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Why France's Health Care Is So Good, The Public Option So Bad and the Co-Ops So Incomplete: An Interview With Kent Conrad.

PH2009072701198.jpgSen. Kent Conrad chairs the Budget Committee, serves on the Finance Committee and was a member of the Gang of Six. I spoke to Conrad today about what Americans can learn from other health-care systems, why he opposes the public option and what felled the Gang of Six.

Let's talk about T.R. Reid's The Healing of America.

I think that book is very instructive in terms of analyzing alternative systems around the world for possible lessons for us, not that we're going to adopt some other country's system, as we're not. We won't adopt the German system or French system or anything of the like. But I think we can get clues on the fundamental differences of various systems. In the book, he talks about four different kinds of systems. The Bismarck model, which is like Germany, the Beveridge model, which is like England, the national health insurance model, which is like Canada, and then out of pocket.

The distinction he makes between the Bismarck model and the Beveridge model is a very important distinction to keep in mind for the debate here. Both achieve universal coverage, Both have quality outcomes. Both are less costly on a GDP basis than ours. But there are big differences. In the Beveridge model, which is Great Britain, waiting lines are an issue. The Bismarck model, which has largely been adopted in France, Germany, Japan, Belgium and Switzerland, is not government-run. That doesn't mean there's no government involvement. But it's not a government-run system. They have largely private insurance, with employers contributing.

The big difference between those systems and ours is that private insurance is not-for-profit insurance. That is the distinction he draws. They're not government-run. The major role for government is to help people who can't afford coverage on their own. That's the proper role.

But that runs over some fairly large variations. In France, for instance, the insurance really is government-run. The vast majority of people are on public insurance, and there's private supplementary insurance atop that. So too with Japan. They're not confined to simply subsidizing the poor.

But it's not government-run. The doctors and hospitals are private. You're right that in France there's more of a government involvement beyond providing money for those who can't afford coverage. There's a regulatory involvement in terms of what's required by the plans. But the plans themselves, the mutuals, are not government.*

You're talking about France here? Not Germany?

Both of them. The intermediaries are not-for-profits. The model is universal. Employers contribute. Reid says we are in part a Bismarck model, where employers contribute. Part which is that Beveridge model, like the Indian Health Service and the Veterans Health Service. We have a national health insurance model with Medicare. And then out-of-pocket for people with no coverage. We have a real mixed system. We really don't have a system. That's kind of what you get down to.

I remember being at the Prepare to Launch event that kicked off the Senate Finance Committee's work. Sen Baucus spoke, and so did T.R. Reid. But building what Sen. Baucus calls a "uniquely American" system seemed to limit our ambition. A lot of people would look at the British and French and Canadian and Germany systems and say, sure, much separates them, but what unites them is they pay half what we do, cover everyone, and get comparable outcomes.

Actually, some of them have outcomes better than ours.

But we decided not to change that much. The real lesson from Reid's book is that we do this badly. If the French came up with a great new medical procedure, we wouldn't say that's just some French procedure. We'd adopt it. But when they come up with a better way to do health care, we dismiss it as French, and inapplicable.

Yeah. We don't want anything to do with it. He talks about that in the book. It's an odd thing.

How much of this is a product of political systems? Reid has a line in the book where he says the difference between America and France is that the French love their system and change it all the time. The Americans hate their system and can't seem to touch it.

It's fascinating, isn't it? I just don't know. I've been trying to figure this out for a long time. I was very involved back in the '90s reform effort. I was part of the Chafee-Durenberger centrist alternative to the Clinton plan. I've been searching ever since for models that I thought would fit America's values and American culture. I've felt for a long time that a system that's not government-run, but does have universal coverage, does a good job on quality and containing costs, and has the elements we see in some of these other countries is most likely to fit here and win political acceptance and be effective. Somehow in this debate, we've gotten very sterile. If it's not public option, somehow it won't be effective at providing competition to the insurance industry. I just don't think that's what the Reid book shows or what other observers of international systems would conclude.

The question of values always runs into the existence of Medicare. You can imagine people saying that Medicare was simply too government-driven when President Johnson was trying to enact it. But Americans love Medicare.

I've thought about that a lot. T.R. Reid's book is so interesting on this point. Different parts of our system fit different models. Part fits the Beveridge model. Part fits the Bismarck model, where employers and employees contribute and it's private doctors and hospitals. And other parts are national health insurance, which is Canada, and that's Medicare. For our senior citizens, we have adopted the model that is closest to the Canadian model. But there are serious issues with that model if it spreads society-wide in terms of waiting times. I don't think that fits American culture.

Isn't that a simple question of funding, though? The Canadians spend much less than we do, as do the British. If they spent as much, they'd presumably not wait as long.

But if that system spread nationwide, I would be concerned that we would wind up in the waiting lines issue. I think America would be much less accepting of waiting lines than the Canadians or British have proven to be. France and Germany and Japan have no trouble with waiting lines. But in Canada, [it can take] months to see a specialist for your shoulder.

One more question before we move to the public option. We can agree that Clinton's plan was much more ambitious and transformative than this plan. It would have done much more to change the average American's system.

Can I interrupt you for a second? When we were working on that plan, a high official in the Clinton administration came to see me and said, "What do you think, Kent?" I said I'd spent hundreds of hours trying to understand how this will work, and I didn't understand it. He laughed, and he said, "Don't tell anybody, but I don't understand it either!" That;s a true story. I won't out who it was. But a high official!

