Dean on Health Care Mandate: 'I Just Don't Think It'll Work'
By Susie Madrak Thursday Mar 05, 2009 10:00amMatt Yglesias is right. Why the focus on keeping the insurance companies in business? If there's no government option in this health care plan, it's not really reform - it's just cost shifting. Dean is right, too, when he says mandates won't work - the Massachusetts plan is a mess, and infinitely more expensive than the politicians said it would be:
Yesterday, ThinkProgress interviewed former Gov. Howard Dean (D-VT) about the health care crisis. This is the first in a series of posts from that interview.
Asked to lay out his principles for reforming the health care system, Dean suggested that the government should offer free health coverage to young people, but should not require them to purchase insurance:
I don’t have an objection to a mandate. And I know Senator Clinton – now Secretary of State Clinton – who I have enormous respect for — argued for one. The president is considering changing his mind and doing one. I don’t have strong feelings against it. I just don’t think it will work. I don’t think the American people like mandates.
If you look at almost every state in the country that requires mandates for health insurance, people find ways to get out of it. You can’t convince me that a twenty-four year-old is gonna choose to comply with a mandate for 3000 bucks, as opposed to making a down payment on a Harley Davidson. You know, twenty-three-and-four year-olds don’t think anything’s ever gonna happen to them, and frankly, it usually doesn’t. When it does, it’s really serious, but it usually doesn’t.
Now, this is not something we’re gonna do in Congress – but if I was gonna push a button to design any health care system I wanted after pretty much a lifetime of experience in this, I would make health insurance free for everybody under twenty-five in this country. Especially eighteen to twenty-five, because from eighteen to twenty-five you’re in college, you’re out of college, you’re working, you’re working for yourself, you’re working with no benefits – it’s a mess. A very high percentage of kids under twenty-five, or even under thirty, are not covered, and they are very cheap. We did health insurance for everybody under eighteen in my state without a tax increase.
Now, granted, 50 percent of it was paid – or a little more than 50 percent – by the federal government because we did it by expanding Medicaid with a waiver from the Clinton administration. But it is very cheap [to] insure young people, and we ought to do it because you get paid back many, many times over when they’re sixty-five. If they’ve had pap smears every year and haven’t skipped GYN visits because it was expensive, if they’ve had the kind of basic maintenance that you need even for a young healthy person, then you’re less likely to get in trouble. And if you teach good health habits early you’re less likely to get in trouble later on. And it is dirt cheap to do it. The over fifty-five to sixty-five population is the next big problem, and that’s a very expensive problem to fix – but it’s really cheap, and if you want universal coverage for people under twenty five or thirty, just let them do it for free.
Some progressives have argued that you can’t fully eliminate cost shifting, manage chronic diseases or invest in preventive care without bringing everyone into the system. In part, they view the mandate as a cost containment measure. Dean is proposing a different option. Offer free health care coverage to Americans under 25 year of age (they’re cheap to insure and you can catch diseases before they become too expensive to treat) and spend less on expensive diseases down the road. (Remember, 80% of our health care dollars go towards treating chronic diseases).
Meanwhile, Matt Yglesias argues, “it’s not that a mandate is such a terrible thing, but its primary purpose is to keep insurance companies in business once progressive stuff like community rating and guaranteed issue policies are put in place. If I were in congress, I’d write a bill that has community rating and guaranteed issue. Let the insurance companies fight for the mandate! Make them deliver some votes for a “compromise” featuring all three. But there’s no particular reason that this favor to insurance firms should be defined as constitutive of the progressive health care agenda.”
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How DARE you be logical at a time like this?
tell all of the self-appointed "progressives" who were saying nonstop that Obama was "more conservative" about healthcare than Hillary Clinton (the only difference being her more conservative mandate??!?)
now in order to do his stupid bipartisanship dance, Obama is moving 'to the middle' by embracing mandates (which solve absolutely nothing) and ditching the one actual 'progressive' part of reform - a public option to buy into Medicare or its newly founded equivalent.
and yes, it is very sadly true - if all they do is sign everyone up for the same bogus "insurance" we have now, it will be an economic and political disaster. and I for one, would be considering challengers from the D side in 2012, just on this issue alone if someone else is promising to do better.
getting healthcare reform right is a huge part of fixing our economy, and our national morale. if Obama settles for some tinkering and tweaking, spends $700B in the process, and then just talks about how bold he is instead of fessing up that it was just too much for him to deal with, I'll be pretty much done with him.
it'd be a lot cheaper.
Fuck you, screaming Deanie...
In case you hadn't noticed yet, ALL these people--every last one of 'em--is in the pocket of big money.
