Think Progress: Howard Dean Launches Misguided Attack On Health Reform

[ProSense]

Howard Dean Launches Misguided Attack On Health Reform

Speaking on MSNBC this morning, former Vermont Governor Howard Dean (D) made the wildly incorrect claim that the provision in the Affordable Care Act requiring almost all Americans to carry insurance is not “essential to the plan”:

DEAN: (T)he truth is the mandate’s not essential to the plan anyway. It never was essential to the plan. They did it in Massachusetts and had a mandate, but we have universal health care for kids in my state without a mandate. … I made this prediction before and I’m going to make it again: by the time this thing goes into effect in 2014, I think the mandate will be gone either through the courts or because it’s unpopular. You don’t need it. There will be two or three percent of the people who cheat. That is not enough to bring the system to a halt and people don’t like to be told what to do.

Watch it:

<...>

Sadly, Dean — who has been a leading progressive champion for health reform — is simply wrong about the mandate. As MIT economist Jonathan Gruber explains, this provision is essential to any health reform package that forbids discrimination against persons with preexisting conditions:

Insurance companies are also prohibited from excluding coverage due to preexisting illnesses. This is a highly popular reform, but it doesn’t work in a vacuum. If insurance companies must charge the same price to people whether they’re sick or healthy many healthy people will view this as a “bad deal” and not buy insurance. This results in higher prices that chase even more people out of the market. The result is a “death spiral” that leads only the sick to purchase insurance at very high prices. Several states tried such community rating reforms—offering health insurance policies within a given territory at the same price to all persons without medical underwriting—in their nongroup markets over the past two decades, and sharp rises in insurance prices ensued along with rapidly shrinking market size.

An amicus brief that I co-wrote on behalf of seventeen disease and health organizations goes into more detail. It explains that seven states attempted to ban preexisting conditions discrimination without also requiring everyone to carry a minimum level of coverage, and all of them saw their premiums skyrocket. According to a scholarly study of Vermont’s health plan, Vermont’s premiums shot up after it enacted a ban on preexisting conditions discrimination but no mandate in 1993. Between 1994 and 1996, most of the country only experienced single-digit increases in its insurance costs. In Vermont, however, average premiums increased by 16 percent during this same two year period.
In Massachusetts, the one state to enact a minimum coverage provision along with its ban on discrimination, the numbers are very different. There, individual premiums fell a massive 40 percent in the years after Massachusetts’ minimum coverage law went into effect, while the rest of the nation experienced a 14 percent increase.

Dean’s claim that the courts may strike down the Affordable Care Act’s minimum coverage provision is also misguided. No one questions that a ban on discrimination against persons with preexisting conditions is constitutional, and, as even ultraconservative Justice Antonin Scalia admits, when Congress passes a constitutional law “it possesses every power needed to make that regulation effective.”

First, despite the media attention given Missouri's vote, attacks on the health care bill failed in 26 states.



Second, Mass has the lowest uninsured rate in the country:



Third, to preempt the RomneyCare claims, there is no such thing. The Mass health care law is a product of the Democratic legislature, primary because Romney vetoed it:

In fall 2005 the House and Senate each passed health care reform bills.

The legislature made a number of changes to Governor Romney's original proposal, including expanding MassHealth (Medicaid and SCHIP) coverage to low-income children and restoring funding for public health programs. The most controversial change was the addition of a provision which requires firms with 11 or more workers that do not provide "fair and reasonable" health coverage to their workers to pay an annual penalty. This contribution, initially $295 annually per worker, is intended to equalize the free care pool charges imposed on employers who do and do not cover their workers. The legislature also rejected Governor Romney's proposal to permit even higher-deductible, lower benefit health plans.

On April 12, 2006 Governor Mitt Romney signed the health legislation.<19> He vetoed 8 sections of the health care legislation, including the controversial employer assessment.<20> Romney also vetoed provisions providing dental benefits to poor residents on the Medicaid program, and providing health coverage to senior and disabled legal immigrants not eligible for federal Medicaid.<21><22> The legislature promptly overrode six of the eight gubernatorial section vetoes, on May 4, 2006, and by mid-June 2006 had overridden the remaining two.

[derby378]

1. Without a pubic option, however...

...the reform bill forces American to purchase a private, for-profit insurance plan whose underwriters are not required to place the public good ahead of their profit margins. This is what may doom the individual mandate.

