Governor, Welcome to the Lake!

Jason, thanks for hosting this Book Salon.

Welcome to Firedoglake – so glad you could join us today!

Welcome, Gov. Dean, and thank you for that FDL shout-out in Pittsburgh.

Jason, thanks for hosting.

Great to be on. What a great job you guys did at Netroots Nation.

Welcome Dr. Dean!

One of the parts of your career that is going a bit unnoticed these days is your tenure as Governor of Vermont. Yet, you were able to pass major health care legislation in the state that dramatically reduced the number of uninsured.

Anything you can tell us about that process that might inform our debate?

Dr. Dean, you said that the public option is like Medicare for all; however, there are many versions of a “public option” and some of them are not yet revealed to us, the public.

Of those we know about, they are far from being like Medicare for All. The Senate HELP bill, the marked-up version, was reviewed by Kip Sullivan and he notes it seems like many smallish HMO’s with no guarantee of choice of doctors and facilities.

Could you please tell us what you’ve been told is the public option, what you think the best public option would be, and what you think might come out of mushing the various bills together.

Thanks for being here, Governor. I’ll be reading along with interest.

In Vermont, we put in guaranteed issue and community rating, which means that insurance companies have to take everyone who can pay and they can’t charge more than 20 percent above their cheapest rate, no matter how sick you are or how old you are. We also made Medicaid a middle-class entitlement for children under 18 in families below 300 percent of poverty, in today’s numbers that means that if your family makes $66,000 a year or less, you can pay $480 and all the children in your family under 18 have health insurance.

Welcome, Governor Dean. So good to have you here today. If not for your leadership this battle would’ve been lost a long time ago.

There’s a quote from a Mike Allen article yesterday that I’ve been mulling over, and I wondered if you’d comment:

This weekend’s comments by White House officials simply acknowledged the long-obvious reality that the idea of a government-run insurance plan was partly a bargaining chip.

Can you explain what you think that might mean?

http://news.yahoo.com/s/politi…..tico/26180

Also, I believe if the public had been presented with the idea of Medicare for All…perhaps with a robust private option, it would have been far more difficult for the anti-government plan groups to attack it.

People know about Medicare, they know people on Medicare, they know Medicare works, some of us can’t wait to get to Medicare, either to have insurance or to be able to choose the physicians we prefer or both.

Why did the Dems ignore this great selling point?

Thank you Dr. Dean, and welcome to FDL. I got to hear your speech at the Copper Union in NYC. It was a great speech and I was so fortunate to be there.

Keep up the good fight.

You are correct. Medicare for all who want it is the shorthand way to describe what a public option does. The actual bills have a variety of proposals but they are all government-funded options run by the government, which guarantee insurance for everyone who pays an income-based premium, and guarantees complete portability regardless of residence or employment status.

My own view is that if you increase Medicare reimbursement rates to primary care providers, Medicare for all who choose it would be the most effective and efficient way for providing care. I also do think that it’s important to allow people to stay in their private insurance if they choose to do so.

Welcome Governor Dean.

I’ve been a bit worried the past week about an article available in the Atlantic advocating transparency of medical costs, HSAs and universal catastrophic coverage is the way to reform.

Transparency seems a no brainer to me. I’m not so sure on HSA/universal catastrophic coverage as a means of promoting affordable care.

How were you able to get such a thing passed? Did you see the same kind of opposition from the insurance industry and ideological conservatives that we see now? How did you overcome their objections and tactics?

Thank you, Dr. Dean, and welcome. I’ll follow this conversation very closely.

Hi Governor Dean, Thanks for all you’ve done, and thank you Jason for hosting this.

Since HR 3200 has emerged from the House committees, and the Senate Help committee bill as well, you’ve been very forthright in your praise of the public option in both of these bills. On the other hand, I’ve been impressed with the very limited scope and organization of their versions of the PO compared with Jacob Hacker’s original public option proposals.

First, in both bills the PO won’t take effect until 2013. In the intervening 3 years or so we know that more than 60,000 Americans will die and more than 3 million will go bankrupt because they lack insurance.

Second, only unemployed individuals and those working for very small businesses will be eligible for the PO, so it’s not Medicare available to everyone who wants it as you’ve implied in some of your statements. CBO has estimated that only 10 million will be able to enroll in the PO in the short term following its activation in 2013, and that this relatively small membership won’t enable the PO to provide any real competition to “keep the insurance companies honest.”

Third, the insurance rates the PO will be allowed to charge will not be tied to Medicare rates, but will be close to private insurance rates.

Fourth, the PO will not have a ready network of providers on Day 1 to provide services, but will have to recruit such a network in an environment where the providers can’t be sure that the PO will survive competitively against the market power of the giant insurance companies.

Fifth, the PO won’t have a marketing staff on Day 1 to help it sell insurance.

Sixth, in the Senate HELP bill, multiple “public options” run by insurance companies are specified in the bill

Seventh, none of the bills under serious committee consideration envision the PO beginning with anything like the pool of members envisioned in Jacob Hacker’s original design for the PO.

In view of these seven points, please explain how the PO version specified in either the House or the Senate bills could possibly be successful in providing competition for the insurance companies?

In fact, isn’t it true that the PO versions specified in these bills will attract a disproportionate number of people who are both unemployed and too sick to work, while healthier, employed people will remain on the rolls of the insurance companies, thus leaving the PO with much higher costs of treatment per member than the private insurance companies and, consequently, making them much less competitive?

In addition, given the latest news that the Administration is withdrawing from the tacit compromise with the progressives, where progressives would push the PO, rather than our real preference for Medicare for All, does the Administration’s retreat from the public option, calling it “a sliver” mean that we are now free to mobilize all of our supporters in back of John Conyers’ HR 676?

