patients. Do that right, you’re evil. Do it wrong, you’re broke. It’s a no win situation.

Cranky is right too. Do people think that running an insurance company is *simple*?


Ken Houghton 11.17.04 at 9:54 pm

Speaking as one whose COBRA ran out before his next health-insurance-covered-in-part-by-the-firm job, I bridged the gap in part with a health plan where the premium was, in part, union dues.

In other words, whatever study they did in the late 1980s that claimed it didn’t work, it clearly did in 2003-2004.

Here in Bluesville, we have subway ads for the “freelancers union,” which highlight that it offers health benefits.

Of course, I fail to see the harm in letting Republicans join as well–it would be, after all, a movement that would succeed due to market forces, and fully compatible with the values of my Ancestral Party, if not the goons who run the one currently using the name.


Ken Houghton 11.17.04 at 10:08 pm

health plans starting at $200 a month

It’s an idea whose time has come; as usual, the Democratic leadership is still thinking about whether it might work.


abb1 11.17.04 at 10:09 pm

I worked for the state of MA for a few years in the 90s. We were all members of the union, paid $6/week or something like that. For that the union gave us optical insurance – two free pairs of cheap glasses every year or something like that. I have a whole bunch of cheap glasses now. It was OK, much better than just giving 6 bucks/week for nothing, because I was a professional and that union doesn’t really do anything for professionals.

I know, this was neither real union nor real medical insurance, but it’s something. If a full-fledged medical insurance is too complicated, they could still provide a simple dental plan, or maybe pay for an annual check-up or, better yet, get you a catastrophic coverage.


Martin Wisse 11.17.04 at 10:17 pm

What Democrats can also do is implement single payer health care at the state level….


BeenThereDoneThat 11.17.04 at 10:24 pm

This could be done but would be complicated. The organizaitonal model is the “health insurance purchasing co-op” (HIPC), a specialized nonprofit demand-aggregating health benefits purchaser. The concept developed as a market reform in the late ’80s and was part of the Clinton plan – but was also enacted in law in Washington state and implemented privately in a number of places. I helped set one up in 1992 which operated until this year – it had to be shut down for reasons having nothing to do with economic viability. It did succeed in making less expensive, better-designed coverage available to several hundred small businesses (no individuals, beyond our mission), and conceptually I don’t see why it wouldn’t work on a party basis. Negotiating the politics of unions and associations as insurance providers might be difficult, and there is also the (ironic?) possibility it would be used as an excuse for some employers to stop providing coverage themselves.


burritoboy 11.17.04 at 11:07 pm


I don’t know if it’s as clear-cut as all that. Clearly, there would be a problem with pre-existing conditions and self-selection and etc., but that’s the same as what every other insurance plan operator faces. There are literally thousands of them, and they’re not all run by geniuses.

Dental, optical and a few other product lines should be at least plausibly do-able. As Henry noted, this type of thing made the Social Democrats the most popular parties in Europe, so there could be huge net side benefits.


I agree with you on the global macro-end (single payer seems to be the best solution on a worldwide experience). On the other hand, we don’t have that right now. Couldn’t this be an excellent route to getting there? After all, if Democratic HealthCare is a huge success (or even a moderate one) that in itself would convince many people that the Democrats are the right people to manage the healthcare system.


Vaughn Hopkins 11.17.04 at 11:41 pm

Kaiser Health plans are run on a non-profit basis and always have been. I belong to one which is partly subsidized by my former employer – I’m retired. My wife and I together pay almost $400 a month. I really doubt that a HMO type plan could be developed for less than that unless it excluded large areas of health care. It is definitely not where a political party should go. However, the Democratic Party could negotiate a group rate for its members with an existing HMO or HMO’s, and that could be a real money saver which could attract lots of Democrats.


william 11.18.04 at 12:37 am

If I remember correctly, the Texas Democratic Party recently did such a thing. Or at least proposed the idea in one of its mailings.

Looking for a link . . .


Jon H 11.18.04 at 1:14 am

Lindsay writes: “A lot of Republicans would join for the cheap health insurance and vote Republican anyway. ”

So let them. Keep the insurance operation mostly separate from the party itself, and make it mostly party-neutral.

If Republicans want to join up, great. It makes the pool of insured people even larger, helping with the economics of the situation. Especially if they’re healthy.

(Actually, though, I really can’t see many Republicans joining up, even if it’s a good deal financially. They vote against their interests, why would they act any differently in this case?)

Even if the insurance weren’t limited to registered Democrats, the Democratic party would still benefit. The mailing list would be fantastic, for one thing.

Also, if the healthcare thing’s name included the words “Democratic Party”, advertising of the insurance plan, and media coverage of it, would gain attention for the party itself.


Jon H 11.18.04 at 1:25 am

pbish writes: “If the Democratic party stands for government sponsored, single-payer health care for at least the portion of citizens who choose to opt into it, how does this idea demonstrate that commitment?”

Um, I’d rather the Democratic party stand for good, affordable healthcare, however it is achieved.

Realistically, the Democrats are unlikely to achieve single-payer any time this decade or next. So they might as well do something that they *can* achieve, which can’t be blocked by the Republicans.

An ideological attachment to a particular approach doesn’t seem to be very useful, especially in the current political climate in Washington.

Clinging to single-payer, while unable to enact it, doesn’t improve anyone’s health, does it?

On the other hand, a Democratic Party insurance operation, like the one being discussed, would provide an excellent training ground for future designers and administrators of a national healthcare program.