But for all of its ambition and all of its flaws, the political trajectory was very similar. Obama is doing a bit better, but back then, there was one solid Republican vote in Sen. Jim Jeffords, there were angry grassroots events, and lots of lies and anger and polarization. It's been striking how much the two plans have not created a different political conversation. No Republicans say they've really trimmed their ambitions on this. They're really trying to take into account American values and culture.

It's very striking. I don't know. It's incredibly hard to do.

When you were involved in the Gang of Six, you produced a plan very similar to the one we're looking at. It's also a plan similar to the one proposed by Sen. John Chafee, a Republican, in the '90s. And it's very similar to what the Republican members of the Gang of Six said they wanted. But it emerged without their support. What happened? What lesson did you take?

I honestly don't know. I think part of it is we ran out of time. We were very close to reaching a conclusion. Now whether or not the politics would have ever permitted all three of the Republicans to agree, I don't know. But I can tell you in those discussions, right up to the end, they were very collegial. They were very professional. There appeared to be solid agreement on the outlines of the plan. If somebody had participated in those discussions, I don't think you could have said there was an ideological divide or a partisan divide. it was very professional discussion. You know, we met 61 times.

It seemed that as time went on, agreement became harder. The politics made it more difficult.

You're right about the politics making it more difficult. The dynamic in that room was very positive and very constructive. We kept making progress until we just sort of ran out of time. I felt we were getting to the point where we were reasonably close. Several more weeks, and there might have been an agreement. But that's outside the political discussions.

Do you support the public option?

No.

Why?

I go back to the T.R. Reid book. I don't think a government-run plan best fits this culture. A plan that's not government-run has the best chance of succeeding in being passed into law.

Second, and this is very important to my thinking, the public option as defined by the committee of jurisdiction in the House, the Ways and Means Committee, is tied to Medicare levels of reimbursement. My state has the second-lowest level of Medicare reimbursement in the country. If my state is tied to that reimbursement, every hospital goes broke.

People say, "Just fix it." I've been on the Finance Committee more than 15 years. I've been trying to fix the unfair aspects of Medicare reimbursement all the time. We run into the House. Membership is determined by population, and the big population states write levels of reimbursement that unfairly treat hospitals in states like mine. My hospitals get one-half as much as urban hospitals to treat the same illnesses.

What about a public plan that can't use Medicare rates?

There are discussions going on about that. Obviously, it would be very important that it would be clear that it's not tied to Medicare levels of reimbursement. Those of us in low-reimbursement states would have our health infrastructure put at risk.

I was also struck when I read the chairman's mark that the co-op option seemed shackled. It couldn't sell to large employers. It couldn't set payment rates. The co-ops are not public. But they were being prevented from competing with insurers on a level playing field. It seemed like private insurers were being protected from competition.

I think there are things I would like to see that would make certain co-ops be given the full ability to compete that others are.

So you would like to see those restrictions lifted.

I would.

Why are they there?

Because that came out of the Group of Six discussions.


*The French mutuals provide supplementary private insurance. Basic insurance is provided by a program the French call Social Security.

Photo credit: AP Photo/ABC News, Fred Watkins.

By Ezra Klein  |  September 24, 2009; 6:00 PM ET
Categories:  Health Reform , Interviews  
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Comments

Ezra,
Why not question Conrad's assertions about fitting "our culture"? Social Security and Medicare seem to have become part of our culture pretty rapidly...

Posted by: michaelterra | September 24, 2009 6:14 PM | Report abuse

You never bothered to ask whether he'd simply approve of changing our system into one more like France's and Germany's.

Posted by: constans | September 24, 2009 6:20 PM | Report abuse

It doesn't fit our culture is the lamest argument I have ever heard. Does dying from untreated illnesses because of lack of insurance fit our culture?

Conrad totally dodged the question of waiting lines for procedures (remember we are talking elective procedures, not life threatening issues where there is no waiting time). Waiting lines are solved by increasing the supply of providers which costs more money. There would be no waiting lines if canada or britain spent 25% more on health care and it would still be cheaper than the US system.

Conrad says they only needed more time. What a lie! How many more months do they need. Health care has been on the table for 8 months! What is taking so long? It is clear that the repiglicans were stalling to give opponents time to stir up opposition to the plan by blatantly lying about the provisions repeatedly. Death panels? Abortion funding? Illegal immigrants getting subsidies? ALL LIES!

Ezra, you needed to push harder to expose the inconsistencies that Conrad spouted.

Why not ask the obvious question: All of the European insurance companies are either non-profit or heavily regulated. Does Conrad support the transformation of US insurance companies to this model? Why or why not? Aren't for profit insurance companies a big part of the problem?

Come on Ezra, put some effort into nailing down Conrad's contradictory statements.

Posted by: srw3 | September 24, 2009 6:25 PM | Report abuse

"I've been searching ever since for models that I thought would fit America's values and American culture."

This guy is an idiot. It's not about culture. People don't understand this issue well. The system overtaxes our society in hidden ways that the people don't appreciate, and people who are "covered" are afraid of losing the lousy, overpriced crap that they have.

If people acted rationally as the conservatives claim they do, each and every one of us would fix the problem by demanding Congress scrap the current system and put together one that would provide equal medical treatment regardless of income.

