Howard Dean says: "Don't pretend you're going to do health-insurance reform unless you're really going to change the system"

KenInNY's proposed Health Care Legislation Rule: From now on, no one should be allowed to participate in any way in the drafting of health care legislation without proving that they have read Dr. Dean's book. Proof that they've understood it would be nice too, but that may be beyond the reach of proof.

"This is a battle between the insurance companies and the American people."

-- Howard Dean, talking to Keith Olbermann about the battle
for health care reform last night on Countdown

by Ken

When Keith asked Governor Dean about the consequences for the Democrats if -- especially now that they have the magic "60th" vote of Sen. Al Franken -- they can't produce meaningful progressive health care reform, he said, "We're going to lose seats in 2010 if we don't pass what the president said was 'change you can believe in.'"

The governor made clear that he doesn't expect Republican support, and for that matter doesn't look for more votes than the Senate majority that would be required doing health care reform as a budget reconciliation matter. And so, for him, "The issue is not so much the Blue Dogs running the show. The issue is people not having enough nerve, you know not having enough spine, to do the right thing."

And what is the right thing? As it happens, wearing his doctor's coat, Dr. Dean has written a book, with Igor Volsky and Faiz Shakir: Howard Dean's Prescription for REAL Healthcare Reform. And for the occasion he's done a terrific interview for Esquire.

It comes at an excellent moment in the "debate." I've been worrying for some time that we were going to pay a steep price for the failure to bring out in the open its murky underpinning. The best way to explain what I mean is to offer two propositions about American health care:

(1) Some 47 million Americans have no insurance coverage at all, and consequently at best uncertain access to the health care system. This is a shock and a disgrace, and something needs to be done about it.

(2) The American system of delivering and paying for health care is so disastrously inefficient that it not only provides inadequate care but is on the verge of bankrupting us. Not only our physical but our fiscal well-being demand that we do something about it.

Both of these propositions seem to me unimpeachably correct. Is there anyone reading this who disagrees with either? But they aren't at all the same proposition, and it's possible to devise a plan to "do something" about one which does little or nothing about the other.

I've had the feeling that well-meaning proponents of reform have been deliberately fudging the distinction, knowing that there are different constituencies lying in wait to attack proposals aimed at each. In particular, I think advocates have been hoping they could pretend to be addressing the less controversial problem of bringing coverage to the uninsured and secretly stick in some stuff to address the "system sucks" problem without causing the uproar that would follow an announced intent to overhaul the whole damned system.

Sure enough, Dr. Dean makes this very point in the interview! "Ninety-nine percent of the discussions among reporters, policy wonks, and politicians focus on the uninsured -- which is, frankly, why nothing is passed. They don't focus on the majority of Americans who have health insurance that doesn't work." And right there he's opened up the can of worms that I think a lot of people were hoping wouldn't have to be opened. But of course merely extending coverage to the 47 million isn't health care reform. That's maybe health care extension.

Remember when Senate Finance Committee Chairman Max Baucus was widely reported to have changed his position, suddenly indicating a willingness to consider the inclusion of a public plan? He insisted that he hadn't changed his position, and if you looked at what he was saying, he hadn't. He had simply acknowledged that if a public plan was necessary to bring about coverage of the 47 million, he was prepared to look into it -- provided it didn't in any way undercut the position of the insurance companies providing coverage to the rest of the public. That, it went without saying as far as the senator was concerned, would be unacceptable, because in his mind the only problem being addressed was that of the uninsured. He insisted that 85 percent of the people who have insurance are happy with it, and therefore his first principle throughout the drafting process would be that the existing system not be tampered with.

Shouldn't that have been headline news? Or at least talked about? What the senator was saying was that he rejects my second proposition totally. See, I didn't say that no one disagrees with it, just that I doubted very much whether anyone who's reading this disagrees with it. And I'll tell you some other people who disagree with the proposition that the system sucks and something has to be done about it: (1) the insurance companies, (2) the drug companies.

One person who agrees is Howard Dean, who explains to John H. Richardson in Esquire that that's why he insists a plan isn't reform without a public option. " It's not. It's a waste of time. Don't pretend you're going to do health-insurance reform unless you're really going to change the system. The discussions in the Senate have not been about changing the system."

