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Kent Conrad Hearts the French Health-Care System?

PH2009091901065.jpgFrom Sen. Kent Conrad's remarks at Tuesday's Finance Committee hearing:

Let me just conclude for my progressive friends who believe that the only answer to getting costs under control and having universal coverage is by a government-run program. I urge my colleagues to read the book by T.R. Reid, "The Healing of America."

I had the chance to read it this weekend. He looks at the health-care systems around the world. And what he found is in many countries they have universal coverage. They contain costs effectively. They have high-quality outcomes, in fact higher than ours. They're not government-run systems in Germany, in Japan, in Switzerland, in France, in Belgium -- all of them contain costs, have universal coverage, have very high quality care and yet are not government-run systems.

Germany, Japan, Switzerland, France and Belgium have a level of government intrusion in their systems that would make the average tea partier retch. In France, for instance, the government provides all basic insurance coverage directly. In Germany, insurers aren't permitted to make a profit. In Japan, health insurance is publicly provided, and private insurance is available only to ease co-payments or cover services that the government leaves out. This stuff makes the shackled public plan look downright objectivist.

That said, I think France, Germany, and Japan offer excellent models, and their low costs, universal coverage, and impressive outcomes back up that contention. But they're not a rebuke to the progressives in this debate. They are confirmation of the argument that systems with more government-intervention offer lower costs and better outcomes. And either way, my sense is that Kent Conrad stands more firmly between this country and the French health-care system than does Barbara Boxer, but I'd certainly be glad to learn I was wrong on that.

Photo credit: AP Photo/Haraz N. Ghanbari.

By Ezra Klein  |  September 23, 2009; 10:20 AM ET
Categories:  Health Reform  
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Comments

Note the use of the term "government-run system." Isn't this just another example of conflating -- as deliberate misdirection or just by stupidity (with Conrad, I'd be open to either conclusion) -- publicly provided insurance with publicly provided healthcare services (a la NHS)?

Posted by: gedwards1 | September 23, 2009 10:41 AM | Report abuse

Kent Conrad sticking it to all those calling for a British system. You know, no one. So he's either lying or is an idiot. I'm not sure which at this point.

Posted by: endaround | September 23, 2009 10:42 AM | Report abuse

sign me up for Germany's model.

Posted by: visionbrkr | September 23, 2009 10:54 AM | Report abuse

--"They are confirmation of the argument that systems with more government-intervention offer lower costs and better outcomes."--

You're lying, Klein. Meyer at his Coyote Blog makes the overwhelming case that, "Removing just two factors – death from accidents (mainly car crashes) and murders – vaults the US to the top of the [life expectancy] list." Others have long pointed out that it is various social factors that mark the difference between health care outcomes in disparate countries, NOT, as dim, propagandizing policy wonk wannabes would have people believe, the particular type of health care system in place in those respective countries. If you have to lie about it, Klein, what does that say for the underlying morality of that which you are trying to achieve?

Posted by: msoja | September 23, 2009 10:55 AM | Report abuse

Kent Conrad sticking it to all those calling for a British system. You know, no one. So he's either lying or is an idiot. I'm not sure which at this point.

Posted by: endaround | September 23, 2009 10:42 AM | Report abuse

I'm sorry didn't I read about HR 676? Isn't it being scored? Wasn't Rep Weiner promised a discussion on the floor of the House for allowing the Energy and Commerce committee bill out of committee via the Blue Dog ammendment?

Posted by: visionbrkr | September 23, 2009 10:57 AM | Report abuse

People like Kent Conrad don't know what they think, or why. They don't KNOW enough to have consistent views.

He's had plenty of opportunity, over the course of this debate, to find out how other countries do universal health care UHC). (Ezra's "The Health of Nations" from a few years back would have been an excellent short primer.) But he just did this LAST WEEKEND.

So NOW he's impressed by France's approach to UHC. He probably doesn't know enough to realize how it compares with what's being discussed in the Finance Committee or in the House.

He's a freakin' moron who's too lazy to do his homework, despite being one of a small handful of people who will decide what our health care system will look like in 2015.

I doubt he's that much different from most Senators in this regard. Some do their homework, but many don't. But they get to run the country anyway.

Posted by: rt42 | September 23, 2009 10:59 AM | Report abuse

msoja,

I have seen that before as well in testimony before the HELP committee before it put its bill out.

NOt surprisingly, those figures were glossed over by the Democrats on the committee. Why let facts get in the way of their agenda i guess???

Posted by: visionbrkr | September 23, 2009 11:05 AM | Report abuse

The fact that you think Weiner is calling for a NHS style system means you're either as stupid or as mendacious as Conrad.

Posted by: endaround | September 23, 2009 11:26 AM | Report abuse

It's all about the language. Unfortunately, Conrad is misusing his party's designated exaggeration & over-generalization talking points.