Someone please tell Conrad that repeating over and over that these countries' systems are not government-run does not make this assertion true.

Posted by: bcbulger | September 24, 2009 6:27 PM | Report abuse

An excellent interview, offering an interesting tilt which doesn't seem to be coming forth in current Senate discussions.

Is it possible that the process IS going too fast and that some additional consideration is needed? Or will this all come up in floor debates once a bill is out of committee?

Posted by: rmgregory | September 24, 2009 6:28 PM | Report abuse

"It's an odd thing."

Yeah, wow! It is so odd that people fail to understand or adopt perfectly good systems from other countries with people like Conrad explaining/obfuscating them.

Posted by: bcbulger | September 24, 2009 6:29 PM | Report abuse

"I would be concerned that we would wind up in the waiting lines issue."

Hey Ezra, don't you find it interesting how he completely disregards your point about the funding and just implies that the waiting lines would continue regardless of how much money, doctors or resources existed.

Boy this guy is sharp! (heavy sarcasm intended)

Posted by: bcbulger | September 24, 2009 6:34 PM | Report abuse

Ezra - Watching my former hero turned corporate media employee lob softballs to this truly evil, corrupt pig turns my stomach. I hope WaPo is giving you great health insurance. Not that it matters as you're young. Wait til you get older and try to switch to private insurance. Then your interview style might become just a wee bit more confrontational.

Question #1: How do you reconcile the millions you've taken from the industry with your actions to represent them instead of your constituents' best interests?

Posted by: akmakm | September 24, 2009 6:34 PM | Report abuse

Oh my God! He didn't understand the Clinton plan! What a shock!

The Clinton plan must have been horrible because Brainiac Kent couldn't understand it!

"I've been searching ever since for models that I thought would fit America's values and American culture."

Posted by: bcbulger | September 24, 2009 6:39 PM | Report abuse

I have to agree that, whatever your political position on this issue, Conrad's answers just don't make sense. He is as bound by rigid ideology as anyone. It may not be orthodox conservative or liberal ideology, but it is rigid all the same. By personalizing the issue as much as he has and by isolating himself behind his "beliefs", Conrad is not serving the best interests of either his constituents or Americans in general. He is a poster child for the term limit argument.

Posted by: Azdak | September 24, 2009 6:40 PM | Report abuse

"Because that came out of the Group of Six discussions."

Wow! Another revelation! This guy is so honest and up front, I wish he were my Senator - NOT!

Posted by: bcbulger | September 24, 2009 6:46 PM | Report abuse

Yeah, what is this obsession with the #*#& waiting lines?

Regular people who don't have health insurance and need to go ERs or county health clinics know all about waiting lines.

I live in the Chicago suburbs and it can take 4-6 weeks to get an appointment with certain specialists.

Not to mention those out of work who must pay high deductibles or those w/out insurance who must wait to save up money to pay for a procedure or a doctor visit. I had to wait 8 weeks this summer to have some important lab work done because I had not satisfied my deductible, am out of work, and had to take care of some acute medical issues with my kids first that used up any available income.

Don't talk to me about "waiting lines"--that's just another excuse for "keep the status quo".

Posted by: Azdak | September 24, 2009 6:47 PM | Report abuse

"I don't think a government-run plan best fits this culture."

We should all get behind Kent Conrad's campaign to protect our "culture," however he conveniently defines it for his own ends. Why would we want good health care at a reasonable price when we have culture?

Posted by: bcbulger | September 24, 2009 6:49 PM | Report abuse

He doesn't know the difference between government-provided insurance and government-run hospitals?? Oy.

And, unfortunately, I have to agree with the assessment of the interview's quality. Oy. A chance to educate a maroooon, but...

Posted by: AZProgressive | September 24, 2009 6:53 PM | Report abuse

Gotta agree with the gist of these comments: you failed to press Conrad on his stupidity and as such it will crystallize as Serious Wisdom from a Committed Bipartisan. Compared to your interviews with Rockefeller and Wyden, this is a vastly inferior effort, to put it charitably.

Posted by: scarlota | September 24, 2009 7:06 PM | Report abuse

Once again Conrad got away (with nary a whiff of objection from the interviewer) with the outright lies about foreign systems not being government programs.

I guess Senators and Congressmen get equipped with Star Wars 'forces' (mostly dark side) that make them immune to being asked pointed, directed questions. The reporter's estrogen or testosterone just gets drained away at the start of the interview.

Hey, I get that Access may be jeopardized in the future if Jedi powers are exhibited by hard questions, and Access is the second (or first?) requirement of journimalism of the corporate variety.

This just makes me want to projectile vomit: "Because that came out of the Group of Six discussions." So, if the gang of six decided in secret that only briefs and no boxers would be allowed on patients, that would be fully justified.

Posted by: JimPortlandOR | September 24, 2009 7:08 PM | Report abuse

Your hypocrisy is now official...

But two factors made the flip-flop more egregious. One was the rhetoric that Democrats used to defend the initial effort to strip gubernatorial appointment power. Many legislators argued that the power to choose U.S. senators ought to reside with the voters, not with one person.

http://www.politifact.com/truth-o-meter/statements/2009/sep/24/massachusetts-legislature/massachusetts-legislature-flip-flops-governors-sen/

Posted by: kingstu01 | September 24, 2009 7:20 PM | Report abuse

I really can't believe that Conrad is that dumb, so let's assume he's being disingenuous for public consumption. And if that doesn't pass muster, then let's assume he's that dumb.

