On Demand
Dr. Dean
Thursday, June 18, 2009
Howard Dean, former Vermont governor, former DNC chairman, and former candidate for president discusses the health care proposals in Washington and other news. Dean is also the author of Howard Dean’s Prescription for Real Healthcare Reform: How We Can Achieve Affordable Medical Care for Every American and Make Our Jobs Safer.
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Thank you for having Dr. Howard Dean on today.
I often hear the argument that if we have government run/socialized/single payer health care we will wait in long lines for inadequate care. I also hear that many doctors are opposed to this plan because they will not be paid enough to justify their education expenses. Can Dr. Dean please discuss the validity of these arguments?
thanks!
Whatever the pitfalls of a single-payer system - sadly it is the only solution for many citizens of truly limited financial means. If it is off the table then this whole process is really just a charade. The real issue is the obvious inadequacy of ANY part of the American government to deliver competent and valuable service of any kind....all of the agencies (FEMA, SEC< FAA< FCC...you name 'em) are hopelessly crippled and corrupted. Healthcare doesn't have a chance in this country. Maybe the hypocracy of founding fathers who were slaveowners setting up an alleged democracy has deeper implications than we are willing to admit?
Dr. Dean told ABC news in 2009 that he fully supports gay marriage because “I believe that equal right under the law is for everyone.”
My sister is gay and in her state she may not marry. My sister’s long term girlfriend is not legally allowed to make medical decisions for my sister (as a husband would) in the event of a serious accident or health event.
Will Dr. Dean do the right thing and include gay rights within the health care conversation? Will Dr. Dean do the right thing and call out President Obama on his campaign promises to fight for gays in the military and health care for all? Or will Dr. Dean continue to give President Obama a pass on his campaign promises? Is Dr. Dean a real liberal or the scared of President Obama brand of liberal?
Thanks for listening sugar cakes.
Susan,
With all due respect, I think your views on the capabilities of our government are, in my opinion, delusional. Public Schools across this country are flourishing and are providing great educations for many children (but certainly not all children). Health care is an issue of resolve and vision. The government can do it if it really tackles the big issues. Let me roll off a few:
-you would need a top person, like a Thomas Frieden, who would do everything in their power not to accept mediocrity.
-unions would need to be dealt with fairly but openly and strongly so that the lunatics are not running the asylum (as a member of a union, I can say this because I know how powerful my union is and sometimes that power leads to bad decisions being forced upon management).
-doctors, nurses and other health care workers would have to be paid fairly, perhaps even bordering on generously.
-perhaps, just perhaps, each state would need to come up with its own healthcare coverage that meet many points agreed upon at the national level. This is not a call for state rights, but more a way to cut down on passing the buck or delayed decision making.
-and it is time to start educating, I mean really educating our children about healthcare. I have worked in a public school for about ten years that offers each class, at best, recess once a week. And during the winter months, no recess at all. What type of message is that sending to children about the importance of exercise? Whatever happened to putting on a coat and playing outside?
-How about mandatory cooking classes where 3rd graders learn that vegetables can taste good? Man, a few years back I a student who had NEVER tasted an apple.
Ugh! I am so mad that I missed Dr. Dean while he was in the slope to lend support to Josh Skaller who is running for City Council!
Anyway, is Dr. Dean involved in the anyway Jonathan Tasini campaign?
It seems to me that under a competing public plan or even a single-payer system, insurance companies could still make a profit by offering "MediGap" coverage similar to the plans currently offfered to Medicare beneficiaries (and, judging by the sheer number of "MediGap" plans available right now, the insurance companies must find it profitable to provide them).
Doctors also benefit by the introduction of such plans, because they usually pay the difference between what Medicare pays and the doctor's usual fee.
I believe that many people under 65 who can't afford comprehensive insurance policies WOULD be able to afford this type of policy, since they tend to be cheaper, so insurance companies would have a large number of enrollees, but fewer administrative costs(since they usually pay out only if Medicare approves payment for the service the doctor provides). They wouldn't have to hire people to decide which claims get paid (since the Medicare program decides that), or which people should be allowed to have a policy.
Thanks Peter. If we start out thinking this is never going to work....it's never going to work.