Mike Huben 11.18.04 at 1:52 am

Unions could implement health plans as a recruiting tool for breaking in to resisting employers such as Walmart.

A union could hire Kaiser P or some other insurance company to provide a low-cost, minimal health insurance to employees of large companies like Walmart which don’t offer benefits and are anti-union. If the offering is good (or perhaps slightly subsidized by the union), enough employees could be signed up to force unionization and collective bargaining. This could start re-energizing membership numbers for unions.


Brennan 11.18.04 at 4:24 am

There’s some experimentation going on right now with a AARP-style union backed group. AARP makes most of its money not from dues but from the health care packages and discount cards it offers.

The experiment, to my knowledge, is offering a similar package to working people for the same sort of minimal dues. The extra money goes to fund the same sort of advocacy for workers that AARP does for seniors. We’ll see if anything comes of it.

This might be the only effective way to fight for better treatment of workers in right to work states throughout the South and West.


kmeson 11.18.04 at 5:11 am

Blue State, Blue Sheild?


Dustin 11.18.04 at 8:20 am

Actually, this is exactly what mutual aid societies like the Workmen’s Circle did around the turn of the last century. The WC wasn’t a union or a party, but a support system for workers — members had to belong to a union and a socialist party as a precondition for membership. Once in, they got life insurance, strike relief, a burial plot, educational programs, and as the years went on, summer camps and children’s programs as well (actually, they *still* offer some of these services: see Lots of organizations offered similar services, although as their memberships grew and the actuarial realities of insuring that many people got too overwhelming, those that didn’t fold typically transferred the insurance options to third-party insurers — still a cheaper option than providing for your own health care! Maybe a little mutual aid is what’s needed for left-minded folk altogether — insurance, sure, but also some sense of community might be helpful, too.


Ragout 11.18.04 at 8:39 am

I don’t believe the Democrats could run a better insurance plan than the private sector or nonprofits like Kaiser. Though of course the government could and does. It’s called Medicare.

Despite that, I think providing these kind of services might be a good idea, if seen as a way to educate/progadandize members about related political issues. The AARP, Kaiser, and Fannie Mae (the last two through their foundations) are examples of this kind of thing.


Ragout 11.18.04 at 8:51 am

I almost forgot: probably the organization that’s curently most successful in the US with combining services and advocacy is the NRA. Besides lobbying against gun control, they sponsor shooting competitions, gun safety classes, even painting contests.

Hey, that’s a more modest plan for the DNC. How about sponsoring an art contest?


ajay 11.18.04 at 10:07 am

Fascinating idea. I don’t know much about the economics of private health care, but from a political point of view this is gold dust. While contributors above have mentioned various 19th century socialist parties with similar plans (social democrats, Workers’ Circle and so on), I’m amazed no one has brought up a party that is doing exactly this right now, with terrific grass roots results: Hezbollah.
One of the main reasons for the tremendous success of radical Islamic parties in the Middle East is their ability to offer social services – primarily education, but also healthcare and relief – which the official government is typically either too poor, too corrupt or too inefficient to provide. If you want your children educated, and cannot afford the elite schools, they will either go to the local religious school or not at all. If you cannot afford a doctor’s bill, the local mosque/Hezbollah branch will help. If you are indigent, you will receive charity; if struck by disaster such as fire, you will receive relief; and it will all come not from the government but from Hezbollah. Imagine the boost this gives the Party of God and the damage it does to the ‘official’ government, whose incompetence is thrown into sharp relief.

Just to be clear, I am not suggesting that the Democrats should follow the Hezbollah/NLF route and set up parallel courts, local governments and tax collection networks; nor that they should set up ‘liberated areas’ where the writ of the capital does not run, after the pattern of the Bekaa Valley. Although the Bekaa, like many Democratic voters, is strongly in favour of the legalised growing of cannabis…


nic 11.18.04 at 10:27 am

I don’t think you can graft on to the US system something which developed in an entirely different system for which privatising health care was the crazy idea. They were already available to everyone, what parties would offer were extras. Besides, in the European context you refer to, party membership meant something more than just paying a fee. It was unthinkable for someone not sharing the ideas of that party to join just as a kind of investment, because it wasn’t an investment. It was more like a cooperative than an insurance plan. So you already have a completely different mentality there. We’re also talking of parties where ideological differences were deeper than Republicans vs. Democrats, while at the same time all enjoyed heavy public funding and the notion that certain services should be provided by public organisations.

There is a reason why no party in the US ever thought of something like this, it’s because there is no cultural or political background for it, and you can’t create it from scratch by starting from the end result…

You’re just thinking of a party taking on a role of service providers like they were yet another private company, and I honestly can’t see the point of that.


Brett Bellmore 11.18.04 at 11:52 am

“Besides lobbying against gun control, they sponsor shooting competitions, gun safety classes, even painting contests.”

Actually, the NRA is VERY big on insurance:

I’d say the suggestion has two basic problems for you Democrats: First, you’d end up recruiting a lot of people who didn’t agree with you. Second, if it worked, you’d be proving why the government didn’t have to get involved!


Scott McArthur 11.19.04 at 4:45 pm

Do it Do it Do it


David 11.21.04 at 3:37 am

And back in the day the big city Democratic machines used to provide an array of favors to party members, much like Arafat’s PA did for so many years. If your child needed to a doctor to set a bone and you couldn’t afford it – no problem. If your husband got thrown in the drunk tank and you needed the bail money, or maybe a couple of party thugs to show up down at the precinct and spread a little intimidation around – no problem.

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