(I don't see those questions as softballs so much as Ezra biting his lip at the the conflations and soggy definitions.)

Can you interview TR Reid, Ezra, with reference to this transcript? I'm sure the Post has his number, for obvious reasons. And I have visions of Marshall McLuhan in 'Annie Hall'.

Posted by: pseudonymousinnc | September 24, 2009 7:21 PM | Report abuse

"Your hypocrisy is now official..."

Oh, kingstu01: you were going to tell us all about the healthcare system with no government involvement that works better than anything else. Can you and msoja and the other libertarian bots discuss it and come up with an example?

Posted by: pseudonymousinnc | September 24, 2009 7:23 PM | Report abuse

I used to believe Conrad was one of the smarter Senators. If he is, I now understand why we are in such a mess.

Posted by: lensch | September 24, 2009 7:30 PM | Report abuse

While I'm not feeling as harshly about the interview as some commenters, you did skip some important issues. The first that comes to mind is funding options- where does Conrad want to get the money to fund this? Why does he oppose limiting tax deductions for the very rich, a truly progressive idea? He is, after all, Budget Committee chair.
Second, where is he on the filibuster question? Will he vote to uphold a Republican filibuster?

Posted by: sideshow1979 | September 24, 2009 7:37 PM | Report abuse

kent conrad is competing with joe lieberman for the title of most unlike a senator in the democratic party


Posted by: jamesoneill | September 24, 2009 7:49 PM | Report abuse

Re-reading the transcript, I'm frankly astonished. And disturbed.

Half of what Conrad says is just banal reiterations of the summary that Reid provided in his recent WaPo op-ed. This is stuff that Ezra and most of his long-standing commentariat already knows. It's filler.

The other half suggests that Conrad doesn't actually understand more than Reid's broad general distinctions, conflates, doesn't grasp things like the French tarif system or the distinction between the Securité and the mutelles or the stipulation that serious illness receives full reimbursement, and so on.

This is the guy who apparently came up with the co-op model on the back of a napkin in his Senate office one evening, and expects people to jump on board and applaud his grasp of healthcare policy? Staggering.

Posted by: pseudonymousinnc | September 24, 2009 7:49 PM | Report abuse

Oh, and one thing you might have asked is whether he thinks that North Dakota is well-served by having a single private corporation handle 90 per cent of health and accident insurance, and how his blessed magic co-ops would handle an environment dominated by BCBSND.

Posted by: pseudonymousinnc | September 24, 2009 7:51 PM | Report abuse

Dumb, Ignorant or Lying. None is very flatering for Conrad, but it's hard to escape that one or more of those things apply.

I also don't think Ezra was tossing softballs or failing to follow up. He did follow up on several of Conrad's more head scratching statements. Conrad just dug in deeper. I think Ezra was less trying to confront Conrad than get him on the record, follow up to give him a chance to correct and error, and then let Conrad's error hang there if Conrad chose not to correct it. Ezra can later come back in to write what he thought about the interview and confront in that fashion.

I can be hard on Ezra, perhaps unreasonably at times. I thought he was fine here. This is far from "transcribing" since we know Ezra has and will pick apart the items he feels are flawed.

John

Posted by: toshiaki | September 24, 2009 7:57 PM | Report abuse

My point is that Ezra is giving a legitimate forum to a guy who takes millions from health insurance companies in return for mountains of legislative quid pro quo, and Ezra is treating him like as if he's a straight up legislator without this ridiculously obscene conflict of interest tatooed across his smarmy white forehead. When you let their lies, obfuscations, and conflicts of interest go unchallenged, you're part of the problem. No two ways about it.

It's no different that it is when Cheney reiterates for the 1000th time that Saddam was directly connected to 9/11 and the interviewer doesn't challenge him.

Posted by: akmakm | September 24, 2009 8:11 PM | Report abuse

I guess the main controversy here is how confrontational and persistent can American journalists be. Can Ezra be confrontational (if that is in him) and continue to get the "good gets"? I think he should work on it...I'm hoping he will work on it...

Posted by: michaelterra | September 24, 2009 8:19 PM | Report abuse

You're great Ezra, but I gotta agree you really failed to followup here re: waiting lines. As aggravating as a guy like Chris Matthews is, there's no denying that if his guest completely dodges a question he will go back and ask it again and again until the guest gives an answer.

Also, I'd be interested in you writing a future post regarding Conrad's claim that tying the public option to medicare reimbursement rates would make ND hospitals go broke. Is this correct?

Posted by: EricthePoliticalHack | September 24, 2009 8:24 PM | Report abuse

Wow, you guys are really being hard on Ezra. He asked Conrad a question, Conrad gave him a bad answer, he followed up to allow Conrad to claw back a bit and Conrad instead dug in deeper. I don't think it's particularly good interviewing to lecture the subject and even worse to spend a finite amount of interview time harping on one issue where the interviewee refuses to give any ground. What is gained if Ezra spent five questions on whether T.R. Reid said that the French system is a government or private system? Conrad clearly doesn't understand the French system and probably still wouldn't understand it if it was explained again. He may very well not like being lectured by Ezra and just end the interview.