There are some political types who believe that, I don’t. I think President Obama understands very well that real healthcare reform is not possible without a publicly-run alternative to for-profit health insurance companies. Whether the administration was testing the waters to see what the reaction was going to be on the left or to see what the reaction was going to be on the right, who knows. What they found out was pretty clear: the right won’t help them no matter what they do to change the bill and the rest of us understand the difference between real healthcare reform and politically-motivated healthcare reform.

Welcome Dr. Dean!

This last few days seem to have been a message mess-up to Obama and his crew. Do you think he needs to get his group singing from the same sheet, and what should he do to rein in the Blue Dawgs?

HSAs can control small healthcare expenditures, but they have almost no effect on the huge expenditures that are incurred by very ill people, which of course are the vast majority of the expenses that have been out of control. So, the HSAs / universal healthcare solution may actually insure people but will do nothing to control costs, which means like the Massachusetts experiment, the government will run out of money if they rely on HSAs and catastrophic insurance.

Dr. Dean,

I am 56 but I’m on Medicare now because of a disability. I love it. I have gone back to work, and I’m going to be kicked off Medicare next spring (unless something changes in the law).

I will be 57 years old with pre-existing conditions. There is no way I will be able to afford health insurance. I’m going to have to just hope I don’t get cancer before I turn 65 and can get back on Medicare again.

I’ll bet I’m not the only middle-aged/older person in a similar situation.

How much of Medicare’s expenses come from not the LAST year of life, but from the FIRST year people go on Medicare, when they’re catching up with all the health care they’ve missed the last several years with lousy or no insurance?

Vermont is obviously different than Wyoming and Kansas, so the political obstacles were not as great as they are in the country as a whole. I’m not intending to pat myself on the back, but people in Vermont generally value leadership which is based on strength and clarity. We made our intentions very clear and we never backed off. That made a big difference in getting this bill passed. Frankly, two-year terms helps. You get a lot more done a lot more quickly if the election is two years away than if it’s four years away.

Dr. Dean–thanks very much for being here and for your leadership on this literally vital issue. What do you think is the most effective thing that citizens who support a public option can do? It has been incredibly frustrating to watch the right wing (egged on by Republican leaders) shout down real discussion and substitute ignorance for reason. How do we change this? Do you think it would be effective to demonstrate public support for a public option through something like a march or peaceful public gathering? I am concerned that the mainstream media is botching its coverage of the “debate” by treating lies about death panels and euthanasia as legitimate concerns (with exceptions of course–e.g. Keith Olbermann and Rachel Maddow).

Thank you for your continued, much needed, work on this issue.

Thanks to Dr. Dean, Jane and FDL we’re still in this fight for real reform.

I guess my biggest question right now, is what do we do right now? FDL has given us some great options to pressure congress and reward those who support the PO. What else should we be doing? Letters to the editor – if so what are the 2 key points we need to get out at this point in the fight?

That’s a great question, very interesting to think about.

Great points, and worth keeping in mind. Thanks for the response.

Montana may not be so different: the Billings Gazette reported that Gov. Schweitzer’s reference to the Canadian system drew loud cheers. This was at Obama’s health care stumping meeting there. (I’ll look for the link)

Is there any real information about how much private insurance premiums would be for individuals under the “reforms” being proposed? For instance, my health insurance (provided my my employer in a very large group) costs about $1000 a month (of which I pay a small percentage). I have seen statements that insurance companies could charge high-risk individuals no more than twice or three times their “base rate” under the new system where they cannot refuse to sell insurance to anyone who wants it. (And everyone must buy it.) But that still looks like $2000 to $3000 a month, mandated by law, for individuals.

Is there any reason to think this won’t be the case?

Hacker’s version was essentially the original Obama campaign platform. It is true that is more comprehensive than either the House or the Senate bill. And I agree that from both a political and policy prospective, 2013 is too late for effective implementation. We need to show the American people real change by 2012, and frankly the American people need real change by 2012.

Dr. Dean – I admit that I have not waded through the 1000 pages of the bills – and at this point, I have to ask this question: What if healthcare reform gets killed? Are we where we are right now? Worse off?

This is a great argument for why should have a public option and an even better argument should be Medicare for those who choose it, even if they’re under 65.

people in Vermont generally value leadership which is based on strength and clarity.

OMG. Could we just clone them? And you, too, while we’re at it? I’ll resume lurking.

The article did a bit of free market handwaving on costs of catastrophic care. I bring it up because I think it will be picked up by a portion of those opposed to a public option.

Fee for service seems to have perverse incentives to drive up care cost, I’ve been happy to hear fee for outcome rhetoric from Obama.

Dr. Dean, I too welcome you to the Lake.

I have yet to read your book, but then, I take a different approach to health care delivered. Take, for example, I am an advocate for expanding access to everyone relative to the Indian Health Services (IHS) and to the VA’s medical and hospital systemic. Moreover, I am in favor of bringing military base hospitals under my ‘vision’ of a national integrated health systemic.

And as to actual cost, I can see that the fictitious $100 billion annual cost can be defrayed even further by reaching into the DOD’s budget for a measely $50 billion or so, and consequently, absorbing any actual costs, can be easily achieved.

Therefore, for the sake of progress, I am willing to “compromise” from the point of my overall advocacy to Single Payer, but no further, despite my fellow Democrats wanting to ‘compromise’ from Single Payer to a Public Option.

Jaango

On “What can we do to push real genuine health CARE reform”: My GP told me that not enough people are contacting Congress, taking action. He said every year my parasite (large insurance company), while it raises my premiums about 15-17%, cuts its reimbursements to his practice.

Would a million person march on Washington affect Congress for Medicare for All…with a robust private option, of course…?

I just wanted to say thanks for all you are doing, particularly during this critical time. I’ll get the book, without waiting for the liquid version Keith Olbermann mentioned.

