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Erreur de Conrad *

Most of the recent talk about overseas health care systems has not been terribly charitable. You'll wait in long lines, you'll die from curable cancer, etc. But during last week's markup hearings at the Senate Finance Committee, Senator Kent Conrad offered a different, more nuanced take:

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.

So it is entirely possible to do the things that I think most of us want to do and not have to have a government-run system. My own belief is that these other systems fit the culture of the United States more closely than does those who rely on government-run operations. So, it is there for us. We have an opportunity to do something extraordinarily important for this country. We need to seize the opportunity.

It was certainly good to see somebody with Conrad's centrist credentials reminding Americans that, in fact, universal coverage has worked--and worked well--in other countries. It was also good to see him recommend Reid's book, which ought to be required reading for anybody following the health reform debate. But I wonder how closely Conrad actually read the book, particularly given what he said to Ezra Klein later in the week:

CONRAD: 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.

KLEIN: 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.

CONRAD: 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.

Sorry, but Klein is right and Conrad is wrong. French national health insurance really is govenrment-run, in every meaningful sense of the word. Although private, nominally independent sickness funds deliver basic insurance, it's not a "choice" system like we're planning to create here. People don't decide which fund they want; it's chosen for them, based on their occupation. And while these funds technically operate on their own, the government effectively sets the prices for physician and hospital services, as well as for drugs. There is a market for private supplemental insurance and some doctors have the right to charge extra. But it's still far more government control than anything we're contemplating here. 

Why is this important? Because Conrad is trying to use the French example to support his refusal to consider a public insurance option when, in fact, the French example does nothing of the sort. If anything, the French example suggests that we should be talking about a more far-reaching government insurance plan--one with monopoly powers over prices and budgets. As New York University's Victor Rodwin puts it, French health system isn't technically a single-payer system but "it operates like one."

To be fair, some countries really do guarantee everybody quality, affordable, and accessible care through systems in which people choose from among competing private insurance plans. In this week's print edition, I write about one of those countries, the Netherlands. But the Dutch story doesn't really make Conrad's point, either.

By the way, for more on Conrad and European health care systems, read Matthew Holt, whose blog should also be required reading if you're paying attention to the reform debate.

*French for "Conrad's mistake." Or so Google translation tells me.