Howard Dean: No Public Option, No Deal

Via Sam Stein:

Former Democratic National Committee chair Howard Dean fired one of the clearest warning shots at hesitant Democratic lawmakers on Thursday, insisting that if the party was unable to produce a health care bill with a public plan, there would be electoral consequences.

As he has done before, Dean criticized talk of substituting a government run program with co-operative insurance plans, calling the latter a "fig leaf." "This talk about co-ops is a political compromise it is not a policy compromise," [Dean said[. . . .] "And I think most people, on both sides of the aisle know that co-ops won't work."


Asked about a column by long-time Democratic strategist Paul Begala, urging progressives not to shy away from tackling health care in a more incremental approach, Dean shot back: "The public option is incrementalism.... But there is no incrementalism without the public option." He explained: "If you don't have a public option this bill is not even incremental, in terms of adequate health care reform... Paul is not entirely wrong. It is just that the last shred of reform is the public option."

Is Dean right? I think so. But more importantly, Dean is saying what he believes, not what is thought to be convenient for Obama and the Dems. Good for him.

Speaking for me only

< Thursday Afternoon Open Thread | Bill Clinton At Netroots Nation >
  • The Online Magazine with Liberal coverage of crime-related political and injustice news

  • Contribute To TalkLeft

  • Display: Sort:
    Now the questions are (5.00 / 2) (#1)
    by dk on Thu Aug 13, 2009 at 04:09:17 PM EST
    how many people get to take advantage of the public option (i.e. is a public option only a tiny fraction of the public have the option to buy really a public option?), and what kind of negotiating power will this option have with big pharma?

    I think (5.00 / 1) (#2)
    by CST on Thu Aug 13, 2009 at 04:10:24 PM EST
    that is the incrementalism he is talking about.

    If it's there, it can expand.  If it's not there, there is nothing to expand on.


    Perhaps, though (5.00 / 1) (#3)
    by dk on Thu Aug 13, 2009 at 04:12:43 PM EST
    it would still be helpful if Dean would describe what he means when he says "public option" if he's taking such a stand.

    If the public option is allowed to (5.00 / 7) (#14)
    by Anne on Thu Aug 13, 2009 at 04:20:49 PM EST
    come into being in the form we last saw it, where perhaps only 10 million will be allowed to enroll/participate, it is going to die before it ever has a chance to live, but the industry may still inherit some 1 trillion dollars.

    The "public option" is not like the space program or the various college loan programs, to take a few examples, all of which can be expanded or contracted as the years go by without seriously threatening the very existence of the program. The "public option" will be a business. And this particular government-run business may never get very big; it may not even survive. If it doesn't get big, or doesn't survive, it won't develop the huge public fan base that protects popular programs like Social Security and Medicare. In fact, the reverse could happen. A miserable early performance may cause Americans to turn against the idea of a Medicare-like program for the non-elderly. Unlike public programs, businesses don't have an indefinite time period to develop a supportive public. Businesses don't automatically take root and go on living forever. The "public option" must prove its ability to survive and undersell the insurance industry quickly. Moreover, the "public option" will be attempting to break into a business that has been consolidating over the last few years. The insurance industry is extraordinarily difficult to crack.

    "Public option" proponents who urge us to support even a token "public option" must remember how much is at stake here. At stake is not only the willingness of the public to believe that government health insurance programs can outperform the insurance industry. At stake as well is whether Congress will give the insurance industry a trillion dollars per decade of taxpayer money.

    The Democrats' legislation calls for subsidies to people under a certain income level (probably 300 or 400 percent of the poverty level) so all Americans can afford to obey the proposed law requiring them to buy insurance from either the insurance industry or the "public option." These subsidies will probably amount to a trillion dollars per decade. If the "public option" doesn't survive, or survives but never insures more than a tiny percent of the population, that will mean that all or nearly all of that trillion dollars will go to the insurance industry.



    Heh, Kip Sullivan (none / 0) (#24)
    by eric on Thu Aug 13, 2009 at 04:30:56 PM EST
    is a Single-Payer only guy.  He is kind of nuts about it.  He is from where I live and is on the radio a lot.

    If it isn't single payer, he wants it to fail.  Here, he is showing how far he will go to help other reforms fail.


    Then address his concerns (5.00 / 3) (#27)
    by hookfan on Thu Aug 13, 2009 at 04:33:36 PM EST
    rather than mind reading his wishes. . .

    wtf (5.00 / 0) (#42)
    by eric on Thu Aug 13, 2009 at 04:57:07 PM EST
    are you talking about mind reading?  I related what he has been known to stand for and then I commented on his position in the article.

    You're not addressing his (5.00 / 4) (#43)
    by dk on Thu Aug 13, 2009 at 05:02:06 PM EST
    argument.  You're just suggesting that people shouldn't believe it based on who he is, thinking that calling him nuts and implying he will "do anything" to see something fail is a sufficient replacement for tackling his arguments head on.

    It's your perogative, of course, but it makes it less likely people will take you seriously.