I think public option and single payer supporters are doing better than the MSM thinks. The truth is this weekend may well have been a turning point that will cement the public option into the bill. The Republicans have made it clear that they’re not going to participate no matter what concessions are made. A majority of Democrats support the public option in both the Senate and House and since the Republicans have “opted” not to have any serious input into the bill and not to vote for it, this bill will be written by a majority of people that support a government alternative to private health insurance being on the menu for any Americans who are dissatisfied with their current healthcare situation.

Individuals will be buying coverage in the exchange, so they will be subsidized based on their income. The price they pay, therefore, won’t be the price the insurance company “charges.”

Two reputable polls have shown support above 70 percent for a public option among all the American people. Republican rank and file voters support the public option at a level of about 50 percent. Most of these people will continue to stick with their current insurance, but they think that the choice belongs to them, not politicians, bureaucrats and insurance companies. I agree.

Medicare for All…with a robust private option

I really, really like that. Let’s change the frame of this debate.

Healthcare reform is alive and well, and I believe the President will sign it in December and the public option will be in it. But we must keep pushing very hard at the grassroots level, as all of you have been doing since the election. Real reform is within our reach. Don’t be shy about e-mailing your Representative along with 170,000 of your closest friends.

Thanks for showing up Dr. Dean. You led the Democratic Party out of the “wilderness” and it would seem that Rahm Emmanuel and the accomadationists, triagulators and the appeasers want to lead the party back to that wilderness. Why do Democrats fear exercising their power when they have it? Don’t they realize they will lose the entire left wing of the party unless they stand up to the bullies and crazies?

Jason, I dislike subsidizing the cost of Big Insurance companies humongous executive compensations packages, their overhead, their myriad regulations which aren’t even the same within the same state, etc. Marketing, denial of service (which may very well continue–Wall St. must be appeased by low “losses” aka paying for patient care).

We need real government run non-profit single payer type Medicare for All.

LindaR… How exactly did you get on Medicare if you are under 65? I understand you apparently had cancer… so did the hospital automatically enroll you in Medicare?

Very curious how that worked pls.

thx.

Delurking again. Medicare for all with a robust private option is a Lakoff-worthy reframing. Dr. Dean, does the language matter, do you think?

Many thanks, Governor, for the response. I fully agree that the MSM is conveying a misimpression that the general public is not behind a public option or single payer–or, perhaps, they are confusing congressional politics with public opinion (and maybe they’re also misjudging congressional politics). I really appreciate your point that this weekend may have been a turning point cementing the public option into the bill–I certainly hope so. Thanks so much for this great discussion.

For more on their non-participation, see here:

http://seminal.firedoglake.com/diary/7332

That’s 9 Republican Senators not supporting even a co-op, and all of the GOP Senate leadership, and that number is only growing. There is no “bipartisan” deal to be had there.

Actually, that’s what they do in most European countries.

Medicare for All…with a robust private option

I really, really like that. Let’s change the frame of this debate.

Here Here!

PS… Howard… you are my hero… thanks for your continued hard work on behalf of our country… and I’ve been working hard too because of you…

I became involved in politics because of you and have never stopped. Working hard on healthcare now.

Thanks for your reply, Governor. But I think that 2012 is too much time giving the number of fatalities and bankruptcies we’re seeing. To a progressive like me, it makes more sense to pass a minimalist bill to end the worst insurance abuses now, and then come back in an election year with very heavy pressure for Medicare for All, including street demonstrations, so that we can have an effective bill by 2011.

Also, I don’t think you really addressed most of my questions, so I’ll repeat them:

In view of these seven points, please explain how the PO version specified in either the House or the Senate bills could possibly be successful in providing competition for the insurance companies?

In fact, isn’t it true that the PO versions specified in these bills will attract a disproportionate number of people who are both unemployed and too sick to work, while healthier, employed people will remain on the rolls of the insurance companies, thus leaving the PO with much higher costs of treatment per member than the private insurance companies and, consequently, making them much less competitive?

In addition, given the latest news that the Administration is withdrawing from the tacit compromise with the progressives, where progressives would push the PO, rather than our real preference for Medicare for All, does the Administration’s retreat from the public option, calling it “a sliver” mean that we are now free to mobilize all of our supporters in back of John Conyers’ HR 676?

And now I’ll add another. Since HR 3200 is the best of the bills that have come out of committee, and that bill is clearly considered too much “public option” for the “Blue Dogs” in Congress, if we now stamp our feet for a PO, how can we possibly get one that is better than HR 3200?

It seems that the Democrats have crossed the Rubicon in terms of going ahead with healthcare overhaul. To falter now would have disastrous consequences for our democracy in that it would be giving in to demagogic lying and physical intimidation involving death threats, assault-rifle carriers, and psychotic screaming. The Democrats have got no real choice now.

I too support Medicare for all with a robust private option.

I got kicked out of my insurance for “seasonal allergies” and “mild osteopenia.” Neither require prescription drugs.

This just infuriates me, a chronically healthy person.

Yesterday I talked to the woman at the front desk of my primary care physician. She says we now must show ID b/c people are using other people’s insurance cards. I never heard of that, but it makes sense.

Post about Gov. Schweitzer warming up the crowd with praise for Canada’s Medicare for All.

For a uniquely American plan:

Medicare for All…with a robust private option.

Dr. Dean, is that doable?

Medicare is OK but it is not full health insurance and it is still expensive to see a doctor. I have medicare which, together with part ‘d’, takes over 22% of my Soc. Sec. cheque and still I have to pay to see a doctor. Last year I had “deductibles” of $268 to pay that took me by utter surprise, I had no idea that I would still have to pay under a government health plan. I come from Europe where we have “free” healthcare, no deductibles, no added costs and damn good service. Incidentally my part ‘d’ premium last year was $20.00 per month, this year it went up to $25.70 a month and the only thing that part ‘d’ paid for last year was 58 cents. Absolutely nuts. Medicare is still only half way to solving the problem Frankly if I get sick I am on a plane out of here and back to Europe where I will get really free healthcare.

