Private insurance rates continue to rise, according to an analysis of all states and the District of Columbia released yesterday by the White House. The state of Washington had the ninth largest increase in premiums, rising 129 percent in the last 10 years. The average family premium in Washington for workers insured through their employers was $13,036 last year, which is higher than the national average of $12,298, according to the Henry J. Kaiser Family Foundation.

Group Health, Regence, and Primera all imposed double-digit premium increases on their individual customers this year. Group Health raised its individual rates 13 percent, while Regence increased premiums 17 percent. State regulators denied Primera a request for a 10 percent increase but allowed a 6 percent hike. A Primera subsidiary, Lifewise Health Plan, was allowed to jack its individual rates almost 18 percent.

For their part, Health Care Cooperative officials say they don't know how Congress will use their example to create a national template, but they insist there is evidence that co-ops lower prices overall.

"The cost of care in Washington state is lower than the national average and much lower than places like McAllen, Texas, or Miami or New York and that has a lot to do with the culture of care that has been developed here," says Michael Foley, a spokesman for Health Care Cooperative.

The best analysis of health care costs focuses on Medicare spending, which co-op critics like Jost and Katz say doesn't accurately reflect the broader market. But using that standard, Group Health says health care costs are lower in Washington.

Medicare reimbursements in Seattle rose 2.9 percent from 1992 to 2006 to an average of $7,218 per person, an analysis by the Dartmouth Institute for Health Policy and Clinical Practice shows. That's lower than the national average of $8,304, which represents a 3.5 percent increase during that same period.

In St. Paul, Minnesota, where another large health care cooperative competes, Medicare costs rose 3.6 percent to $7,244, an increase that was just slightly above the national average. The co-op, HealthPartners of Bloomington, Minnesota, is about twice as big as Group Health with 1.25 million members.

Foley notes that Washington has lower insurance premiums for small business, according to a 2008 study by the industry group America's Health Insurance Plans. The survey found Washington's small-business premiums were the lowest in the country, averaging $521 a month for a family plan compared with a national average of $913 a month. Small-group insurance accounts for 5 percent of Group Health's members.

The bottom line for proponents of President Obama's reform who want powerful, market-transforming competition for private insurance companies is that co-ops aren't a viable option. "They're very good institutions," says Andy Stern, president of the Service Employees International Union. "But to imagine scaling them up to compete against (insurer UnitedHealth Group Inc.) is like scaling up town-hall meetings in Vermont to compete with New York City."