(It seems a couple of commenters are getting tripped up in a similar fashion.)

The argument seems to be:
1. current reform proposals constitute "government-run health care".
2. France, Germany, Japan & Switzerland do very well without "government-run health care".
Therefore, we should drop our current reform proposals.

I think we should concede that Conrad is quite correct and offer to drop all of the current proposals on condition that:
a) he sponsors a much more *modest* reform bill that implements either the French, German, Swiss or Japanese systems;
and
b) he guarantees broad Republican support for said bill.

In return, the left wing of the party will agree, under duress you understand, to accept this watered down "non-government-run" reform. It won't be easy but they'll struggle through.

Meanwhile, congratulations go to visionbrkr for also misconstruing HR676 as an proposal for the British system. Meh, "socialized medicine", "single-payer system", "British system", "Canadian system", they're all the same. Why bother knowing what the differences are? It'll only confuse people.

The second place award (in the "You Lie!" category) goes to msoja for also deciding to throw his dictionary in the trash. Apparently, the terms "lower costs" and "better outcomes" are now synonymous with "life expectancy".

Posted by: AndrewNYC | September 23, 2009 11:48 AM | Report abuse

Hmm...that should have been "his own" and not "his party's". Though, sometimes, it's difficult to tell to which Party Conrad belongs.

Meanwhile, the irony of making a language mistake in a comment about language has not escaped me.

Posted by: AndrewNYC | September 23, 2009 11:53 AM | Report abuse

=You're lying, Klein. Meyer at his Coyote Blog makes the overwhelming case that, "Removing just two factors – death from accidents (mainly car crashes) and murders – vaults the US to the top of the [life expectancy] list."=

I'd like some proof of that, but even then, it's mostly a red herring. What matters are things like denial of coverage, survival from disease, cost per capita, etc.

=In France, for instance, the government provides all basic insurance coverage directly.=

From what I've read, they basically cover all high-cost treatments and 80% of the cost of everything in general. The rest is covered by supplementary insurance, purchased from either private insurers or non-profits, and often from the employer. There are subsidies if you can't afford it still.

That's somewhat similar to the Singaporean model, although the latter automatically re-directs some of your paycheck into an equivalent of an HSA as opposed to allowing you to buy supplementary insurance.

I like both, although I should point out that they both are set-up in the context of heavily unitary governments. The US is highly federalistic, so Germany might be a better example to look.

Posted by: guardsmanbass | September 23, 2009 11:56 AM | Report abuse

google is a beautiful thing!

Here is the testimony that I speak of in writing first and then via youtube:

http://www.manhattan-institute.org/html/testimony_gratzer_6-24-09.htm


http://www.youtube.com/watch?v=cwlB3FZQ7go&feature=related


look to around 58:30 of the youtube to see it live.


Posted by: visionbrkr | September 23, 2009 12:03 PM | Report abuse

Well, I guess msoja punked me. I went to this "Coyote Blog" looking for the "overwhelming case" made that our life expectancy is actually top of the list if you factor out murders and car crashes, and of course, there is no such thing. What there is is a quote from Reason which in turn quotes an AEI book on health care, but of course there are no numbers. I find it difficult to believe that the homicide and/or accident rate is sufficient to make up the 6+ years that separate US life expectancy from the top countries in the world.

But hey, msoja, if you think you've got some actual numbers and not just bs, let's see 'em.

Posted by: gedwards1 | September 23, 2009 12:07 PM | Report abuse

endaround,

Oh, ok. I guess you're splitting hairs between single payer and the NHS model? So maybe TECHNICALLY you're right at the onset but its a very slippery slope to the NHS system. Sure Weiner's single payer system will be "Americanized". It doesn't mean that its right or that it will work.

Posted by: visionbrkr | September 23, 2009 12:08 PM | Report abuse

Dumb ol' hair-splitting endaround, actually distinguishing between different concepts and using different words to refer to them! How elitist.

Posted by: gedwards1 | September 23, 2009 12:16 PM | Report abuse

gedwards1,

well I don't know where you get your 6 year figure from but that's ludicrous. See below for what I've found.

http://www.infoplease.com/world/statistics/life-expectancy-country-2009.html

We're 78.1 and that is increasing. I assume when we get to a more universal coverage that number will also go up. A large factor of it is not just accidental deaths and murders but its a part. Another part is obesity as Dr gratzer points out in the single payer congressional panel that I linked.