If you needed anymore evidence, that is...
think of how many would have to be hired to clean up the leavins....sorry...but it was your idea...
;)
At first he refused to invite Rep. Conyers to the event because Conyers has H.R. 676 "on the table" which is Medicare for all health insurance.
Finally, after much cajoling, Obama DID invite Conyers. According to my sources that means there will be 2 single payer advocates out of 120 attendees at the meeting. The other attendee besides Conyers will be Oliver Fein, the national Chairman of Physicians for A National Health Program.
Which means the other 118 attendees will be representing the insurance companies that paid for Obama's victory.
The ol' quid pro quo. Works every time.
#1) I didn't realize until it was pointed out (sorry .. no link) a coupla days ago that Insurance Companies really didn't get involved in Medical Insurance until LBJ brought them in to cover Medicare.
ooooooops!
#2) Providing free (government paid for) Health Care (without Insurance Companies) for the very young is precisely where France started her State-Funded Health Care System over a hundred years ago, and gradually expanded it to include everyone.
I know we Americans are supposed to revile everything French (can't have any of that Free Health Care here!) but that's the system I'd choose to emulate.
Start with pre-natal and post-natal and time off with pay for all pregnant women. Go from there.
while those who grow up getting used to free care begin to expect it when they're grown up.
Although that does actually help explain the antipathy of the Pukes toward programs like s-chip, innit?
It would never be FREE healthcare at all.
The American People would either have another chunk of $$ deducted from their paychecks to cover the expense (taxes) OR (my preference) the military industrial complex would get their 55% of the pie cut back to pay for healthcare.
"...free (government paid for) Health Care..." did you miss the government paid for part?
However, using the word "FREE" anywhere in this discussion I feel is misleading.
"Somebody" has to be paid for the aspirin, I.V., E.R. doctors service etc.
My point is that the insurance companies should be totally eliminated from the equation in order to save money.
The "profit" has to be completely removed from the equation.
Any use of the word "FREE" in a healthcare discussion serves no purpose, regardless of the context in which it is used.
i am sick of people, govt officials, politicians, healthcare industry assholes profiting off my great aunt's alzheimer's, my nephew's eye injury, my health issues, etc.
the healthcare industry as it exists today, and as the 'leadership' of both parties defend, is simply based on profiting from the sickness and disease of citizens. how fucking sick is that?
any market fundamentalist asshole that screams like a wounded rat about "socialism" and big govt can fuck off. fuck off, disease-profiteers (in the govt, healthcare industry, and their defenders) that look to profit from disease are the scum of the earth and deserve nothing but contempt and scorn.
So long as these Health Care pimps insanely profit off the old, the needy and the helpless who have no where else to turn when they're sick and hurting. These people would gladly keep any of us alive no matter how ill we may be as long as we can make them cash.
the amount of money funneled from insurance to the political class almost guarantees, short of massive organized protests, that the system will stay the same. a couple nibbles around the edge for show is about all we can expect without intense public backlash.
Maybe my words are a tad more PC ... but your thoughts are right on! What am I missing? If Insurance Companies are the problem... what is the difference between my boss paying them, or the Federal Government?
political correctness is merely a yoke
as far as insurance companies go, the federal govt won't be paying the insurance companies b/c there won't be any.
As long as there are buckets of money to be made, the system will stay as it is. People have NO IDEA how far the insurance companies are willing to go to keep the system just like it is. They rake in the insurance premiums every month, while coming up with new and better ways to deny care.
And, in my opinion, the really f-ed up part of this system is that it keeps people sick, at least those with good insurance. Where is the incentive to get people healthy? No wonder we're a country of lazy, fat-asses.
what was it that the whole nixon-kaiser permantente cabal was about: they money through the denial of service.*
a john wouldn't even accept that in a whorehouse, but our children are denied coverage so some insurance company disease-profiteer can buy that third home in beavercreek?
*"Edgar Kaiser is running his Permanente deal for profit. ... All the incentives are toward less medical care," Ehrlichman says to Nixon, according to a transcript. "The less care they give them, the more money they make."
this is nazi-evil. sorry, but it is.
corporations are.
After 20 years of not having any medical insurance I decided to call Blue Cross/Blue Shield one day after clipping an ad out of the newspaper.
They told me that at the age of 58, having had no insurance for 20 years, that I would have to pay $500/mo. for a YEAR and then I'd have to have a physical to prove no pre-existing conditions. Only then would the coverage start with a $2000 deductible.
They are in the "Just Say No" and profit business, not into taking care of the American People's healthcare.