Please have Dr Dean discuss the dirty secrets of American health care, i.e., that we already have single-payer and even Socialized (!) systems in place. The care that Active Duty and Retired Military receive amount to state socialism -- my father, with 30 years in the Navy, has had cancer three times, received high-quality and has never had to pay a medical bill. Shock! Horror! Taxpayers picking up the bill for innovative cancer care for other Americans!
Two examples of Single-Payer: the VA and Medicare...both have high satisfaction ratings and far lower overhead than Insurance companies provide. Discussions of the intractability of financing Medicare should not neglect the Elephant in the room: That Medicare's efficiency gets gummed up when Private Insurance intervenes, as in Part C and Part D.
The above are great examples of "uniquely American" systems. The kind that are admired and built upon when other countries overhaul their health delivery systems. (e.g., Taiwan basing their single-payer system on us, the US, simply by not having any age limits to Medicare. That's right -- based on the US's own single-payer system...)
Improving Medicare by keeping the gamblers (I mean Insurers) out, and then expanding to the all Americans can work. It just takes courage to keep the pirates (I mean insurers) out of a system where their only role is to obstruct care on both ends. Their function is political, not medical, and they do more harm than good in the end.
Don't businesses want to get out of paying for their employees' health benefits? Couldn't they muscle Washington to get the government to pay for health care? Health care costs are killing individuals, but they're also killing our businesses. Countries where businesses don't have to pay for health care have a built in competitive advantage.
why is public option refered to as "controvetial" when recent polls show 75% support?
Brian,
Please ask what the Obama plan means in practical terms for the uninsured - how much $, what kind of benefits etc.
Doctors are grossly overpaid. You can have whichever system you want, if the AMA monopoly is not broken, it will still be expansive. It is just shuffling papers around.
Family medical insurance: $20k/yr is what I paid for very good insurance.
I head Kathleen Sebelius interviewed saying that any bill would be written is exclude the eventual possibility of a government plan morphing into single-payer due to sheer popularity.
This seems crazy to me, when even the president says that single-payer is ultimately a better system. It's the stimulus plan all over again -- the president is "negotiating with himself" and trying to placate republicans who aren't going to vote for any plan no matter what. We may not be ready for single-payer, but we should still push for the best plan that we can.
our COMMON situation:
1. daughter grad college, entry job, no insurance
2. daughter needed emergency operation
3. $30,000.00 our retirement funds go to pay out-of-pocket
4. how many of these can middle aged, middle class parents handle before eating out of a dumpster in retirment?
Let me see if I can follow the argument against: public option will be at-cost, so it won't have to be profitable, so it will unfairly compete with the private sector . . . his argument comes from the same people who think the public sector is less efficient than the private sector, right?
This still wouldn't work on a sliding scale voucher thingy you mentioned Brian...unless your other financial obligations are taken into consideration. Besides that is what the "County Health Services" does now. That is not what is proposed in the Federal Health Plan.
Here it is:
http://www.wbur.org/2009/06/16/sebelius-health-care
Brian, I have studied and analyzed this subject. Forty (40%) of the money we pay into health insurance companies does not go to provide health care.
It goes to pay for the overhead of the insurance company, and to the shareholders as profit.
And the less an insurer pays for real health care, the more profit they make. So their incentive is counter-productive.
We need to buy all of the health insurance companies, and have one payer. Period. Anything else is nonsense.
Brian...Can you bring up the fact that while many people are uninsured, there are also many people that have bad insurance...deductibles and premiums that are so high that they might as well be uninsured.
In many cases, if you don't qualify for a low income health care plan (Healthy NY, etc)...you end up having to pay a large monthly fee for health care coverage. The price gap between some of the subsidized programs and private health care is too large. It assumes that if you don't qualify for a subsidized option, all of a sudden you can afford $400 or more a month for terrible coverage.
Could you have Dr. Dean elaborate on the public option and why (from reports I’ve heard) it seems to be tailored to protect private insurers, pharmaceutical corporations, and device manufacturers. Would it not be better to have free (tax supported) insurance for primary care and certain catastrophic coverage for all and private can cover all other and become a employer provided benefit again and not a necessity.
Would it be possible to subsidize the cost of malpractice insurance for doctors that signed as government providers?
