Conrad stands firm in Mayville

MAYVILLE, N.D. -- Several advocates for a government-run "public option" insurance plan as part of health care reform legislation challenged Sen. Kent Conrad, D-N.D., at a public forum here Tuesday, but the architect of the co-op alternative to public option stood firm.

"How can you continue to ignore what people want?" a woman asked after citing polls she said show a majority of Americans still support a public option, and that despite an effort by opponents to demonize the approach as socialized medicine.

"I have to deal with reality," Conrad responded. "There aren't the votes to pass public option in the United States Senate."

Minutes later, another questioner asked Conrad whether he's championing health care co-ops as a matter of political expediency or because he truly believes in the concept.

"In my life experience, co-ops work really well," he said, listing a half dozen examples ranging from small rural electric and telephone cooperatives to such giants as the Farmers Union and The Associated Press.

"Also, it seemed to have a chance at bridging differences" between supporters and opponents of public option, Conrad said, though "some progressives seem to have forgotten" that the concept was an important part of the American progressive movement in the early 1900s.

Conrad said that House bills already passed out of committee with a public option "would be a disaster for North Dakota" because reimbursements would be tied to Medicare payment schedules. Because of historic formulas used to set Medicare reimbursements to providers, he said, North Dakota ranks second to bottom.

"Every single hospital in North Dakota goes broke" if that payment standard is applied to many more patients through a public option plan, he said.

Again, a questioner pressed, asking Conrad if he would support public option "if the votes were there" and the Medicare inequities could be resolved.

"None of those things will happen," the senator said. "I know where the votes are. The people, the committee chairmen who asked me to come up with this, they know where the votes are."

Conrad, chairman of the Senate Budget Committee, is one of six senators -- three Democrats and three Republicans -- who were asked by Senate leaders to devise a health care reform bill that would extend coverage to most Americans, restrain rising costs and receive bipartisan support.

Republicans are solidly opposed to public option. The Democrats theoretically have the 60 votes they need to avoid a filibuster and pass a health care reform bill, Conrad said, but in actuality they don't. Two members, Sens. Edward Kennedy, D-Mass, and Robert Byrd, D-W.Va., are ill and may not be able to vote, "and there are three (other) Democrats who've said they won't support public option. If you do the math, it's about as clear as it can be."

Still, the question returned one more time, put to Conrad by Andrew Lindner, 28, of Fargo, a volunteer for the liberal advocacy group MoveOn.

If a way could be found to rally 60 Senate votes for public option, Lindner asked, would Conrad prefer that approach?

"That's not how I spend my time, answering every hypothetical question out there," Conrad replied.

'Hoping, wishing'

After the 90-minute session, attended by about 100 people, Conrad said the questions about public option vs. cooperatives didn't surprise him, nor did the angry push-back from liberal members of Congress who were dismayed by indications over the weekend that President Barack Obama may be stepping back from public option as "essential" to health care reform.

"It's a matter of disappointed expectations," Conrad said. "I can understand that. But I have to deal with reality. It doesn't do any good to deal with hoping and wishing."

He said the public option vs. cooperatives debate is unfortunate because it's detracting from a focus on "what is centrally important to reform, which is reform of the health care delivery system."

Reform should emphasize preventive medicine, fee schedules based on outcomes rather than on services provided, and teams of physicians working together and sharing diagnostic and other resources, he said.

Fit into such reforms, "this co-op model could be a very effective competitor" with private insurance providers, he said.

The audience in the Mayville State University student center included opponents of public option, including Victoria Colwell of Gardner, N.D., who brought a printed sign: "No Govmt-run health care!"

"I'm concerned about the future of our country," she said before the meeting started. "I feel we're becoming Socialist, and this is a very big part of it.

"I think they should scrap out all they've done and start over with some new ideas. Doing nothing would be better than this."

But Conrad insisted that doing nothing is unacceptable. In North Dakota, the cost of health insurance is increasing three times faster than wages, he said, and without significant reform Medicare will be bankrupt in eight years.

Reach Haga at (701) 780-1102; (800) 477-6572, ext. 102; or send e-mail to chaga@gfherald.com .