My fear is that if we try to get a little bite of what is needed..we’ll get nothing more. The more time we give the right wingers and the GOP to get their feet underneath them and stir up the craziness with lies, the less chance we have to get anything that is needed. I’m sticking with the Yoda Principal: Do or Do Not. We go for everything – and that means robust public option.

“You are correct. Medicare for all who want it is the shorthand way to describe what a public option does.”

But the public option isn’t Medicare for All. It’s not available to anyone, it’s not tied to Medicare reimbursement rates. It doesn’t share Medicare doctors network.

The CBO predicts HR 3200 would have at best 10 million enrolled over ten years, and the HELP bill would have zero enrolled over ten years.

How do you reconcile this with the argument that it’s Medicare for All?

Question… under the proposed House HELP bill, people with existing employer-provided health insurance CAN NOT opt into the public plan unless their premiums exceed 10% of their gross pay.

Given that most employers pay part of the premiums, this is a stiff requirement that will exclude many/most of people with employer-provided healthcare.

How does the this jibe with one of the three legs of the PO… that it be available to everyone?

is there any way to change this… considering that the healthcare lobbyists probably are responsible for this requirement?

Dear Doctor Dean,
I negotiate public employee contracts and can tell you that neither the employer nor the employee can continue to fund double digit premium increases every year. The cost spirals bear no relation to cost of living or consumer price index. Don’t get me started on Brokers and their fee structure or steering efforts. California has had true leadership by former Senator Sheila Keuhl and her SB 840 – universal single payer for all californians. No role for insurance industry. Uses the admin savings to extend coverage. Oversight, accountability – essentially medicare for all. SB 840 got through both houses twice. Our Governor, Schwarzenegger vetoed twice. Senator Kuehl is termed out. However, Seantor Mark Leno is reintroducing the Bill as SB 810. Please, if you have time, take a look at this Bill. Even the Lewin group agreed that it could save over 20 billion in the first year alone if enacted. Onecarenow has a great vidoe describing healthcare nightmares for both the insured and uninsured, and goes on to show how and why it would work.
All the best!

Governor Dean, thank you so much for all your work.

OT, I stumbled onto this and thought there was a chance you could find it marginally helpful. Care and Chaos on the Night Nursing Shift The author is John Blanton. After 9/11, he left the Wall Street Journal to become a nurse. He is also the editor of a book that just won the Pulitzer for non-fiction, SLAVERY BY ANOTHER NAME.

I think it’s a good idea to mobilize for 676 because even though I don’t think it will pass, single payer needs to be aired as a legitimate part of the debate. No matter what you think of single payer, the fact is that it is by far more efficient than private healthcare, and therefore much less expensive.

As far as attracted a disproportionate number of sick people, that is less likely because of the insurance reforms in the bill. But even if that were to happen, since Medicare-like programs have only one-fifth of the overhead costs, which the private sector for-profits have, there is an ample cushion if public option patients are more expensive. In addition, I think there’s a moral imperative that these patients, who are far more likely to be without insurance, are adequately cared for. Many of them are cared for now in a haphazard non-system, which is expensive and delivers generally poor care through emergency rooms, which is often postponed with very bad results. We can surely provide better to this high risk population at less expense to the taxpayer through a public option.

Which is why Rep. Weiner wants to substitute Rep. Conyers’ (possibly Dingell’s) Enhanced Medicare for All for what’s in HR 3200.

Dr. David Himmelstein of Harvard and PNHP.org says that single payer (enhanced) Medicare for All would save $400 Billion a year and cover everyone, from Day One, Dollar One comprehensively, with dental and vision.

If we did go with Medicare for all with a robust private option, what would we need to do with reimbursement rates to keep physicians happy? I know from working for my state medical association that many doctors have legitimate complaints about physician reimbursement from Medicare.

I knew we were in for some big compromises when Rahm was added to the Obama Team. But healthcare is not something I can compromise on.

My last health insurance was a six month plan that could be renewed. It had a $5000 deductible. I got an ulcer, and went through that…then the insurer started bugging my old doctor for medical records and I got many notices a week from the insurer…sometimes 3 a day. I had to fight to have them cover what they told me over the phone they would cover. Eventually, the 6 months was over, and they declined to let me renew.

Insurance companies WANT to be like car insurance. They don’t want to pay out, just take money in. This does not help people stay healthy and see doctors regularly.

Without a public option, the insurance companies will find a way around regulations imposed by congress. Blue Cross wants to become a co-op for crissakes.

Dr. Dean, a question on taking action. What’s the best way for folks to get involved directly with the work you’re doing at Democracy for America?

From a practical point of view, both bills in Congress over time will allow the public to make their own choice about being in “Medicare for all” or being in a “robust public option.” The great strength of the platform that the president ran on is that Americans get to choose how fast they want to reform the system through their own actions.

Great comment, thank you.

The reason I agree with you is that if we dump $60 billion a year, which is the price of the House bill, in to the for-profit health insurance industry, the cost will go up so fast that reform will never again be possible. In addition, the real possibility of bankrupting the nation does not come from a government-run system, it comes from a private insurance sector, which gets a blank check.

it is certainly a thrill being on the same thread as Howard Dean.

I want to know why democrats don’t want to ask the “anti socialism” pundits things like;

“are you saying you don’t like the police, don’t like the fire dept, don’t like the military, don’t like water to your house nor electricity, don’t like the roads and tunnels?

because all of those are social, tax funded, government supplied programs

even money is a social program, do you hate money also?”

things like that would set their hair on fire

and jane had a GREAT comment and point when she said, “the public option IS the compromise from single payer”

that is one great point prgressives need to use when they discuss health care

Initially, this provision makes sense. It will take some time to set up the public option as is currently designed. Allowing large number of employer-insured individuals into the public option could overwhelm the plan before they are ready to be operational on a large scale. This is one of the reasons that I think people ought to be able to use Medicare as the public option. This is a system that already insures 50 million people and has a very good record regarding overhead control, and availability.