Ezra got his positions on the record. Now he can write posts about how wrong Kent Conrad is about everything. I sure wish some of these interviews would get play beyond Ezra's blog because he's gotten people to say some interesting things that should be brought up in a bigger venue.

Posted by: MosBen | September 24, 2009 9:24 PM | Report abuse

My question to Conrad, "Are you going to filibuster with the Republicans to defeat the Public Option? Are you willing to lose your chairmanship in order to side with the Republicans?"

Posted by: cmpnwtr | September 24, 2009 9:59 PM | Report abuse

thanks MosBen, and also toshiaki.

Personally I don't want Ezra to become confrontational. Sooner or later we have to remember what it used to be like to let reason operate without having to raise voices.

Posted by: rosshunter | September 24, 2009 10:11 PM | Report abuse

"Personally I don't want Ezra to become confrontational. Sooner or later we have to remember what it used to be like to let reason operate without having to raise voices."


kent conrad is given a place to put his thoughts and ideas on record, and the messenger gets mistaken for the message.

many people are trained now to a diet of red meat and boiled frogs.

Posted by: jkaren | September 24, 2009 10:53 PM | Report abuse

When I saw Mr. Pennypincher today on C-Span voting not to claw back $100 billion in PhRMA's ill-gotten gains, I decided I've heard all I need to hear from this man.

Posted by: bmull | September 24, 2009 11:12 PM | Report abuse

"many people are trained now to a diet of red meat and boiled frogs."

True, but a test of whether Ezra has been assimilated into Village journalistic practices at the WaPo is whether he can point out the half-thoughts and misrepresentations in Conrad's words, or get T.R. Reid to do it for him. Letting them stand as if they're factesque will not do.

Posted by: pseudonymousinnc | September 25, 2009 1:17 AM | Report abuse

A longer waiting time to see a doctor in Canada and France? Oh, so that explains why those folks live longer.

Posted by: leifrakur2 | September 25, 2009 1:33 AM | Report abuse

"Both of them. The intermediaries are not-for-profits. "

This is technically true, but far from complete. Conrad fails to mention that out of the funds, one of them basically covers almost the entire population. Not to mention that their rates, funding, and premiums are set by the government, and that the government picks up the bill for 70-80% of the costs of care.

It's basically like an almost-complete single-payer system.

The German system is more complicated - there are a bunch of non-profit funds, but their management and rates are set by a single agency, if I recall correctly.

Posted by: guardsmanbass | September 25, 2009 2:04 AM | Report abuse

How is it possible for Senator Conrad to be aware of the gross inefficiencies of our system, and the indefensible additional deaths to which it gives rise (to say nothing of lives lived less fully because of inaccessible health care), and do essentially nothing? He claims to have been searching since his participation in the "centerist" alternative that killed Clinton's reform effort for a more effective health care model that would fit our culture. That and a couple of bucks will get him a cup of coffee. What matters is that his actions then and in the years since have served no one but the insurance companies and drug companies who have so generously supported his political career.

It is past time to call these political leaders what they are - accomplices to murder by spreadsheet. It is also past time to do something about it.

Posted by: eroot | September 25, 2009 2:05 AM | Report abuse

What an evasive nonsensical bastard, but I suppose he's *our* evasive nonsensical bastard.

Posted by: zosima | September 25, 2009 3:00 AM | Report abuse

Whoever thought Republican TownHollers had a monopoly on being completely insane should read this.

Here is Kent Conrad talking about the Gang of Six: "But I can tell you in those discussions, right up to the end, they were very collegial ... If somebody had participated in those discussions, I don't think you could have said there was an ideological divide or a partisan divide. it was very professional discussion. You know, we met 61 times."

And then why did the "co-op" plan evolve to be so amazingly crappy as to to include anti-competitive restrictions that even Kent Conrad (gasp!) supports?

"Because that came out of the Group of Six discussions."

I think the interview is actually quite helpful in showing that the odds of a rational and informed debate with Kent Conrad on health care reform is roughly in the same ballpark as the odds from a discussion with a TownHoller. And at least TownHollers weren't able to delay reform by meeting 61 times.

Posted by: ArininSF | September 25, 2009 4:53 AM | Report abuse

Request for Ezra:

Can you please ammend your asterisk-ed comment about the truth regarding French insurance?

Reads now: "*The French mutuals provide supplementary private insurance. Basic insurance is provided by a program the French call Social Security."

SHOULD read: "*The French mutuals provide supplementary private insurance. Basic insurance is provided by a GOVERNMENT (PUBLIC) program the French call Social Security."

Posted by: ArininSF | September 25, 2009 5:03 AM | Report abuse

So much of the health care program has to be approved on how it is to be payed for that it seems to me that at least 4 top brains in the world of finance ought to be summoned to Washington DC and not let out of a conference room until they have come up with what they and others feel is the best plan possible for the United States government and citizen representatives to agree on how it is going to work and, most importantly how it is going be payed for. For instance, isn't the U.S. government paying a good enough salary to Mr. Timothy Geither for him to be summoned to help out. When all of that is accomplished, then it should be submitted to the House and Senate.

