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Friday, July 24, 2009

A sit-down with Dean

Howard Dean was in town today, for a lunchtime gathering at Powell's. It was ostensibly a book signing, but it was obviously a political mission. Dean was here to pitch President Obama's health insurance plan -- a "public option" plan designed to let people who currently have private health insurance keep what they have, but to give them and everyone else the option to be covered by a government plan akin to Medicare.

Dean, who led the Democratic Party to amazing success in the 2006 congressional elections and has been a stalwart asset to the party since then as well, is trying to hold his fellow Democrats' feet to the fire on the medical finance issue. Part of his strategy is to mobilize public support -- to get rank-and-file voters to twist their representatives' arms to do something substantial about the nation's expensive health insurance system, which leaves large segments of the population out in the cold. Hence the book, and the session at Powell's.

It was pretty much a lovefest for Dean, with 200 to 300 people in the crowd in the Pearl Room. A couple of hecklers who disrupted the first few minutes of the event were shown the door, by general acclamation, and then Dean, former governor of Vermont, one-time physician, and current spouse of a primary care doctor, got down to his stump speech and some question-and-answer. Among those asking questions were doctors, long-time activists in the health care wars, dedicated Dean fans (right), and folks who had obviously spent large chunks of time in the clutches of the health care system. After he signed copies of his modest $12.95 paperback for everyone who asked for an autograph, Dean sat down with some Portland bloggers and answered a few more questions. He was a most gracious guest.

We noted earlier today, live from Powell's, that Dean took a soft poke at Sen. Ron Wyden, who has been dragging his feet on the "public option" plan: Dean urged Oregonians to e-mail Wyden to tell him to get with the party program. Here, in no particular order, are some things that Dean added that we found revealing:

· Although pharmaceutical companies are clearly a villain in the piece, Dean & Co. find the health insurance companies to be more harmful agents in the system. Part of the professed goal of the "public option" is to put the government in competition with the private insurers, to make the latter less wasteful and less predatory.

· A pure "single payer" system, which would eliminate the insurance companies entirely, will never fly politically. Although Americans are critical of the health care system, those who have good private insurance now will fight to retain it. As people dislike Congress but always re-elect their own congressional representatives, many people dislike the current health care system but think their own insurance is pretty good. A brilliant aspect of the Obama plan is that it doesn't take private insurance away from anyone lucky enough to be able to get it.

· Private insurance co-ops, which some have proposed, will never survive in competition with the larger health insurance companies. "They'll be crushed," Dean said.

· Imposing stricter governmental regulations on health insurance companies is a good idea -- Dean cited as an example his own state's rules that require the insurers to adopt "guaranteed issue" and "community rating" -- but without government competition against the insurers, reforms are likely to have at most a limited benefit.

· Reforming the finance, or insurance, side of health care is just the first battle. Thereafter will come a fight over needed changes to the health care delivery system itself -- moving away from the traditional fee-for-service model and over to something more akin to the Kaiser model. As long as health care providers make more money on treating you when you're sick than on keeping you healthy, the system is going to produce inferior results. Acknowledging that he's heard some horror stories about Kaiser, Dean still thinks their model of integrated care, from the primary to the tertiary levels, keeps the focus where it should be, on wellness.

· A nice feature of the Obama plan is its endorsement of "comparative effectiveness research," which would eventually lead to making coverage decisions based on which medical procedures work, rather than on practice traditions and biases. This could help nontraditional treatments such as chiropractic and naturopathy to get covered by insurance plans, where they aren't now.

· Although specialist doctors do quite well financially in the current U.S. system, primary care physicians don't make out like bandits. The average primary care doctor in Britain makes more than the average primary care physician in the United States.

· It is highly unlikely that Dean will ever run for President again.

In the private time with the bloggers, Dean predicted that under the current timetable, the health care reform bill will probably be voted on during "budget reconciliation" in mid-October. If I understand it correctly, this is crunch time on the federal budget, when Congress has to pass something or close the government. At that juncture, if a measure can get tied into the budget package, its proponents can force an up-or-down vote. Dean said he was "looking forward to reconciliation," because he thinks the President's plan will have the 51 votes in the Senate that it needs for passage.

Dean also stressed to the bloggers that although the media hasn't covered it much, the past week has been a particularly good one for the Obama plan. The American Medical Association -- the nation's most powerful league of doctors -- endorsed the leading House bill on health care, which includes a "public option." And a state government panel in Massachusetts -- which already requires that everyone have medical insurance, with premium subsidies for low-income residents -- recommended that the state stop paying doctors and hospitals on a fee-for-service basis, but rather make payments to providers on a per capita basis, without regard to how many or which services are provided to any patient.

When my turn came to ask a question, I threw Dean one that a reader had sent along in response to my call a few days ago: Why is this so hard? The Democrats have comfortable control of the House, they have 60 votes in the Senate, and they have the White House -- why can't the Democratic Party just get this done?