“Thank you for calling 911. Please enter a credit card number, followed by the pound sign before selecting the nature of your emergency. Please be sure to listen to all options as some of the numbers have changed…”

There’s a little preview of the anti-socialism utopia.

Well, that assumes the choice Americans want is in third party payer, and not doctors and hospitals.

You say: No matter what you think of single payer, the fact is that it is by far more efficient than private healthcare, and therefore much less expensive.

But then you say it “won’t pass”.

Is that because you don’t think Americans would find a less expensive, better health care finance system that they already know more appealing? Or, is it that you think the power of the insurance and pharma industry is too difficult to fight?

Rep. Weiner gave the Repubs the chance to vote against to vote against a government run single payer plan by challenging them to vote to do away with the existing Medicare! Not a one voter for doing so!

Guess they do recognize there are some limits to the craziness about health care reform.

Dr. Governor Chairman Dean: The fact that you are here today proves (to me, at least) that you’re a stand-up guy. I only wish there were many more like you in the Democratic party. In that regard, why do you suppose it’s so difficult to get members of the Democratic party to stay on message and to work in unison toward the same goals, goals that are clearly supported by a majority of the American people? One would think that with a Democratic president and majorities in both the house and senate, things would go a bit more smoothly. And yet here we are. It’s frustrating, to put it mildly.

Thank you again for taking time out of your schedule to meet with us. Very classy.

This is actually a positive contribution to the bill from the Blue Dogs. One of the pieces of the compromise from the House is that the public option cannot use Medicare as their rate base. That will make it easier for primary care physicians to accept Medicare patients. Of course, in Massachusetts where they are talking seriously about eliminating fee for service medicine, with the blessing of much of their physician community, primary care doctors might actually be able to make a decent living and practice decent medicine are the same time.

Go to StandWithDrDean.com. They often have updates of actions that can be taken. You can also take action right here at FireDogLake on the campaign silo.

Here’s the best way to join the FDL campaigns:

http://action.firedoglake.com/…..careaction

“are you saying you don’t like the police, don’t like the fire dept, don’t like the military, don’t like water to your house nor electricity, don’t like the roads and tunnels?

because all of those are social, tax funded, government supplied programs

Bingo!

Agree completely that expanding Medicare as the public option is the best approach.

However, we are getting a watered down public option (if indeed we DO get it) instead.

Do you think that more people with employer-provided insurance will be allowed to choose the PO down the road?

Seems like if we start with such a high standard, it will be hard to lower it.

tx.

than 20 percent above their cheapest rate, no matter how sick you are or how old you are. We also made Medicaid a middle-class entitlement

the term “entitlement” is a perjurative, doesn’t really help our cause using the republican talking points, this should read “necessity” or some other word that shows it as beneficial to our country and her future

Massachusetts has a great plan… however, it’s running out of money and
the recession is hurting us. Any advice for Mass, and can it be used as a prototype? You are one of the few individuals who make sense and can
articulate the issues. Thanks.

Dr. Dean, LBJ signed the existing Medicare legislation on July 30, 1965. It was up and running 9-11 months later. Oh, and no computers back then!

Everyone with payroll tax deductions currently is signed up to contribute to the Medicare fund, so those folks are ready to go.

I would imagine we could get people enrolled, doctors and facilities signed up in 2010, and, perhaps, have it ready to go no later than 4thQ 2010, definitely by 2011.

Uninsured and underinsured people die, about 22000 a year. Many more go bankrupt. Others live in a state of fear and insecurity. How long must they wait?

excellanty sufilizard2

This is one of the larger developments that people often miss. Eliminating fee-for-service, with the blessing of providers, is huge.

This frustrated me as well.

If the republicans were in this position…with the White House and majorities in both Houses….they would ram through all their plans. Plans that benefit corporations at the expense of citizens.

People voted for change…not more of the same.
Part of the reason poll numbers are going down for Obama and Congress is because change is NOT happening. Not because there is too much.

If I were polled and asked my opinion, it would be negative. But for a very different reason than if a right winger were polled.

Well, it is not so hot if you totally can not afford the private insurance on the Exchange, and don’t qualify for the state program.

For my money, I’d say yeah, it gets expanded. Social Security started by excluding farmers and domestic help and all sorts of folks. Look where it is now.

Obama has successfully recognized that change does not happen until the pain of staying the same overcomes the fear of something different. For many Americans with decent health insurance, albeit too expensive, they are nowhere near overcoming their fear of something different. The Republicans know this too, which is why they use the many “scare tactics.”

Actually, I believe the emergence of the Palin “death panel” controversy is a good sign. The usual complaints of socialism and “driving insurance companies out of business,” which have been used since Ronald Reagan was a spokesman since the founding of Medicare are now completely ineffective. That is why the falsehoods about a public option have become so outlandish. Because they’ve become so outlandish, I think reform will finally prevail, but I do think we have to treat fear of change with real respect because it’s a very powerful human emotion.

bravo!

and a well phrased and researched question from letsgetitdone.

Thanks for the shout out. The truth is the vast majority of Democrats in the Congress support a public option and roughly 100 of them (about one-third) support a single-payer. The press always focuses on the atypical rather than the typical.

Using an existing system, such as Medicare, would shorten the waiting a lot.

Thank you for chatting today, Dr Dean, and for your leadership on this vital issue.

Can you please explain the odious Dick Armey’s “state lines” stalking horse he talked about on Meet The Press Sunday? It seems like the right has a new proposal to let insurance companies charter in the state with the least regulation and then operate everywhere in America, like they did with banks moving their credit card operations to South Dakota. What’s really at stake here and how can we stop it from being slipped into the bill at the last moment.

Again, many thanks.