[bluethruandthru]

51. ding, ding, ding....we have a winner!

This is exactly right. We should not be forced to buy insurance from a for profit company. The simplest solution would be medicare for all...but if we don't have that, we all should have the option to buy into medicare.

[justinaforjustice]

2. I Trust Gov. Dean, Not Dem Party Leadership Figures.

Family doctor and six term Vermont governor, Howard Dean, has long been in the forefront of bringing health care to the people who need it. If he says no mandate is needed, I believe him. Think Progress has been co-opted by the corporatists wing of the Democratic Party, who gave insurance companies the gift of requiring all citizens to buy private insurance. There was never a need for such a requirement, as Obama argued when he was running for election. The big campaign bucks of the health insurance industry changed Obama's tune, not economic facts. People should not be mandated to buy private insurance policies. We need Medicare for All. Thanks, Dr. Dean.

[ProSense]

3. Dean's 2004 health care plan sucked, so it's not a given that he is a

policy wonk on this issue.

[No Elephants]

32. He wrote a book on it and more than qualifies as a wonk on the subject. See Reply 35.

[karynnj]

4. Incredbile nice work in debunking this quickly!

[zipplewrath]

5. I remain unconvinced

With the provisions in this bill that encourage/coerce employers to supply health care to employees, and the fact that in the individual market, people tend to buy "family" plans, ultimately there will be only a smattering of people "cheating". The general rise of health care costs will be a larger problem than the "death spiral". If it were that important, the fine/penalty/tax would have been much higher if it was truly that important. It was set where it was apparently to in essence encourage/allow people to actually choose to do this at a price they would pay, such that a revenue stream was created.

The White House was well aware of the numbers of "cheaters". They predict that as many as 25 million will remain uninsured, and many of those will be people who chose to not pay. The CBO scored it under those assumptions. The fine is so low that if there was any "death spiral" it would have surfaced in the various "models" used to score these proposals by both the CBO and the White House.

Without the public option, the mandate should be dropped, or an alternative through medicare should be offered.

[ProSense]

8. This isn't convincing either

"They predict that as many as 25 million will remain uninsured" and a full one-third are undocumented immigrants.

"Without the public option, the mandate should be dropped, or an alternative through medicare should be offered."

Given that the OP is about Dean's comment, it's interesting that Vermont didn't have a public option and is still only at 92 percent insured, which is 3 percent less than the current health care law.

There are many factors that will make the law more attractive over time, starting now.

"The fine is so low..."

This and the fact that 83 percent of Americans are already in the system make the outrage over mandates a bit hyperbolic.

[zipplewrath]

41. It is the comparison

The public option was the only thing that this bill that had any real transformative chance with health care reform. The mandate was just a way of developing additional funding streams. And it was the harshest on those who could least afford it. Sorta the anti-progressive feature. It is the most obvious case of serving the wrong interests, of which there are multiple examples in this bill.

[karynnj]

52. Though the public option could have been a veryt transformative feature it was in no way the only

one. The creation of a the exchange and the provisions that all plans needed to satisfy is actually more trans formative. The new subsidies that start at the level that Medicaid ends up to 4 times the poverty level is also transformative and being designed to taper to zero rather than (like Medicaid) being a threshold - below which you get it and above which you don't. (That alone is important as people actually are sometimes now in a situation where a raise can actually have big negative consequences.

In fact, the main purpose of the public option was to keep the insurance companies honest by having them have to compete with a plan run by the government following all the rules the companies do. If the insurance companies do not move to reduce their increases (or their costs), there is a real threat of the Congress allowing a public option. Adding this is far less complicated than the HCR bill that included the overall structure and the subsidies. The threat alone might push the insurance companies. In addition, nothing stops a non-profit from creating a plan and getting it on the exchange.

[askeptic]

6. What we need is national healthcare - not insurance

This is why the industrialized world extracts taxes to pay for a nationalized health care system and the fact you are a citizen entitles you to the care -- there is no need for this blood-sucking middleman called insurance at all. Until we are ready to face that fact, we will just see a lot of thrashing about. I am also not convinced that the mandate is Constitutional. The government under the Constitution has the power to collect taxes, and I can find nowhere that they have the power to mandate citizens to spend money in a directed way in the private sector.

[niceypoo]

38. Before the bill we were 37th in healthcare in the world

Now after the bill we are 37th in healthcare in the world. Any questions?

