Compromises Made, Issue Still To Be Resolved

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To pass health care legislation, Democrats in the Senate have had to make some compromises. Democratic Senator Kent Conrad of North Dakota says the Senate doesn't have the votes to pass the public option plan favored by President Obama. Conrad talks to Steve Inskeep about his plan to use nonprofit cooperatives to compete with private insurers.

STEVE INSKEEP, host:

Some of the Senators we just heard are part of a group of six - three moderate Democrats, three Republicans - working out their own bill, and they're likely to drop provisions the president favors.

Senator KENT CONRAD (Democrat, North Dakota): The reality that we've confronted is that there are not the votes in the United States Senate for public option.

INSKEEP: North Dakota Democrat Kent Conrad says the six key lawmakers will not approve a government run insurance plan. Private companies don't want to compete with it. Conrad favors an alternative - health care cooperatives or co-ops.

Sen. CONRAD: Membership controlled, membership governed, not government run, government controlled - a not-for-profit alternative to for-profit insurance companies.

INSKEEP: I want to make sure that I understand the notion that you're pushing there. Are you basically saying, I mean this is oversimplifying, but people in a neighborhood don't have insurance and so they all band together and pretty much insure each other. Is that what this is?

Sen. CONRAD: Yeah. The leading actuaries in the country tell us that this cooperative model could secure 12 million members very quickly and be the third largest insurer in the country. So, we've got lots of reasons to believe that this would be a successful competitor.

INSKEEP: Why not fight harder for a public option? Why insist that be kept off the table? Why not fight for some alternative to insurance companies, which a lot of people are dissatisfied with?

Sen. CONRAD: Well, first of all a cooperative plan is an alternative to for-profit insurance companies. And I hear this all the time, why not fight harder? You know, when the votes aren't there, the votes aren't there. I mean, sometimes you have to deal with reality, even in the United States Senate.

(Soundbite of laughter)

INSKEEP: Although in progressive circles or liberal circles, if you read blogs and opinions in the last few days you get a sense of people beginning to throw up their hands and asking why do this bill at all. They seem to be negotiating away the whole concept.

Sen. CONRAD: Well, I think that really misses the point of what is the real concept. Number one, we are covering virtually everyone in the country and as you know 46 million people have no insurance coverage. Two, we are headed on the current trend line to spend one in every three dollars in this economy on health care. That would be a disaster for our families, for our businesses, and for the government itself.

INSKEEP: Well, let me ask about those two key points that you made there, Senator. You talked about trying to cover everyone. Isn't your group of senators negotiating over the possibility of not requiring employers to insure their employees? That's something that the president seems to want, that's something that many Democrats seem to want but doesn't seem to be on the table in your negotiations.

Sen. CONRAD: What is on the table is an individual mandate, so that everyone in the country has asked to have health insurance. Those who can't afford it would be given assistance. There would be incentives for businesses to continue to provide coverage. There would be a small business tax credit. But that is the form of the current discussion with respect to how to proceed.

INSKEEP: Again, some people will ask why let employers off the hook?

Sen. CONRAD: Very simply, it again is a matter of votes.

INSKEEP: Let me ask about another thing here, because you said the other key point is bringing down costs. You add 40-some million more people to the insurance rolls. You might get some of them, but by no means all of them, into these co-ops, but many of them have to go to the insurance companies, which are already charging premiums that a lot of people can't afford and suddenly they're deluged with plenty of new customers and they can charge what they want.

Is that really going to control costs?

Sen. CONRAD: That isn't what happens. According to the best actuaries in the country, premiums would go down eight percent.

INSKEEP: Explain why that would be.

Sen. CONRAD: Because we have a whole series of things in this legislation that help control costs. Number one: delivery system reform. So that we're not paying for every procedure.

INSKEEP: Meaning the hospital doesn't get extra payment just for ordering extra tests. That's what you're saying.

Sen. CONRAD: Yeah. Number two: we will also address the income tax subsidy to health care. We pay no taxes on it. Some of the plans are really Cadillac plans that have a value of more than $25,000 a year. They'll get taxed on those high-value plans - the amount over $25,000 a year.

INSKEEP: How influential have various interest groups in the health care industry been in shaping this debate and forcing this debate into a particular direction?

Sen. CONRAD: You know, that's very hard to assess because, you know, what's in the head and heart of colleagues is a complex calculation. I think people would be very impressed by the discussion of this group of six. It is very professional; it is very focused on getting results that are good for the American people, and it is very focused on understanding that we're on a course that is absolutely unsustainable and we have got to make changes - as difficult as it is, and it is difficult.

INSKEEP: Is it appropriate that the changes only come if they are comfortable for business groups who are interested in what you do?

Sen. CONRAD: No. You are going to find when we come forward that almost everybody is going to be made uncomfortable. Because you make changes, there is going to be discomfort. That's the reality.

INSKEEP: Senator Kent Conrad of North Dakota is one of six lawmakers -Democratic and Republican - who are negotiating one health care proposal in the United States Senate. Senator, thanks very much for your time.

Sen. CONRAD: You bet.

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