Dean: Give Americans A Choice, ‘I Don’t Think We Should Impose Single-Payer On Everybody’

[ProSense]

Dean: Give Americans A Choice, ‘I Don’t Think We Should Impose Single-Payer On Everybody’

Some political pundits have portrayed former Gov. Howard Dean (D-VT) as a wacky liberal caricature, whose online supporters spam blog comment sections in favor of single-payer health care. But during an exclusive interview with ThinkProgress, Dean described parts of his own health care philosophy as conservative.

Rather than advocating for a broad overhaul of the health care system, for instance, Dean argued that we can build on what works in our current system and reform health care by giving Americans the choice of keeping their existing insurance plan or enrolling in a new public option.

Dean predicted that more Americans would chose a public plan, but he ultimately argued against a single-payer proposal:

The American people will preferentially choose Medicare, but not all of them will choose Medicare. So we will have a hybrid system. Many more people will be in a public sector because it will probably be better for them. But they will only be in the public sector if they want to be, and they can get out of the public sector if they choose to try something different later on. That seems fair to me. I don’t think we should impose a single payer on everybody, but I do think we should give Americans the choice of having one if they like it. If it works for them, that’s what they’ll choose; if it doesn’t work for them, they’ll choose the private sector. But I don’t buy that the private sector has a right to compete and be more inefficient. I don’t think anybody has a right to serve people worse than somebody else just because they’re private sector.

Watch it:

(http://wonkroom.thinkprogress.org/">Dean On Single-Payer Health Care)

Dean proposes an interesting framework for opposing critics who argue that progressive plans would result in a “government-take over” of health care. At their core, progressive proposals compliment true conservative values of personal freedom/choice and business competition, and push back against those who want a monopoly of private sector options.

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[FrenchieCat]

1. I see as Dr. Dean does.......

Barack Obama has said too many times that he will make a government (medicare) option available as part of the menu of options available to the public. This means that if enough choose that option, then whether folks like it or not, we would be on our way to a single payer health care provider....and in the meantime the health care reform offered doesn't appear to "Force" folks into a government program, and in essense provides the "Choice" that many in this country have been programmed to believe that they should have.

The objections that took down the last Health Care reform undertaking were:
Lack of Choice,
Too complicated,
and done in secrecy without consultation by interested parties.

Barack Obama is addressing each and everyone of those issues in how he is approaching health care reform, and in so doing is striking a blow at anticipated objections before they happen.

[vaberella]

10. Agreed. n/t

[bvar22]

27. Obama has never said he will make "MediCare" an option.

He has only obliquely referenced a "MediCare like" option that would be available for people to "buy into".

I would really like to see the details of this "new" system.
How much will it be "like" MediCare?
Will it be "like" MediCare Part D?
Will it compete with real MediCare?
How much will it cost to "buy into"?

Why build a whole new system "from scratch" when MediCare is already up and running? :shrug:

[FrenchieCat]

30. I think you are getting ahead of yourself....

You say that what Obama described was "oblique" in his description,
meaning it wasn't clear to you.....

Yet on the other hand, you appear to know what this "oblique" like option is going to be.

But Either you know or you don't know.

Perhaps patience would serve you well right about now.
I think you will know much more soon enough.

[D-Lee]

35. Agree, and start thinking about "taming and civilizing" insurance administration

I suspect we need to consider not tossing a lot of those still employed by insurance companies into the unemployment rolls, and to weigh minimizing economic disruption as a new approach is discussed.

Revenge and blood-letting has an appeal, but something more moderate and multi-faceted is probably best for our country as a whole as we strive for accessible health care.

[DeepBlueC]

2. I think he's spot on

Conservatives can't bellyache about being "forced" to have decent insurance. The system may well evolve into a single-payer system but if it does it will be because people choose it. And I am a great believer in building on what we have already; it really is what most European countries have done to arrive at universal coverage and it makes sense for us to do the same.

[Samantha]

3. Perhaps this is why Dean was not given the HHS spot

He prefers to speak the literal truth instead of playing ball with corporate interests.

I am so glad he is continuing to speak out. I truly admire the man.

