Howard Dean: "to change [health care] to a totally public plan is crazy"

Former Democratic Vermont governor and practicing physician and presidential candidate Howard Dean tells The New York Times Magazine that going to a single-payer, government-run health care system "is crazy":

You've got to start from where you are, not from where you wish you were. The Europeans have much more comprehensive and cheaper health care plans than we have, but they got there because their health care systems were essentially destroyed during World War II. We grew our private health care system around World War II—the only way that American employers could give their employees a raise was to enhance health-insurance benefits—so to change it to a totally public plan is crazy.

Dean remains convinced that the so-called public option is the cornerstone of any reform worthy of the term. Whether he believes that the public option will lead inexorably to a single-payer plan is not clear. More here.

It's not fully clear to me what Dean means by "much more comprehensive" plans in Europe, given the vast array of subsidized and free services available in these United States. There's no question that European countries pay less overall for health care, but that's mostly because of rationing of one form or another. Indeed, it's not self-evident why spending more for health care is a bad thing, any more than higher spending on restaurant meals or cars is a bad thing, in and of itself.

I think it's great that Dean points to the post-World War II wage-and-price controls as the origin of our current stupid and inefficient employer-based health-care system. What I'm curious about is precisely which existing, large-scale government system would he point to as a model for the public option: Medicare? Medicaid? the Veterans Administration? The simple fact is that every large-scale public system in the U.S. is riddled with waste, fraud, abuse, and more. Why should anyone believe that the next reform would somehow solve any or even address any of those problems?

Here's a Reason.tv video that explains how to cover half of the uninsured in America. Go here for embed code, downloadable versions, and more.

Comments

[R C Dean]

Why should anyone believe that the next reform would somehow solve any or even address any of those problems?

Because they are idiots, that's why.

[PapayaSF]

Every time I hear Americans "pay more for health care," I want to see some detailed figures to see exactly why this is. E.g.: we're a rich country, and so have lots of cosmetic procedures. Is every botox injection and boob job included? Viagra and Rogaine? Do expensive designer eyeglass frames with prescription lenses count? Are we more expensive because many people get laser eye surgery instead of just glasses? If someone comes here for special treatment from another country, is that counted? How much we are paying for health care of millions of illegals, and is it fair to count that as a point against our health care system? How much comes from the fact that doctors make more than they make in most other countries? Etc.

[classwarrior]

"Indeed, it's not self-evident why spending more for health care is a bad thing, any more than higher spending on restaurant meals or cars is a bad thing, in and of itself."

Actually there is when health outcomes and life expectancy are worse, and millions go bankrupt because of costs.

[Unwashed Masses]

"Why should anyone believe that the next reform would somehow solve any or even address any of those problems?"

But we have to do SOMETHING!

[kilroy]

and millions go bankrupt because of costs.

[citation needed]

And on the impossible chance you produce these "millions", what's wrong with that?

[Abner MacGillicuddy]

"Actually there is when health outcomes and life expectancy are worse, and millions go bankrupt because of costs."

There is no real evidence that either of these statements is true, or, ifthey are, that they have anything to do with access to healthcare.

[Xeones]

And on the impossible chance you produce these "millions", what's wrong with that?

But, but, but it's not fair that people have different outcomes!

[creech]

I wonder how our health care outcomes would look if we merely spent as much as other countries? Maybe our habits, culture, gene pool, etc. are such that Americans have to spend a heck of a lot more to achieve the same healthy results as, say, Danes? Lots of people don't even use their health insurance to get routine physicals. Others "overuse" it.
Some get extra tests because they can and, sure enough, the extra test turns up a potentially fatal disease. But, are we to remain the owners of our self or are we to be owned by government, with mandatory doctor visits every three months, fines for being overweight, impressed service as health care workers, forbidden to reproduce if genetically defective, and all the other totalitarian measures that would be needed to ensure the best of health for all?

[TheZeitgeist]

The elephant in the room for healthcare costs in this country - and one the Democrats are loathe to even acknowledge - is the malpractice industry.

When I was in Europe a couple of years ago, a common theme of Europeans about the USA was how sue-happy everyone in this country is. Tort law both adds a huge back-end cost to every payment in our healthcare system, and encourages what in the end is pointless CYA procedures on behalf of the medical establishment around here.

I don't see how a government run system in the USA can accommodate the costs of malpractice. I've noticed its the one aspect of insurance in the health-biz that all government programs - both implemented and envisioned - will not touch or even consider subsidizing.