Posted by: allset707 | September 25, 2009 7:12 AM | Report abuse

Senator Conrad is obviously very knowledgeable about various approaches to providing health care. But, I think he mischaracterizes American values. I believe the vast majority of Americans don't really care about the mechanics of the plan as long as they get good care at a reasonable price. Sure, the insurance companies, drug companies, and some others in health industry want to preserve the golden goose but who is looking out for the average citizen? Obviously not Senator Conrad. As to waiting lines, I think we have that to a degree now. It took me four weeks to get an appointment with my primary care physician under my HMO. Of course, the cadillac fee for service plans are a different deal but we can't afford to provide those plans to everyone. So, you see we have rationing already. Conrad in effect is saying we can't provide care for everyone because that would result in lines. Too bad if you don't have coverage! Suck it up until you go broke and then you can get Medicaid.

Posted by: cdierd1944 | September 25, 2009 8:09 AM | Report abuse

I sure know that when _I_ want insight into "American Culture", the first person I'm going to ask is a senator from North Dakota!

I'm not going to take these brayings about how it is important that the health care reform fit into "American culture and values" until the Gang of Six retains Bill Bryson as a consultant.

Posted by: tyromania | September 25, 2009 8:31 AM | Report abuse

Perhaps that's what this ludicrous backlash is about; a section of the country sees this as a threat to their narrow conception of American "culture", a challenge to their monopoly on American identity-- a fear that perhaps their nostrums that America is supremely individualist and capitalistic are hollow and self fulfilling prescriptions, rather than actual descriptions.

Posted by: adamiani | September 25, 2009 9:05 AM | Report abuse

"many people are trained now to a diet of red meat and boiled frogs."

True, but a test of whether Ezra has been assimilated into Village journalistic practices at the WaPo is whether he can point out the half-thoughts and misrepresentations in Conrad's words, or get T.R. Reid to do it for him. Letting them stand as if they're factesque will not do.

Posted by: pseudonymousinnc | September 25, 2009 1:17 AM | Report abuse


I really LOVE how all of you want Ezra to rip Conrad a new one. You do realize that if he did that he'd never EVER get another interview with him, right and likely any other Centrist Democrat once word spread out? At some point you need to come outside of your bubble and see how the real world works.

Posted by: visionbrkr | September 25, 2009 9:52 AM | Report abuse

Face it folks, Conrad is bought just like the rest of Congress. They don't represent the people, they represent the corporations.

They are sending the American people our country down the tubes, whether its healthcare reform, tax reform, financial reform, or stopping the military industrial complex and CIA from running our foreign policy.

We are in deep do-do, but as long as we continue this system that allows their palms are being greased things will only get worse.

Posted by: wayoffbaseguy | September 25, 2009 9:54 AM | Report abuse

and did anyone else see Sen. Grasserly nodding off around 10:05 pm last night during the hearings?

Posted by: visionbrkr | September 25, 2009 9:55 AM | Report abuse

Wow, he's every bit the blithering idiot I had been led to believe he was. Depressing.

Posted by: gedwards1 | September 25, 2009 10:32 AM | Report abuse

All businesses want to eliminate the competition in order to maximize their profits – from the guy that runs Kinko’s – who worries about Copy Connection opening up down the street to AT&T wanting to be the only Phone Company, or Cable wanting to shut out Satellite from operating in your neighborhood.

If you think the insurance companies are going to lower their cost while having a monopoly over the process – well I’ve got a bridge to sell you …and I think Wall Street should be completely unregulated because I trust strangers with my money…and pollution is good and we should take all of the air bags out of the cars.

Unregulated markets are anarchy not democracy. The free market system is a myth. Vote your own pocket book and don’t care what happens to the millionaire strangers trying to pull the strings in Congress for their own benefit, and to eliminate competition. What's good for GM is only good for GM - not the entire market system we all depend on.

A vote against the public option is a vote against competition. And whether an individual business or market sector likes it or not competition is vital to our whole global economy. Individual agendas run at cross hairs to the vitality of our markets. Sorry fellas gotta level the playing field.

Posted by: JourneyHomeBurke | September 25, 2009 10:44 AM | Report abuse

I'm not sure Ezra needed to push much harder, as satisfying as it would be.

Just look at the comments: No one's unclear anymore about how obtuse, ill-informed and illogical he is after reading this ...

It opened my eyes.

Posted by: anthonywhite2 | September 25, 2009 10:50 AM | Report abuse

What a strange interview. Half the time it seems like he knows what he's talking about, and then he veers off in a direction completely unsupported by what he said before. Instructive of how the Senate works, I guess. Now if you'll excuse me, I need a drink.

Posted by: Chris_O | September 25, 2009 10:56 AM | Report abuse

Kent Conrad is right. Universal healthcare does not fit our culture. Our culture of greed, of which is both an enabler and full participant.

Posted by: wayoffbaseguy | September 25, 2009 11:01 AM | Report abuse

its interesting that just moments ago Senator Kerry brought up the old "car insurance" comparison while debating the age portion of rating of health policies. He said basically that "car insurers charge people more when they get points due to accidents and tickets" and inferred that it was good. So I'm guessing he's FOR charging people more who are obese and less if they live healthy lifestyles???

sorry for posting this here but of course Ezra won't catch this and won't bring it up in any post

Posted by: visionbrkr | September 25, 2009 11:04 AM | Report abuse

Fascinating. Note why Senator Conrad opposes the public option..."I don't think a government-run plan fits this culture." Which culture would that be Senator? He answers it in the next sentence "..the one that stands a chance of being enacted into law."

