I don’t think that arguing over whether we should or should not fear the proponents of a deficit commission is very productive. After all, if you look at what Conrad and Gregg have agreed to it’s clearly not going to do anything and there’s no reason for liberals to play the role of scapegoat by refusing to agree to the creation of a doomed-to-fail commission. Read their press release:

Importantly, the task force would ensure a bipartisan outcome. Broad bipartisan agreement would be required to move anything forward. Fourteen of the 18 Task Force members would have to agree to report the recommendations. And final passage would require supermajorities in both the Senate and House.

“Our Bipartisan Fiscal Task Force is designed to get results,” said Conrad and Gregg.

As Jon Chait points out there’s something very strange about their apparent belief that the impediment to broad reform in the United States is that it’s too easy to get bills through congress. The whole commission concept has been sold as a way of streamlining the dysfunctional legislative process, but what we have here is a proposal to make it more dysfunctional: “if that fails, maybe they’ll conclude the process was too easy. Next time they could also require the commission members to create a cold fusion reactor or retrieve a magical ring from inside a volcano.”

I think the easiest way to make sense of this is that commission proponents are hoping to use the fact that liberals won’t give them their pet commission as a reason to block progressive priorities. But this isn’t a commission worth blocking.

One of the strangest spectacles throughout the health reform debate has been Kent Conrad’s insistence on repeatedly citing T.R. Reid’s book The Healing of America as a source for erroneous factual claims about foreign health care systems. It’s especially noteworthy because as best I can tell not only are the things Conrad thinks are true not true, but Reid’s book says they’re not true.

This all started when Conrad started saying Reid’s book shows that France has a great system without a public option. In fact, the French system shows no such thing and Reid’s book says that “In practice, France acts like a single-payer system.”

Today, though, Conrad went on Dylan Ratigan’s MSNBC show. Ratigan’s hobbyhorse for weeks (months?) now has been to complain that the health reform bill isn’t dramatic enough in its impact on most people. He wants to see something more Ron Wyden-style that would sever the employment-insurance link more rapidly. I think this is a fair point, but it’s not practical and in the long-term it’s not going to matter since the bills in congress do head in that direction. Either way, Ratigan had Conrad on this morning to harass him about this, resulting in a dialogue in which Conrad asserts that Germany, France, Japan, Switzerland, and Belgium all have great employer-based systems. Ratigan points out once or twice that this is wrong, but Conrad insists, Ratigan seems to lose his confidence and pivots to Singapore, then Conrad comes back to his claim about Europe and Japan and says everyone should read T.R. Reid:

I think it’s fair to say that Ratigan had this right the first time. Employment isn’t totally irrelevant to French health care, but it works nothing like our employer-based system and most French people are covered by what amounts to a single-payer system. In Germany employers have a big role in financing people’s insurance premiums but, again, that’s not the same as what America’s employer-based system does. In America what happens is that the cost of your premium is split between you and your employer, but your choice of insurance options is determined by your employer’s HR department. The German system is more like a payroll tax that funds government subsidies for you to sign up for the “sickness fund” of your choice. In Switzerland “individuals — not employers or the government — choose from a broad array of health plans, sold by private insurance companies.”

I don’t know anything about Japanese or Belgian health care and I don’t want to look it up. But the common thread here, it seems to me, is that you shouldn’t confuse the idea of financing things through a levy on employers with the idea of a system in which the employer actually plays a large role. You might like at Social Security and decide that it’s an employer-based pension system, since it’s financed largely through payroll taxes and historically speaking eligibility for benefits was related to which sector you worked in (initially, for example, agricultural workers and domestic servants were excluded). Today, though, it’s actually a public sector pay-as-you-go pension scheme.

According to Kent Conrad it does. Here he is talking to Ezra Klein:

EZRA KLEIN: 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.

ENT CONRAD: 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.

As I read that I was saying to myself “but what about Medicare.” Fortunately, Ezra asked about this:

EZRA KLEIN: 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.

KENT CONRAD: 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.