[w4rma]

46. That is all the evidence required. (nt)

[karynnj]

53. Very little has been implemented and no new assessments of our healthcare system

have been made in the last 6 months.

[area51]

40. +1

Each day, 273 people die due to lack of health care in the U.S.; that's 100,000 per year.

We need single-payer health care, not a welfare bailout for the serial-killer insurance agencies.

[inna]

7. unrecommended

:eyes:

[ProSense]

9. What a detailed response. My rebuttal

:eyes:

[Jim Sagle]

10. Dean RRRAWWWXXXXX, his opponents suck, and that's the end of it.

[Exilednight]

11. This is fucking hilarious. One of the only reasons Obama, and not Hillary, got my vote was ........

because of the mandate issue.

There is only one true way to mandate health insurance that is fair and just, and that is to have a truly universal health-care system. One that every person gets equal coverage in, no matter their income. Any other mandate is just smoke and mirrors.

[ProSense]

12. This is the perfect example of what's wrong with the argument

Hillary wanted automatic enrollment and garnishing wages. Obama always said he was open to mandates as long as certain criteria were met. Children's health care is mandated.

Also, the people screaming loudest against the mandate are conservatives, the very people who want to preserve the status quo.

Do you think that these people would become less vocal if a single payer system was implemented tomorrow and everyone automatically enrolled in it?

The fact is that the current health care law puts the U.S. is universal health car and with 95 percent of Americans insured, it puts the country well within reach of 100 percent. Just as there will be improvements to the law, the number of people covered will also go up in time.

[Exilednight]

13. This is the perfect example of what's wrong with this argument ............

Obama did campaign on a mandate for children, but not for adults. He never said he was open to mandates for adults during his campaign. In fact, during one debate, he told Hillary that mandates on adults were bad policy.

It's not only conservatives that are yelling the loudest about the mandate, it's also the liberals and progressives who supported Obama during the primary and general who are holding him to his words. Remember, it was Obama who stated that "words matter", and asked for his party to hold him accountable to his campaign promises.

The fact is, this bill as is will not get us anywhere near 95%. This was the same argument used for mandating auto insurance (not that I am knocking auto insurance mandates), but the reality is that we are no where near 100% of cars that are on the road being insured, and to be honest, we're not even close to 95%. Here's the stupidest part of the health mandate, it's suppose to be enforced by the IRS, and the IRS gets money for it, but there no mandate to hire agents to enforce it.

[ProSense]

14. "The fact is, this bill as is will not get us anywhere near 95%."

No, that statement is not a fact.

"Here's the stupidest part of the health mandate, it's suppose to be enforced by the IRS, and the IRS gets money for it, but there no mandate to hire agents to enforce it."

So what's everyone upset about?

[Exilednight]

16. Why am I upset? It's quite simple ..............

Why give the IRS money, which is suppose to come from taxing health care benefits, for a mandate that they aren't going to hire agents to enforce?

As to your part about not being a fact, get back to me in 2014, if the mandate takes effect, and prove me wrong. We'll be lucky if we hit 80%, but I am willing to bet the life of my child that we are not going to be at 95%.

[ProSense]

18. "We'll be lucky if we hit 80%"

It was 83 percent prior to the health care law.

[Exilednight]

22. How many have health adequate health insurance?

Everyone just looks at the number and says x% are now insured. But are they?

This bill does nothing to solve the bigger problems. It's putting a band-aid on a bleeding artery. You could put a thousand band-aids on that artery, but it won't stop bleeding until you suture it up.

The mandates we need are the ones on insurance companies that caps the increases on premiums. But instead, we get a president that takes the view that the onus is not on insurance companies to keep prices low, it's that individuals must purchase insurance and hopefully that will keep prices down.

[No Elephants]

33. Obama campaigned on a public option and no mandate.

He gave us the opposite, the worst of all health insurance worlds.

Besides, as long as an affordable public option is in the picture (or very meaningful cost controls), a mandate is a very different issue. Medicare has a mandate that seems to trouble no one.

[Phx_Dem]

45. He did not campaign on a public option. He campaigned on a "pool"

similiar to what Congress has, where people who are uninsured or have pre-existing conditions, can join together to negotiate plans/rates. And that is exactly what we got.

