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Dr. Dean's Second Opinion
Manuel Balce Ceneta / AP Photo
Republicans are ramping up attacks on President Obama’s proposed health-care plan as he pushes Congress to pass the bills before summer. Howard Dean, the former chairman of the DNC, tells us what to like about the plan—and why 2009 won’t be like 1993.
For the first time since Harry Truman, real health-care reform is finally within reach. While health-care reform may well pass with only Democratic votes just like Medicare in 1965, this should no longer be seen as a fight between liberal and conservatives, Democrats and Republicans. This is now a fight between the insurance companies and the American people. The reason we are finally going to get real health-care reform is that the plan President Obama put forward recognizes the importance of giving the American people a choice: If you like what you have, you can keep it. If you don’t, there will be a public-health-insurance option. The president’s steadfast support has been critical to reform because without a public option, there is no reform, just a shuffling of deck chairs and wasting $1 trillion in taxpayers' money.
Republicans in Congress now have the opportunity to be on the right side of history in the health-care reform debate.
A large number of the American people—more than 72 percent, including more than 50 percent of Republicans—strongly support the public option.
Recently, both the U.S. House of Representatives, led by Speaker Nancy Pelosi, and the Senate Health, Education, Labor and Pensions Committee—ably led by Sen. Chris Dodd and guided by the wisdom of Ted Kennedy—demonstrated that they are listening to the American people. Both have passed plans that represent real reform. While the bills are not perfect, they include a public-health-insurance option like the American people have asked for. It’s not yet clear what the Senate Finance Committee will do, but it’s clear that they too should take a stand for real reform and support the bill passed by the HELP committee.
A great majority of Americans face a constant struggle to stay one step ahead of mounting medical debt. Medical crises contribute to approximately half of all home-foreclosure filings. According to a study conducted by researchers at Harvard University, 50 percent of all bankruptcy filings in 2004 were partly the result of medical expenses; 68 percent of those who filed for bankruptcy actually had health insurance, but found that insurance inadequate to cover their bills.
Even as skyrocketing health-care prices are bankrupting millions of Americans, however, the earnings of private health-insurance firms are rising. In most areas of the country, the insurance market is dominated by one or two large providers. Rather than bargaining for lower rates, large insurer conglomerates are transferring the higher prices charged by hospitals to patients and padding their profits. Between 1999 and 2008, as premiums increased 117 percent for families, the profits of the top 10 insurance companies grew by approximately 1,000 percent. During the same period, insurers merged more than 400 times, but employee premiums increased nearly eight times faster than average U.S. incomes.
Large insurers have little incentive to bargain for lower prices, and smaller insurers do not compete on premiums to gain market share. Instead, they “follow the pricing of the dominant insurer” and compete on risk. As the Urban Institute has pointed out, “competition in insurance markets is often about getting the lowest risk enrollees as opposed to competing on price and the efficient delivery of care.”
For real health-care reform, we must restore competition into health markets and reorient the business model toward quality of care. A health-care reform initiative that includes a public-health-insurance option (like Medicare) would permit individuals who do not receive coverage through an employer to choose from a menu of private and public coverage options. Enrollees would pay a subsidized premium (should they qualify for a government subsidy) and receive the coverage of their choice. The new public health plan would negotiate with hospitals and doctors for the best health-care prices. Costs would be set through a process of competitive bidding in which all of the different health-care plans (public and private) would participate to provide standard benefits.
The new plan would also use its inherent advantages to do what private insurers have only promised: Control costs over the long term. Unlike private companies—which typically spend between 20 and 50 percent of health-care dollars on expenses such as administration, executive salaries, advertising, and shareholder return on equity—Medicare has low administrative overhead and the ability to bargain for volume discounts, just as the new public plan would have.
A public-health-insurance option could use its ability to negotiate for lower prices and volume-purchasing capacity to muscle private insurers into lowering their administrative spending and using more health-care dollars to provide actual health care. This kind of reform could reduce projected health-care costs by about $2 trillion over 11 years. It could lower premiums by 20 percent on average, simplify the medical billing process (thus pleasing doctors and patients alike), and allow small businesses to finally enroll their employees into a health-insurance program that provides comprehensive health benefits.
