Doug Dammrose could be riding his mountain bike at Bear Basin near McCall or making a few turns on Brundage Mountain this winter. But the 68-year-old physician and former medical director for Blue Cross of Idaho is a hard worker.

As the executive director of Mountain Health CO-OP (where CO-OP stands for “Consumer Operated and Oriented Plan”), Dammrose is preparing to take his nonprofit’s website live, just in time for the Nov. 15 open-enrollment period for Idaho health insurance sign-ups.

One would be hard-pressed to find someone who knows more about health insurance than Dammrose. The complex relationships among patients, doctors, hospitals and insurance companies is one thing. Explaining the history, economics and current landscape of health care in the U.S., and how to improve it, is another. Dammrose has full command of the issues. He paraphrases Washington Post columnist Robert Samuelson’s quote about “our unlimited budget for health care, and we’ve just exceeded it.”

Health cooperatives are designed to provide low-cost health insurance to their members. They are subsidized by the federal government, and they provide direct competition to commercial insurance companies.

Medical co-ops are allowed by the Affordable Care Act, whose authors supported single-payer systems like those in Canada and Europe. Members own the co-op, benefit from lower premiums and cost efficiencies, and have member representation on the board of directors.

Dammrose is sensitive to the economics of health care. His pragmatic approach is simple. The average Idahoan cannot afford typical premiums and co-payments. Personal bankruptcy is not the answer for nonpayment of medical bills. As a percentage of the overall economy, health care is too big.

The quality of health care declines as its share of GDP increases. Annual cost increases of four to five times the rate of inflation are unsustainable. Fees for service, or “the more medical stuff you do the more you make” approach, encourage unnecessary tests and procedures. More transparency about the cost of health and delivery of health care is needed.

Known top-line payments and consistent reimbursements to hospitals would provide better financial reporting and planning. Medical inflation should approximate percentage increases consistent with consumer inflation.

As if these issues aren’t difficult enough, how about taxing capital gains and investment income to pay for health care? Dammrose believes better allocation of resources would eliminate the need for the 3.8 percent Medicare surcharge.

Should hospitals be allowed to issue public debt such as municipal bonds through the Idaho Health Authority? Are hospitals and insurers more like businesses than health delivery and payment systems?

Like the Affordable Care Act, health cooperatives are here to stay. Twenty-three states have embraced them, and $2 billion has been loaned so far, according to

In the giant health care puzzle, medical co-ops are a small piece. Their future relevance may be determined by the number of subscribers who embrace them.

Will they deliver on the promise of affordable health insurance for Idaho using an entirely new model? Will they remain financially solvent? Is health care changing from a privilege to a right?

Stay tuned.

Mark Daly