Now that the carefully laid plans of the Administration and the Congressional Democrats for health reform have gone just a bit awry it might be time to consider some changes that would have seemed Utopian before.

Which observation leads Wonks Anonymous to introduce the following compromise that might please both the liberals and the blue dogs - nothing short of Obama giving the presidency to Sarah Palin will please the Republicans. We can have a public option and health care cooperatives at the same time.

The Public Option would run pretty much like Medicare. People would pay premiums that would support services and the government health insurance agency would pay claims to doctors and hospitals and so on. Unfortunately this leaves us with the same old system for producing and providing medical care. Lots of individual doctors working by themselves and charging fees for complex medical services.

And this is where the co op idea comes in. We need to encourage doctors and hospitals to work together, to take responsibility for each other and to provide integrated health care. When this happens, as it does at the Mayo Clinic or Kaiser Permanente, the quality of care is better and the costs are lower. These Doctors Cooperatives are some of the greatest success stories of US medicine.

But cooperatives require investment and, by definition, they offer no return to shareholders and no opportunities for IPO's or other forms of stock jobbing and speculation. So why not take the billions that Senator Conrad and others want to add to the health reform to promote cooperatives and give them their cooperatives. Doctors Cooperatives.

The Public Health Insurance Agency could then provide its enrollees with a Medicare Advantage type option. They could choose to get services from a Doctors Cooperative, which would take the average cost of services in the area as payment for integrated health care. Cooperatives would no longer have the incentive to multiply painful and wasteful procedures. At the same time enrollees could choose another doctors cooperative or public option fee for service insurance. Cooperatives would be forced to provide better service.

Doctors Cooperatives might also contract with private insurers. In Wonks Anonymous experience this is unlikely to be popular or particularly productive.