The American people have made it clear that they want change. Republicans in Congress now have the opportunity to be on the right side of history in the health-care reform debate. It’s time to abandon the false rhetoric of the right wing and the scare tactics of the insurance companies desperate to hold on to their profits and do what’s right for America.
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Jacob Bernstein is a senior reporter at The Daily Beast. Previously, he was a features writer at WWD and W Magazine. He has also written for New York magazine, Paper, and The Huffington Post.
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Lloyd Grove is editor at large for The Daily Beast. He is also a frequent contributor to New York magazine and was a contributing editor for Condé Nast Portfolio. He wrote a gossip column for the New York Daily News from 2003 to 2006. Prior to that, he wrote the Reliable Source column for the Washington Post, where he spent 23 years covering politics, the media, and other subjects.
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Jeff Madrick is a contributor to the New York Review of Books and a former economics columnist for the New York Times. He is editor of Challenge Magazine, visiting professor of humanities at Cooper Union, and senior fellow at the New School's Schwartz Center for Economic Policy Analysis. He is the author of Taking America, The End of Affluence (Random House) and The Case for Big Government.
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Excellent? As much as I support major health care reform, including a public option, this column is nothing but political showboating. There's no meat, no attempt to address the concerns of those that oppose a public option, and no real details concerning the actual plan.
So, not excellent...Howard Dean may DO some great things, but he never SAYS anything other than what the Democratic Party's message advisers feed him.
"Appealing to Republican higher angels" WTF does that mean?
I resent your mindless support for the bankrupting of this country, just to eliminate about a third of the 50 million uninsured, which also includes non-citizens.
DO ANY OF YOU REALIZE WE HAVE TRILLIONS OF UNFUNDED LIABILITIES???
TENS OF TRILLIONS!
Don't worry, we found a way to cover the cost..
we can human traffic the republicans to third world countries. Too bad they aren't too sharp, we could have gotten a little more money out of them.
In my opinion, the largest single problem that we face in healthcare is that insurers/HMOs are driven by a profit motive (i.e., SHAREHOLDERS).
SHs demand profits by any means, usually by reducing costs. Cost reduction in healthcare sometimes comes as improvements to efficiency, and these companies very well may be better at managing the health beauacracy than federal govt would be. Cost reduction also comes by decreasing payouts like refusal of certain treatment options and denying claims after treatment was initially approved.
Normally I would defend corporations and the benefits they bestow upon our country, but I really don't see what benefit we get from shareholder owned healthcare. They just seem like parasites on us all.
I don't know what the solution is, but I think I know the real problem.
Thank you for your comments and thoughts....what's happening now is that there's an insurance representative coming between the patient and health care by means of denial of service, regardless of premiums paid.
In this country, we do not need health insurance reform - the big insurance folks will never cut themselves out of the picture. We need health care reform, in some sort of single payor, that cuts big insurance out, unless there are those folks that would like to buy additional coverage on top of single payor.
We don't need any more government bureaucracies.
No Thank You.
People in this government seem to be all about
seeking power through over-regulation.
Over site in the case of Wall Street is one thing.
If politicians didn't spend so much time handcuffing the
citizens (small business) through over regulation, they wouldn't
know what to do with themselves.
Power.
For The Lobbyists, By The Lobbyists.
Even though, we the taxpayers, put politicians in office
(our fault), pay their salaries, and their pensions,
when the government's healthcare plan goes into effect,
will the rest of us have access to the same pool of
healthcare politicians will receive ?
Or will the taxpayers have to ration, and wait months for
routine care thanks to a maze of money wasting, bureaucratic, incompetence ?
We've seen how the government runs AmTrack.
Isn't it pretty much a mess ?
As goes AmTrack, goes General Motors, goes healthcare ?
Government impedes progress and innovation.
"People in this government seem to be all about
seeking power through over-regulation."
Really you mean after the market crashed because we where not regulating anything, the gov is seeking power through over-regulation? how bad is over regulation worse then a great depression?
