It is hard to know where to begin with Ezra Klein’s assessment of Sen. Kent Conrad’s “compromise” proposal to establish member-owned “co-ops” instead of a government-sponsored “public” health insurance option. Klein thinks the co-ops might work, but he fears Congressional progressives will not accept the idea as compromise. How did the debate get this confused?

You’d think we’d never thought of non-profits or the co-op model before, but the nation has some 29,000 different co-ops, most of them local and designed to help individual sellers or individual buyers aggregate their market power, pool risks and achieve economies of scale.

Moreover, we’ve had co-ops in health care for years in several states; they’re just called something else. [Updated: That's fine, but where's the evidence they've made a significant dent in the underlying problems in our national health care system?]

Conrad’s co-op approach adds nothing new to solve those problems. It’s a distraction, and meant to be one.

There are several questions I wish Klein had asked Conrad in his interview, because the answers to those questions are critical when comparing a robust public plan with the still unspecified details of Conrad’s co-ops. For example:

1. What entity would have the responsibility to ensure that one or more co-ops meeting the requirements (yet to be defined) were formed for every region in the country – and if it didn’t do that, how would you achieve universality? Would we leave that up to each state, and then watch co-op formation drag on in the worst states for the next decade?

2. Does anyone seriously believe that getting this approach applied on a universal scale would not involve major federal direction, mandates, sanctions and funding, followed by continuous/permanent federal oversight?

3. What entity would determine whether a co-op had sufficient scope and scale to achieve the (still undefined) criteria for viability, efficiency and bargaining power? Does anyone seriously believe that anything short of a full federal involvement in those questions would be essential?

4. Assuming we could overcome these enormous obstacles, what entity would be responsible for policing the policies and practices of the state/regional co-ops? Are the advocates suggesting, when they claim member-owned co-ops would get government control out of the picture, that every co-op would voluntarily establish and enforce solid non-discrimination and other fairness rules to protect consumers? Who would police the co-ops, and how effective would that system be?

5. If/once it became clear that co-ops would have to be huge – as Robert Reich notes — to achieve economies of scope/scale and to provide a strong competitive alternative to the increasingly concentrated private system, how could a member-owned and member-operated co-op system function without taking on all the attributes of national governance? It’s one thing to organize a co-op to sell New England cranberries or Wisconsin butter, but where is the successful model for a national-scope health care system?

6. Who would be eligible to receive co-op health insurance coverage? A robust public plan would be open to everyone, including those who did not like or want what they have and those who currently don’t have coverage. Real competition means that consumers could freely choose to walk away from what they have and choose something different, with no restrictions, waiting periods or other rules to discouraging shopping. No such open access requirement for the co-op concept has been promised. Why not?

7. If the co-op is only open to those who currently don’t have coverage, or who work for small businesses, as originally suggested, how does that limitation put any competitive pressure on the current private insurance system, which simply fails to cover these consumers today?

In sum, it is hard, to conceive of a viable, workable co-op model on the scale needed that does not de facto fail unless it turns into a robust government-sponsored public plan. It’s hard to conceive of a workable co-op model that deals with universality, while treating consumers fairly, without major federal direction and continuous oversight.

Even if there were a national co-op large enough to compete with the private plans, there is no reason to believe that the total system would solve the underlying problems of industry concentration, discrimination, private system rationing by price, exclusion of high-cost patients and – critically important — the perverse incentives of the existing for-profit compensation paradigm, the very problem for which the President said, "this is what we have to fix."

All of these problems will require strong federal direction and oversight to force genuine reform of how the system operates today. At a minimum, we need a robust government-sponsored alternative to keep the private insurers honest, and strong federal direction to change how the perverse incentive structure leads to excessive costs.

The co-op model falls woefully short in all the ways that matter. It is both dishonest and irrational to think that a proposal expressly designed to preclude federal oversight has any chance of achieving meaningful reform.

How about some answers to these questions, Congress.

More on Conrad Co-ops:
mcjoan/DKos, Conrad against public option, pushes co-ops
Igor Volsky/WonkRoom, Baucus: We might replace public health option with a co-op
Robert Pear, NYT Caucus, Coop Plan emerging as Senate option
Robert Reich, The latest public option bamboozle, and how to recognize the real thing
Open Secrets, Sources of Kent Conrad’s campaign donations
Matthew Yglesias, UK Conservative Love Socialized Medicine
Rep. Lynn Woolsey, Progressive Caucus principles for robust public plan