For some Americans, the push for health care reform seemed like the perfect time to get Howard Dean involved in national policy. Unfortunately, Barack Obama disagreed. But Dean's got something to say about how reforms are shaping up anyway.

First off, Dean thinks that bipartisanship on health care reform is bullshit.

I think it's a very good thing [that the Democrats might not get bipartisan support for their bill]. I think the Republicans have correctly diagnosed that the way to stop Obama is to stop the health-care bill. They're determined not to have a bill. In the long run, we're going to have to do this on our own.

In other words, since the Republicans have now announced their intention to kill the bill for political reasons regardless of what it contains, fuck 'em. They had their chance.

Besides which, if Obama wants to take credit for it in 3 years when he's running for reelection — let alone the House and Senate members who are up for reelection next year — they've got to be able to have something to show to their constituents that they, and they alone, are responsible for. And Dean's got the best idea this underinsured freelancer's heard all year.

Put in guaranteed issue and community rating at once, so people cannot be turned down for insurance in the private sector, nor can they have their insurance taken away because of an illness. He'll get huge credit for that and there's no budgetary cost.

It's so rare that constituents' personal interests and legislators' political interests align so nicely.


Dean's got another suggestion that I would have loved when I was just a tiny bit younger.

You say the federal government should provide free coverage to everyone under 30. That's pretty radical.
It's incredibly cheap. Statistically, only two expensive things happen to people under 30: one is a malignancy and the other is an accident. Everything else is mostly preventive maintenance and it's very inexpensive. But this is not what's going to be passed.

Sigh. Guess that's what we get for not voting as much as the oldies.

Anyway, although Dean doesn't use the word "market failure" to counter all the Republican arguments about how the free market ought to be allowed to "work" in the case of the health insurance market, he's got a pretty good handle on why it never will.

Everybody talks about preventive medicine, but almost nobody does it because there's no payback. A private practitioner invests money in preventive care and the hospital benefits. They're not connected. Second, pay people - particularly primary-care providers - for taking good care of patients without rewarding doctors for doing more and more and more. That's what the system is currently based on. The more you do, the more you get paid, which is an incentive for inefficiency.

In other words, the market that functions the most efficiently in terms of cost-incentives functions the worst in terms of caring for people's health. That's because the health insurance market has become the de facto health care market, rather than an addition to it.


In a speech to Campus Progress, Dean offers a potential — but politically untenable, which is why he's so beloved — solution to the market failure problem. Bonus: it's one the government has already implemented in other industries and which, until relatively recently, was the model the health insurance companies were often forced to abide by on the state level until they successfully lobbied for full privatization.

If you ever want to save costs, it can never happen in the private sector. ... Switzerland and Netherlands treat their private insurers like regulated utilities. Our private insurers are not going to want to do that.

No kidding! Providing health care to their insurance customers might cut into insurance companies' profit margins... and they wouldn't want to do that.


Howard Dean On The Politics Of Health-Care Reform [Times]
The Ever-Quotable Howard Dean [The New Republic]

Related: GOP Focuses Effort To Kill Health Bills [Washington Post]