I know exactly what you mean Progressive, we should have never allowed Barney Frank to open up loans to people who couldn't afford to pay them back and we certainly shouldn't have allowed Bill Clinton to do away with the century-old credit default swaps regulations.
Out of curiosity... have you ever lived in another country? For all of its faults, our government actually does a great job running things. The things it doesn't do a good job on is health care, gun control, education, the poor and mentally ill.
You mention wallstreet as "one thing". How the heck is it different? Healthcare companies are running just as rampant. You want it to completely run into the ground before our government does anything?
And I'm terribly confused... you will still have the ability to buy private health insurance, right? What are you all up in arms about?
Do you have something against the uninsured?
http://www.youtube.com/watch?v=c6NgN35-ZWM
@kiwibelle
" our government actually does a great job running things "
Sorry, nobody wastes more money than government.
Remember the $600 government toilet seats ?
Many people say, "why not regulate big business."
Is there not a connection between
lobbyists of big business and politicians, who set policy
in the best interest of those lobbyists and the
companies they represent,
ultimately placing the burden on the average taxpayer ?
Aren't the people watching the hen house, in bed with the hens ?
Don't be surprised if there are big players in healthcare reform,
large corporations, involving lobbyists from General Electric,
Blue Cross, Walmart, etc., intertwined with government,
holding a corporate monopoly,
posing as so-called "government" healthcare.
sophia5 - Yes I know all about the lobbyists etc. I personally find the of privatization of jails to be a worse business then $600 toilets. Still in spite of all that, I still think this is a great country, every system is corrupt in one way or another. It's not perfect but guess what, nothing is. but we should strive towards becoming better and I think this is a step in the right direction. More money spent on the right causes will mean there will be less to be spent on stupid ones (like on airplanes we don't need for the bloated defense budget).
You know the health care industry is taking unfair advantage of the American people. Wringing them dry for everything they've got. A drug that costs $1.50 in another country costs $135 dollars here. Employees are now being told to buy supplemental cancer insurance because the basic insurance they are already purchasing may not cover all costs if they get cancer. What's next? Separate emergency room insurance? Separate diabetes insurance?
It's already broken, the government can't make it worse.
garryboyle - thanks for the link but I can't youtube at work.
"Or will the taxpayers have to ration, and wait months for
routine care thanks to a maze of money wasting, bureaucratic, incompetence ?'
I don't want that either, but it's not like HMOs are much better. The difference is that with HMOs the maze of red-tape is not due to incompetance but is carefully designed in order to limit payouts.
Which is better, which is worse?
Go to redstate.com moron. We're already over our limit of wingnuts here.
I travel frequently on AmTrack and usually have no problems at all. On time departures and arrivals. I even receive my "government run" mail on time.
Okay, Ronald - overregulation hasn't been a problem for 20 years. We have had a steady pattern of deregulation that led to the global financial collapse last fall.
And we already ration healthcare, but it's decided based on profits rather than on need.
Government isn't always perfect, but Government funds progress and innovation.
"Power.
For The Lobbyists, By The Lobbyists"
The main reason Healthcare hasen't gone through is insurance company lobbists spending millions on influencing politicians to vote against it. Millions that could've been spent helping someone who's been denied service despit paying premiums.
"Or will the taxpayers have to ration, and wait months for
routine care thanks to a maze of money wasting, bureaucratic, incompetence?"
Isn't that what's happening now? Only now, it's not incompetence, but greed. USA is the only "1st world" country in the world wherein, the first question they ask when you show up for treatment, is "do you have insurance."
Don't believe yourself. I'm a Canadian who lived in the States for 10 years, and the best thing about coming back up here was not needing to worry about that crap anymore.
Important: Drug companies provide low cost medicine -- the big pill companies haven't come up with much new in years -- this is no boon for them; no expensive proceedures to keep granny and grandpa alive another few days; kids get good care; hypocondriacs can go to hell. George Patton
This is the most important line in the entire article:
"As the Urban Institute has pointed out, "competition in insurance markets is often about getting the lowest risk enrollees as opposed to competing on price and the efficient delivery of care."
