Kent Conrad Hasn’t Understood T.R. Reid Very Well

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.