Misplaced concern for the insurance companies he describes as "one of the many problems the Senate is now having."

They are focused on anything but the American people. But the insurance companies will be fine. It won't happen overnight, and they'll make plenty of money. But this is not a matter of making the insurance companies happy. This is a matter of making the 72 percent of the people who want a public option happy, including the 50 percent of Republicans who want a public option.

As far as I'm concerned, every proposal that includes a "trigger" for the public option is also intentionally ignoring the distinction between my two propositions. Because there's no place for a trigger if you define the problem as "The system sucks and has to be fixed." A trigger is only a talking point in the extension-of-coverage discussion, and anyone who advances the notion that inclusion or omission of a trigger could be what saves or sinks health care either doesn't understand the basic issues being discussed or is being intentionally deceptive.

Why is it not surprising to find Master Rahm Emanuel, a man apparently devoid of any principle beyond what suits his personal interests, emerging as the leader of the "intentionally deceptive" party?

The time to stand up and shout was when Senator Baucus acknowledged that his driving principle in "reforming" the health care system is that most of it not be changed because of that bogus 85 percent satisfaction rate among those with insurance. Oh, I'm sure the insurance companies can produce some crap survey that was rigged to produce those results. But those results aren't worth the computing time it took to manufacture them.

Which is not to say that nobody is satisfied. I'm sure that high-ranking executives whose companies pay for their super-deluxe coveage are thrilled. I'm sure that members of Congress, with their swell plan, are pretty happy. Beyond that, though, I suspect there are two huge, overlapping categories:

* people who cling tenaciously to what they have, for fear that what they could wind up with will be worse. There is, of course, no shortage of demagogues working the circuit trying to scare the dickens out of those people. As Dr. Dean says, "The Republicans just make things up out of whole cloth. Nothing they say about health care is true. It's all just nonsense and fears and what-ifs. It doesn't happen."

* people who don't know how inadequate their coverage is because they haven't yet been sick enough to expose its inadequacy, especially now that the insurance companies' leading business strategy has expanded from simply denying coverage in individual cases to lopping off the coverage of people who are presumptuous enough to try to use their insurance. You know, sick people. Why should sick people be their problem? (Just because they chose to go into the health insurance business? How unfair.)

What's more, those insurance-company "studies" almost surely don't reflect satisfaction with the cost of insurance -- except, again, in the cases of people like those corporate honchos and members of Congress whose cushy packages come all paid for. The rest of us live in terror of next year's leap in insurance premiums.

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From the many years that Dr. Dean has been dealing with these health care delivery issues, as a physician and as governor of Vermont and now as a concerned citizen ("It was one of the reasons I ran for president," he tells John Richardson in Esquire), he has obviously spent a lot of time thrashing out the economic issues. To him there's nothing mysterious about why a public option is so important for health care: "The private sector can't manage costs. Health care is one of the few places -- defense is another -- that the government works more efficiently and more effectively than the private sector. That's just a fact."

And why is the private health care system so inefficient?

Because there is no feedback in the private health-care system. When I was practicing medicine, nobody with substernal chest pain ever got off my examining table and said, "The guy down the street does it for $2,000 cheaper, I'll see you later." That's why we've had 40 years of costs that increase between two and three times the rate of inflation every single year. It's breaking our economic system. People are yelling and screaming about jobs going to China, but they're not yelling and screaming about jobs going to Canada. But they are. Because the right-wingers can scream and yell about rationing if they want, but economically their system works much better than ours does.

And speaking of "rationing," this is another of those issues that the Republican liars are fond of obfuscating. "We have rationing today," Dr. Dean points out.

I'll tell you who rations. It's the private insurance groups. This ridiculous nonsense that the right-wingers are talking about, that public insurance will put a bureaucrat between you and the doctor — that goes on every day in the system we have. But only in the private sector. It doesn't happen in the public sector. I have never had, in my 10 years of practicing medicine, a Medicare bureaucrat call me up and say, "You can't do this and you can't do that." But that used to happen every day with the private insurance companies. You'd beg to have your patient have this drug or that procedure.