I agree–I’m going to tell my wife about this later! a definite thrill to share this thread with the Governor

There are aspects of the Massachusetts plan that are very impressive. Their uninsured rate is about 2 1/2 percent, which is comparable to many European countries. I think if they had a public option, probably based on Medicaid expansion, such as we did for young people in Vermont, they would have had better luck controlling costs. Nonetheless, there are good lessons to be learned from Massachusetts and I think the exchange mechanism that Massachusetts used will be in the final version of the bill that the President signs.

Hear hear, that’s exactly right. We’ve pushed the right into such an extreme position because opposing real health care reform is itself an extreme position.

Well, I think that sells Americans short. I have yet to encounter one person not on Medicare or Tri-Care who is super happy with their insurer. I think better health care cheaper is a more compelling argument than the market-based Exchange approach.

Single payer in Cape Cod is finally being taken up by our leg., Minnesota just passed a single payer plan out of committee, PA is very close to passing single payer, how will states be protected from the feds superseding single payer state initiatives by way of ERISA under this health reform?

Dr Dean,

Can you explain why it is so difficult for Obama and congressional Democrats to come out and make the case as clearly as you do?

The mechanical and game-theory problems with a private health insurance market and the perverse outcomes they lead to, seem pretty manifest. Why has it proven so difficult to make this argument?

For instance: I want insurance to protect against catastrophic issues, but that is the time when the insurers are most likely to look into my past to try to find a pre-existing condition to disqualify coverage. I would be happy to pay regular Dr visits and foreseen treatment, such as dental, but the whole medical/insurance billing thicket generally means that bills for even standard visits are confusing and/or astronomical and thus you need the insurer to fight those battles.

If the public knew that it could get comprehensive health care, dental, vison, from Day One, Dollar One, no deductibles, no co-pays with a true single payer plan, I think they might jump at the chance.

Medicare for All…with a robust private option.

Yes, it would be an enhanced Medicare–for everyone, seniors included.

Now, docs, esp’ly GP’s, do imho desperately need better reimbursement, esp’ly so thay afford to take the time to actually talk to their patients and draw them out. My GP says he really can’t afford to handle more tha one issue per visit, but he can’t help himself. Plus, he often learns about other issues by letting patients talk. That sometimes allows him to realize what the underlying issues really are.

Dick Armey comes from the state that has the worst health insurance record in America. 25 percent of adults and 22 percent of children have no health insurance in Texas. I would hate to have my kids live in a state where Texas insurance companies could underbid our healthcare companies because they only took healthy people who could pay lots of money as clients. That is the fundamental flaw in Armey’s argument for those of us who don’t live in “every man for himself” political climates. We prefer to keep it that way.

You have said that healthcare reform will save money. You have also said that it will cost a trillion dollars over ten years (with most of that going to insurance companies). Please explain, especially since none of the plans currently have any solid cost containment provisions, just wishful hopes.

You have also said you do not favor single payer, that Americans like variety. Beyond that bald statement do you have any evidence to support either that Americans actually care how healthcare is delivered as long as it is delivered in a secure affordable way?

Re competition, you also seem to be all over the board there as well. You have said that a man with a coronary is not going to shop for a cardiologist but you also seem to think with this variety kick that competition will be good for the system. Healthcare is not however like other industries as your example points out so what is the relevance of the claim? What evidence do you have that economic competition makes healthcare better, especially looking at the last 30 years of the current “competitive” American system?

Note: References to what you said are taken from an article from a book signing in Colorado.

Masslib–the only person I know who doesn’t want to lose his insurance plan is a vet and has VA access! And that’s socialized medicine…. Plus, people on Medicare.

Oh, and most execs at large companies have very fine health insurance, usually more comprehensive than their employees’ plans.

This was a central tenant of John McCain’s godawful health care “plan” as well.

Thanks to all of you for participating and an extra special thanks to Jane Hamsher, Jason Rosenbaum, and all those who wrote in. Keep fighting.

Sincerely,

Howard Dean

As we come to the end of this Book Salon,

Governor, thank you so much for stopping by the Lake and spending the afternoon with us discussing your new book and Healthcare in America. I know you’ve had a busy week.

And Jason, thanks so much for hosting this robust Book Salon.

Everyone, this is a wonderful reference on the Healthcare debate, if you haven’t bought the book yet, here is a link.

Thanks all!

Let’s not forget about workers who have been screwed out of the retiree healthcare through bankruptcy proceedings – which the Eric Cantors, Corkers, Boehners were just all gungho about. Benefits that workers contributed to for all their working lives and now nothing to show for it. If a public option or single payer were available to them it would be a good thing.

“If the republicans were in this position…with the White House and majorities in both Houses….they would ram through all their plans. Plans that benefit corporations at the expense of citizens.”

Absolutely no doubt about it. Republicans might be borderline psychotic in the ideas and programs that they advance, but they are very good at corralling their troops and getting them to march in lockstep. The Democratic party could take a lesson in that regard.

Thanks, this has been great!

Thank you Governor Dean – most helpful.

Thanks Elliot! And thank you Dr. Dean.

Robust book salons for all! Now! :)

Hi Toby,

For me everything is Medicare for All, and I think that’s what we should go for. Even the best PO should be nothing but a forced settlement in Conference Committee.

As for my comment about a minimalist bill, I meant that is we can’t get Medicare for All or a very good PO, then the Congressional Progressives should go to the White House and offer them a compromise bill with the following in it. Make it illegal for insurance companies to

1) deny coverage based on pre-existing conditions,

2) charge people with pre-existing conditions more than others are charged,

3) rescind anyone’s policy because they failed to report a pre-existing condition, or because they got sick while insured,

4) raise anyone’s premiums because they’ve gotten sick while insured. and

5) charge individual policy holders anything more than 20% above their best group rates.

Then come back next year for a big Medicare for All fight.

