Most of them closed or merged over the years, generally because they lacked a sufficient economy of scale (i.e., they were too small to function efficiently).
[11] In June 2009, Republican Senator Chuck Grassley told reporters, "if it’s all done entirely within the private sector, you know, it doesn’t seem to me it’s got the faults that you have... by having the government institute something.
"[12] Steven Hill, a program director at the New America Foundation, has written for Salon.com that "co-ops may hold the key to a substantive compromise", comparing the U.S. reform proposals with health care in Germany.
He argued that they can produce quality care for less money given that they would lack the profit motive, they would negotiate fees for service, and that they would end current market monopolies that insurance companies have in several states.
[12] 2008 Nobel Economics Laureate Paul Krugman and political commentator Robert Reich have also questioned co-ops' ability to become large enough to reduce health care costs significantly.