The Obama administration appears to be backing away from the idea that a health care overhaul has to include the option of a government-run insurance program. If this public plan is removed from the bills currently under construction in Congress, it could be replaced by nonprofit health insurance plans run on the co-op model, where people who buy the insurance are the ones who own the insurance company.

Sen. Kent Conrad (D-ND) is pushing for health co-ops; he sees them as a way to provide competition to conventional insurers without the political negatives of a government-run plan.

But health co-ops as part of a nationwide health care fix are controversial. Robert Laszewski, who heads a Washington, D.C.-area consulting firm, says, “I think they’re the single dumbest idea I’ve heard in 20 years of being in Washington and working on health care policy.”

Laszewski says there’s no need to promote co-ops. They can already form on their own. As for the nonprofit advantage, he says there are plenty of nonprofit health insurers around, including many of the Blue Cross/Blue Shield plans. The only difference is that they’re run by board members who are appointed, rather than elected. Laszewski says any kind of new insurer will need a lot of cash on hand to line up doctors and hospitals willing to treat patients, and to set up health IT and billing systems.

“Actuaries have figured it will cost about $6 billion to establish the insurance reserve requirements that cooperatives will need, and 12 million people will sign on,” Conrad said in an interview with NPR on Monday.

“Those of us who have to count votes know that the public option does not have the votes,” he says. But he’s confident he can get the votes for co-ops.

But how exactly do health co-ops work?

NPR spoke with Pam MacEwan, executive vice president of public affairs with the nation’s oldest health cooperative, Group Health Cooperative. Group Health covers 11 percent of the health insurance market in Washington state. It offers various types of insurance, at average or just below average prices. Its HMO was recently ranked the nation’s best by Consumer Reports magazine. Here are some excerpts from the interview, edited for clarity:

How does Group Health work?

We are a nonprofit organization, and we’re cooperatively governed. The members, that is, the patients, actually elect the board of trustees, and each of our trustees receives care here.

What does that mean for someone who buys health insurance from Group Health?

We consider you a member, and you’re eligible to vote in the organization, and you have a say in how we organize care and design benefits. Our members participate in reviews of grievances and in discussion about the benefits packages. Most of the work is done by the board of trustees that’s elected by members.

What kind of care do members of Group Health get?

We have really different kinds of packages. You can buy individual coverage for your family with a high deductible that would look very much like any other insurance package. We offer full coverage through employers and Medicare Advantage plans. Some people purchase a policy that allows them to go to any doctor; other people purchase something that’s a little more restrictive that just allows them to go to Group Health doctors.

So how would a member feel the difference?

You would feel in control; you have access on e-mail to your doctor; you can make appointments on e-mail; you have access to your medical record. Overall, there’s a sense of transparency, with you being in the middle and calling the shots.

Would member-run health co-ops work as part of the overhaul plan in the place of government-run health plans?

I would need to know much more about how they intend to put the cooperative plan together to know if that will be the answer to how we design public plans.

Related story: Co-Op Option Offers Compromise In Health Debate