All you nay sayers on public health care need to think of this closely. The prime objective of a health care system should never be profit before quality of care, and that's what you have in the States. Rather than provide quality care, insurance companies simply try to find the healthiest people possible.
You may think you're well insured but come time to use your insurance and you'll soon find that the fine print has be designed in a way to reduce you quality of care therefore reducing your cost to the insurance company.
I live in Canada, in Alberta, and say what you want about the ills of public health care, I have had 4-5 surgeries, including an appendectomy performed the same day as my diagnosis, 2 broken arms, my wife has given birth to 3 children - one a C-section and never once have I paid any money out of my own pocket (other than my taxes that pay for public health care) and I have never once worried that I will go bankrupt and lose my house because of mine or my families medical condition. I have never been refused care or waited an unreasonable amount of time for treatment.
One MAY be able to get the BEST health care in the States, but the majority of US citizens probably get poor health care due to the inequity built into the for-profit system. But you can all sleep well knowing that the rich can get great healcare in the US, while all the rest get screwed.
Unfortunately, for all the excessive costs and worry about bankruptcy, the US does not provide the best care.
One more thing --- Keep HRC out of the country until heathcare is signed! George Patton
Why was Dean passed over by Obama for HHS?
He's too much of a free thinker, maybe, but he should be in there.
If health care reform gets passed, it will be because Dean made it an issue in the 2004 election.
Personally, I think it is because Dean is viewed as an idiot.
Sorry Garry.
He growls
Not enough Electoral Votes in Vermont. If he was from NY, PA, CA he would have. And then we would have been screwed....because he is an idiot.
"if you like what you have you can keep it. If you don't, there will be a public health insurance option."
Unfortunately, this isn't correct. The one thing most people don't realize and Dr. Dean is not describing is that currently, in the bills circulating the halls of Congress, if you have insurance you will NOT be able to enter the "exchange" and have access to the public option. It's unfortunate that people who would like to join a public option will not be locked into their job's insurance.
See more here: http://www.kaiserhealthnews.org/Stories/2009/July/15/Firewall.aspx
"President Obama and leading Democrats have stressed that people who like their employer-sponsored insurance would be able to keep it, under a health care overhaul. But they haven't emphasized the flip side: That people who don't like their coverage might have to keep it.
Under the main health bills being debated in Congress, many people with job-based insurance could find it difficult to impossible to switch to health plans on a new insurance exchange, even if the plans there were cheaper or offered better coverage. The restrictions extend to any government-run plan, which would be offered on the exchange."
If you want an eye opener, check your Senator's web page for his schedule. My senator, Bill Nelson from Florida, spent his entire day meeting with a large insurance company and several other organizations that don't want anything changed. He's a dem and is on the Finance Committee. Now I know why their bill is stalled. At least one of them is still trying to round up contributions and those contributions they're giving sure aren't of the helpful variety.
We need a public option, we need it now - and we don't need a senator who doesn't care about the people he represents. I'm looking forward to primary time.
Sounds like you should get on the phone with your senator and remind him who he works for.
I am not sure where Dean gets his numbers for approval of this reform. Gallup says 56% of Americans approve of reform, and only 23% of Republicans approve. To say people want a public option, 72%, may have been true in theory, but now as details of the complexity and costs come out, its not so "overwhelming".
And what good is his example on Medicare? If anything, it should tell Americans to stay away! So it got ZERO votes from Repuplicans. Sounds like the Republicans saw the writing on the wall; that the costs would spiral out of control.
Medicare, according to its trustees this May, has an unfunded liability of $38 Trillion. And they have been cutting costs and negotiating lower payments to doctors and hospitals.
I feel really bad for my Grandchildren. What will the "unfunded liabilities be in the next 50 years? What comes after Trillion anyway? Quadrillion?
Except that Medicare costs pennies on the dollar versus what private overhead costs are.
What is your definition of "pennies on the dollar"? Dean was pretty vague when he claimed insurance companies had admin costs of 20-50%. Thats a pretty broad range.
But my numbers are from the trustees of Medicare in May 2009. Give us all some solid numbers on these pennies.
