"Howard Dean Now Supports Passage of Health Reform Bill After Winning Improvements"

Blog for Iowa:

Howard Dean, who many consider to be the most trustworthy authority on health care reform, has a lot to say about the most recent version of the health care [insurance expansion] bill. When he came out publicly last week against passage of the Senate version, it ended a long period for Dean of championing the bill. Saying that health reform is his "life's work," Dean underlined the fact that he really does know what he's talking about. BFIA agrees.

Last night (12/22) on the Rachel Maddow show, Howard Dean didn't, but could have, taken credit for the changes that have made the health care reform bill a better bill he can now support (see Howard Dean Still Fighting for Real Health Care Reform (and Winning).
Here is BFIA's audio transcript of Dean's appearance on last night's Rachel Maddow show.

Rachel: You were saying the senate bill should be killed, and now you're no longer saying that. Why have you changed your feelings about that?

Dean: Well, there are two reasons. The first is, the bill was improved. What the President and the Congress have essentially done is to expand the existing system, rather than reform the system. There are a lot of things that have been changed, there are some faults, as we talked about last week.

In the intervening weeks,they tightened up the cost controls, money was added for community health centers, for wellness and prevention, and they increased doctor reimbursements for rural physicians. So they have done a number of things that will make this approach more likely to work, and it also is going to conference committee with a body that did vote for a public option, and in my view, in order to have any reform you gotta have a public option. You've got to give Americans a choice between different kinds of systems, and not just require them to be in a system we already have. That may or may not happen in the House.

The second thing is, honestly, to see the Republicans carrying on the way they are, I've basically concluded that maybe we should just pass this thing...if the Republicans hate it, there must be some good in it.

Rachel: In terms of the process, it seems like we are coming to the end of the process...it looks like it will pass at 8:00 am on Christmas Eve, but then as you say, it does go on to the conference committee, and a lot of people are looking at this bill and think that it got worse over time, and they are looking to the conference committee to hopefully, make the bill better, and then there's going to be another vote. What's going to be your bottom line at that point... what do you need to see as improvements in order to support people voting for it?

Dean: I would like to see a public option, but that is unlikely. Most of the House bill is better than the Senate bill. For example the so-called pre-existing condition - in the Senate bill you can charge three times as much to an older customer; in the house it's twice as much. In Vermont, it's only 20% more, so a whole lot less. I'd like to seem them lower that number substantially, to make the bill more affordable.

Secondly, I'd like to see the biggest expansion Medicaid could possibly have, using federal funds to do it the way Ben Nelson cut the deal for Nebraska. That should be applied to all 50 states. When we went to universal health care for kids under 18 in my state 15 years ago, we used Medicaid as a vehicle. You do have to increase reimbursements to physicians, but that would be significant help. So, if this is the bill that's going to pass, and if we're going to have these fights for the next 30 years with the insurance companies, you might as well give us a head start.

Rachel: Senator Harkin of Iowa said this week that in his mind, the public option is not totally dead. He says he plans to revisit the idea of the public option in the near future. If this bill passes, does it actually provide an appropriate foundation for a public option to be introduced as a separate matter after it passes?

Dean: Actually, it does. The Senate idea originally was actually better than the House's - the so-called Medicare compromise. In the public option there will be something called an exchange, that's where you're going to go to buy your health insurance. All you've got to do is put in that exchange a public option. There isn't one now, it's some kind of non-profit hocus pocus, that's run by the private sector and governed by the office of personell management.

If you could give people the choice of enrolling in Medicare, if they're under 65, or give them the choice of another public option, I think Medicare is a much smarter way to go, because you've already got the bureaucracy set up and ready to go, they already do a billion claims a year, and you could put that choice into the exchanges. Once you have the exchanges set up, which is something that also came out very well in the House and the Senate - a little stronger in the Senate now, you could modify this - Tom Harkin is right you could modify this at a later date. I wish that weren't necessary, I wish we had that change now, but you could do it later if this doesn't work out. I think this 30 year battle with the insurance companies over regulation is going to be tough to make work properly.