Howard Dean: "This Is Ridiculous. We're 60 Years Behind the Times" on Fixing Health Care

During the 2004 presidential primaries, the conventional wisdom among Howard Dean's energized supporters was that the over-the-top conservative attacks on the Vermont governor reflected the degree to which the right feared his nomination. With his blunt, plainspoken populism, the argument went at the time, Dean represented a threat to the Bush administration's prospects for re-election that his more polished Democratic opponents lacked.

Five years later, and it may be the "disease care" industry -- now spending $1.4 million each and every day to lobby lawmakers against implementing significant health reforms -- that may be sweating Dean's simple, but uncompromising, brand of politics.

In his new book, Howard Dean's Prescription for Real Health Care Reform, the physician and former candidate explains what makes the American health care system the most expensive in the world but nowhere near the best. He calmly destroys the industry's arguments against substantial change and offers a plan to give everyone access to quality health care at a price that won't break the bank.

AlterNet caught up with Dean to discuss the book and the larger political landscape in which the debate over health care is taking place.

Joshua Holland: In your new book, you offer a prescription for fixing our ailing health care system. You lay out the scope of the crisis really well, both in human terms and in terms of the costs -- the financial burdens our system places on households and firms. And like the plan that Obama has laid out, like the Hacker Plan, your prescription revolves around a robust public health insurance option. Can you explain in a nutshell what that is -- what that looks like?

Howard Dean: In a nutshell, it looks like Medicare. We've had a single-payer in this country for 45 years, and the Republicans have used the same language today that they were using in 1965 to denounce it. And it works really well.

It has its faults like every system, but it is cheaper, it is more efficient and a far smaller percentage of dollars that goes into it is spent on non-health-care items. It's about five times as expensive to insure yourself with a private health insurance than it is with Medicare. So that's what the public option looks like. It's what we've had -- and your grandparents, and your parents have had -- for years.

JH: Now, you note that the debate has shifted over the years, from "how do we cover the uninsured?" to "how do we contain out-of-control costs?" So, in terms of this public insurance option, it'll result in a very large insurance pool, which will give it the ability to negotiate better prices and cut down on overhead. Can you just give me a little bit more on other ways that it might help contain costs?

HD: Well, there are two ways it contains costs. The first is that, of course, it's a huge pool. The second is, in terms of containing costs for ordinary Americans, [Medicare] can't and won't engage in the kinds of things that private insurance companies do. They don't have bureaucrats who second-guess doctors and make bad medical decisions. They don't pay extraordinary amounts of money for repeat procedures -- at least they do that less than the private sector does. They don't pay chief executives in the seven-, eight- or nine-figure range for their salaries. They don't have to advertise.

So it's much cheaper and more effective and efficient to control costs if you have a large public option. And the other thing about this is that the American people get to choose. You know, the Republicans are screaming and yelling about socialized medicine. Well, let the American people choose -- if they don't like it they won't choose it.

JH: Okay, that brings me right to my next question. You don't pull any punches when you describe insurance companies' practices. You say that they have mutually exclusive goals in protecting their shareholders and maximizing profits and their responsibility to give their customers good service. Now, in the book you cite an estimate that around 115 million people would remain with their employer-based insurance if a public option were added to the mix. Can you help me understand how the addition of a public insurance program with, say, 80 million people in it would change the behaviors of the insurance companies as it relates to the 115 million who will remain with their current insurance?

HD: Well, ultimately what's going to happen -- first of all, employer-based insurance with large companies is better than the individual market because it's already community rated with guaranteed issue -- that is, you cannot kick people out of their health insurance once they get sick, which many of these companies do, and you have to accept all comers.

Second, if the companies don't do their job in the employer-based system, there will be a lot of public clamor to change their insurance over to the public option. Now that is, of course, what the Republicans are terrified of. But in my view, and in the president's view as well, why not keep the insurance companies operating in a more consumer-friendly way and give the people a choice? That's what competition is all about -- it's giving people choices to do what's in their best interest.