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

By Joshua Holland, AlterNet. Posted July 8, 2009.

JH: Let me go back one step. You were talking about the Republicans' scaremongering over socialized medicine. Just to be clear so my readers have a good grasp on this -- private insurers would also be able to participate in this large, federally managed insurance pool as well, is that right?

HD: Yeah, they do. They absolutely -- that is something that exists [for federal employees] today. The Federal Employee Benefit Health Plan is an exchange, essentially. The only thing the president wants to do is add a public option to that exchange. And you know, just while we're talking about this, the thing that I get such a chuckle out of, all these conservatives getting so upset about socialized medicine -- that's what they have is socialized medicine. They have government-sponsored medicine.

JH: I remember a Rand study a couple of years ago that showed that vets, who have truly a single-payer, British-style system are the most satisfied with their health care.

HD: This is a ridiculous debate. We are alone, we stand alone among industrial democracies in having a health care system that is 70 percent more expensive and much less effective than every other industrial democracy. This is ridiculous. We're 60 years behind the times. We need to fix this problem, it should be fixed now, and it should be fixed right.

JH: Now, in the book, you talk about single-payer advocates. You say that they are most likely "correct in terms of the inefficiency of the system, but they fail to understand the American psyche." Do I understand correctly that if you were, say, a benevolent monarch, King Howard the First, and you didn't have to worry about Congress, and the bobbleheads on Fox News, and you were starting from scratch, you would institute a single-payer system?

HD: No, because of where we are, no. And Obama totally gets this. You have to start from where people are. And it's not just Congress and the Fox News talking heads, and all that kind of stuff. The American people -- you know, health care is awfully personal -- even more personal than taxes.

JH: Right.

HD: So you've got to -- you know, [Obama] is the first president, I think, that's really understood the American people and why we've struggled with health care reform for so long. You've got to give people choices. Let them choose. Don't have the politicians choose for them. Let them choose, and they'll choose what's best for them.

There are employer-based systems that work in other countries. Now what it means is you've got to treat the insurance companies as regulated utilities in order to make that work. But let the American people make their own choices. So I would not, if I were a benevolent despot, just force people into systems. Let them make their own choices about which system is best for them.

JH: Let me just push you on this a bit. As I was reading that -- first of all, I agree with you to a large degree -- but I kept thinking about Social Security. What is it about our political culture, or this moment in history, that is different from when FDR made everybody enter into a social insurance program for the first time, without a choice?

HD: The difference is that in those days, 80 percent of people struggled to survive retirement. And the people over 65 were the highest percentage of Americans who were below the poverty line. Nobody had anything, except for the very, very wealthy, and there weren't so many of them during the Depression. Furthermore, Social Security started in 12 states -- I think it was already in 12 states. Don't forget, for many Americans, the Depression started in 1926 not 1929. The Dust Belt was hit much earlier than the fallout from the Wall Street crash in 1929. So some states already had the rudiments of Social Security in place.

So first of all, Roosevelt had the advantage of having a system in place that already worked in some states, and second, the group of people that he was trying to help were catastrophically in trouble. On the contrary, even though health care is very expensive in this country, 80 percent of Americans have it. Now it's a scandal that 20 percent don't, but 80 percent in a democracy always trumps 20 percent.

So that's one of the reasons that the debate is not being run on the issue of the uninsured, it's being run on what's good for everybody in terms of the cost and the competitiveness. And the other reason is -- it's also the reason that you have to let people make their own choices. They have experience with a system that they like some aspects of, and they should be allowed to keep that system if they want it.

JH: OK, let me ask you a related question about the politics. In 2004, I was a volunteer for your campaign in Los Angeles.

HD: Thank you.

JH: Yeah, we almost rumbled with those [John] Kerry nerds. (Laughter). Anyway, you came out and you talked to a crowd at UCLA and really fired up the audience. And one thing that you said that stuck out for me was that the era where we start in the middle in terms of these legislative debates and move to the right has got to end.

What do you think about the argument that if we in the progressive movement had started basically pushing [Michigan Rep. John] Conyers' HR 676 [single-payer bill], we might not have a better chance of meeting in the middle with a hybrid plan such as the one that you've laid out.

See more stories tagged with: health care reform, dean, public option

Joshua Holland is an editor and senior writer at AlterNet.

Liked this story? Get top stories in your inbox each week from Politics! Sign up now »