    Ok well (5.00 / 0) (#59)
    by eric on Thu Aug 13, 2009 at 06:58:38 PM EST
    maybe I shouldn't bother, but here goes:  My comment was meant to convey the view that Mr. Sullivan lacks credibility, and that his doomsday predictions were based upon what I view to be his single minded dedication to a "single payer" model.  My comment was indeed only my opionion and was based upon my experience hearing him on the radio and reading what I have read.  That is all!

    If you don't know me, you may not put much stock in what I write.  That is fine.  Maybe even the people that do know me won't put much stock in my opinions.  Who knows.

    But I am not "mind reading" (whatever that even means in this context) nor do I need to address his arguments on the merits as I find them silly.

    Anyway, please feel to disregard this comment if you think I didn't do it right.


    Eric (none / 0) (#65)
    by hookfan on Thu Aug 13, 2009 at 07:30:32 PM EST
    I didn't ask you to address his concerns or issues to put you down, but because I respect your insights and thoughtfulness. Perhaps I did it poorly. I was really inviting you to debate the content of his argument, rather than merely stating your views of his intentions (even if you are correct). I still don't know why you think his arguments are silly. Your merely stating that it is so, is unsupported opinion. For all I know your reasons for thinking so may be silly.
       Secondly, being a zealot doesn't in itself make one wrong. One may have very good reasons for being so. Or not. How can you tell unless the reasons are discussed?
       In this case, I think the ad hominem is a mere deflection from substantive discussion.

    Fair (5.00 / 1) (#82)
    by eric on Fri Aug 14, 2009 at 08:27:57 AM EST

    And if "other reforms" do fail, ... (5.00 / 3) (#58)
    by cymro on Thu Aug 13, 2009 at 06:46:15 PM EST
    ... will that be because Kip Sullivan "helps" them to fail, or because they did not actually address the sources of the problem with the present system?

    Inadequate proposals do not even deserve to be described as "reforms", because they are doomed to failure. And when they do, should we blame the likes of Kip Sullivan for "helping" to produce that failure, or respect their wisdom and applaud their opposition to other so-called "reforms" from the outset?

    Churchill was a political outcast before the inevitable march of events finally made him a hero. It seems likely that the reputations of supporters of an effective single-payer system of healthcare in the US will follow a similar trajectory. But as always, things have to get bad enough produce the right political climate for real reform. At present we seem to still be stuck in that phase which Churchill famously described in a 1936 speech:

    The Government simply cannot make up their mind ... So they go on in strange paradox, decided only to be undecided, resolved to be irresolute, adamant for drift, solid for fluidity, all powerful for impotency.


    Good For Dean (5.00 / 2) (#4)
    by squeaky on Thu Aug 13, 2009 at 04:13:32 PM EST
    The voting booths are our leverage.

    He's got standing, (5.00 / 0) (#35)
    by NYShooter on Thu Aug 13, 2009 at 04:48:31 PM EST
    he's a doctor; he's got a heart; by necessity he must also be a politician, but with a small (p)

    The fact is that it isn't about leverage (5.00 / 6) (#48)
    by inclusiveheart on Thu Aug 13, 2009 at 05:35:42 PM EST
    or threats.  The reality is that if the Democrats retreat from a robust public option open to all, they will ultimately be doomed to electoral savagery.  If they split the baby, the voting public will notice in short order; and the Republicans will rightfully exploit the many weaknesses that these half-cooked options offer.  Dean is in actuality protecting the party from its own overly compromising and cowardly self.  Given what I know now and what I've seen, we'll be lucky if nothing passes.  I think these people in Congress and the White House either need to lose their jobs or wake up before we are going to get the kind of change that would endear them as FDR and LBJ were on social issues.  It is REMARKABLE how completely tone deaf they are; and even more remarkable how convinced many seem to be of their own ability to pull a fast one on the American public.  What the Democrats don't understand is that the GOP has the corner on the market on stupid people.  The majority of the rest, the people who voted for Obama are actually smarter than that.  They might "trust" Obama at the moment, but that won't last long if the Dems throw us all under the bus on this issue.

    I don't think it's necessarily (5.00 / 3) (#61)
    by Spamlet on Thu Aug 13, 2009 at 06:59:09 PM EST
    about tone deafness (a charge that could justly be leveled at the media, however).

    I think if it's not about corruption, in terms of the insurance and pharmaceutical industries' deep pockets and ability to fund the next campaign, then it's about disregard of elected officials' duty to represent their constituents.


    I think they've shown significant (none / 0) (#88)
    by inclusiveheart on Fri Aug 14, 2009 at 09:48:27 AM EST
    tone deafness on both the economic and healthcare fronts.  They keep thinking that people are in a more forgiving state of mind than I think they really are at this point.  They foolishly took the polls showing that people were willing to be patient back in Feb/March and now they are finding out that people aren't as patient as they said they would be.  The notion that people are "happy" with their current insurance plans is equally ridiculous because most of those people haven't tested their plans - if they had they wouldn't have insurance right now or would be paying ridiculous rates.  I get the sense that people in Congress and in the White House (with a few exceptions) are totally out of touch with how bad this economic downturn is for most people in America.  We were promised "bold" action on both fronts and so far we've not seen it play out in ways that address people in any immediate fashion.  I believe there will be political fallout as a result of their timidity.