Sam

[WinkyDink]

40. Obama needed one voice; Dean's was his own.

"Admirable", I'll give. "Team player", not so much.

[Jackpine Radical]

4. Dean's plan makes sense to me.

The fact is that administration of health care finances is one of those things that the government can do a much better job of than the private sector. Over time, more people will opt into it, and we then just shift the financing to the tax base.

[sandnsea]

5. Precisely - I'd like to be able to choose Medicare

And I should be able to. That's the way we need to go to win this thing so that everybody has a single payer style plan available to them.

[DJ13]

6. Im worried that a bastardized healtcare system will only result in

....the worst of both worlds.

I understand that politicians feel a need to "protect" an industry (even one like the health insurance industry thats a vampire on society), but to do this right so our health care system serves everyone they will have to get the balls to do whats right and stop worrying that the insurance lobby gets upset.

[Occam Bandage]

8. Like it does in Canada? nt

[Occam Bandage]

7. I think that's rather obviously the best choice. Open Medicare to anyone who wants it,

and be done with it.

[SoCalDem]

9. The problem with ":opening medicare" is that it's still 80-20

and would require insuance companies to stay in the mix, for "supplementals",and just as cable has done, watch for more and more procedures to be declared ineligible and only available through "upper tiers' of service.. nd watch for insueres to come through , with "super-supplementals"

This "plan" could actually weaken medicare, and cause it to cost even more..

We just need the same set up that the fed govt employees get...like the senators & the congress people and the postal workers etc....at the same cost of course:)..actually the cost should go DOWN, once all these extra people are put into the one big group:evilgrin:

[Ewellian]

26. There's not a federal

employee plan. Federal employees choose from a selection of plans offered by private insurers.

[annabanana]

36. jeez...

I've been fighting with that so-called "fed gov't employee" system for decades... all it is is a list of HMOs and regular insurance to choose from..

http://www.opm.gov/insure/health/planinfo/index.asp

[SoCalDem]

47. It's about how much/LITTLE it costs them, more than what "plan" they choose

I KNOW it's a laundry-list of plans available...but what's different is that congressional/senatorial types pay far less for "their share".. that's the angle i was going for :)

[Thothmes]

14. Medicare is all well and good

but, because of reimbursement rates none of the physicians in the area I live in will accept new medicare patients. Politicians play balance the budget games with the medicare reimbursement. If the system is to be viable, the physicians have to be reasonably reimbursed for their services. If this is not going to happen, doesnt make a difference how many choose medicare, they will still be out in the cold as far as health care is concerned.

[idlisambar]

29. not really

As the percentage of medicare patients increases, physicians will have to take them. "reasonably reimbursed" will be redefined to be a little less than it is now.

[madfloridian]

31. Exactly! The more on Medicare...the more obligated doctors are to see them.

It can be easily maintained.

[Thothmes]

34. How?

[Thothmes]

33. The reimbursement rates

have to be hi enough for the physicians to be able to pay for their practices. Right now a lot of doctors would be out of business if their sole source of reimbursment for services was medicare.

[madfloridian]

38. Our doctors want traditional Medicare. Their clinic prefers it.

They are treated shabbily by the private Medicare plans.

[idlisambar]

39. some costs will have to be reduced

There will be some savings because (if it's done right) fewer employees will be needed to extract money from the various insurance agencies. A lot of man-hours, especially in a small practice, are spent getting insurance companies to pay up.

Second, it is probably the case that physicians and other medical professionals will have to accept a little less money for themselves. Maybe some will go out of business. Others will do just fine. Any change in the healthcare system is bound to cause some disruption. If you are reducing costs someone is going to be hurt -- no way to avoid it. still that shouldn't prevent us from doing what is best for society in the long run.