Medicare administrative costs are usually reported as around 2%, whereas in actuality they're closer to 5%. The most generous data I could find lists private insurer administrative costs as averaging around 16.7%. Giving the current system the benefit of the doubt, we're talking about a difference of at least more than 11%. But wait, there's more: under the proposed reforms there would be measures to reduce costs and the increase in individuals with health insurance would further reduce costs through economies of scale. Thus, health insurance would be more efficient than the current oligopoly, and the markets would be corrected.
Bravo--Dr. Dean!
I thank God that healthcare reform is still moving it's way thru Congress. I was afraid that with all the "bribes" that the insurance industry was throwing at every elected official in Washington, that our greedy Senators would cave into the industries demands that nothing should change. I believe Congress has finally begun to get the message that Americans want to be represented by them and were not elected to sit around and collect pay, healthcare and lobbists "contributions" while those of us without insurance try and stay healthy by treating ourselves. Thanks to Mr. Dean for all his work on the reforming of our healthcare system. As for all the big insurance companies...."enjoy yourself while you can, because the days of profitering off the sick and infirm of this country are coming to an end."
I have relatives all over Europe and whenever any of them visit they are always horrified by the little containers in convenience stores that basically beg for spare change so some kid can live. These cans usually have a picture of a kid who needs something expensive like an organ transplant which insurance won't pay for and the parents cannot afford.
I'm sorry, we can't let people beg for money to save someones life AND call ourselves "the greatest country in the world."
Oh, and don't try to use the trite "generosity and volunteer-ism is what makes this country great" bullcrap.
Hear, hear!
Thanks Dr. Dean - The story in a nutshell. Our only hope is to keep the legislation free from lobbyists' dirty little fingers and then later to keep it from becoming the cash cow for pet projects not related to healthcare.
We actually don't need to spend money to fix this. A real 4-point plan should look like this:
1) Get employers out of the health business and eliminate self-insurance. This will make Health Insurance portable from employer to employer. It's also one of the biggest tax scams going.
2) Require every insurer to accept any paying client, with no exceptions for pre-existing conditions.
3) Institute price and performance regulations for the insurers.
4) Make illegal any pre-existing conditions clauses on existing contracts.
This actually should cost less than the current healthcare proposals and insure everyone.
No your plan won't work as long there are for-profit insurance companies. When there is a profit motive, insurance premiums will ALWAYS be diverted to CEO's and shareholder profits.
Anything less than a not-for profit system, public option, or universal health care will be more of the same.
If you really think you have good insurance not, you must be healthy and have never had to use your insurance.
Why not have Congress put the onus on the 25 million small business owners who employ 70% of americas workers?
Small business have and still can't get their associated health plan through congress, passed the house with anamazing majority only to have it killed in the Senate by Kennedy and Clinton.
If the plan to penalize the mall businees owners with an 8-10% tax by the government (thats the estimate in the bill) it will decimate enough businesses, they will be out of business.
Our country is sliding into hole we may never recover from,so pass health care and call it reform, call it whatever sounds good, but this Edsel won't work, mainly because like most government programs it creates another beraucracy.
I'm sorry, but I'm so sick of the "Creates another bureaucracy" argument. You realize that right now health care is run by a FOR PROFIT bureaucracy, who's job it is to find any possible reason to deny coverage to people who pay premiums every month, never mind the millions of people who can't afford insurance at all.
It's already a bureaucracy, and it's one designed specifically to screw you.
A public option isn't perfect, but at least its primary purpose is to make sure the population is healthy, rather than making a few already-rich people even more money.
Howard Dean, we see you are still screaming like a crazy idiot. Didn't you learn your lesson the first time around? Why haven't they restrained you already?
Because he's damn good at what he does.
Dean is the face of the Democratic Party. That alone should scare the hell out of any normal person.
This isn't about Democrats or Republicans. It is about providing quality cost efficient health care for the country.
The for-profit method currently employed has failed.
How has it failed?
Failed for whom? We are a family of five with a high deductible health care plan and an HSA.Our premiums went down significantly when we changed to the high deductible plan and, yes, I do have to pay for more out of pocket, but I know I am covered if anything major (or actually not so major) happens to a member of our family.
