Dr. Dean on Healthcare Reform

When Howard Dean spoke to us at Netroots Nation on Friday morning, he started by talking about the difference between Healthcare Reform and Healthcare Insurance Reform.  He said that there are a number of insurance reforms available to us in this bill but only one healthcare reform provision left - the public option. Everything else, including single payer, has already been compromised.  Dean would much prefer a single payer plan and wishes that it had been our starting point.  He said that we would not have been able to pass it but that it would have been a far better place to begin the compromises.

If we are unable to get a public option through, then we might as well call it a Healthcare Insurance Reform bill and be done with it.  The co-ops are a political compromise to get the bill out of committee and they will not work.

Why a Public Option is So Important

Dean's take on the public option is insightful.  He says that if we give the American people the choice, i.e. the public option, they will reform the healthcare system.  I take this to mean that the people who first opt for the public option will begin raving about it, and slowly others will shift over and then those folks and companies that are prevented from joining initially will make a big hubbub and the laws will be changed to allow more and more people to be covered under the public option.  Dean added later that the reason the public option is such a good path for this country is that it allows the public to move at its own speed.  The American public is conservative, he says, and it takes a while to decide to change.  This plan allows for that transition.  He also reiterates what Obama has said over and over - that a public option will provide needed competition for the private plans.

Sympathy for the Screamers and Appreciation for the Blue Dogs

He also had an interesting take on both the the screamers at the Town Halls and the Blue Dog Democrats.  He had more sympathy for the screamers than anyone else I've read or heard or talked with.  And certainly more than I had.  He basically said that these people are desperate.  The culture is turning away from their values and they are being more and more marginalized.  (We do know from other sources that the same folks who turn out to scream about taxes or where Obama was born turn out for Healthcare Town Halls; there are just more of them for this topic).  However, the impact has been to turn what should have been a national discussion into a shouting match.  

As for the Blue Dogs, Dean thinks they have actually been helpful.  Since the Republicans won't work with Obama and the Democrats at all, the Blue Dogs are representing the moderate Republicans and the Independents in this national discussion.  He says that there is lots in the bill as it stands now that has been improved because of the Blue Dogs, most particularly the changes that allow small businesses to buy into the public option.  From my point-of-view, the jury is still out on the Blue Dogs being helpful.

Nuts and Bolts

It's when Dean talks about the facts regarding actual healthcare policy that I especially appreciate his point-of-view.  After all, he is a genuine doctor and hasn't forgotten that.  He says that the best part of the public option, or, even better a single payer plan, is that it costs so much less than anything that involves insurance companies.  He says that the overhead on single payer would be 4%, while the overhead on public sector programs, i.e. Medicare, is 12% and on private sector programs is over 20%.   It's the ROI that private sector companies require that drives the costs up so high.

And a grab-bag of other facts and observations:

• A qualified nurse-practitioner can do 60% of what a physician can do.  They should be allowed to hang out their own shingles and practice on their own with the obvious caveats.
• The federal government should help pay off physicians medical school debt if they go into primary care; part of why so many doctors go into specialties is to make the money to pay their medical school debt and the number of specialists if part of the overall problem.
• Invest in prevention.  Currently companies that provide health insurance for their employees do the best job on preventative care, i.e. paying for health club memberships, holding on-site yoga classes, etc., because its the best way to manage costs.
• If he had his way, we'd give everyone under 30 access to Medicare.  As the father of kids in their twenties, he says it is impossible to keep them in health insurance.  They move; they don't leave addresses for their mail.  Number-wise, this is the largest group of uninsured.  And they need the least care.  He said that in Vermont, they managed to insure everyone under 30 for $480/year.  

For the 435 People Making This Decision

Dean says that this debate is about two things:

1. Are we going to allow the American people a full range of choice?
2. Whose side are you on?  The American people have spoken.

Lastly, Dean said that we, meaning his organization, Stand with Dr. Dean, and others are going to track every one of those 435 votes.  Those who stand in the way of a public option will hear about it.  The Democrats in the Democratic Party need to support this bill.