[Thothmes]

48. Just what we need physicians going out of business because

they cannot afford to practice medicine. Does this mean that we should belooking for 5H visa nurses for Guine-Bissau, or Guatamaula. My GP clears $79,000 a year on her family practice. She has two full time people doing insurance paperwork. Even with medicare, she still needs one to do the paperwork. Someone has to pay for the building lease &upkeep. Someone has to pay for the staff of RNs and lab techs. Someone has to pay for equipment and supplies used. In the case of her practice, medicare patients are subsidized by the private insurance companies. That is why she will accept no new medicare patients. Current patients that become eligible for medicare are allowed to continue in her care. There must be a reasonable, stable medicare reimbursement rate based on a solid progressive tax collection program to pay for it. If this is extablished, the system will work very well for the Amercian people. As long as medicare reimbursment is subject to the whims of budget cutting Congress, the system is shakey at best. JMO

[idlisambar]

51. The devil is in the details

and each situation is different. Physicians deserve a good living -- no dispute there (disclosure - my dad is one of them). My only point is that there will be disruption and people will have to adjust. If reform is successful, there will be less money sloshing throughout the system so something has to give. Remember, there is a reason why healthcare reform hasn't happened yet.

[depakid]

11. What Dean's describing is essentially Australia's system

which is a FAR CRY from what's currently on the table.

[firedupdem]

12. Sounds good to me. I would rather have a choice. n/t

[tavalon]

13. Whoa good doctor!

It's clear you've been out of the "medical system" for a while. There is nothing to build on anymore. It's completely, totally broken. It is only by the absolute dedication of each and every medical professional that people aren't being hurt and dying at much higher rates. Sheer fucking willpower is all we have left.

I've been in the trenches for 20 years and there has been a massive shift.

[madfloridian]

15. He's been saying that. He's fighting for the public option like Medicare to stay.

Seems like Obama might be deciding to go with a health care "mandate", and Dean is afraid that won't work.

Seems we are going to have to fight to keep Medicare or something like it. Next in line...Social Security?

Yeh, I know, all us old folks are getting tired of being jerked around. We saved it all from Bush, now we are going to have to save it from our own party. :shrug:

[Phx_Dem]

16. Couldn't agree more! That's why I love Dr. Dean.

[Faryn Balyncd]

17. Dean also specifies that any plan that has NO PUBLIC OPTION (Z. Emanuel's) is NOT a "reform" at all.

This is in marked contrast to "White House advisor" Zeke Emanuel's (Rahm's brother) proposal to PRIVATIZE/("voucherize")Medicare, and eliminate a public option for future retirees:

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x5180499


While both Dean's plan & Zeke Emanuel's voucher plan both provide choies, the long term results of each plan would likely be diametrically opposite:

Dean would allow younger Americans to "buy in" to Medicare, and the result is that escalating insurance prices would encourage more and more to choose this option, possibly leading to a mostly Single Payer plan in the future.

Zeke Emanuel's plan would ELIMINATE public plans, leaving only private options. It would destroy our only approximation of Single Payer.

This plan would likely be a permanent POISON PILL for Single Payer that insurance interests have always wanted.

We should be listening to Howard Dean, not Zeke Emanuel.

[madfloridian]

21. Exactly. We will have to fight to keep a public option like Medicare.

We are going to have to fight our own party on this.

[Cha]

18. Dean is such a uniter! And, a great

advocate for Obama. I love his yellow tie and he's looking ever so good these days:D

[lumberjack_jeff]

19. This is the only sensible step at this point. n/t

[jenmito]

20. I like my Drs. and my insurance and I was happy to hear him say we can keep our insurance if we want

just as Obama said all during his campaign-that we could keep our insurance if we liked it and we'd just pay less for it.

[Rosco T.]

22. It shoots down the freeper arguement ....

"THEY WANT TO FORCE ME TO USE THEIR DOCTORS!!!"

No, it dosen't.. you wnat to pay 1,000 a month for your insurance.. you go right ahead.

Those screaming that "Obama lied to us! Oh Nos!" are obviously missing the point..

With the Medicare option, you get single payer... the freeps can still pay out the nose.. you don't have to.

[mvd]

23. It's better than mandatory health insurance

Which might impose new regulations, but keep the insurance companies entrenched.

In Dean's plan, though, how would we keep Medicare from being the inferior choice?

[Festivito]

24. If you don't want to go to the doctor, guess what? DON'T GO.

Does it need to be more simple?