What is the argument for employer-based insurance? Why should the employer be involved?
By the way, I am 68 and still employed. I use my employer-based health care rather than medicare because it offers more and includes my family. I do this even though I would really compare a full single payer system.
My physician favors single payor. And no wonder, as negotiating reimbursements from insurance companies has caused him to eliminate one company after another.
I had Aetna insurance 10 years ago when suddenly I couldn't find a primary care MD in NYC to take it - one by one they were dropping it. So much for choice!
Brian, let your guest and callers speak! So annoying!
Thank you Dr. Dean for bringing up the bureaucratic aspect of the private system.
Also, I just heard Dr. Dean use the term “market rate” in regards to reimbursable expenses, has he considered the true market rate may actually be inflated? Who or what is setting the market rate (surgeon salary, device/procedure cost, hospital costs, malpractice insurance cost, drug costs, private insurers, or consumer’s willingness to pay)?
Oh, not that clip from the whiney surgeon!
1) Technology has made much surgery faster. That ought to explain part of it.
2) Why didn't he say how much he makes (e.g. taxable income) today?
Given what the national surveys and studies say about how much surgeons make, I have a lot of sympathy for him. Heck, I don't have any. Plenty of other people graduate with lots of debt, some as much or more than doctors. But few other professions don't make that kind of money.
please address the aspect of obama's plan that will impose a tax on individuals who have employer-provided health plans.
this will impose a particular burden on middle class workers. having just witnessed taxpayer funded bailouts of the banking and auto industries, working people are being told that if they want universal health care, they have to pay for it.
that's pretty hard to swallow.
Bill Moyers had an outstanding program about the single payer option a few weeks ago. Check it out: http://www.pbs.org/moyers/journal/05222009/profile2.html
Brian, please invite those same guests -- Dr. David Himmelstein and Dr. Sidney Wolfe -- on your show to give this a full airing. People just don't get it.
I pay for private insurance through my employer and the employer pays a portion as well and STILL my deductible, my portion BEFORE the insurance kicks in is PHENOMENAL...Doctors are GROSSLY overpaid!
Whyy are people opposed to affordable or government sponsored health care, for the sake of the DRS salary???? Seriously?? Why don't we all just move to Canada.
Brian,
A sliding scale voucher idea is wonderful. Anyone who disagrees with such innovative ideas are, in my opinion, lying to themselves about the possibilities out there. Thanks for the great idea sugar.
As one who worked as office staff in a NYC teaching hospital, I've seen how private insurance doesn't work. Every year I worked at the hospital the plans offered even to healthcare workers got more absurd, costly & with ever-decreasing coverage.
That is inefficient for medical care which has to be re-purposed to primary care & holistic support including making sure that the poor & elderly have sufficient & healthful nutrition, supplements to counteract med side effects & access to social & exercise (yoga, etc.) to maintain health.
One reason our economy takes so long to recover from economic downturns is that our population has no nutrition and health support to make sure that our workforce is not compromised by new underlying illnesses "acquired" during times when they can't afford health care.
It's simple - we should make sure that our population has health care available. Cut out the private insurance middlemen who do little to help the wellness of their beneficiaries.
regarding the doctor whose medicare reimbursements have been reduced, perhaps what he used to get paid was too much. he's still practising, so obviously whatever he's receiving now is enough to keep him in business.
Doctors, stop whining about how much money you'll lose if we move to single-payer. You'll get back all that money you're now wasting on administrative costs, and you'll hopefully have time to see more patients.
Brian, the other day you had a physician call in complaining that she had more than 100K in student loans, and if all reimbursement was at Medicare rates, how would she pay for her mortgage, and childcare.
Sweetheart, you'll pay the same way the rest of us do--by living within your means, based on a budget that deals with the reality of your student loans. Why do you feel entitled to own a house right out of school? Rent a house, or get a smaller house. Drive a Honda instead of a Lexus, until your loans are paid off. I have 86K in loans because I went the distance with higher education (and worked just as hard at it as you), but I'll have to pay that off with a social worker's salary. So, I'm not getting a mortgage, and I'm driving a not-so-fancy car. I'm not expecting the people I serve to subsidize a life of luxury for me. If you think you're entitled to that, you entered the wrong profession.