The health care debate has at times nearly ground to a halt over the subject of cost, but again, there seems to be no way of making people understand -- especially while the Republicans and right-wing Democrats are in "high lie" mode (though in fairness it's entirely possible that they don't understand either) -- that the way the Congressional Budget Office is mandated to evaluate costs and savings is uniquely ill-suited to the way they occur, or can occur, in health care. One point that intrigues John Richardson is Dr. Dean's claim that the $1.5 trillion a reform plan would cost is "already in the system." The good doctor is only too happy to explain:

Let's take somebody who works who doesn't have insurance. They get sick. They end up going to the hospital, and the hospital has to treat them. It's called uncompensated care, and it just gets shifted to taxes or higher premiums. There are hundreds of billions of dollars right now that you're already paying. Next, let's say that 65 million people leave the private sector and go to the public sector. That's new money that the federal government has got to figure out how to put in the system. But those 65 million people are not paid anymore by business, so you're freeing the business community from all that responsibility -- which was exactly the point I was making in the story of General Motors investing in Canada. In Canada, the business sector has no responsibility. Do they pay higher taxes? Yes, they do. But their taxes do not go up two or three times the rate of inflation, as health-care costs have in America.

Back when President-elect Obama was assembling his cabinet, an idea that made a heck of a lot of sense to us was that of Dr. Dean for secretary of health and human services. It seemed a great fit before the president-elect slotted his tax-cheating corporate-stooge crony Tom Daschle in for the job, and it seemed like an even better fit once that plan went kerplooey.

Now, of course, we have six months' worth of evidence why Dr. Dean not only would have been unwelcome in, but would have difficulty working in, that corporate-crony environment. From the outside, though, he could be the administration's most potent weapon for "REAL health care reform," assuming the administration really wants it.

IS BLANCHE LINCOLN FEELING THE HEAT FROM
OUR CAMPAIGN FOR HEALTH CARE CHOICE?

Greg Sargent reported this afternoon (links in the original):

The Plum Line Greg Sargent's blog

Under Pressure, Blanche Lincoln Shifts on Public Plan

Looks like pressure from the left might be getting results, albeit limited ones, in the case of “centrist” Dem Senator Blanche Lincoln, who has been resisting any commitment to backing a public health care option.

Lincoln, who’s getting hammered by ads demanding she commit to the public option, has now shifted towards supporting one, at least in rhetorical terms. In a piece for today’s Arkansas Democrat-Gazette, she says health care reform should include a public plan or a non-profit substitute.

Here’s the key graf from Lincoln (the piece is subscription only):

Health care reform must build upon what works and improve inefficiencies. Individuals should be able to choose from a range of quality health insurance plans. Options should include private plans as well as a quality, affordable public plan or non-profit plan that can accomplish the same goals as those of a public plan.

The assertion that reform “should” have a public plan or non-profit substitute is a shift from her previous position, which was only that she was “evaluating” a public plan or a substitute.

Lincoln’s position had made her a top target of the left. The Blue America PAC, which is headed by liberal bloggers Howie Klein, Digby, dday, Jane Hamsher and John Amato, raised money for ads targeting Lincoln in her home state of Arkansas, pushing her to commit to a public option.

To be sure, Lincoln left herself wiggle room. The non-profit substitute for a public plan could take many forms, and the idea is viewed in some quarters as a potential ruse to avoid creating a strong public option. But Lincoln clearly seems to be shifting on the question.

PLEASE HELP US KEEP THE PRESSURE ON

Have you seen the three spots Blue America's Campaign for Health Care Choice has produced to help her Arkansas constituents understand how remote she is from their interests? You can see all three here, including the one that was voted to run first. And of course if you can see your way clear to pitch in, contributions of any amount will add up.


MEANWHILE SEN. MARY LANDRIEU IS ALSO THE
SUBJECT OF A PROGRESSIVE "EDUCATION" CAMPAIGN

MoveOn, Democracy for America, and Change Congress are continuing their campaign to bring a similar awareness to the Louisiana constituents of another public-option skeptic, insurance-industry stooge Sen. Mary Landrieu,.



If you have more to give, I'm sure they can use your help.

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