Dr. Dean,

Just wanted to comment that I’m grateful for everything you’ve done over the past several years. You continue to be a symbol of hope for the progressives. Personally I think you’re somewhat underappreciated by the current Administration, which owes you a lot for your fantastic leadership of the DNC. More importantly right now, thank you for your continued support of a robust public option that will bring about real health care reform.

Best,

Seth

Thanks for bringing that up. I met a guy in his late 70’s at my auto repair shop. He delivers parts bcz he lost his insurance (pension reduced as well) that way, and now can’t make ends meet so is working –and driving all over northern NJ’s crowded roads– to keep body and soul together. His wife is ill; he’d like to spend more time with her…and can’t.

Is to cry for.

For my money, I’d say yeah, it gets expanded. Social Security started by excluding farmers and domestic help and all sorts of folks. Look where it is now.

I got here late so I am still reading through the comments. If has not been asked, what evidence is there that the public option will have any substance to it even if it is eventually included in a bill. We are very late in this process, yet we still do not know if there will be a public option, we do not know how many people it will be made available to: 4 million up to 130 million, we do know it will be delayed 4 years until 2013, and we have no idea at all as to its content, except that it will be more expensive than Medicare.

indeed–there are so many awful, heartbreaking stories out there–they all need to be heard

Thanks Governor, for a more detailed look at your thinking. I agree that “Medicare for All” may not be feasible any longer, primarily because progressives blew it by signing on to the PO compromise, However, if we could get a fire going around Medicare for All we might be successful in arriving at a much better compromise than we have so far, because “Medicare for All” would be much more popular with the public than PO, and as a result the industry would be much more afraid of that than they are of the PO. Fear is a much better motivator of compromise than just disapproval, and the PO has a far too vague and ambiguous connotation to allow its supporters to deliver a clear message that people can understand. I’ve laid out these arguments here, here, and here. You may want to take a look.

OK, now I am going back through the comments.

Dean: You are correct. Medicare for all who want it is the shorthand way to describe what a public option does.

This is of course not at all what the public option does. Dean could not be more wrong in his characterization. This is one of the reasons that he has been called dishonest by some here on the healthcare issue.

BTW, Warren Buffett sold off a bunch of energy stocks and bought millions in Big Pharma...so I think Wall St. and, obviously, Mr. Buffett think the BHIP (Big Health Industry Players) are going to come out of this health care “reform” doing quite well. As will their sharefholders.

Bob Herbert makes the same point.

The public? The insured? The uninsured? Not quite so well…most likely.

Or is it because the President decided to take it off the table; and there was nary a peep from progressives?

Spot on!

No surprise that they’re stocks soared yesterday on the weekend news.

Aw come on, Hugh. Next time show up on time if you want to make accusations about dishonesty. He played ping-pong with about thirty, wrote amazingly thorough answers, and remained polite.

You have said that healthcare reform will save money. You have also said that it will cost a trillion dollars over ten years (with most of that going to insurance companies). Please explain, especially since none of the plans currently have any solid cost containment provisions, just wishful hopes.

US national spending on Health Care in 2009 is about $2.5 trillion when you include private and public money. If insurance companies continue their cost increases at the current rate (rather than accelerating the curve), it will be $4.4 trillion in 2018. That’s a total increase in health care expenditures of at least $15 trillion over ten years.

$1 trillion, spread over ten years, looks pretty damn good in comparison, doesn’t it? Medicare for All would cost even less.

“a public option” does not mean “the public option in HR 3200 or the public option in the Senate HELP committee bill”. But the whole idea of a public option in an exchange framework is to provide Medicare-like coverage for all who want it. And that includes the same sort of individual cost impact of Medicare, minus the Part D fiasco. None of the bills in Congress do this because of fear of running the insurance companies out of business. So you have two different sorts of “firewall” rules for the exchanges – one in the House version and one in the Senate version.

A distinction that should not form the basis of an ad hominem attack.

We do have to tear fear of change with respect, but I think you do that by advocating something to people that they know is going to work, like Medicare, or expanded VA, not some wonky recent invention like the PO that has never been tried anywhere, and that nobody really knows will work.

Medicare or something like it has worked in many nations. We could have demonstrated that to people. We could have gotten them to talk to their parents and Grandparents about Medicare. There would be no widespread fear of Medicare.

There’s plenty of fear about the PO because it’s an unclear concept and it’s easy to lie about and to lie about a 1050 page bill. It’s a lot harder to lie about a 30 page like HR 676, and to get people afraid of something they know and, for many of them, doesn’t even feel like a Government program.

The decision to try to sell the PO rather than Medicare for All was a bonehead play by this Administration and the progressive organizations that supported it like HCAN and Move-on, and the longer they take to admit they were wrong and need to change direction the worse it’s going to be.

That’s true. But the vast majority who support the PO do so because the President supports the PO. Of he supported HR 676, they’d do that too. Here I’m thinking of Reps like my Congressman, Jim Moran.

They’ll only be protected if the Kucinich Amendment is in the final bill.

Hugh, Good questions. I hope the Governor tries to answer.

Crosstimbers, whether I arrive on time or a day late, dishonesty is still dishonesty. There were two enormous howlers in Dean’s comments. The first is the dishonest conflation of the public option and single payer. The other is that the “death panels” show how desperate Republicans are. But the truth is that the White House has throughout the process been making deals with industry and conservatives and progressives have been scrambling to get what will probably be a very watered down version of a public option included as a sop. So yes, I consider statements that fly in the face like that to be dishonest. Dean can always respond later if he chooses.

beth meacham, it is a trillion dollars going to insurance companies without any in place controls on other costs. So it is a trillion on top of your numbers. The question is to what end? Is it even a believable number?

I’m sorry but you are just making that up. We have no idea what the content of a public option will be and we should by this point have a fairly solid idea of what it is. If your version of a public option isn’t in the legislation, how can you possibly say that is what is going to be in the exchanges. It seems like wishful thinking. Again re dishonesty, Dean is a player on the national scene. He is very aware of the differences between single payer and the public option. Yet he continues to use the two interchangeably. It isn’t sloppiness because he has been called on it before. I concede that he familiar with the issues so it isn’t ignorance. That pretty much leaves dishonesty.