[Tricky Prickears]

$100/ month? I don't think so! Try more like $250/month. For minimum coverage, with some plans as high as $550. That's almost as much as my cable bill! And yes, I did have it. Until I went the doctor for an annual physical exam. First one in over 20 years. Annual exams were covered, according to my plan. So, imagine my surprise when I received notice that they wouldn't be paying for it. So, I called them. They said they wouldn't pay because I had the dreaded "pre-existing condition". "Wait a minute", I said. I went for an annual exam, not treatment for my acid reflux (which I treat with OTC Prilosec). I was told that didn't matter. I had a "pre-existing condition". So, they weren't going to pay the lousy $20 on top of the $40 co-pay I had already put out. So, I called ther doctor - no luck, their hands were tied. So, this all begs the question, if they wouldn't pay for a shitty annual physical, due to a PEC, what if I really got sick? Would they deny coverage for the same reason? Even if wasn't at all related to the PEC? So, you know what? You can take you're insurance and shove it straight up your ass! I don't have insurance today, and I'll be damned if I waste my money on something that doesn't pay. If I get sick, I'll go to the ER and get on Charity Care. Fuck 'em all.

[TheZeitgeist]

" I don't have insurance today, and I'll be damned if I waste my money on something that doesn't pay. If I get sick, I'll go to the ER and get on Charity Care. Fuck 'em all."

Word up.

Way I look at it, all my Medicare payments are down the drain anyways, so if I have to get on Charity Care as it is I will break even by the time I'm eighty!

[The Reverend Terence Fformby-S]

Health care is expensive because of greedy doctors and hospitals.

Enact price controls to make it a crime for doctors to charge more than a set amount for a given procedure ($5 for a bottle of aspirin, $40 for an X-ray, $25,000 for a coronary bypass).

[Jordan]

Actually there is when health outcomes and life expectancy are worse, and millions go bankrupt because of costs.

To borrow a them from robc:

Lifestyle choices Reporting differences Lifestyle choices Reporting differences Lifestyle choices Reporting differences Lifestyle choices Reporting differences Lifestyle choices Reporting differences Lifestyle choices Reporting differences Lifestyle choices Reporting differences

Keep saying it until it sinks in.

[Jordan]

A theme, even.

[rm2muv]

While the roots of employer provided health insurance may have come from WWII wage/price contols, it's exponential growth came from employers finding it cheaper to provide insurance (and retirement plans) to recruit and retain employees than to provide increased wages. This model persisted through decades of baby boomers and boom echoes of relatively young, healthy families and increasingly effective industry standards of excluding coverage for more costly patients and procedures.

It should surprise no one that, with traditional coverage being precipitously dropped by employers without commensurate pay increases, people find themselves increasingly unable to afford health insurance.

A public option plan is a critical part of health care reform. It is important because many are denied coverage by private plans, because it will provide portability to those who lose or change jobs, and because we all end up paying vastly increased fees for services to make up for costs incurred caring for the uninsured. Most important, however, is the need to provide competition for the bloated private insurance companies and drive down costs.

Most people (save those in their healthy teens and early twenties) want to buy reasonable health insurance. Having a public option will help make that possible.

I do agree that tort reform should be a major part of lowering the cost of health care in this country. I've never understood how the justice system could get twelve people to agree on the astronomical awards against doctors and hospitals who were simply doing their best to help people. Limits on these claims are vital.

[Michael Ejercito]

What was the circumstances behind these astronomical rewards?

[robc]

To borrow a them from robc:

I was confused (not by the spelling) until I realized I had annoyed at least one someone with my COASE posts. 🙂

[Jordan]

Actually, I find them to be pretty funny.

[jacksmith]

AMERICA'S NATIONAL HEALTHCARE EMERGENCY!

It's official. America and the World are now in a GLOBAL PANDEMIC. A World EPIDEMIC with potential catastrophic consequences for ALL of the American people. The first PANDEMIC in 41 years. And WE THE PEOPLE OF THE UNITED STATES will have to face this PANDEMIC with the 37th worst quality of healthcare in the developed World.

STAND READY AMERICA TO SEIZE CONTROL OF YOUR NATIONAL HEALTHCARE SYSTEM.

We spend over twice as much of our GDP on healthcare as any other country in the World. And Individual American spend about ten times as much out of pocket on healthcare as any other people in the World. All because of GREED! And the PRIVATE FOR PROFIT healthcare system in America.

And while all this is going on, some members of congress seem mostly concern about how to protect the corporate PROFITS! of our GREED DRIVEN, PRIVATE FOR PROFIT NATIONAL DISGRACE. A PRIVATE FOR PROFIT DISGRACE that is in fact, totally valueless to the public health. And a detriment to national security, public safety, and the public health.

Progressive democrats the Tri-Caucus and others should stand firm in their demand for a robust government-run public option for all Americans, with all of the minimum requirements progressive democrats demanded. If congress can not pass a robust public option with at least 51 votes and all robust minimum requirements, congress should immediately move to scrap healthcare reform and request that President Obama declare a state of NATIONAL HEALTHCARE EMERGENCY! Seizing and replacing all PRIVATE FOR PROFIT health insurance plans with the immediate implementation of National Healthcare for all Americans under the provisions of HR676 (A Single-payer National Healthcare Plan For All).