    It's odd that we applaud (5.00 / 2) (#6)
    by The Last Whimzy on Thu Aug 13, 2009 at 04:15:53 PM EST
    Dean for saying what he believes

    For mere civilians (5.00 / 1) (#10)
    by Fabian on Thu Aug 13, 2009 at 04:18:08 PM EST
    that wouldn't be noteworthy, but for politicians, it's often career suicide to say what they think - instead of what they think people want to hear.

    Yeah, but (5.00 / 3) (#19)
    by gyrfalcon on Thu Aug 13, 2009 at 04:28:03 PM EST
    that's the Howard Dean we all (or a lot of us) fell in love with back in '96, and who vanished without a trace once the '08 primaries started, the guy who said what he thought regardless of the political consequences to the PPUS.

    I'm very glad he's back, but he's LATE, probably too late.


    That is a mystery. (none / 0) (#25)
    by Fabian on Thu Aug 13, 2009 at 04:31:05 PM EST
    Why did he vanish?  Was he pushed or did he jump?

    I am glad that he hasn't changed.  We need someone with his stature who will say what he does without worrying about the powers that be.


    Dean went even farther than what (5.00 / 6) (#67)
    by MO Blue on Thu Aug 13, 2009 at 07:53:38 PM EST
    is quoted by BTD.

    In an interview today with The Huffington Post's Sam Stein former DNC Chair and presidential candidate Howard Dean warned that Democratic lawmakers who oppose the creation of a new public health insurance plan in health care legislation will face primary elections:

    I do think there will be primaries as the result of all this, if the bill doesn't pass with a public option," Dean said, in a phone interview with the Huffington Post.   Think Progress

    I, for one (5.00 / 5) (#68)
    by NYShooter on Thu Aug 13, 2009 at 08:48:45 PM EST
    would love to see a mass, 50 state, primary onslaught.

    Our choices are so limited that staying at home might be the winner next election. I think the disillusionment is that great. I mean, if large majorities in both houses, an extremely popular President, and an unequivocal, voter mandate can't produce the tiniest bit of progress from the status quo, what will? And, to top it off, the mandate was, specifically to produce change;

    What, for G*d's sake is it that they didn't understand?


    What don't they understand? (5.00 / 2) (#73)
    by MO Blue on Thu Aug 13, 2009 at 10:03:38 PM EST
    That they were elected to represent people not corporation.

    I think (5.00 / 1) (#78)
    by cal1942 on Fri Aug 14, 2009 at 04:01:30 AM EST
    you're right about staying home as a possible outcome.

    Many people will believe their vote makes no difference and simply drop out.

    Health care isn't the only serious issue the nation faces.  

    Our principle problems, the dominance of the finance industry, diminishing manufacturing sector, widening a war we can't win, bloated military budgets, foolish trade policies, etc. are all but ignored while our communities continue to decay.

    The joke is that ordinary people can readily identify the problems while a tone deaf elite political class lives on spin.

    It appears that no important issue will be adequately addressed.

    I believe that many many people will simply stop participating in the political process.


    Is it? (5.00 / 4) (#49)
    by inclusiveheart on Thu Aug 13, 2009 at 05:38:06 PM EST
    Seems like applauding people for speaking the truth has been the norm for a number of years now because so few people have been inclined to do so.

    It would be a silly tangent (none / 0) (#62)
    by The Last Whimzy on Thu Aug 13, 2009 at 07:02:20 PM EST
    But I think we -- and I totally do it too -- that when we hear an opinion we agree with we say that the person is saying what they really think ...  which sort of creates a built in construct of demeaning anyone who disagrees with us because they are not saying what they really believe.

    In some cases it is self-serving but now that I think it through it may be very relevant to this situation because we seem to be dealing with a president who believes as Dean does but has some difficulty saying it.

    Like I said, silly tangent.


    You are missing the point (5.00 / 4) (#63)
    by Steve M on Thu Aug 13, 2009 at 07:11:08 PM EST
    The reason it is apparent that he really believes this is that it runs contrary to the Democratic party line right now.  The only plausible reason for him to rock the boat is that he believes it is important to do this as a policy matter.

    I botched it (none / 0) (#64)
    by The Last Whimzy on Thu Aug 13, 2009 at 07:17:14 PM EST
    Cause that's what I meant to say.

    As crazy as they often are, (none / 0) (#87)
    by inclusiveheart on Fri Aug 14, 2009 at 09:41:52 AM EST
    I often find myself having more respect for the Republicans because they do say what they believe - it is crazy - but they aren't afraid the way the Democrats continue to be.

    They say what they think will enflame (none / 0) (#96)
    by sallywally on Fri Aug 14, 2009 at 07:17:29 PM EST
    their "base" and destroy the Dems. I don't think even they (Repub leaders) actually believe it, unless they are delusional, which is possible. They like and want power, and to keep it they have to destroy the Dems.

    They are, however, unafraid to say dramatic, violent, vicious - and totally false - things to accomplish their purposes.