See below for disturbing statistics on obesity rates in US as compared to other countries. Everyone knows that obesity leads to diabetes, heart disease etc. that leads to HIGH COSTS for insured and uninsured alike. Take a good look at this and see where France and Germany are at as compared to the US. I don't profess to know how accurate these statistics are either I just googled "obesity rate in the world" and it was the top one that came up.

http://www.nationmaster.com/graph/hea_obe-health-obesity

Posted by: visionbrkr | September 23, 2009 12:21 PM | Report abuse

gedwards1,

you can be as obnoxious as you like but as I said I'VE PROVIDED FACTS. You've provided rhetoric.

i'll gladly click back here when you admit that you're wrong.

Posted by: visionbrkr | September 23, 2009 12:23 PM | Report abuse

To msoja and visionbrkr: When health care experts talk about better "outcomes" they aren't talking about life expectancy, which as you point out is the result of many factors. They are talking about outcomes from specific diseases or specific conditions. So unless the doctor murders the patient on the operating table, the murder rate has nothing to do with it.

Posted by: moore_te | September 23, 2009 12:51 PM | Report abuse

gedwards1 - The AEI book is Ohsfeldt's and Schneider's 'The Business of Health', out in 2006.

There's more info and plenty of links on the subject at:

http://blogs.wsj.com/numbersguy/does-the-us-lead-in-life-expectancy-223/

Klein's contention is fatuous, at best, and dishonest, at base.

Posted by: msoja | September 23, 2009 12:52 PM | Report abuse

Re: Life Expectancy
Generally, economists find that within industrialized countries, income has a large statistical impact on life expectancy, and interaction with health care, not so much so.

E.g.
http://www.nationalcenter.org/NPA547ComparativeHealth.html

You can read or consult the references at the bottom. Also, a rudimentary internet search on the topic will yield many decades' worth of top quality academic research.

The U.S. is a rich country, but has more skewed distribution of income and wealth than other such countries. So-called European welfare states have larger programs that transfer wealth from the rich to the poor, and that likely brings up the sort of baseline health and living standards for the poor many times more than it reduces it for the wealthy, so average life-expectancy increases.

Economists often prefer pure transfers to targeted susbsidies because it gives consumers the ability to make the choices to maximize their utility. As an example, imagine a poorer citizen that has to endure numerous factors that will affect his or her mortality. What are those factors: Perhaps an older, less safe automobile; living in a high crime neighborhood; low quality food; no access to exercise or recreation; poorer air or environmental quality (despite regulations on environmental justice); in general, a lifestyle highly likely leading to a relatively short life span. Suddenly introducing free health care may help some, but the weight of these other factors is likely to great to be offset in any meaningful way.

That is not to say that there are not meaningful reforms needed in U.S. health care. But sending more people to the doctor is but a tiny fraction of overall public health. (I am willing to bet you'd get a huge improvement to public health merely by imposing a massive "sin" tax on restaurant meals).

Posted by: Wallenstein | September 23, 2009 12:52 PM | Report abuse

Thank you. These guys aren't used to having the smoke they blow fact checked.

Posted by: SarahBB | September 23, 2009 1:18 PM | Report abuse

gedwards1,

i'm not surprised but still waiting.

Wallenstein,

I agree totally with you. Access to care will help but until we get our statistics back in line with the rest of the world it will only be a dent in life expectancy.

Some or your points though carry more water than others. McDonald's sells salads too for not much more than a Triple Cheeseburger but i'll bet that the Triple Cheeseburger is a much bigger seller.

No access to exercise is just an excuse. Walk around your neighborhood. If you live in a bad neighborhood, walk around your house. There are always options and even more excuses not to use those options.

Posted by: visionbrkr | September 23, 2009 1:19 PM | Report abuse

"Removing just two factors – death from accidents (mainly car crashes) and murders – vaults the US to the top of the [life expectancy] list."

Let me just clarify this statement a little because I'm sure I'm not the only one confused. If we remove murder and car accidents as factors from all countries life expectancy, not just from the US, it would vault the US to the top? If thats the case, can you provide the link?

Posted by: sicksidvt | September 23, 2009 1:45 PM | Report abuse

Our system is rigged for the insurance corporations, period. We are all(except for Medicare) one paycheck away from having no health insurance. When the businesses raise the rates too much, or drop coverage to save money, and you're standing on the sidewalk wondering what happened, don't come crying to me. Go knock on Grassley's and McConnell's doors. Grow up, the U.S. dosen't always get it right.

Posted by: jckdoors | September 23, 2009 2:58 PM | Report abuse

"I guess you're splitting hairs between single payer and the NHS model? So maybe TECHNICALLY you're right at the onset but its a very slippery slope to the NHS system."

Bullpucky. Canada hasn't slippery-sloped anywhere near the NHS model, and it gets pretty icy up there.

Conflating HR676 and NHS-style government provision is a tactic for dumbasses or the deceitful. I'm going to grant that you're not a dumbass. So, TECHNICALLY...