That should be occupying MOST of the seats at Obama's little healthcare soiree:
http://www.pnhp.org/about/about_pnhp.php
Well it certainly won't, not with that shitty attitude.
as to why Dean is still seemingly being marginalized. Or is it just me that sees it this way?
its a side-effect of Rahmbo-s influence. he hates the Dean with an irrational passion.
Dean is such a smart dude, and truly loves this country.
They should seek his expertise, not shun him like a jealous schoolgirl.
onceler do you have any links as to why that is? I feel that Obama is depending too much on Rahm's worldview to the detriment of the rest of the country. Dean is one of the casualties. And no, I don't get where Rahm is coming from, where his ideas are so great that Obama listens.
The society that attaches the profit motive to health care is inhabited by barbarians.
are ghouls and parasites.
http://www.youtube.com/watch?v=6Xmz-p9FYW8&fe...
Can we just play doctor then?
we have stood by as our tax money is guzzled down by the MIC, only to make us less safe.
we have stood by as our tax money was funneled to the financial sector, only to watch the economy plummet further
we have stood by as our tax money went to the "war" on drugs, to absolutely no effect
when, as citizens, will we tell the disease-profiteers to fuck off and DEMAND that, as american citizens, we have a right to FREE and universal healthcare for all. no insurance companies, no HMO, nada, bupkus.
i am not the biggest michael moore fan, but he was spot-on in his remarks that this healthcare problem transcends partisan politics when it comes to actual citizens.
Samson
Well said. It is simply bizarre that Dean argues that those under the age of twenty five in the United States should be entitled to free health care while apparently excluding everyone else from also being covered by the government. As Moore correctly notes in Sicko, health care in this country should be considered a right and not a privilege. What Obama has never addressed, to the best of my knowledge, is how the poor and working class in this country can somehow afford health insurance while barely able, if at all, to get food on the table for their families as well as paying the rent each month.
It is no wonder the United States ranks 38th in terms of quality health by the WHO. They were 37th but Cuba, a third world country, just vaulted over the U.S. into the 37th slot.
Here is a novel idea. If the United States and Obama stopped occupying Afghanistan and pulled ALL the troops out of Iraq, that would certainly go a long way to afford single payer health care in this country. It would seem that the United States is more interested in killing citizens of third world countries than it is in providing for the General Welfare and health of its own citizens.
stop the cash dump into our imperial endeavors and give citizens what should be our right: free, universal healthcare
and, i agree, not only haven't i heard obama really address how the poor fair with healthcare, i rarely hear any politician, ever, even mention the poor.
So I want to repeat it here:
Scribe it on your tombstone, if you like me, are over 60...
http://www.youtube.com/watch?v=hbvfDG1lHK4
Ooops again, Kucinich.........
http://www.youtube.com/watch?v=OOB0f3I1AXk
*snuck up on ya today* :p
Thanks NW. Great link and a good point on why many of today's proposals are doomed to fail.
Why is it that when you're talking healthcare and medicine, it always has to be inundated with Mumbo Jumbo kinda talk? Nothing is straightforward black and white. Is it purposely complex? Does it really have to be? I for one get lost in a fog trying to understand the do's and don'ts, the have's and have-nots of it all.
Calling Dr. Dean...calling Dr. Dean:
http://www.youtube.com/watch?v=Z6OmYOVmk98
the big tax deduction that companies get for providing heath insurance to employees is subsidized by tax payers. many of these tax payers do NOT get health insurance provided by their employer. unemployment numbers will be out friday. many of these jobs/people are lower wage people who don't have financial reserves. many NOT all will now be on some type of government healthCare program or they will go without. if going without is a choice when something does happen (catastrophic)they will go to the emergency room and put it on their tab they can't pay.
The government runs Universal Healthcare for those not on Medicare, within Medicare or as a parallel to it, providing essential care and preventive care.
There is Option 1, which is not-for-profit private healthcare providing the same care as the government plan, except they may offer additional coverage for an additional premium.
Option 2 is insurance as it currently exists.
All working people must be enrolled in one of the three, and provide proof at tax-time. New hires must state their option at hire-time, and private companies must be required to inform employers if the employee has cancelled.
Actually Ronhohn, you are pretty much right if this is what you are saying:
A mandate is fine, as long as there is a public insurance option like Medicare, with the same low cost structure, the same low overhead, the same freedom from private insurance bureaucrats meddling in care decisions.
Then, private insurers can still compete for clients, let them have at it. Then we'll see how efficient the mystical magical market place really is. Can it compete with a Medicare like system? I doubt it and then they will cede the market to the public payer option and we will get where we want to be, though a bit more slowly than some of us would like. BUT, it will demonstrate our point about the inefficiencies and waste of private insurers.