    But Dems are mostly afraid to say what they believe, and to confront the Repubs, fearing it is too dramatic.



    not odd (5.00 / 3) (#57)
    by dws3665 on Thu Aug 13, 2009 at 06:37:25 PM EST
    You reward the behavior you would like to see repeated and ignore or punish behavior you would like to discontinue.

    Probably, yes (5.00 / 2) (#8)
    by andgarden on Thu Aug 13, 2009 at 04:17:05 PM EST
    I think if I were a legislator, I would be hard pressed to vote against a Massachusetts style plan. But I will be very disappointed if Congress can't do better than that.

    they don't have (5.00 / 1) (#12)
    by CST on Thu Aug 13, 2009 at 04:18:54 PM EST
    the Mitt Romney excuse.

    Ben Nelson is essentially as bad (none / 0) (#15)
    by andgarden on Thu Aug 13, 2009 at 04:21:08 PM EST
    But he's feeling the pressure.

    and (5.00 / 1) (#20)
    by CST on Thu Aug 13, 2009 at 04:28:03 PM EST
    MA legislature could override a Romney Veto pretty easily.  Which they had to do to get the bill in the form it's in, since he vetoed eight sections of it which were all over-ridden.

    Also, I think it's harder to have a public option run by a small state than it is to have one run by the fed.  Just in terms of economies of scale.  There are people complaining that 10 million people isn't enough to control costs, etc...  That's more than the population of the entire state.


    Yup, (none / 0) (#22)
    by andgarden on Thu Aug 13, 2009 at 04:28:54 PM EST
    Doing this nationally is a whole different ball game.

    That still doesn't mean that (none / 0) (#28)
    by dk on Thu Aug 13, 2009 at 04:36:16 PM EST
    it's enough.

    doesn't mean (none / 0) (#31)
    by CST on Thu Aug 13, 2009 at 04:42:24 PM EST
    it's not either.  It's almost 1/3 the population of Canada.  How big does it have to be to reach a threshold of success?

    That's the question I (5.00 / 1) (#32)
    by dk on Thu Aug 13, 2009 at 04:46:10 PM EST
    posed in this comment.  It would be great if Dean could provide his thoughts.

    However, since Obama's public comments tend to imply that more people will have the option than the 10 million estimated in the CBO report, however, I am skeptical.  If that were enough, why is Obama hiding it.


    Dean's expertise (5.00 / 1) (#86)
    by ricosuave on Fri Aug 14, 2009 at 09:37:28 AM EST
    I don't disagree, but would like to point out that Dean's experience (and that of most every other doctor you talk to) is not in the providing of insurance or paying for medical care.  They are experts at providing medical care, and possibly even billing insurance companies.  Dean does have the added benefit of also being a public official who we all believe actually gives a darn about people, but that doesn't make him any more an insurance expert than the dastardly Rick Perry.

    "Health Care" includes different business like medicine, hospitals, and insurance--just like the generic "Energy" includes varied things like electric generation, oil drilling, and windmills.  I think we make a mistake (and play into the hands of the "you're changing the greatest system in the world" folks) when we talk about this effort broadly as "Health Care" and assume that doctors have some special knowledge.  We are talking about the insurance business, about which most doctors know little more than the name of the companies they accept payments from.

    Want an example of their policy inexpertise?  How many medical offices have recently asked you for your Social Security number?  I have been asked by nearly every doctor and dentist office I have been in for the past few years, even though HIPAA apparently forbids it.  If they don't know that, why do you expect them to know about risk pools, redlining, and the actuarial nuances of pre-existing conditions?

    Besides: everyone likes their doctor, nobody likes their insurance company.  Let's focus on the right target.

    So I am happy that Dean is saying good stuff, but where are insurance experts like Deborah Senn?  Why isn't Kathleen Sebelius (former insurance commissioner) the front-line person for this?  Isn't there a big and well known insurance commissioner from New York whose name I can't remember?


    also (none / 0) (#33)
    by CST on Thu Aug 13, 2009 at 04:46:35 PM EST
    greater than the population of Austria.

    They manage to control costs pretty well.


    Right, but it's about the (5.00 / 1) (#34)
    by dk on Thu Aug 13, 2009 at 04:47:38 PM EST
    proportion of people in the public plan versus the private plans.  And the entire population of the U.S. is considerably larger than that of Australia, if I remember correctly.

    wrong country :) (5.00 / 1) (#36)
    by CST on Thu Aug 13, 2009 at 04:50:12 PM EST
    Austria - and yes.  But I guess what I am saying is - not that 10 milion is good or as good as it should be, but that it is big enough to not fail.  I am not sure why we assume that if it only enrolls 10 million people it will be an abject failure.  Obviously I would prefer it to be available to everyone.  I am just wondering what is the logic behind saying 10 million is too small to succeed.

    The logic is that (5.00 / 2) (#39)
    by dk on Thu Aug 13, 2009 at 04:53:39 PM EST
    it is such a low proportion of the overall population that it will not have the negotiating leverage it needs to bring down costs.

