America's healthcare system is sick, Howard Dean writes in his new book, Howard Dean's Prescription for Real Healthcare Reform. Dean, a physician and former governor of Vermont who unsuccessfully sought the 2004 Democratic presidential nomination and then served four years as chairman of the Democratic National Committee, recently spoke with U.S. News about the politics and policy of healthcare reform, as well as about Republican National Committee Chairman Michael Steele and his own political future. Excerpts:
What's the most important part of your prescription for healthcare reform?
That Americans should have a choice. That the choice should not be up to Congress, it should be up to the American people, about what kind of reform they want and how fast they want it. And that means a public option must be part of the bill that passes the Congress.
In the book, you write that the public plan could "outcompete the private insurers and drive them out of business." If that's the case, are you taking choice away from Americans?
No, no, no. Because the American people would make that choice for themselves. Really, in fact, it will be the health insurers that drive themselves out of business. Because if they continue to cut people off who have already been paying their insurance premiums, if they continue to deny people coverage, if they continue to have bureaucrats between the doctors and themselves, then people will choose the public plan. In fact, most of the Republican rhetoric about the public plan actually applies to the private plan. It's kind of a Kafka-esque rhetoric on their part. And people are sick of it.
Is healthcare a right?
I don't use that kind of rhetoric in general. I think it's certainly a moral imperative.
What mistakes did President Clinton make in his healthcare push that President Obama is avoiding?
The process was relatively closed under President Clinton. And it was complicated. This is—the choices are pretty clear to people. You can keep what you have if you like it, or you can have something like Medicare. Your choice.
What would Obama take away from your book?
That the public plan is absolutely essential to reform. Although I think he believes that. He was the one who suggested the public plan. It's his plan that I'm supporting in the book. Healthcare spending has grown faster than the economy . . . Two and a half times the rate of inflation since World War II. Medicare has gone up at 2 percent over the rate of inflation. Private health insurance has gone up much faster.
Isn't this due, at least in part, to medical innovation?
Yes and no. It's partly due to that. But let's not forget that some innovation has actually saved money. For example, most of the new drugs reduced hospital stays. So, yes, it's partly true. But part of the problem is that the innovations can be incredibly overused, and fee-for-service medicine gives us doctors enormous incentives to do that.
Couldn't waste in the healthcare system be solved by limiting lawsuits against doctors?
No. Some could. But not a huge amount. The huge amount is the insurance companies that take 20 to 40 percent of the premiums . . . for other reasons. But certainly, the tort system is not helpful.
Have you had any role in the negotiations regarding the healthcare reform bills?
No. If I did, I wouldn't tell you.
What do you say to the GOP objection that government should not come between the patient and the doctor?
The only place where people stand between a patient and a doctor is in the private health insurance industry. That doesn't happen in government.
Can you elaborate on that?
Sure. I practiced for 10 years. Lots of times insurance companies refused payment after the fact. No such problem with that in Medicare. Republicans are just frankly making that up.
What's the worst possible result of the current push for healthcare reform?
Wasting all this money on a good political solution, which is a bad medical solution.
Do you think healthcare reform will pass?
I do.
What role do the Republicans have in this? Does Obama need them?
No. And right now they have no interest, obviously. They're using it as a political cudgel against Obama, but they have no interest in the substance of the bill. The Republicans aren't interested in this. They weren't interested in Medicare 45 years ago. And they're not going to be interested in this. We should just pass it and do the right thing.
So will Democrats be blamed if nothing passes?
Well, obviously the Republicans are doing everything they can to kill it. I mean, look, the Democrats are ultimately responsible because we have huge majorities, and if you can't get a program through when you're a huge majority, that's a big problem. And that's not going to be very helpful to the Democrats in 2010 or 2012.
What do you think of Republican National Committee Chairman Michael Steele?
I like Michael Steele personally. He's probably not suited to be chairman because he wasn't able to stand up to Rush Limbaugh. And you can't be pushed around by a talk show host if you're going to be the chairman of the Republican Party. Or the Democratic Party, for that matter.
How would you take on Steele if you were still head of the DNC?
I would ignore him.
What does the future look like for you?
Who knows? I really want to do everything I can to get a decent healthcare bill passed. And then who knows what's next?
Might you run for office again?
Probably not.
But the option is open?
All options are open in politics.
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