The rural USA faces a healthcare crisis that cannot be solved by the market alone – and needs intervention from the co-op sector, says Doug O’Brien, CEO of co-op apex NCBA Clusa.
In an opinion piece for RealClearHealth, O’Brien argues that the co-op model can improve access to services, cut costs, and return power to communities.
This will help deal with a broken healthcare system, he adds, pointing to problems such as staff shortages and skyrocketing costs. These come longside hospital closures which have been sparking protests for more than a decade. The situation, O’Brien notes, is especially acute in rural areas and has been worsened by decades of market-led reform.
Rural healthcare providers, says O’Brien, have to pay more for supplies, pharmaceuticals, insurance, and administrative services because of their lack of scale. As a result, much of rural America’s primary healthcare begins at home, with carers travelling door-to-door to support the elderly, the disabled, and families with chronic illness.
However, following the launch of the $50bn federal Rural Health Transformation (RHT) Program, O’Brien says state authorities have a “once in a generation opportunity” to transform rural healthcare – by backing co-operatives.
He writes: “They can continue funding fragmented fixes that treat symptoms – or they can invest in co-operative infrastructure at scale to address root causes.”
Calling them “one of America’s greatest hidden assets”, O’Brien outlines how co-operatives could play a critical role in a “scalable strategy”for tackling rural health transformation –: by stabilising essential services, expanding home care access, supporting local economies, and strengthening democratic decision making.
Related: Can co-ops help end capital extraction in the UK care system?
In his op-ed, O’Brien gives the example of purchasing co-operatives, which enable independent clinics, pharmacies, hospitals and home care providers to pool demand and negotiate lower prices. Pharmacy co-ops like the Independent Pharmacy Cooperative (IPC) in Wisconsin and Care Pharmacies in Maryland operate group purchasing models to deliver more affordable care to their communities as well as free up scarce resources for patient care and expanded services.
He also highlights home care co-operatives as a model for tackling high staff turnover and low wages in the home care sector. “The difference is significant,” he says. “Turnover in the home care industry is as high as 80%; meanwhile, home care co-operatives report turnover rates between 15 and 30%.”
He adds: “Co-operatives offer rural communities something direct and proven that the market alone has failed to deliver: locally rooted, democratically governed health infrastructure that aligns health care delivery, workforce stability, and cost control directly and personally tailored to meet community needs rather than shareholder returns.
\“When applied across the health ecosystem – home care, purchasing, and clinical services along with the ability to reach millions with healthcare messages – co-ops don’t just patch holes. They can transform how rural health works.”
Main image: A protest in 2015, held in Washington DC against rural hospital closures (Al Drago/CQ Roll Call)