I also had to laugh at your tragic scenario of one doctor marrying another and "doubling" your debt. First, you'd increase your collective student loan indebtedness, but presumably you'd share the mortgage. That isn't a doubling. But all things being equal, you'd double your income. You're still going to be OK. Don't worry.
How about talking more about serving the public interest, rather than your own special interests.
AAARGH!!!
If workers no longer are desperately competing for miserable cube jobs, stuck either way on New Jersey Transit -- all to "be insured" -- can you imagine what might happen to AMERICA'S financial system?
Six months of working the jobs we really want and we'll all be sitting around the town square eating cheese and laughing like Frenchmen...and THAT'S just lunchtime!
WASHINGTON -- SAVE US FROM THIS APOCALYPTIC VISION! KEEP HEALTH CARE IN THE HANDS OF CORPORATE HR!
I don't agree with Dr. Dean's assertion that Medicare works adequately. As a physician, the claim submissions to Medicare are painful; the slightest irregularities in the cumbersome format and your claim is lost forever in bureacracy. If someone with my education and training cannot correctly submit claims, who can? Until this is addressed, Medicare is substandard.
Dean's mistatements of facts:
1. The reason Congress has a wonderful plan is not because it's government run. It's because for every Congressman, there's 3 million taxpayers PAYING for his health plan. You cannot extrapolate that to the general population, OBVIOUSLY.
2. Gov does not run healthcare well. Medicare has low adminitrative costs only because the government shovels money out the door without screening for fraud and mismanagement.
I am self-employed and pay $385 per month to Atlantis Health Plans. I had symptoms of a heart attack in Jan. EMS came to my apt. and told me I'm seemed stable, but b/c I have an underlying heart issue suggested I go to the ER. I went. Without going into the personal details, the doctor in the ER wanted to admit me b/c they did not (would not) discharge me w/o running some more complicated tests (b/c of my underlying heart problem). Yesterday I was told by Atlantis they are only paying for the ER visit. At this point, it's not clear to me if the hospital is going to demand I pay for the stay or battle it out w/ Atlantis. But I am furious. Why am I paying for my health insurance? The only other time in my life I have been admitted to the hospital was to give birth. If I am stuck with the admit bill where am I to turn to get help with the dispute w/o hiring a lawyer-probably no where.
Janet I understand your situation and the only help you are going to get is from the hospital business office...they are going to set up a repayment plan for you.
The basic problem with our current system is that consumers of health care cannot vote with their dollars. Only employers get the chance to deduct healthcare costs from their taxes. And even if one can find a plan that offers non-drug therapies or therapists, or a plan that insures for necessary things like getting hit by a bus----instead of having to pay to plans which offer non-essential cosmetic surgury, the company may not be legally permitted to sell insurance in the state you reside.
Pharma and other medical supply companies influence each states insurance codes. It forces every MD to treat symptom A with drug B. That's not a choice. You end up by taking a dangerous drug like say, motrin for diarhea (slows peristalisis), when you could have been prescribed digestive enzymes (exhausted or congested glands being the cause).
None of this will change under Obamacare.
Peter,
Sliding scale may not be as fantastic as you think… but it could just be a problem with the way it was initially presented by Brian/Dr. Dean. Paraphrasing, they said the plan is to subsidize the lower income workers and phase out the subsidy as personal income increases. One could infer what will happen is artificially high amounts will be reimbursed to physicians and hospitals (as part of this non-compete clause the government is adding to the public option) supporting the already high amounts of healthcare dollars that go to private insurers profit/admin/advertising costs. What would be more fair, is to see what actually costs are and what would be a fair to even slightly generous profit for hospitals and physicians, set that as the unsubsidized amount to be updated regularly then index down for lower income earners. It sounds the same as what Dr. Dean said, but is fundamentally different in that it doesn’t inflate market costs.
2 years ago, I'd've said I'd be glad to switch to public-option insurance. But now I have insurance that I like a lot better (mostly because of how they treat policyholders), & it actually costs less! I'd still look at public-option insurance & compare it w/my current plan, though. Maybe having that option would put pressure on the insurance co's. that treat their own members like crap to treat them better.
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