For a fleeting instant there, it appeared that this wasn't a question that Dean was anticipating. He answered it by pretty much repeating the question. We've worked so hard over the last four years to bring the party to this point, he said. If we can't get real health care reform done, then perhaps it wasn't worth all the effort.

I came away energized and inspired to follow this issue more closely, but I haven't shaken the impression I had before I went down there. This perception was shared by a person in the audience, who complained about it to Dean during the Q&A: The media is big on reporting the daily drama of the politics involved, but they're doing a terrible job of actually presenting to the public the details of the competing health care plans. It's hard to get the public mobilized when the public doesn't even know what the issues are.

Dean had several explanations for this. One is that the mainstream media is on the decline. Another is that the topic is complex, and difficult to squeeze into sound bites for radio and television, and small news holes in hard-copy publications. And finally, the details of the various proposals keep changing so rapidly that it's hard to keep up with them on a daily basis.

Sounds like a job for the blogosphere.

In the meantime, Dean recommended this writer in The New Yorker. And of course, there's the very book that he was in Portland to promote:

Comments (17)

Wish I had attended this event--but I will get the book to learn more. Let's hope Dr. Dean is correct about healthcare reform getting the votes from the Senate in October.

Thanks for attending and for giving the rest of us passengers a take on where this train is taking us. I'm encouraged.

I think I may get the Dean book. However, the issue seems to be the cost of medical care. Besides making all employees straight salary, any other suggestions on how to stop the rising prices.

I have to agree with his dismal outlook on single-payer insurance. The public-employee unions (and the few others) with gold-plated insurance will fight this tooth-n-nail or get some kind of carve-out. I'd almost be convinced to go that way if everyone (including Congress) had the same coverage.

Great summary. A real public service.

I do not believe the promise that we can keep the health insurance we got if we like it. We now know that the feds will load up so many mandates on private insurance that ultimately the plan we like will not be the plan we get.

For example, you report: "This could help nontraditional treatments such as chiropractic and naturopathy to get covered by insurance plans, where they aren't now."

See, I don't really care about naturopathy. I believe it is quackery. What benefit do I get from paying higher premiums for a "benefit" I know I will never use.

I have great heath insurance. Recently I used this great insurance becuase I had twisted my ankle, and after a few weeks it didn't seem to be getting any better. First visit for me to the doc in a long time.

Visit and exam ($275.00) x-ray ($296.00) MRI - after repeated requests by "them" to have it done ($1459.00) Boot/brace ($329.00). Results (useless). I didn't wear the silly boot, and my ankle got better in a few weeks.

The insurance company paid, but you have got to be kidding me. I so wish that 2.4K in treatment could have been used by someone who needed it. Not sure what, but something needs to change.

P.S. - Just yesterday I asked an informed friend why no one had clearly identified the proposed changes in the health care system for the public. I am glad someone at least asked it of Dean.

Did Dean talk about possibly using another country's health plan as a model for the U.S?

Frontline on PBS had an interesting program several months ago, in which it analyzed the national health care systems in several industrialized countries, and compared them to the various health care systems we have in U.S., like Medicare, HMOs, Blue Cross, the V.A, etc. And there were actually quite a few similaries between those foreign systems and those in the U.S.

Also, last night, Bill Moyers's program on PBS focused on health care. I missed the first few minutes, but his guest speakers were talking about an approach that sounded very interesting.

Basically, that approach would be to build on what already works, and expand coverage over a period of several years, in order to make the transition easier.

Both programs are available on demand online.


We have the 37th worst quality of healthcare in the developed world. Conservative estimates are that over 120,000 of you dies each year in America from treatable illness that people in other developed countries don’t die from. Rich, middle class, and poor a like. Insured and uninsured. Men, women, children, and babies. This is what being 37th in quality of healthcare means.

I know that many of you are angry and frustrated that REPUBLICANS! In congress are dragging their feet and trying to block TRUE healthcare reform. What republicans want is just a taxpayer bailout of the DISGRACEFUL GREED DRIVEN PRIVATE FOR PROFIT health insurance industry, and the DISGRACEFUL GREED DRIVEN PRIVATE FOR PROFIT healthcare industry. An insurance bailout is all you really get without a robust government-run public option available on day one.

These industries have been slaughtering you and your loved ones like cattle for decades for profit. Including members of congress and their families. These REPUBLICANS are FOOLS!

Republicans and their traitorous allies have been trying to make it look like it's President Obama's fault for the delays, and foot dragging. But I think you all know better than that. President Obama inherited one of the worst government catastrophes in American history from these REPUBLICANS! And President Obama has done a brilliant job of turning things around, and working his heart out for all of us.

But Republicans think you are just a bunch of stupid, idiot, cash cows with short memories. Just like they did under the Bush administration when they helped Bush and Cheney rape America and the rest of the World.