    So, to me, logically, 10 million, proportionately, seems far to low to make much of a dent in the U.S. healthcare context.  If Obama, or Dean, thinks that it would, I would like to hear their arguments for that position.  So far, both seem to, instead, disingenuously play down the lower number (or at least Obama seems disingenuous about it, I don't know if Dean has addressed the numbers yet, that's why I was asking).


    I was thinking (none / 0) (#44)
    by CST on Thu Aug 13, 2009 at 05:07:25 PM EST
    more in terms of admin costs.  Not sure why they would have a harder time negotiating than they already do for the existing government programs.  It would be like adding 10 million people to the federal plan in place right?

    Sometimes it's hard to remember we are all talking about hypotheticals here though.

    I guess my point is, it would make a dent in the number of uninsured.  Which is a step in the right direction.  I am not sure how it would implode or blow up and ruin a chance for greater reform.  But maybe that's not what you are arguing.


    They only need 50. (none / 0) (#16)
    by dk on Thu Aug 13, 2009 at 04:23:54 PM EST
    Without nuking the filibuster, it's messy (none / 0) (#17)
    by andgarden on Thu Aug 13, 2009 at 04:24:56 PM EST
    But personally, I would nuke the filibuster.

    Politics is messy, no? (none / 0) (#18)
    by dk on Thu Aug 13, 2009 at 04:26:26 PM EST
    Messy in a bad way (none / 0) (#21)
    by andgarden on Thu Aug 13, 2009 at 04:28:14 PM EST
    In that, it's not clear to me exactly what survives through reconciliation.

    No one is happy with th Mass plan (5.00 / 7) (#50)
    by inclusiveheart on Thu Aug 13, 2009 at 05:44:30 PM EST
    except the insurers who get mandatory premiums.  I wouldn't think twice about voting against a plan a la MA.  Obama et al screwed this up from the start by not defining the "gold standard of care" and working from there.  There is little substance to the debate.  It is all about numbers and process at the moment.  If you want to pass "sweeping healthcare reform", you must define the healthcare - and that doesn't mean freakin' discussing the perils of soda.  That means you define what goes into care that is both preventative, efficacious and cost effective.  Right now the way it is I know they might compel me to buy health insurance, but I have no clear idea of what I would get in return for my money.  That is the worst possible debate for "tax and spend" Democrats to engage in and of course because they did not define the goals the GOP took the opening and I must say are doing an excellent job of exploiting their weakenesses right now.

    This is the mandate fight all over again (none / 0) (#51)
    by andgarden on Thu Aug 13, 2009 at 05:47:47 PM EST
    Not exactly (5.00 / 2) (#52)
    by MO Blue on Thu Aug 13, 2009 at 06:07:00 PM EST
    Many of us were and are for either single payer or a strong public option combined with mandates.

    Mandates by themselves are no more than a give away to the insurance industry and do nothing to control costs or compel the insurance industry to change their behavior.


    Yes and the first mandate fight (5.00 / 5) (#53)
    by inclusiveheart on Thu Aug 13, 2009 at 06:09:33 PM EST
    was lost because the Clinton plan was essentially set up to pay into the private insurers' coffers AND there was no good definition of "gold standard care" put forward then either.  Frankly, they've blown it again.  Single payer is the most practical and economical option assuming that care is the focus.  But they've totally ignored/avoided defining care throughout this debate.  I have no desire to be forced to pay for some undefined program.  I am amazed they thought they could get away with this approach.  It didn't occur to them that every single person in this country is looking closely at how they are spending their pennies?  It is amazing - really amazing.

    It's also amazing (5.00 / 2) (#79)
    by cal1942 on Fri Aug 14, 2009 at 04:37:08 AM EST
    that Obama stated that employer provided health insurance would be the base for coverage at a time when people are losing jobs, employers are cutting coverage levels and even dropping health insurance altogether.

    Go, Dr. Dean! (5.00 / 1) (#11)
    by Spamlet on Thu Aug 13, 2009 at 04:18:48 PM EST

    More evidence that Dean is out (5.00 / 5) (#13)
    by Cream City on Thu Aug 13, 2009 at 04:20:36 PM EST
    of touch with the party leadership, probably.  

    Donna Brazille won that round, and she wants whatever Obama wants, and that's not what Dean wants.

    Oh, we all know Dean (5.00 / 8) (#23)
    by gyrfalcon on Thu Aug 13, 2009 at 04:29:04 PM EST
    is talking from way, way under the bus.

    I think (5.00 / 3) (#26)
    by jbindc on Thu Aug 13, 2009 at 04:31:26 PM EST
    He's so far under, he's embedded in the cement.

    Well, at least he's got teevee (5.00 / 5) (#46)
    by Cream City on Thu Aug 13, 2009 at 05:16:31 PM EST
    under that bus, so he apparently is keeping up with those newfangled cable news shows now.

    This makes me feel better about Dean again.... (5.00 / 2) (#29)
    by kempis on Thu Aug 13, 2009 at 04:37:00 PM EST
    His "Gee, I didn't know that Hillary was subject to sexist attacks until a couple of days after she conceded because, shucks, I just don't watch cable" was way beneath him.

    But Dean on the necessity of the public option is Dean with integrity. And when he's saying what he knows to be the truth, he can be pretty righteous.