Posted by: pseudonymousinnc | September 23, 2009 3:57 PM | Report abuse

pseudo,

well because Canada hasn't slipped to there that means we can't??? To me it all depends on where you take it from your version of single payer once its proven that it doesn't decrease costs and it gets to be unsustainable.

And what is it you do for a living again???

Here you go, just fill in

the blank, ________________

I'm trying to make it SOO EASY for you to be truthful. For all our sakes just tell us what it is you do for a living, please. Otherwise how can i take anything you say seriously???

Posted by: visionbrkr | September 23, 2009 4:33 PM | Report abuse

visionbrkr,
I just threw some stuff out there in what would be a long list of adverse factors on the health of poor people. But I wouldn't want to go for a jog in a bad neighborhood after work!

Posted by: Wallenstein | September 23, 2009 4:36 PM | Report abuse

"well because Canada hasn't slipped to there that means we can't???"

That's really pretty lame. No surprise, then, that it's the McArdle argument, helpfully demolished here:

http://crookedtimber.org/2009/08/12/mcardle-vs-national-health-care/

And I've told you before, I really don't want to buy what you're selling.

Posted by: pseudonymousinnc | September 23, 2009 5:26 PM | Report abuse

pseudo,

If i promise to NEVER sell you anything will you tell me what you do to pay your bills, live your life of luxury? Do you even have a job? If so how well does it pay? As you know I'll be out of a job soon and I'm looking around for gainful employment seeing as my deal with the devil is almost up.

Posted by: visionbrkr | September 23, 2009 11:18 PM | Report abuse

Sit, Blue Dog, sit! Good, Blue Dog! Nice, Blue Dog! Now be a good little doggy and lie down and play dead! On second thought, lie down and stay dead! GOOD boy!

What gives here anyway? I grew up believing that the Democratic party was the "party of the people"! I was reminded of this again last weekend when I made a little pilgrimage to the FDR Library in Hyde Park, NY. President Roosevelt ushered regular people like you and I into the twentieth century. He brought electricity to the rural south! The middle class that we all now take for granted - which hadn't even existed prior to the New Deal - is now in serious danger of vanishing. Look around you. The signs - ominous and disturbing - are all there. The entire reason for the existence of the Loony Right Wing since 1964 has been to roll back the advantages gained by the New Deal and the civil rights movement. Do you think I'm being an alarmist? Fine. Just keep sending these Right Wing extremists and these Blue Dog Democrats to Washington and see what happens.

The Democrats are not going to distinguish their party by trying to sell themselves as Republican Lite. They're not going to turn America around by foolishly preserving the policies of the last thirty years. They need to educate their constituency by showing them the folly of their abhorrence of things "Left" and "Liberal". Three-quarters-of-a-century ago, American democracy was saved by a government that was decidedly left-of center in all but a few areas. It can happen again. But it's only going to happen if WEEDA PEEPOLE refuse to turn right at the next crossroad. It is only down the road.

http://www.tomdegan.blogspot.com

Tom Degan
Goshen, NY

Posted by: tomdeganfrontiernetnet | September 24, 2009 6:57 AM | Report abuse

T.R. Reid needs to make a personal presentation to the entire Democratic Caucus -- both House and Senate. And he needs to meet with Obama and all WH domestic policy advisors.

Posted by: mdargo | September 24, 2009 9:51 AM | Report abuse

Conrad is the paid shill of the insurance lobby. He addresses Progressives and demonstrates he is either a huckster or completely incapable of absorbing a book he says he read. Either way, he helped create a terrible bill with Baucus. It will bankrupt the middle class. Fight it if you think your financial future is important.

Posted by: BlinkThink | September 24, 2009 11:28 AM | Report abuse

"Removing just two factors – death from accidents (mainly car crashes) and murders – vaults the US to the top of the [life expectancy] list."

But what happens when you consider those two factors when evaluating the life expectancy of the other nations as well? Wouldn't their average life expectancies go up also and hence would the US slip back down on the list?

Your argument is the equivalent of saying, "Well, if my aunt had balls, she'd be my uncle."

Posted by: puakev | September 24, 2009 3:40 PM | Report abuse

I could almost imagine some sort of organization with a staff of researchers and writers, and a way to publish what it learned, asking Sen. Conrad about this contradiction. Almost.

Posted by: AlanSF | September 24, 2009 5:42 PM | Report abuse

"They're not government-run systems in Germany, in Japan, in Switzerland, in France, in Belgium -- all of them contain costs, have universal coverage, have very high quality care and yet are not government-run systems."

WTF is he talking about? I live in Japan, and we certainly do have a government-run system. It works very well, too (not perfect, but IMO much better than the US "system").

Posted by: Hokuto | September 24, 2009 10:00 PM | Report abuse

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