Seem government will be (and is) the provider of last resort. If one buys another policy and it fails, guess where that person is going to go. TO THE HOSPITAL. Guess who will pay. SAME AS WHO PAYS NOW. We pay.

Why isn't this simply simple?

[Laelth]

25. Brilliant rhetoric (but a little disingenuous).

Let's face it ... 99% of us will choose public sector (single-payer) health care because it's pre-paid.

And that's a good thing. I'm all for it.

:dem:

-Laelth

[Proud Liberal Dem]

28. I agree with Dr. Dean

If we are to remain consistent with our principles of "free choice," I believe that freedom to choose private (crappy) health insurance coverage or some kind of public option would be the best way to go. Plus it would help in the long run by introducing more competition into the market and private health insurers would (theoretically) be pressured to offer more benefits at lower prices. The biggest challenge IMHO will be getting people to support publicly funded coverage for "other people" with THEIR "hard earned tax dollars" although I don't imagine that right now there are really a lot of people out there- except for maybe the rich- that can honestly say that they have good and affordable health insurance coverage (if any at all). Maybe back in 1993-1994 there were more people who could say this and I know that for the first few years of my current job my benefits were outstanding and the cost was minimal but that has taken a drastic turn for the worse over the past 2-3 years and right now we are priced out of any HMO plans and basically can only afford a HIGH-deductible MSA plan (which is almost as good as having no health insurance coverage whatsoever until we meet our $2900 deductible!). There's got to be *something* better that we can come up with that is more affordable and does more for us than the stupid system we've got now. Heck,I bet that most conservative wingnuts in Congress don't even seem to believe much in private plans for themselves and their families and seem content to accept their government-provided health insurance plans.
:wtf:

Maybe if they ditched their government health insurance plans and went with private insurance plans they paid for themselves, we'd have enough savings right there to pay for something (more) sensible for those of us who want it. :shrug:

[FlaGranny]

32. Excellent and smart - because

if Americans are given the option of choosing a plan, and the BEST plan is Medicare (or single player-type plan), more and more people begin to choose that plan, and insurance companies gradually lose more and more business. Companies will eventually stop selling health insurance. The option that is left is the single payer plan.

[avaistheone1]

45. I agree. Very, very smart.

Good, going Dr. Dean.

[nichomachus]

37. Single-payer universal coverage only works

if it's, well, universal. Otherwise, people who are well off or consider themselves "healthy" would opt out -- leaving the system for the very sick and would doom it to failure from the start.

Spain operates very well with parallel systems -- public and private. Everyone has access to the public system, which they pay for through taxes. Then, if you're wealthy, you can buy into a private system, which has some added benefits -- such as faster access to doctors and some medical procedures.

[GreenPartyVoter]

42. "Then, if you're wealthy, you can buy into a private system, which has some added benefits -- such

as faster access to doctors and some medical procedures."

But that is what irks me. Why should poorer people have a poorer standard of care?

[nichomachus]

43. Well, you could frame it that way

which is pejorative -- or you could say that rich people gave added benefits.

You may not like it, but that's life. If you're rich, you can have things other people can't have. Sorry, it sucks, but it's the way it is.

To do otherwise is to deny well-off people the right to use their money to their benefit. That's like saying people with money can't send their kids to Harvard or can't fly in first class. It would never work.

As long as the public system is adequate, I don't have a problem with it.

[GreenPartyVoter]

44. Rich people's benefits should be about having mansions and rolls royces, not

better basic needs like health care and education.

Just because something is a certain way doesn't mean it is the right way for it to be.

[nichomachus]

46. I don't have a problem with parallel systems

as long as the public system is adequate.

If you insist that everyone have the exact same access to health care, you won't get anything at all. It will stay the way it is now -- and that is unacceptable to me.

[WinkyDink]

50. This is Britain, and I don't think we want an exodus of doctors to a Top Tier.

[GreenPartyVoter]

41. So is there going to be a quality difference between single payer and private insurance, because if

so somebody screwed up on how to make single payer work right.

[iamthebandfanman]

49. yup! if you dont want it, by all means dont take it.

but if you do need it , then theres a safety net for you to take so you dont go without any at all.