    I appreciate his (and anyone else's) unequivocal support for the public option.

    I'm no fan of Dean (5.00 / 0) (#30)
    by Bemused on Thu Aug 13, 2009 at 04:37:06 PM EST
     and don't often agree with him on politics. This time, however I not only think he has it right, I think someone needs to move the debate so the options move from between no act and  a bad one, which is where i think we are right now.

      Is he the ideal person for the job? Probably not but he has the luxury of speaking his mind without worrying about damaging his political future and I'm not sure anyone of much stature eyeing a future has the guts right now.

    "No Public Option, No Deal" (5.00 / 3) (#38)
    by nycstray on Thu Aug 13, 2009 at 04:51:50 PM EST
    needs to show up in numbers at the town halls etc.

    Good for Dr. Dean (5.00 / 2) (#40)
    by Steve M on Thu Aug 13, 2009 at 04:55:52 PM EST
    a very important voice in this debate IMO.

    If we were reallty serious about controlling costs (5.00 / 3) (#45)
    by Bemused on Thu Aug 13, 2009 at 05:09:34 PM EST
      there would not be a public option, there would be a public system, eliminating the profit taking by insurers. The single payer government system would not merely have negotiating leverage, it would schedule payments and reduce the profits of doctors, hospitals, etc.

      But, we're not really serious about controlling costs because the people who profit from those costs don't want it.

      OK. That's how politics works. So, what we are doing is looking at ways of differently distributing the burdens of increasing costs. That creates winner and losers so some people will support that who would never support single payer. Doctors and hospitals, etc., would tend to like more people covered by nsurance to pay for more of their services.

      Insurers aren't thrilled but they get to keep making enough money they aren't going to kill something now that perpetuates their existence when having no change might lead to more drastic action if we start over after another aborted attempt.

    At the very least it calls the rest of the pols (5.00 / 2) (#47)
    by ruffian on Thu Aug 13, 2009 at 05:21:22 PM EST
    out to tell us their own bottom line.

    Thank you Dr. Dean!  When you're good, you're very very good.

    Several noted physicians who have (5.00 / 2) (#56)
    by KeysDan on Thu Aug 13, 2009 at 06:23:58 PM EST
    long spoken out about the social justice of public health policy, including Quentin Young, Sidney Wolfe, David Himmelstein, Steffie Woolhandler, and Marica Angell have a different take on the public option as set forth in a letter to the Nation (which supports a public option). It is their feeling that even a "kinder, gentler public option would quickly fail in the health care marketplace".  These authors underscore that insurers compete by not paying for care. A public option that did no marketing would soon be saddled with the sickest patients, whose high costs would overwhelm any administrative efficiencies and drive up premiums. Moreover, eschewing private insurer's schemes, they continue, that shift costs to patients and other payers  would be a crippling disadvantage and to survive, a public option would have to imitate the  bad behaviors of private plans--becoming a public clone.   Of course, their preference is Medicare for all, but these are critical points to evaluate.

    From the September Harper's Index (5.00 / 8) (#60)
    by Dadler on Thu Aug 13, 2009 at 06:59:02 PM EST
    Percentage change since 2002 in average premiums paid to large U.S. health insurance companies: +87

    Percentage change in the profits of the top ten insurance companies: +428

    Chances that an American bankrupted by medical bills has health insurance: 7 in 10

    That's just horrifying (5.00 / 1) (#72)
    by gyrfalcon on Thu Aug 13, 2009 at 09:23:09 PM EST
    Yep, my premiums have gone up (5.00 / 1) (#91)
    by Cream City on Fri Aug 14, 2009 at 10:56:59 AM EST
    almost that much.  And I know a young man now, a single dad who was laid off but has a chronic condition and huge medical bills, who is about to lose his and his kid's home.  So he has stopped buying his costly meds, stopped getting his regular visits to the doc and his regular treatments.  When he did that last time he was laid off, to be able to save their home, is when his condition got worse and he piled up those huge medical bills that have been hanging over him, ever since.  

    Btw, he also needs treatment for depression, I think.  But the best fix for that would be for Obama and Congress to get off their a*sses, as this guy I know has worked harder than they have, and for what?  For this horrible vicious cycle.

    Oh, and since being laid off, he wants to go back to school to change his life and get out of factory work and train for a health care job.  But all that supposed stimulus funding to help laid-off workers retrain, etc.?  The schools say that it's tied up in folderol and isn't there yet for so many of these workers.  Same thing we have seen for the supposed help for people to keep their homes.  Funny how the stimulus funding to banks and big business was expedited, huh?


    whoa (none / 0) (#71)
    by coigue on Thu Aug 13, 2009 at 09:08:14 PM EST
    that third one has my head spinning.

    There will be no public option (5.00 / 1) (#74)
    by Slado on Thu Aug 13, 2009 at 10:16:36 PM EST
    Obama needs to put this back together and it starts by dropping the public option if he wants to get anything passed.

    If he keeps it in then Obamacare is dead.