But you don't have to put up with that. And this is what you can do. The Republicans below will be up for reelection on November 2, 2010. Just a little over 13 months from now. And many of you will be able to vote early. So pick some names and tell their voters that their representatives (by name) are obstructing TRUE healthcare reform. And are sellouts to the insurance and medical lobbyist.

Ask them to contact their representatives and tell them that they are going to work to throw them out of office on November 2, 2010, if not before by impeachment, or recall elections. Doing this will give you something more to do to make things better in America. And it will help you feel better too.

There are many resources on the internet that can help you find people to call and contact. For example, many social networking sites can be searched by state, city, or University. Be inventive and creative. I can think of many ways to do this. But be nice. These are your neighbors. And most will want to help.

I know there are a few democrats that have been trying to obstruct TRUE healthcare reform too. But the main problem is the Bush Republicans. Removing them is the best thing tactically to do. On the other hand. If you can easily replace a democrat obstructionist with a supportive democrat, DO IT!

You have been AMAZING!!! my people. Don't loose heart. You knew it wasn't going to be easy saving the World. :-)

God Bless You

jacksmith — Working Class

Republican Senators up for re-election in 2010.

* Richard Shelby of Alabama
* Lisa Murkowski of Alaska
* John McCain of Arizona
* Mel Martinez of Florida
* Johnny Isakson of Georgia
* Mike Crapo of Idaho
* Chuck Grassley of Iowa
* Sam Brownback of Kansas
* Jim Bunning of Kentucky
* David Vitter of Louisiana
* Kit Bond of Missouri
* Judd Gregg of New Hampshire
* Richard Burr of North Carolina
* George Voinovich of Ohio
* Tom Coburn of Oklahoma
* Jim DeMint of South Carolina
* John Thune of South Dakota
* Kay Bailey Hutchison of Texas
* Bob Bennett of Utah

There are people who are happy with their insurance??

A brilliant aspect of the Obama plan is that it doesn't take private insurance away from anyone lucky enough to be able to get it.

Thats not entirely true. If you already have it, yes. But it sure looks like you wont be able to get private insurance after the legislation is in force.

I got this from the bill, page 16...


—Subject to the succeeding provisions of this section, for purposes of establishing acceptable coverage under this division, the term ‘‘grandfathered health insurance coverage’’ means individual health insurance coverage that is offered and in force and effect before the first day of Y1 if the following conditions are met:


(A) IN GENERAL.—Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day of Y1.

(B) DEPENDENT COVERAGE PERMITTED.—Subparagraph (A) shall not affect the subsequent enrollment of a dependent of an individual who is covered as of such first day.

—Subject to paragraph (3) and except as required by law, the issuer does not change any of its terms or conditions, including benefits and cost-sharing, from those in effect as of the day be fore the first day of Y1.

@ jacksmith - you have let your President down. He wants a bipartisanship in Congress in a post-partisan world.

Anyway, did you forget that your beloved Democrats have absolute majorities in both houses? That means they don't need Republican votes.

Please get current before hitting us with partisan diatribes.

Thank you.

Hmm . . . it's not just the media that isn't laying out the specific details of the various plans, it's also the president. Sure, he's on the air every single day with an interview or speech on health care, but it's short on particulars.

Jack -

Nice piece.

One comment.

I think that if there is no "single payer" system this time around, that within 24 years after the passage of whatever "reform" we get this time that there will be a "single payer" system.

While the politics right now may not be right for it, a the politics are evolving that way and eventually there will be a government single payer system.

Who else was in the sit-down? Or is that under embargo?

To all of you "you can keep your current health care" please read the above post by Jon closely,especially (2)limitation on changes in terms and conditions. This means if your employers insurance changes anything in the plan YOU are now under the government option.

"We have the 37th worst quality of healthcare"

Where'd you get that fifure from? I think we have the best medical care (i.e. if someone gets a serious sickness in the world, they'd get treated here in the USA.) As for as the most cost-effective insurance, I'd agree we can do better.

Typical - can't ram through Congress what you want? Blame the other party!

Never mind that Democrats hold a filibuster-proof Senate (60 seats), and 256 seats out of 435 in the house (58.8%).

Democrats can vote strictly along party lines and do anything they want, except amend the Constitution. You sound ridiculous.

"jacksmith" - why don't you use Google to research who the Blue Dog Democrats are, and then you might have an idea of who is really "stalling" the health care legislation.

I think we have the best medical care (i.e. if someone gets a serious sickness in the world, they'd get treated here in the USA.)

Only if they have the money to get treated here. We do indeed have high-quality treatment available for the people who can afford it, but the median level of health care for an American citizen doesn't include the kind of care someone like the late Shah or Iran or King Hussein of Jordan was buying when they came here for cancer treatments. I've got a friend who just started chemo last week, as a matter of fact, and while I have no doubt that she'll get good care through the 21-week treatment, her insurance is going to be picking up a paltry portion of the cost, despite the fact that she's been paying hundreds of dollars a month for it.

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