[dsc]

15. It was no less necessary during the primaries

Obama is President today in part because he opposed mandates for health insurance. Now he is for them. I will say Dean is wrong about the need for mandates but the mandates in this bill are quite weak. Strong enough to punish some people who are on the margins but not strong enough to force people gaming the system to stop. We will see the extent to which this works, but as someone who consistently argued for mandates only to see a candidate game the system by saying he was against them and then 'change' his mind, it is irritating. It is even more irritating to see people like you, who in the primaries never once said Obama was wrong on this issue, now trumpet mandates as the obviously needed things on planet earth.

[ProSense]

17. Hmmm?

"Obama is President today in part because he opposed mandates for health insurance...It is even more irritating to see people like you, who in the primaries never once said Obama was wrong on this issue, now trumpet mandates as the obviously needed things on planet earth."

Obama won because he won the debate and more people agreed with him overall. Speaking of "irritating," what's your feeling about the people who supported Hillary and her automatic enrollment, wage garnishing mandate, but are now upset because President Obama's plan includes a mandate.

[dsc]

19. actually hers was coupled with a public option

meaning we weren't being required to by private insurance. That is a pretty big difference. I happen to think it isn't big enough to flip the issue but I respect that others may see it that way.

[ProSense]

20. So was Obama's, and

I'm not sure health care reform would even have passed had Hillary won.

[dsc]

24. No it wasn't

once the mandate complaints started really happening here the public option was a dead issue.

[ProSense]

25. Yes, it was.

The debate in the Senate and its inability to pass a public option had nothing to do with the mandate issue.

[dsc]

26. it most surely does

the mandate we have now, is different from the one that was being discussed in the primaries. Now again, I still support it because I think the ability to end pre existing is more important than my discomfort with the mandates. But I can see others coming to a different opinion and still be far less hypocritical than Obama supporters who complained about the mandate in the primary but think it is hunky dory now.

[ProSense]

27. Again:

"...Now again, I still support it because I think the ability to end pre existing is more important than my discomfort with the mandates. But I can see others coming to a different opinion and still be far less hypocritical than Obama supporters who complained about the mandate in the primary but think it is hunky dory now."


Repeat

[ibegurpard]

21. good

wish he'd said something when it mattered

[depakid]

23. Go mandate! and try to smear Dean!

Best thing that EVER happened to Dean is that he stayed far away from this fiasco (and any of a dozen others this administration's been involved with).

[Milo_Bloom]

28. Hopefully they can get the mandate on the ballot in CA

So I can vote against it, along with the vast majority of the state as well.

In the end the mandate will be struck down by the Supreme Court. At least they will be doing SOMETHING right.

[ibegurpard]

29. I wouldn't expect this corporate friendly Supreme Court

to strike down the most corporate-friendly piece of healthcare "reform."

[John Agar]

30. I never much cared for the mandate.

Gotta agree with the Doctor on this one.

[No Elephants]

31. Massachusetts has Romneycare, as the quote you provided proves.

The Massachusetts Legislature worked from Romney's proposal. With six changes, Romney's proposal is what is in effect in Massachusetts today. Few large bills, if any, get adopted without changes.

Saying Massachusetts does not have Romneycare goes well beyond spin.


Eta: Originally, Romney and the legislature could not agree, period. Kennedy jawboned both sides, pointing out Massachusetts was going to lose an opportunity to get federal money unless it passed health care legislation by a certain date. And that's how Massachusetts got Romneycare, despite a Democratic legislature.

[cornermouse]

34. Howard Dean is a doctor.

You're not. I'll take what Dean says on this issue any and every day of the week ahead of anything you link to.

[No Elephants]

35. Yep A doctor who wrote a book on the subect and governed a state for 6 terms, among other things.

"While Governor of Vermont, "Dean also focused on health care issues, most notably through the "Dr. Dynasaur" program, which ensures near-universal health coverage for children and pregnant women in the state; the uninsured rate in Vermont dropped from 12.7% to 9.6% under his watch. Child abuse and teen pregnancy rates were cut roughly in half."

http://en.wikipedia.org/wiki/Howard_Dean

"The New York Observer attributes Barack Obama's success in the 2008 U.S. presidential election to perfecting the internet organizing model that Dean pioneered.<37>" Id.


And his stint as Chair of the DNC, including his 50 state strategy, had more than a little to do with Democrats gaining control of Congress in 2006 and of the Oval Office in 2008.