Coverage can begin immediately through our current medicare system. With immediate expansion through recruitment of displaced workers from the canceled private sector insurance industry. Funding can also begin immediately by substitution of payroll deductions for private insurance plans with payroll deductions for the national healthcare plan. This is what the vast majority of the American people want. And this is what all objective experts unanimously agree would be the best, and most cost effective for the American people and our economy.

In Mexico on average people who received medical care for A-H1N1 (Swine Flu) with in 3 days survived. People who did not receive medical care until 7 days or more died. This has been the same results in the US. But 50 million Americans don't even have any healthcare coverage. And at least 200 million of you with insurance could not get in to see your private insurance plans doctors in 2 or 3 days, even if your life depended on it. WHICH IT DOES!

If President Obama has to declare a NATIONAL STATE OF EMERGENCY to rescue the American people from our healthcare crisis, he will need all the sustained support you can give him. STICK WITH HIM! He's doing a brilliant job.

THIS IS THE BIG ONE!

THE BATTLE OF GOOD Vs EVIL!

Join the fight.

Contact congress and your representatives NOW! AND SPREAD THE WORD!

(http://action.firedoglake.com/page/s/publicoption) (http://www.actblue.com/page/healthcareheroes)

God Bless You

Jacksmith - WORKING CLASS

[rm2muv]

Michael Ejercito
"What was the circumstances behind these astronomical rewards"

Actually, failing a conspiracy to cause harm to a patient or deliberate negligence, I don't think it makes a difference.

Health care professionals are people, too. They sometimes make mistakes that cause harm, and they should pay for those mistakes. But, in my opinion, awards for anything beyond actual costs is unreasonable. Those costs should include expenses for ongoing care, actual and potential lost income, and reasonable (how 'bout a fee schedule) legal costs.

Awards for 'pain and suffering' are rediculous on the face of it (how much money will make it worthwhile to live with the pain?), and punitive fees should be reserved for egregious and ongoing conspiricies to knowingly cause harm.

[bookworm]

Jack Smith is a typical statist who paints matters as emergencies in order to get legislation passed.

[bookworm]

"A public option plan is a critical part of health care reform."

A public option plan will lead to a one-payer system. Private insurance will not be able to compete when the government can subsidize the public option plan through taxes. I believe it's Obama's Trojan Horse to a one-payer system.

Also national health care isn't the only option to our current health care "crisis". Allowing people in all states to purchase high deductible catastrophic plans would lower the cost of health insurance and the competition brought about by people shopping around for routine care would bring down those costs by creating more competition in the medical market place. Giving vouchers to Medicare, SCHIPS, and Medicaid recipients would create more competion as the recipients began to shop around for medical help, knowing they could keep the amounts they didn't pay out for medical care.

All this would have the advantage of avoiding the rationing of services which adding 47 million recipients because of the perverse incentives of getting unecessary routine care just because it's free to them, with the same number of doctors, that Obamacare would bring about.

[bookworm]

"Health care is expensive because of greedy doctors and hospitals."

Reverend, you're treating the symptom, not the cause. Doctors and hospitals are greedy because big insurance companies, Medicare, and Medicaid are paying the bills. This would be reduced if people shopped around more for their care which they would if they paid more out of pocket expenses through high deductible insurance and vouchers through Medicare and Medicaid, and SCHIPS recipients.

[kreel Sarloo]

bookworm, I'm fairly sure that replying to Jack Smith is as pointless as replying to anonymity.guy.

[Brendan Perez]

I don't see how a government run system in the USA can accommodate the costs of malpractice.

I do.

Some variation of sovereign immunity. As long as the medical professionals believes his conduct was legal, they can't be sued.
Basically, treat doctors the way cops are treated when it comes to malpractice.

[R C Dean]

A public option plan will lead to a one-payer system. Private insurance will not be able to compete when the government can subsidize the public option plan through taxes. I believe it's Obama's Trojan Horse to a one-payer system.

Me, too.

[Alice Bowie]

" I don't have insurance today, and I'll be damned if I waste my money on something that doesn't pay. If I get sick, I'll go to the ER and get on Charity Care. Fuck 'em all."

If more people had this attituge...we wouldn't have an insurance problem.

What is the purpose of paying the $1,500 per family if they're just goin' 2 take my house/retirement funds/college fund once someone gets SICK in my family.

If it's just me, I can at least kill myself and let me family get the policy and all the bills DIE with me.

But, if someone in my family gets sick...I'm really screwed....So why bother. I pay a LOT LESS than $18,000 per year in health care. Best I spend the money on my family and myself today while we are still healthy and younger.

[Alice Bowie]

attitude=attituge

[Andrew Webers]

The Reason Health Care is so HIGH? GO ASK "DR. Howard Dean" and the other USA Doctors who become "Filthy Rich" and demand excessive fees to drive the U.S. Healthcare System Broke. Cap their salaries at 60,000 a year and you will change HealthCare overnight. Those that attend Medical School only for the MONEY should never become Doctors' anyway and Dr. Dean should become a Lobbyist for all of them.