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?

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.

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.

This guy is CENTRAL TO HEALTH CARE REFORM.

Weep for America.

Baucus Moves Forward

As shitty as the Baucus bill is, we do need him to report it out of committee, to move along the process. His committee has been holding things up for months. So it's a major step in the fight for a bill that he'll start marking up the week of September 20.

Senate Finance Chairman Max Baucus (D-Mont.) told a Democrats-only meeting of his committee Wednesday that he plans to begin marking up a health care reform bill the week of Sept. 20, with or without a bipartisan deal in place.

According to a source with knowledge of the situation, Baucus informed his Democratic Finance colleagues that he would move forward next week regardless of whether the gang of six bipartisan Finance negotiators brokers a deal.

A Democratic Senate source said Baucus would lay down the mark on Tuesday, the Sept. 15 deadline the chairman set for a deal with the gang on a bipartisan plan. This source said that as of now no Republicans are on board with the framework for reform that Baucus has proposed.

“He [made] clear in the meeting that this is the time for action and time to move forward to get a bill done by the end of the year,” the source said.

Better, Baucus signaled his intent to move forward regardless of whether Republicans sign on. So the Gang of Six is basically dead, and the move from the Senate appears to be to deliver something that Olympia Snowe can hopefully support, removing from them the need to go the reconciliation route. That probably means no public option and maybe a trigger, at least for the time being.

It's good that Baucus has given us time to see his framework and whip up opposition to its most egregious provisions. As for the public option, that really is going to depend on Presidential leadership, IMO.

Baucus Caucus: Less Health Care For America NOW

The six-headed Presidential hydra, also known as the sub-group in the Senate Finance Committee, has decided to ignore everybody and keep working diligently to do absolutely nothing on the health care bill.

Senate health-care negotiators agreed late Thursday to ignore the increasingly strident rhetoric from Republican and Democratic leaders and to keep working toward a bill that can win broad support from the rank-and-file in both parties, according to sources familiar with the talks.

In a conference call, the three Democratic and three Republican members of the Senate Finance Committee agreed to redouble their efforts to craft a less costly alternative to the trillion-dollar initiatives so far put forward in Congress. They discussed the possibility of also reining in the scope of their package, the sources said.

The senators rejected the idea of imposing a deadline on their negotiations, and they agreed to talk again Sept. 4 -- four days before lawmakers are scheduled to return to Washington from their August break. The consensus, one participant said, was "to take your time to get it right." [...]

Before leaving for the month-long recess, Baucus had pegged the cost of the negotiators' ideas at less than $900 billion over the next decade. Thursday's discussions focused on driving that cost lower, the sources said.

Their draft bill was already woefully short in terms of subsidies for those who can't afford insurance. The Gang of Six wants to drive them even lower.

I'm sure the people most enamored of themselves did reject having a timeline on their circle jerk. But look who is making these decisions. Chuck Grassley has basically said he'd vote against his own bill, even if he gets everything he wants, if he cannot get more than 80 Senators total on board. The #2 ranking Republican in the Senate has already said that votes for reform aren't coming. So Grassley, one of the key negotiators here, has admitted that he won't support anything the Gang of Six does. Mike Enzi is probably stronger in that direction. Olympia Snowe admitted today that the public option was never on the table in this Gang of Six, and that co-ops are worth exploring, even though two months ago she called them worthless. Kent Conrad has been ideologically opposed to the public option for as long as anyone can remember, and came up with co-ops, in all likelihood, as a way to steal seed money for the "non-profit" Blue Cross of North Dakota, which has captured 90% of the market in his home state. Max Baucus admitted as far back as March that the public option was nothing but a bargaining chip. Jeff Bingaman hasn't been getting nearly enough heat for being part of this charade, but he has talked the talk on co-ops as well.

These six Senators, who come from states representing 2-3% of the population, have proposed ideas out of step with 77% of the public, and think they're entitled to hijack the entire process in Congress to serve those ends.

The question is what to do about this. 270,000 people listened to the President's strategy session yesterday, and over 5,600 supporters have contributed almost $350,000 to lawmakers standing up for the public option. These six lawmakers, most of whom probably want no bill at all, know that the longer they hold up the process the harder it becomes to pass anything. Harry Reid needs to use whatever means necessary to force a bill out of the Senate - discharge petitions, going around the committee of jurisdiction, whatever. At that point, we're talking about a conference committee. Which is what Obama has asked for all along. The problem is a matter of trust, as Paul Krugman put it today.

...Chris Bowers is right that this is the worst part about it - the Senate Finance Committee has decided to take two additional weeks off before meeting again. They are so bound and determined to get health care right that they'll do nothing for weeks, presumably in the hopes that health care reform will die on the vine and they won't have to do anything at all.