And those are only some of the highlights of his accomplishments. See also reviews of his health care reform book at://www.amazon.com/Howard-Deans-Prescription-Healthcare-Reform/dp/1603582282

I'm guessing his record in general, and as to health care in particular, puts to shame that of the Think Progress author linked in the OP, along with the rest of Dean's critics.

(Just for the record, I am not now, nor have I ever been, a "Deaniac.")

[cornermouse]

36. Yep.

He has access to information that prosense is unlikely to know about.

[bornskeptic]

48. Rand Paul is a doctor too.

Being a doctor qualifies a person as an authority on healthcare policy like riding in an airplane qualifies a person to be a pilot.

[cornermouse]

50. Rand Paul is a libertarian.

Its not a question of profession in his case as much as it is a matter of money and greed.

[brentspeak]

37. "Mass has the lowest uninsured rate in the country!!" Oh, goody -- it also has the highest premiums

How come you failed to highlight that important fact? Duh.

http://www.boston.com/news/health/articles/2009/08/22/bay_state_health_insurance_premiums_highest_in_country/

Bay State health insurance premiums highest in country
Rein in health costs, Massachusetts urged

By Kay Lazar
Globe Staff / August 22, 2009

Massachusetts has the most expensive family health insurance premiums in the country, according to a new analysis that highlights the state’s challenge in trying to rein in medical costs after passage of a landmark 2006 law that mandated coverage for nearly everyone.

The report by the Commonwealth Fund, a nonprofit health care foundation, showed that the average family premium for plans offered by employers in Massachusetts was $13,788 in 2008, 40 percent higher than in 2003. Over the same period, premiums nationwide rose an average of 33 percent.

[Hello_Kitty]

42. Yep. Because contrary to popular belief here health insurance isn't "just like" auto insurance.

Mandated auto insurance (and the mandate is really just for liability for damages you cause to others) works because it's relatively inexpensive to insure a large pool of people against the relatively small risk that individuals will have accidents or collisions costing tens of thousands of dollars. Plus, all auto insurance policies, comprehensive or bare-bones, are strictly catastrophic by definition. IOW you can't use your car insurance for routine maintenance or to correct manufacturing flaws. And premium rates tend to go DOWN with the age of the car and driver, not up. In all these areas the exact opposite is true for health insurance. So even taking into account the (exaggerated IMO) "free rider" factor, mandating that everyone carries health insurance is no guarantee that health care costs will be lowered or even controlled.

[ibegurpard]

44. and there are alternatives to automobiles

not much of an alternative to just existing...

[karynnj]

54. It also has the highest or near highest cost of living

If you normalize the premium by the cost of living in the state, it is nowhere near the top. In addition the percent increase this year was far less than most states. (This suggests that their plan does help stabilize the costs.

If you look at the "allowable costs" in most corporate plans, they differ by location. The cost for a doctor's visit in Idaho is much lower than in NJ. (I know this for a fact as one of my kids - on our plan, is in Idaho and has doctor's visits.)

[Enrique]

39. this hyperbole is unusual for Think Progress

I wonder what's up? Why the need to come down so hard on Dean on this?

The mandate was been debated all through the primaries. There have been plenty of democrats strongly against it, Obama being the primary one, all along. I don't recall Think Progress declaring that position totally unacceptable the way they are doing with Dean here.

[ProSense]

43. It's not hyperbole, and

there is no use desperately trying to spin Dean's comments. He's basically making claim about the mandate based on the bogus position supported by Missouri Republicans.

[Enrique]

55. Obama opposed the mandates during the primaries

it was debatable then and it's debatable now. Mitt Romney is not God, all his ideas are not Gospel.

[w4rma]

47. The mandates were declaired a failure in the primaries and that

hasn't changed one bit. Mandates aren't needed.

[Jeff In Milwaukee]

49. I love Howard Dean....

but this is bewilderingly stupid for a guy who is generally so smart -- especially on this issue.

No Mandate? So if we let decide "I'm young and healthy so I don't need insurance" then we a) keep all the costs of uninsured persons dragging down the system and b) take low-risk persons out of the pool entirely, leaving those to be insured as primarily older and sicker.

EVERY Healthcare Reform -- Including a Public Option -- is underpinned by the idea that everyone gets in the pool and everybody pays. It's Socialism at its best -- and consequently why the Republicans hate it so.