Health Insurance, Anti-Abortion Amendments, & Howard Dean's Big Brass Balls

Howard Dean, who will probably still never live down The Scream, is sick of Senate members pandering to the worst instincts of the nation's health insurance companies rather than their constituents. And he's not shy about saying so.

In a new interview with Esquire scribe John H. Richardson to promote his new book Howard Dean's Prescription for Real Health Care Reform, Dean places the blame for our fucked-up health insurance system on the private sector and its government enablers.

For starters, Dean takes on the idea that the marketplace is more efficient than government in providing health care.

ESQ: Boil it down, if you would. Why isn't it working even if you do have insurance?

HD: Because it's too expensive. The private sector can't manage costs. Health care is one of the few places - defense is another - that the government works more efficiently and more effectively than the private sector. That's just a fact.

ESQ: Why is that?

HD: Because there is no feedback in the private health-care system. When I was practicing medicine, nobody with substernal chest pain ever got off my examining table and said, "The guy down the street does it for $2,000 cheaper, I'll see you later." That's why we've had 40 years of costs that increase between two and three times the rate of inflation every single year. It's breaking our economic system.

In effect, Dean is arguing that because there's no competition at the provider-level, the "health care" market already isn't a true market. Republicans have argued that the solution to that problem is more provider information and programs like Health Savings Accounts that force people to keep track of health expenses (as though health insurance companies aren't price-setting); Dean is suggesting that health care, like national defense, is a social good that will never properly be accounted for by the market because its intrinsic value is borne by too broad a segment of the population. Market failures — like the poor valuation of social goods like defense and education — are accounted for in economic philosophy by having government provide them to people by spreading the costs as widely as the benefits.

Dean then ascribes the business opposition to the public option to one of two things: political ideology; and lack of foresight.

Then there are lots of businesses that aren't particularly ideological but genuinely believe that if they keep doing the same thing, they'll somehow get a different outcome. That's human nature. They think they can manage health-care costs even though it's been 40 years since any of them ever have. That's why I think Obama's plan is so great: If you like what you have, you can keep it.

Dean, obviously, believes that both businesses and their employees will end up preferring the public option — and that despite Republican fears of that, that's not a terrible thing.

He also thinks that the polls back him up that most Americans agree with him — and that the Senate should stop fucking things up.

ESQ: But still, even you say you expect 65 million people to enroll in the public option, and a study by a health-care company put the number at 117 million. That's a lot of people.

HD: It is.

ESQ: But isn't that a threat to the insurance companies? Especially at a time when we want to keep businesses healthy and people employed?

HD: This is one of the many problems the Senate is now having. They are focused on anything but the American people. But the insurance companies will be fine. It won't happen overnight, and they'll make plenty of money. But this is not a matter of making the insurance companies happy. This is a matter of making the 72 percent of the people who want a public option happy, including the 50 percent of Republicans who want a public option.

ESQ: Fifty percent of Republicans want a public option?

HD: Yeah. That's in a Kaiser poll and in a New York Times/CBS poll last week. The Senate is in the process of self-destructing. They are talking about managing health-care reform to make sure that a relatively small sliver of American industry is satisfied at the expense of 72 percent of their constituents. That's unbelievable.

Can you tell the man doesn't have to worry about getting a bunch of Senators re-elected any more?

Dean also takes on Republican tropes that the public option will result in rationing and "a bureaucrat standing between you and your doctor" — which is a hilariously ironic thing to say to any American who's ever dealt with a health insurance company.

But we ration in America today. If you are one of the 47 million people who don't have insurance at all or if you're someone who has a lousy plan because you can't afford a good one, that's rationing by price. I'll tell you who rations. It's the private insurance groups. This ridiculous nonsense that the right-wingers are talking about, that public insurance will put a bureaucrat between you and the doctor - that goes on every day in the system we have. But only in the private sector. It doesn't happen in the public sector. I have never had, in my 10 years of practicing medicine, a Medicare bureaucrat call me up and say, "You can't do this and you can't do that." But that used to happen every day with the private insurance companies. You'd beg to have your patient have this drug or that procedure.

In fact, Dean cites the insurance companies' bureaucracy — and CEO salaries — as one of the reasons they're so economically inefficient.

I'm going to use Medicare as an example because it is a public plan. About 4 percent of every dollar that goes into Medicare is spent on administration. In the private sector, that number is between 12 percent and 50 percent. That's because of return on equity, very high CEO salaries, advertising, and general administration. But you don't have return on equity in a public plan, and there doesn't have to be advertising, and the people who run it aren't going to be making $20 million a year. They are probably making less than $200,000 a year. And that's before you get to cost controls.

Return on equity is a fancy way of saying that most health insurance companies are public companies, and so there are profit-pressures and dividend-pressures and stock-price-pressures for them to contend with before they get around to providing people health care — which, in fact, isn't their mission: it's to insure their customers.

In somewhat-related news, the health care reform bill will likely be the center of this year's abortion debate: NARAL President Nancy Keenan says they're aware that anti-abortion Senators plan on introducing a range of anti-abortion amendments to restrict women's access to insurance coverage for (at the least) abortion services; and 19 House Democrats (full listing here) have sent a poorly-worded letter to House Speaker Nancy Pelosi asking her to keep abortion out of the health care reform altogether. Since that reform comprises both public and private coverage, it could mean they've asked their own party to restrict or prohibit private insurance companies from covering abortion services. Fab.

Howard Dean: Private Health Care Is Breaking Our Economy [Esquire]
NARAL Pres Nancy Keenan On Health Reform And Abortion Rights [American Prospect]
Anti-Choice Dems Trying To Keep Abortion Out Of Health Care Reform [Feministing]