So the culture he's referring to isn't the larger American one, but the Senatorial one, dominated by the huge, disproportionate, for-profit interest of insurance companies that contribute to the political campaigns of many Senators, him included. Well of course a single-payer or public option (just a choice covering only about 5% of the population) would interfere with that culture, wouldn't it!

The difference between the American system and the European one is the difference between a for-profit and a not-for-profit one. The for-profit one leads to oligopoly, higher price, reduced output and poorer quality. What's to defend in that system that has anything to do with "culture?"

Posted by: corbinbrooks | September 25, 2009 11:13 AM | Report abuse

"You do realize that if he did that he'd never EVER get another interview with him, right and likely any other Centrist Democrat once word spread out?"

Possiblly so. Though I'm not sure what would be so terrible about that, if the alternative is to go Village courtier and gloss over Senator Conrad's difficulty with basic concepts as if it's somehow irrelevant here.

In the meantime, Just keep doing what you do best, which is greasing the wheels of a broken machine. That's "how the world works", isn't it? Gotta know a guy who knows a guy who can cut you a deal. As if that's not a bubble in itself. So spare us your cant.

Posted by: pseudonymousinnc | September 25, 2009 11:20 AM | Report abuse

""It doesn't fit our culture is the lamest argument I have ever heard. Does dying from untreated illnesses because of lack of insurance fit our culture?""

Very interesting that so many people were struck the same way as I was when I read that Conrad is bringing up a culture defense for not supporting the public option. Who's culture? Our culture is pretty diverse, and it's clear for Conrad "culture" is his term for political landscape.

Most of us who want real reform are trying to drag the troglodites into the light, kicking and screaming if we have to.

Posted by: delantero | September 25, 2009 11:29 AM | Report abuse

*I really LOVE how all of you want Ezra to rip Conrad a new one.*

visionbrkr, that's not what they said, and you know it. Now take that straw man and put it away: you parents have repeatedly told you that you're not allowed to play with it.

Posted by: constans | September 25, 2009 11:43 AM | Report abuse

constans,

how many examples do you need???


Here are just a couple:

Come on Ezra, put some effort into nailing down Conrad's contradictory statements.


Posted by: srw3 | September 24, 2009 6:25 PM | Report abuse


Ezra - Watching my former hero turned corporate media employee lob softballs to this truly evil, corrupt pig turns my stomach. I hope WaPo is giving you great health insurance. Not that it matters as you're young. Wait til you get older and try to switch to private insurance. Then your interview style might become just a wee bit more confrontational.

Posted by: akmakm | September 24, 2009 6:34 PM | Report abuse


You're great Ezra, but I gotta agree you really failed to followup here re: waiting lines. As aggravating as a guy like Chris Matthews is, there's no denying that if his guest completely dodges a question he will go back and ask it again and again until the guest gives an answer.

Also, I'd be interested in you writing a future post regarding Conrad's claim that tying the public option to medicare reimbursement rates would make ND hospitals go broke. Is this correct?

Posted by: EricthePoliticalHack | September 24, 2009 8:24 PM | Report abuse


Posted by: visionbrkr | September 25, 2009 11:56 AM | Report abuse

you cant stop talking civilly to people, just because you disagree, or even hate them.
kent conrad was voted into office, and like it or not, he is a key player.
his positions were completely laid out....whatever connections he has, whatever motivations he has.
his interview showed his views in complete transparency.
perhaps the people who elected him, can read this interview and decide if they still want him in office.
the way to change things is not to castrate people, humiliate them, stop listening to what they have to say, or shut them out of the dialogue.
what has come out of all of that?
a generation of rush limbaughs and sean hannitys and now, worse, glenn beck.
nations that we no longer have diplomatic relations with...
stalled peace processes....no dialogue.
you know, even chldren stop listening when you keep screaming at them.
kent conrad exposed his opinions.
you just cant throw up your hands and hope that he will go away, anymore than the issues with iran, north korea, china, or middle east negotiations will go away.
what part of kent conrad's opinions didnt you understand.
what part of his thinking do you think would change on the basis of a nasty encounter?
what good does it do to talk over someone.
is that how you think you can change minds?
this is who he is.
this is what he believes.
this is who was voted into office.
unhappy with his positions?
then use his words to vote someone else into office.

Posted by: jkaren | September 25, 2009 11:57 AM | Report abuse

constans,

I also find it hypocritical of you that when I post virtually the same thing that Mosben said below you rip me a new one but let his pass by the wayside. Any reason for that? Oh forget it, I know.

MOS BEN's comments:

Wow, you guys are really being hard on Ezra. He asked Conrad a question, Conrad gave him a bad answer, he followed up to allow Conrad to claw back a bit and Conrad instead dug in deeper. I don't think it's particularly good interviewing to lecture the subject and even worse to spend a finite amount of interview time harping on one issue where the interviewee refuses to give any ground. What is gained if Ezra spent five questions on whether T.R. Reid said that the French system is a government or private system? Conrad clearly doesn't understand the French system and probably still wouldn't understand it if it was explained again. He may very well not like being lectured by Ezra and just end the interview.

Ezra got his positions on the record. Now he can write posts about how wrong Kent Conrad is about everything. I sure wish some of these interviews would get play beyond Ezra's blog because he's gotten people to say some interesting things that should be brought up in a bigger venue.

