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