    I think the Count in Congress (none / 0) (#75)
    by andgarden on Thu Aug 13, 2009 at 10:24:51 PM EST
    disagrees with you. The fight now is over how big the public option will be.

    That's not what I'm reading. (5.00 / 1) (#76)
    by BrassTacks on Thu Aug 13, 2009 at 10:35:39 PM EST
    Even the WaPost said that the public option is dead.  So I really have no clue what Obama is trying to save in his town hall meetings.  

    Wouldn't it be nice if Obama could tell us what exactly he wants and what he and Congress are likely to do?  


    Just what I have been thinking... (5.00 / 1) (#90)
    by lentinel on Fri Aug 14, 2009 at 10:12:35 AM EST
    He is touted as a great orator, but he can't communicate worth a damn about this issue. IMO, that's because he knows that single-payer is the way to go, but he did a 180. So he is trying to sell something about which he himself is confused and unsure.

    He never supported single payer (none / 0) (#97)
    by sallywally on Fri Aug 14, 2009 at 07:24:28 PM EST
    in the primaries or the campaign, so whatever 180 he's done, it was before he ran for president. He was to the right of Hillary during the primaries.

    It's Obama v/s Obama. And we are the losers. (none / 0) (#99)
    by lentinel on Sun Aug 16, 2009 at 08:13:45 AM EST

    I am referring to what he said in 2003 to the AFL-CIO:

    "I happen to be a proponent of a single payer universal health care program." (applause) "I see no reason why the United States of America, the wealthiest country in the history of the world, spending 14 percent of its Gross National Product on health care cannot provide basic health insurance to everybody. And that's what Jim is talking about when he says everybody in, nobody out. A single payer health care plan, a universal health care plan. And that's what I'd like to see. But as all of you know, we may not get there immediately. Because first we have to take back the White House, we have to take back the Senate, and we have to take back the House."

    What he said at that time was simple, understandable and comprehensive. It is true that he abandoned this position before the primaries. Well before the primaries.

    He had also abandoned his opposition to the war in Iraq by 2006. He campaigned for Lieberman's reelection.

    So what he is left with is trying to sell us a mishmash. Compared to his forthright delivery in 2003, his recent speeches on the subject are babble.

    video - Obama on single payer in 2003

    He sold out to the insurance industry.
    He sold out to a whole lot of industries.
    And he's trying to make it come out right.
    But it can't.


    There are some fairly conservative (none / 0) (#77)
    by andgarden on Thu Aug 13, 2009 at 10:52:30 PM EST
    House members on board. The public option is getting to conference--I can pretty much guarantee that.

    Several (none / 0) (#80)
    by Ga6thDem on Fri Aug 14, 2009 at 05:45:33 AM EST
    members of the Senate have said that there arent the votes to pass the bill with the public option and that it is dead. I've read there are the votes in the house though.

    That may be true in the House (none / 0) (#85)
    by MO Blue on Fri Aug 14, 2009 at 09:33:58 AM EST
    but not in the Senate.

    "We have heard from both chambers that the House sees a public plan as essential for the final product, and the Senate believes it cannot pass it as constructed and a co-op is what they can do," Mr. Emanuel said. "We are cognizant of that fact."

    Asked whether the president would accept the weaker co-op, Mr. Emanuel declined to comment. "I am not going to fast-forward the process," he said.

    Industry lobbyists and moderate Democrats in both chambers, though, argue that the White House's actions behind the scenes show a recognition that the finance panel's anticipated compromise is the most likely template for any final legislation. NYT

    If he drops (none / 0) (#89)
    by lentinel on Fri Aug 14, 2009 at 10:08:35 AM EST
    the public option, what's left?

    Death Panels? (none / 0) (#92)
    by squeaky on Fri Aug 14, 2009 at 11:31:22 AM EST
    Oh right, the Senate took that out too..

    Personally I would be delighted with any reform of the health insurance business. They are criminals, record profits on the backs of the sick, and weak.


    Are you aware what this "reform" ... (none / 0) (#93)
    by sj on Fri Aug 14, 2009 at 02:21:03 PM EST
    ... basically consists of?  

    It consists of REQUIRING that everyone PURCHASE insurance.  It guarantees the health insurance business criminals millions of new customers.  

    ANY reform would be good.  But simply calling something "reform" doesn't make it so.  Frankly, I'm puzzled why you comment so prolifically in these Health Care threads when, by your own admission, it is an issue that you neither know nor care much about.  

    Nevertheless you have seem to have lots of opinions based on ... what exactly?  Do you just like dropping grenades?  C'mon squeaky.  Spend time in threads where you have something to offer.


    Well F' You Too (none / 0) (#95)
    by squeaky on Fri Aug 14, 2009 at 05:47:27 PM EST
    Please if you do not think my comments have anything to offer you, please disregard them.

    Despite the fact that I am not a health policy wonk, and despite the fact that I have health insurance and can afford the criminal rate increases, poor service and arrogance of my insurance company, I do have opinions about the health care debate, that are just as valid as anyone else's.

    I would be happy for any regulation of the industry. And it is clear to me that my interests will be met at least to some degree. And yes, I would like it if everyone in the US to have health coverage like most other developed countries.