This is nonsense. Canadian waiting times are caused by budgetary issues. If they went up to our per capita level of Medicare spending, they would eliminate those waiting times. The relevant difference between US Medicare and Canadian Medicare is that we get more services because we spend more money, not that expanding the system to cover those under 65 would magically cause waiting times.

At any rate, a couple of questions later Conrad is back to talking about culture:

EZRA KLEIN: Do you support the public option?

KENT CONRAD: No.

EZRA KLEIN: Why?

KENT CONRAD: 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.

Conrad’s right, of course, that it’s easier to pass a bill that goes easy on for-profit interests than one that includes a public option. But that’s not because of “culture” it’s because of interest-group pressure. And of course one major practical problem with the public option is that powerful senator Kent Conrad opposes it. But Conrad doesn’t—or at least shouldn’t—get to cite his own opposition as the reason he opposes it.

Budget master Kent Conrad

This is a bit in the weeds, but you should go read Ryan Grim’s story about Kent Conrad directing the CBO to score health care reform in a 20-year budget window rather than the usual ten. This will tend to make the score less accurate, since projections get more and more uncertain the further you go out. It will also make it harder to pass a health care bill. But it will disadvantage the more-liberal House bill more than it disadvantages the Senate bill. And I think it’s usually best to assume that members engage in these kind of procedural moves because they understand their impact—Conrad is trying to kneecap the liberal version of health reform, and considers making it harder to pass any kind of health reform an acceptable price to pay to meet that goal.

Officially, though, we’re just supposed to think that Conrad really, really hates budget deficits. But as Ezra Klein notes, Conrad’s record doesn’t totally support that:

The first came earlier this year when Conrad modified Obama’s first budget. Obama had eliminated a couple of Bush-era gimmicks that made the deficit appear smaller than it really was. Bush, for instance, shortened the budget window from 10 years to five, so the total deficit sounded smaller. Obama’s budget returned it to the traditional 10. And then Conrad changed it back. The Politico reported that Conrad made this decision “because of the uncertainty of long-range forecasts.” Others thought he did it to hide the size of the deficit. In any case, 10 years, as the alert reader will notice, is less than 20 years. If 10 years was too long a time period for certainty, then it is difficult to see how 20 years could possibly be acceptable.

The second came in 2003, when Conrad voted for the Medicare Modernization Act, better known as Medicare Part D. The Congressional Budget Office estimated that the bill would increase the federal deficit by $421 billion and reduce federal revenue by another $174 billion. The total cost to the deficit, then, neared $600 billion. Conrad not only accepted the CBO’s 10-year time frame, but he voted for the bill. His press release enthusiastically touted the fact that the bill would “bring more than $70 million to North Dakota hospitals over the next ten years.”

Conrad’s record in the Senate, then, would lead you to believe a couple of things. For one, he distrusts long-range projections. Even 10 years is too uncertain. He also believes some priorities overwhelm deficit concerns, health-care coverage being one of them. But when faced with a health-care reform that will be deficit neutral within the 10-year time frame, he is demanding that it instead be measured against an even more uncertain 20-year time frame, and by an agency that he claims underestimates savings. The CBO’s scores are terrible, in other words, and come in such small portions!

To be fair to Conrad, the vast majority of soi disant “deficit hawks” on the Hill are huge hypocrites, much worse than Conrad. Conrad didn’t vote for the 2001 Bush tax cut, the invasion of Iraq, the 2003 tax cut, or the Kyl-Lincoln estate tax cut all of which attracted Democratic support, typically from the kind of members who complain about deficits. So in the scheme of things, he really is a committed deficit hawk. Still, per Ezra’s post there’s still lots of wiggle-room in this commitment, and the latest twist makes very little sense on the merits.

Note that the theory that the CBO underestimates the cost savings in health reform isn’t just some nutty theory. Among others, the Institute of Medicine agrees. I think there are sound reasons for the CBO to be conservative in its approach, but we should keep in mind the fact that the CBO’s approach is deliberately designed to be conservative.