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

Progressive leader and health crusader Dean on what it's going to take to overhaul our health care system.

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HD: Well, I think that was a mistake made by the administration. I do not think we should have "taken single-payer off the table." I don't believe that the votes are there for single-payer, and I don't believe that the politics are right for single-payer, but single-payer has some good things to recommend it, and we should be discussing what those good things are. And the most important part of single-payer is its cost effectiveness. It is just incredibly cost effective relative to any other system.

And so, you know, I don't know about the positioning, because in some ways you're right -- because we started with the public option. The public option -- and people don't understand this in Congress -- the public option is the compromise.

JH: Right.

HD: If you give up the public option, then this is not worth doing. You can do some insurance reform, but you shouldn't put any money into it. Just force the insurance companies to behave differently by the law, but don't put a trillion dollars into the system we already have. It's already too expensive.

JH: OK, in the book you discussed the "black hats" standing in the way of reform. I just want to briefly discuss a couple of proposals that I think most people would agree are attempts to water down this public option. Can you tell me a little bit about what the talk of a " trigger mechanism" is about?

HD: Yeah, a trigger mechanism -- these are internal compromises in the United States Senate to try to get a bipartisan bill. Well, you know, I think a bipartisan bill is always a wonderful thing, but if it doesn't do anything and it's a lousy bill, then what's the point?

So a trigger mechanism is one version of what I call the fake public option -- it's been used before in different forms. It was used against the inflation fighting in the '80s where inflation was high, so they had a trigger mechanism that was going to force some wage and price control if corporate America didn't do the job itself.

And of course, the minute that the time period passes, the private sector goes back to the usual behavior. So a trigger mechanism is worthless. You'll get some concessions from the insurance companies in the short term, and we'll be right back where we are in the long term as soon as the deadline passes.

Another fake public option is the co-op proposal. They'll be crushed just like Blue Cross was crushed. Most Blue Cross chapters are now for-profit. They've been taken over by the insurance industry. Any reasonable-sized insurance company can crush a not-for-profit co-op.

So these are all what I call fake public options, and they're really not serious health care reforms. They're not aimed at reforming the health care system, they're aimed at getting a bipartisan vote in the Senate. That's just not going to happen. We should just give up on the bipartisan vote in the Senate and pass a decent bill.

JH: And the co-ops, of course, undermine the idea of having a very large insurance pool.

HD: Well, that's right. You can't do this without a large insurance pool, and the private insurance companies will just crush the co-ops.

JH: Our readers tend to be very activist oriented. My final question is this: How can ordinary people like the people who read your book or read this interview -- how can they get involved, and how can they make sure that they don't get screwed as health-reform legislation moves through Congress?

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