    Lots of new customers (none / 0) (#94)
    by sj on Fri Aug 14, 2009 at 02:23:59 PM EST
    for the insurance companies.  In return for some promises to self-police.

    A public option . . . (5.00 / 3) (#84)
    by allys gift on Fri Aug 14, 2009 at 09:00:32 AM EST
    is Medicare.  If you want to do it in increments, just lower the age to 60 this year, 55 next year, 50, the next and so on.

    Even the elderly have the option of not taking Medicare.  And they still need supplemental insurances.  So folks could slowly be offered Medicare according to their age, and they could take it or not at any time once they are eligible until you're eligible at birth.  That would give the insurance companies time to adjust and offer other products and slim down their workers.  BCBS, who I think administers Medicare, would be hiring, as well as CMS, so the employment numbers would all come out in the wash.

    Sheesh.  It's a no brainer!

    Does anybody (none / 0) (#5)
    by Ga6thDem on Thu Aug 13, 2009 at 04:14:10 PM EST
    in the party listen to Dean? Supposedly Rahm dislikes him. Right?

    yeah I question (5.00 / 2) (#7)
    by lilburro on Thu Aug 13, 2009 at 04:16:04 PM EST
    whether Dean has been rehabilitated enough in the public sphere to be an appropriate spokesmen on this subject (regardless of his eloquence and commitment).  BUT he is certainly right, and somebody has to be out there saying what he is saying.

    They fought over how much money (none / 0) (#9)
    by The Last Whimzy on Thu Aug 13, 2009 at 04:18:07 PM EST
    Should be spent in red states during the 06 elections.

    Emanuel hated the 50-state strategy (5.00 / 2) (#41)
    by sallywally on Thu Aug 13, 2009 at 04:56:40 PM EST
    Dean pursued as Party Chair. He wanted just to find and support certain Dems. Not sure if those were the Blue Dogs or not.

    The 50-state strategy was validated by results, if I recall correctly. No admission of that from Rahm.


    validated by results? (5.00 / 1) (#70)
    by coigue on Thu Aug 13, 2009 at 09:03:37 PM EST
    Which results exactly? The results I see now are that the blue dogs are ruining this process.

    I don't see the point in choosing sides (none / 0) (#54)
    by The Last Whimzy on Thu Aug 13, 2009 at 06:17:59 PM EST
    But Rahm's issue was not the 50-state strategy per se, but how much money was being spent in red states.

    20k for a field office in Salt Lake City might make perfect sense.  Especially if none already exists.

    But if they were putting tv money into places where it would do no good then I'm on Rahm's side on this.

    As far as the successes of 06 are concerned, there were enough and of many variety, so much so that everyone should be able to take some credit, I should think.


    Short-term versus long-term (5.00 / 2) (#69)
    by gyrfalcon on Thu Aug 13, 2009 at 09:00:59 PM EST
    is what the fight was about.  Dean wanted to think long-term how to build the party in places it had been swamped and demoralized, Rahm only wanted to win elections that year and then worry about next year when it came around.

    Exactly what's getting the Dems (none / 0) (#98)
    by sallywally on Fri Aug 14, 2009 at 07:29:07 PM EST
    in trouble now. I'm thinking maybe the Blue Dogs can be traced to Emanuel.

    Watching the end of Star Trek scene (none / 0) (#37)
    by joze46 on Thu Aug 13, 2009 at 04:50:54 PM EST
    Watching the end of Star Trek scene

    Yes they are in a Jam; some evil space freak has Captain Picard hostage. But temporality free he says he needs options to be able to get the hell out of the jam he is in. Don't we all need options?

    We need Options, Options are opportunities. Opportunities encourage hope, growth, accession, a cultural moment that that fuels a continued well being to fulfill basics in something familiar to all of us...

     We the people of the United States, in order to form a more perfect union, establish justice, insure domestic tranquility, provide for the common defense, promote the general welfare, and secure the blessings of liberty to ourselves and our posterity, do ordain and establish this Constitution with health care establish for all in the United States of America.

    Even hate radio and hate cable should likely conclude healthy citizens are happy citizens:)

    Hmm (none / 0) (#55)
    by kaleidescope on Thu Aug 13, 2009 at 06:20:28 PM EST
    Whatever happened to Wes Clark?

    He's out working to elect Dems (none / 0) (#66)
    by nycstray on Thu Aug 13, 2009 at 07:41:13 PM EST
    Got an email in the last week or 2 in regards to the issue, iirc.

    Dean is right (none / 0) (#81)
    by Militarytracy on Fri Aug 14, 2009 at 08:11:45 AM EST
    The only other possible incrementalism I can fathom is creating co-ops and I know nothing about what that would take to get done.  What sort of legislation do we need to enable and empower healthcare co-ops?

    The question is will a co-op work (none / 0) (#83)
    by MO Blue on Fri Aug 14, 2009 at 08:59:08 AM EST
    Where are examples of successful health care co-opts, how much will they cost vs single payer or a public option, who will be able to participate, what percentage of the population is expected to sign up, will they be large enough to put any pressure on the insurance industry to contain costs?