Posted by: MosBen | September 24, 2009 9:24 PM | Report abuse

Posted by: visionbrkr | September 25, 2009 11:58 AM | Report abuse

There seems to be some confusion about how the French plan is financed: Every employer and every employee pays into the health fund...it is not a general government fund; it is a public healthcare fund administered by private, non-profit companies. The government's role is to set hospital charges; the private funds negotiate with doctors.

A key element of the French system is that most patients pay their share of costs for treatment at the time of service ... and are immediately reimbursed. The French "Green Card" that carries a patient's medical record, also notes which mutuelle should be billed for reimbursement or whether his copays are subsidized by the government. Doctors receive payment from the Securite within 7 days and mutuelles reimburse copays well within a month.

The current bills in the House and Senate would introduce more government red tape to marginally increase coverage and do little about the underlying cost problems.
If Conrad and his colleagues were really concerned with the cost to government, they would stop talking about extending Medicare with more for-profit insurance subsidies and start talking about real reform.

The bottom line here, is that we are spending far more on healthcare (both per capita and as a percentage of GDP) than France and we are getting less for it.
When do I get to stand up and say "I want a European style, universal healthcare system"? I thought I was doing that when I voted for Democrats last fall but both the President and my Senators don't think I knew what I wanted. When do I get a chance to set them straight?

Posted by: Athena_news | September 25, 2009 12:03 PM | Report abuse

visionbrkr, I find it telling that you regard a journalist actually asking a pointed question or a follow-up to an incoherent statement from a senator as "ripping him a new one." You constructed a straw man for reasons unknown, and it was not out of bounds of me to call you on it.

Posted by: constans | September 25, 2009 12:21 PM | Report abuse

constans,

and again you make no mention of how others said virtually the same thing as did I but you didn't call them on the carpet for that? Like that analogy better? Your double-standard towards me is disgustingly obvious.

My God even pseudo although it must have pained him so agreed with me.

Posted by: visionbrkr | September 25, 2009 12:45 PM | Report abuse

its funny when constans or pseudo know that i'm right about something,

THEY CLAM RIGHT UP.


Good thing I didn't hold my breath waiting for you to admit to a double standard.

one of these days I'm going to waste 5 minutes of time and get a new screen name and just mess with you both.

Posted by: visionbrkr | September 25, 2009 11:17 PM | Report abuse

Huh?

There's nothing more to be said in this thread. I've been waiting all day for Ezra to point out Conrad's errors in as polite a way as necessary. He hasn't. Very, very disappointing. Very Village.

So you can blow your own horn here if it makes you feel like a big big man, visionbreaker. Woo fracking hoo.

Posted by: pseudonymousinnc | September 26, 2009 2:04 AM | Report abuse

"We have a culture of the rich raping the rest of you, and we're not changing that!"

Ezra can't be expected to do tough interviews. He's not a tough man.

Posted by: drzen1 | September 26, 2009 5:44 AM | Report abuse

This strike me as an offer:

"Second, and this is very important to my thinking, the public option as defined by the committee of jurisdiction in the House, the Ways and Means Committee, is tied to Medicare levels of reimbursement. My state has the second-lowest level of Medicare reimbursement in the country. If my state is tied to that reimbursement, every hospital goes broke.

People say, "Just fix it." I've been on the Finance Committee more than 15 years. I've been trying to fix the unfair aspects of Medicare reimbursement all the time. We run into the House. Membership is determined by population, and the big population states write levels of reimbursement that unfairly treat hospitals in states like mine. My hospitals get one-half as much as urban hospitals to treat the same illnesses."

Shorter: "Fixing this inequity is my priority. Do that and I could do a lot- even back a strong public option"

Why not take him up on it?

Posted by: wrb1 | September 26, 2009 5:18 PM | Report abuse

Someone needs to kick conrad's teeth down his stinking republican throat.

Opposing heath care reform (and with no public option, there IS no reform) is murder, plain and simple.

Posted by: bigbillhaywood | September 26, 2009 8:57 PM | Report abuse

Does money talk? Talk? Money screams!! Here's why those 5 turncoat, Blue Democrats voted against Rockeller's bill.


Sen. Kent Conrad (D-ND) 2005-2010 cycle - $1.6 million from health and insurance. Finance, Insurance & Real Estate his largest at $954 million. Up for re-election in 2012.

Blanche Lincoln (D-AR) 2005-2010 cycle - $1.2 million from health and insurance. Health her largest at $641 million.
*Up for re-election in 2010.

Tom Carper (D-DE) 2005-2010 cycle - $1.3 million from health and insurance. Finance, Insurance & Real Estate his largest at $1 million. Up for re-election in 2012.

Bill Nelson (D-FL) 2005-2010 cycle - $2.6 million from health and insurance. Finance, Insurance & Real Estate his second largest at $2 million. Lawyers and lobbyists his largest at $3 million. Up for re-election in 2012.

Max Baucus (D-MT) 2005-2010 cycle - $4 million from health and insurance. Finance, Insurance & Real Estate his largest at $2 million. Up for re-election in 2014.

*All facts gleaned from The Center for Responsive Politics


Posted by: wmichaelh29 | September 30, 2009 12:44 AM | Report abuse

Ezra: You failed to ask one essential question: how much has the Senator taken from "Big Health" during his career? According to OpenSecrets.org it's an amount in excess of two million dollars! I wish you had asked him about that.

Posted by: maxeepr | September 30, 2009 10:26 AM | Report abuse

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