The non-profit one will fail bigger. NHS is failing in the UK.
Dean was the face of the Democratic Party; we have a president now - Barack Obama is the face of the Democratic Party.
Why do you think the Republican Party is in such a state of disarray? One reason is they don't have a clearly defined leader.
Another taxpayer for the Public Option.
Let's see some reform!
Let's hope it passes - With a PUBLIC option.
Looks like you are going to get your wish! Page 16 of the House version makes it illegal for any new private policies to be written on the date the legislation takes effect. So, sure, you can keep your plan--until you change jobs, your insurer goes out of business, or your employer drops the plan. Then you must join the public plan.Thank goodness the Dems won it all! Allows them to overreach and put little jewels like this in the plan which means this plan will be accepted by the public and passed only in your dreams.
We won the election.
Screw the Republicans
The CBO just said this plan will increase Healthcare costs to the Federal Government. This, even as the Fed has announced planned cuts in Medicare and Medicaid. And Medicare is sitting on an unfunded liability of $38 Trillion, according to its trustee report from May, 2009.
So while the Utopian idea of healthcare for everyone sounds great, the little problem of how to pay for it continues to be ignored.
The most intelligent and well wriiten article I have seen to date on this immense concern. Thank you, all of you, who have worked so hard to provide "real competition" to the marketplace. This is what good responsible government is supposed to do - protect the majority of our nation. The middle class will never be able to thank you enough.
Is it just me or did the better part of Howard Dean run down the crack of his mother's ass and end up as a stain on the sheets?
I'm 58, retired , with wife, on an income of $55,000. I'll die in the street with gun in my hand fighting against Obama's plan. That is because Obama will give me a choice between paying a $2,000 penalty fine for not buying the government plan and about $8,000 a year of money I don't have for Obama's policy. I need that $2,000 to pay for my health. I do not have that other $6,000 for the Obama policy. The gun is the only choice left.
In that case, I guess that the only thing the rest of us can say then is "good riddance". But before you do that you better check a different source of numbers than the conservative propaganda that you have been brainwashed with. It might save your life in more ways than one.
I would like someone to answer one simple question, if Obamacare is so good, why is congress exempt from it. Why aren't it's supporters showing leadership and state that they will be the first ones to sign up for it.Real leaders who believe in what they say lead by example. No real leader is a "Do as I say not as I do" person. No doubletalk or speak. Why won't this apply to congress. That's all you need to know.If they thinks its so great, let them show real leadership and sign onto it first.This really shows that all this a politcal show and has nothing to do with offering the best healthcare to its citizens.
The bills now before Congress would force you to switch to a managed-care plan with limits on your access to specialists and tests. And as soon as anything changes in your contract -- such as a change in copays or deductibles, which many insurers change every year -- you'll have to move into a qualified plan instead (House bill, p. 16-17).
When you file your taxes, if you can't prove to the IRS that you are in a qualified plan, you'll be fined thousands of dollars -- as much as the average cost of a health plan for your family size -- and then automatically enrolled in a randomly selected plan (House bill, p. 167-168).
It's one thing to require that people getting government assistance tolerate managed care, but the legislation limits you to a managed-care plan even if you and your employer are footing the bill (Senate bill, p. 57-58). Nowhere does the legislation say how much health plans will cost, but a family of four is eligible for some government assistance until their household income reaches $88,000 (House bill, p. 137). If you earn more than that, you'll have to pay the cost no matter how high it goes.
Half of the tab comes from tax increases on individuals earning $280,000 or more, and these new taxes will double in 2012 unless savings exceed predicted costs (House bill, p. 199). The rest of the cost is paid for by cutting seniors' health benefits under Medicare.
You are full of it. No plan is in place as yet, and your conclusions are put forth to scare not enlighten. As a GOP troll, you have no right to quote any part of any bill, as many proposals are on the table, and none have been decided.
Your doublespeak is staged to look official, but NOTHING you say is actually even past committee.
Unless we get healthcare and allow feds to negotiate drug prices, and offer public option, no one will be able to afford care.
The drug and insurance companies are spending a fortune spreading toxic misinformation...and so are you.
Thank you.
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