I also saw you points and wished I had made mine half so well.

Hi Tarheel, I think what yous say is right, narrowly construed. But I also think that the Governor is talking about this in a context where the left wing of the debate is now HR 3200, and in that context Hugh is exactly right about the Governor’s line that the PO is just Medicare for All who want it. I won’t say that the Governor is being disingenuous; but I do think his view on this is confused, and that what we have on the table now in HR 3200 is not Medicare for All who want it. Moreover, HR 676 is Medicare for All in the sense we’ve been talking about it here, i.e. Medicare for every American as a right.

Thanks, your earlier question was spot on, too.

Perhaps that’s so. Perhaps also it’s his attempt to market the PO. The interesting thing about that is that his attempt to market it that way suggests that he thinks that the PO can do better if it is wrapped in the mantle of Medicare. And this, in turn, suggests that Governor Dean thinks that Medicare for All as in HR676 is more salable to the American public. If it’s true that HR 676 isn’t feasible now, it’s not because it can’t be sold to the American people. it’s because the elites in industry, Congress, and the Executive don’t want it. They want the insurance companies to continue to survive as they are today.

Hugh, You did. You always do.

Do you really think that if Hugh had told the truth about Dean’s prevarication in calling the public option “medicare for all” while the mods were still around that it would have gotten through?
_
I don’t.

Has anyone ever tried to organize PAIRS of individuals — a patient and his or her physician — to contact their representatives?

I think it would be especially powerful if it were an in-person meeting, but even a joint email or phone call might make a big impression.

I am sorely disappointed that Dr. Dean did not respond to my notional for an expanded Indian Health Services and/or the VA Medical Systemic, as well as including the military base hospitals as part and parcel to an integrated health schema of national significance.

As a military vet, I can safely say that all military vets understand the utlization of the base military hospital while in uniform, and the continuation of the VA while in a civilian status. Thus, mililtary vets can be the invaluable allies that Progressives are in much need of in today’s toxic environment, and that of course, scares the bejerbles out of Dr. Dean.

Consequently, Letsgetitdone, in his post above, is truly clear-eyed when he says, “…it’s because the elites in industry, Congress, and Executive don’t want it”.

Jaango

Well in all fairness to the mods, I don’t think I have ever been censored.

have you ever called one of their special guests a liar before? ;)

Hi Jaango, Thanks for your kind comment about my views.

On Howard, why do you think:

“. . . mililtary vets can be the invaluable allies that Progressives are in much need of in today’s toxic environment, and that of course, scares the bejerbles out of Dr. Dean. . . .”

Personally, I’m a progressive who’s happy to ally with military vets in progressive causes like universal health care, and I don’t know why that would scare “the bejerbles” out of Howard Dean. I’ve never known him to say or do anything that shows anything but support and friendliness for vets. Have you seen something else?

I and others have taken issue with quite a few of the guests here. Think what Joe Lieberman would get called (accurately) if he visited here. We are not a softball venue and if Dean thought we were that is his mistake. I have said before he could have taken a leadership role here. He could have been the voice that kept single payer on the table and in front of the public. But he didn’t do that. Maybe he got too used to talking to pols as chair of the DNC and too unused to talking to ordinary Americans. But like most Democrats, he can’t seem to bring himself into open opposition to Obama and this seriously weakens his credibility.

As for calling people dishonest, I have been saying recently that Krugman’s endorsement of Bernanke as chair of the Fed is also dishonest. Krugman got his job at Princeton through Bernanke, a fact which he brought up during another book salon here last December. This gets back to the idea of accountability we are supposed to have on the left side of the blogosphere no matter who is involved.

Letsgetitdone,

Lest you not know, my advocacy for an expanded access to the IHS and the VA, is in the form of “integrated health services”. Thusly, ‘yardsticking’ the integrated health services in any comparison or contrast with a medical doctor in private practice, would effectively demonstrate a greater benefit realized for both consumers and taxpayers.

Now, I understand that Dr. Dean is in private practice, and for him to advocate his self-interest via a public option with doctors receiving a much larger pay envelop from either the patient, the insurance company, or even the government, is understandable. Consequently, his self-interest collides with my self-interest, and to have a debate over this is fair and reasonable approach, but getting Dr. Dean engaged in this discussion or debate, is not going to happen on his part. And as such, this indicates to me via his non-response, that I am correct in my assessment for his lack of engagement. And in this regard, Dr. Dean will pontificate his ‘concern’ to whomever is willing to listen, and yet, he will never effectively address this perceived opposition to integrated health care from the standpoint of the consumer/patient. And his ongoing political behavior continues to reinforce his unspoken opposition to a national schematic for integrated health services from the standpoint of medical care delivered.

Jaango

jaango, I think this is very well-taken. I do think that Dr. Dean has a bias that comes from his practice experience. You could see the bias in his remarks about primary care physicians being able to finally make a good living if certain reforms occurred, and I found myself wondering what he thought a good living was: $300,000 per year? $500,000 per year? I don’t know what the statistics are, but I doubt that there are any primary care Doctors around who aren’t making somewhere in the six figures? Of course, there’s a shortage of them because specialists make a lot more, but we could certainly fix that in the context of a National Health Service (NHS). So, clearly, Dr. Dean’s bias is based contextually in a view that Doctors are entitled to a better living than most of the rest of us.

Anyway, changing the subject a bit, I support Medicare for All, rather than a VA or NHS-style model mainly because the international statistics on health care appear to indicate that single-payer systems appear to have better outcomes than the UK’s NHS. I am not ideological about this. If the UK’s outcomes were better than Australia’s, New Zealand’s, Canada’s or France’s, I’d favor an NHS. But, apparently, that’s not the case.