Cheers,
{ Deleted, I'm sorry, But blogwhoring is a no no.SiteMonitor}
All working people must be enrolled in one of the three. All others will go into the government run system, and will pay a premium according to their ability to pay - no freeloading for those able to pay.
Medical decisions like Medicare. Works OK for me.
obama wants to increase the size of the PAYing pool. most people want health insurance it's TOO expensive. look at the "cheap labor " movement. they can't afford health ins. and/or auto ins. for that matter.so they use the local public services and private hospitals. they can't usually pay by definition so
the cost is passed on to the PAYing pool/TAX payers. corporations wan this "cheap labor" to compete
well bring down healthCare insurance so we can compete. at annual increases at 6-8% per year wages aren't keeping pace. so people take the RISK to go without health insurance reducing the size of the PAYing pool. although different it's a mandate to have auto insurance in the state i'm in. although i will say my auto insurance has gone up because of uninsured and under insured motorists.
Would y'all prefer this doctor?
http://www.youtube.com/watch?v=gcpmM-eTESI
http://www.youtube.com/watch?v=8Sp-VFBbjpE
Next we will be considering this as a new health care idea--hee
No-one gets free medical insurance. Someone has to pay for it.
It all boils down to how much it costs to manage. We can keep paying Billionaire CEOs or lower paid Federal workers under Medicare; These "Say NO" companies that tell us what they will cover in their policies; every needed medical procedure they deny is money in their pockets. Obama is now trying to kill the Bush Private insurance Medicare plan that allows insurance companies 30% profit.
I pay $3000 a year to just hear NO? I'd just as well pay the money to someone who would say YES for once.
Raise the Medicare Tax rate; Say NO to overpaid private health insurance CEOs.
take profit out of my health, my family's health, your family's health.
i don't want anyone trading shares based on how well my insurance company denies me coverage.
no-one gets free AH-64 apache attack helicopters either.
We need health care for ALL people! The other industrialized countries do it. Why can't we? Ask the conservatives if France (Canada, England etc) can do it, why cant we?
We need to stop fighting for health care for small groups of people and demand it for everyone. Now we have one plan for children, one for seniors, one for the military.
People are unlikely to get fired up about coverage that doesn't affect them. And our time is divided fighting one day for childrens health care and then for seniors and then for military.
We need health care for EVERYONE!
Food permits building and regeneration of body and mind, for all ages.
People have to eat. They get sick if they don't.
Automatic food stamps for all?
Every American should have the same standard of health care benefits that all the Congress Critters get.
I'll take their benefits ANY day!!
Especially that rosy PENSION they all get (plus medical/dental/optical!!)
I think every American should also get the same salary that Congress gets. And they get a raise whenever Congress does.
Simply funding a massive nationwide program that will keep paying the out of control prices on prescription drugs and the inflated charges to hospitals and clinics will do nothing.
Other countries have health care models that could work in America...
Prescription drugs and hospitals have very little to do with how vital health, free of disease, can be achieved.
they gotta be cleansed
As an American living abroad, my family is enrolled with the German gov't health program and find the care to be excellent. It isn't free, like many people believe, you pay according to your income (with a cap on the amount for top earners). I find the program reasonable.
If you are looking for Universal Healthcare, why involve insurance companies at all?
or, for that matter, hmos, are involved in the 'solution,' it will be a failure.
Bittorrent torrent
A 5½ MB file - featuring a Bill Clinton snippet explaining that we don't have to spend any more money on health care, we need to do like the Europeans and Japanese do, spend it more smartly.
He doesn't exactly explain what it is that our competitors are doing, but we need to figure that out, and the method that our competitors are using.
Contrast to the profligate Obama, who wants to throw $60B/year at it insuring the uninsured, while leaving the costs high for our businesses who have to compete in the international arena, under Free Trade, which Obama also supports.
An approach dependent on borrowing is not sustainable.
The number of people who can really afford healthcare will never be correctly portrayed for the simple fact that our government has created an entitlement mentality among the lower class. Their are many people who could afford healthcare if only they could bring themselves to not spend money on things like cell phones, cable tv, new cars, big screen tvs, cigrattes, alcohol, and a host of other items that are luxuries. These are some of the same people who Obama would roll out the red carpet for and give healthcare to regardless of the fact that if they were willing to sacrifice their luxuries they really could afford healthcare.
Currently the single biggest change that could help reduce healthcare costs would be to work to eliminate frivolous lawsuits which would in turn bring down the cost of malpractice insurance. This would go a long ways toward making healthcare more affordable and bring profitability back to the medical field since not every doctor out their is as rich as the ones portrayed on television.
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