As featured on p. 218 of "Bloggers on the Bus," under the name "a MyDD blogger."

Thursday, September 24, 2009

Stooge (D-ND)

Sherrod Brown sez that, contra Rahm Emanuel, no Democrat will vote with Republicans on a filibuster to kill the health care bill, even if it includes a public option.

Brown should go have a talk with Kent Conrad (D-ND). Ezra Klein just did, and I don't know how he got through it without banging the telephone against his ear until it hurt. That Conrad displayed an unconscionable ignorance, as well as an arrogant belief in his own falsehoods, would be normal if he were a teabagger attending a town hall. That he's a Democratic United States Senator fills me with nothing so much as fear.

Conrad raised eyebrows this week when he told the Senate Finance Committee that the health care systems of countries like France, Japan and Germany should be models for the United States because they aren't "government-run systems," even though the government intrusion into those systems is far greater than anything this country is contemplating, even with a public option. Conrad got this from a book he read over the weekend, T.R. Reid's "The Healing of America". That's right, the chair of the Senate Budget Committee, a leading voice on the Finance Committee and a member of the Gang of Six, who has been working on health care for months if not years, JUST DECIDED to look into how other countries around the world manage their health care systems.

Klein started by asking Conrad what he was talking about with respect to France and Germany:

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.

Klein puts an asterisk there, kindly not telling Conrad on the phone that he's totally full of it. Basic insurance in France is provided through a government program called Social Security. The mutuals only deal with supplementary private insurance.

Conrad segues into the "innocent bystander" approach to policymaking, renouncing his status as a US Senator and just marveling at how the universal "we" balk at changing the health care system:

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.

Sure is! If there were only a US Senator who praised T.R. Reid's book, who could draw a lesson from it about acting boldly and not getting caught up in nonsensical American exceptionalism! Wherever could we find someone?

After some talk about Medicare and the Clinton 1994 plan and the Gang of Six ("We had 61 meetings!"), Klein moves to the public option, and here Conrad reveals his true grievance:

Do you support the public option?



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.

For all of Conrad's talk about "uniquely American systems" and "not fitting the culture," what Conrad wants is a full-on handout for providers in his state. He wants the Medicare reimbursements to go higher for North Dakota. There's probably a point where they get high enough that he can tolerate the government intrusion. He's essentially calling for a bribe.

And mind you, this is the deficit hawk chair of the Budget Committee, whose entire goal in health care reform is to "bend the cost curve." Now, raising reimbursement rates for rural areas would, of course, INCREASE HEALTH CARE COSTS across the system. But Conrad thinks it's terribly unfair to his doctors to get less than urban hospitals to treat the same illnesses. Has anyone asked Conrad about the cost of living in North Dakota as opposed to New York City?

Then, Conrad whines about that damn House of Representatives where "membership is determined by population," as if the majority should be allowed to rule or something!

Conrad, of course, is also protecting his boomer baby idea of co-ops, which he pulled out of thin air after meeting with the CEO of UnitedHealth Group. Blue Cross of North Dakota, which covers 90% of the market in Conrad's home state, would qualify as a non-profit to be a co-op and receive millions in seed money. Again, payouts are the goal here. Klein asks Conrad why the co-ops in the Finance Committee bill are so weak, leading to this incredible exchange:

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.

I have no words.

OK, I have a couple. The Group of Six discussions FELL APART, and yet the useless co-op plan, which Conrad admits he does not like, still comes out of the language from those meetings. Why? I'd have to guess that Conrad doesn't care that the co-ops won't work, as long as Blue Cross of North Dakota gets their seed money.


Weep for America.

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