E-mail a friendHoward Dean
airdate August 19, 2009
Howard Dean served six terms as Vermont's governor, before running for the '04 Democratic presidential nomination. In '05, he was tapped to chair the DNC and, later, founded Democracy for America. He began his political career in the Vermont legislature and served as lieutenant governor. Before entering politics, he received his M.D. from the Albert Einstein College of Medicine and practiced internal medicine. In his new book, Howard Dean's Prescription for Real Healthcare Reform, he addresses how to overcome today's crisis.
Former DNC chair responds to the possiblity of taking a public health option off the table in a reform bill. (1:41)
Full interview. (13:50)
Howard Dean
Tavis: And speaking of healthcare, we begin tonight with Dr. Howard Dean. One of the more uniquely qualified voices in the current healthcare debate, in addition to serving in public office as the governor of Vermont he was also a practicing physician for more than 10 years.
His new book on the subject is called "Howard Dean's Prescription for Real Healthcare Reform: How We Can Achieve Affordable Medical Care for Every American and Make Our Jobs Safer." He joins us tonight from Burlington. Dr. Dean, nice to have you back on this program, sir.
Dr. Howard Dean: Tavis, thanks for having me on again.
Tavis: My pleasure. I want to start with a clip. You were kind enough to join me on my public radio program just a few days ago, and I want to play a clip of what you said to me in our radio conversation on public radio and get your response to that very comment tonight, just a few days later. Here's Howard Dean on my PRI program just days ago.
[Begin audio clip.]
Howard Dean: Tavis, I promised myself when I was writing this book that I was not going to attack the Congress on stuff that could be changed later. Sure, would I write the bill a little differently? Yeah, I would. But the whole thing comes down to whether there's a public option or not. If there's no public option, this is a waste of everybody's time and money.
[End audio clip.]
Tavis: The day after you made that comment, front page, "New York Times," "Public Option May Be Dead." And in the days since that conversation, that's all we're talking about. Your thoughts now, days later, about the public option?
Dean: Well, I think one thing this flap did was something which is very good, which it basically showed that after this is all said and done that the Republicans have no interest in healthcare reform. As soon as there was talk about giving up the public option, they were backing away and saying, “Well, the co-ops were no good, either;” and the administration now realizes that this is going to be done with Democrats alone, and that means there'll be a public option.
Because the vast majority of Democrats in the Congress and frankly, a majority of Americans think there ought to be a public option. All a public option is is allowing people under 65 to sign up for something like Medicare. That's all it is, and giving people a choice. Nobody has to sign up for this. If they don't want a government program, then they don't have to sign up for one.
And that's the way America works, is giving ordinary people the choice instead of having the choice made for them by insurance companies and congresspeople and bureaucrats.
Tavis: So speaking of these congresspeople, you don't think any of these persons, members of Congress, that is, when they come back to work in just a matter of days, basically, are going to have been spooked by all of this hue and cry in these town hall meetings, and therefore not cast their vote for the public option?
Dean: I think at the end of the day they'll do what congresspeople are supposed to do, which is work stuff out. The only difference is the Republicans won't be at the table. But conservatives and moderates will be, in the form of Blue Dogs.
When we talked last week I said I thought the Blue Dogs had made the bill a better bill, and I continue to think that it's going to be a very good bill at the end. It won't be perfect, but it'll be a real piece of reform that's badly needed. And I think the president's plan - I've said this many times - the president's plan in the campaign was the best healthcare plan I've seen in 30 years in this business, and I think that's what - something like that is what's going to finally be put in place.
Tavis: Two questions about what you've just said now. Number one, can it be, to your words, a very good bill in the end if it's done in a partisan way?
Dean: Sure. Social Security was done without any Republican votes. Medicare didn't have any Republican votes until the final reading of the bill, when they didn't dare vote against it. The Republicans are experts at guerilla warfare when they're in the opposition. They're not so great at governing, at President Bush showed, but they're terrific at throwing monkey wrenches in.
The whole point of getting a huge majority in the House and the Senate and getting a Democratic White House is so we actually move the country forward again, and the president's made it very clear he wants to move the country forward. I think he wanted to have bipartisan cooperation. I think the American people would have liked that. But the Republicans have taken themselves out of it. We're going to have to do it on our own. The important thing is to get it done and get it done right.
Tavis: What I think doesn't matter around here; you're the guest. But let me just add to this conversation that when we were covering the campaign of President Obama - Senator Obama at the time - there were a number of things we heard about what he wanted to do on healthcare. You referred to it a moment ago as the best healthcare plan you'd ever heard in 30 years, but we heard last summer during the campaign about single-payer - gone.
We heard about buying drugs in volume to save money - basically gone. We heard about taxing windfall profits of the healthcare industry - basically gone. And now the public option as we now know it is being debated, and that's still the best healthcare plan?
Dean: Well, the public option is what makes or breaks it, and as I said last week on the radio show, I'm not going to quibble with all the other stuff. Sure, I could criticize it, but Congress has a tough job, the president has a tough job. They have to make tough decisions. There's been a lot of analysis about this public option and all this, and I think the people who mostly get it wrong are the inside-the-Beltway analysts, who say, "Oh, the left wing, the left, the left."
This is not about the left versus the right; this is about what works and what doesn't work. Without a public option, Tavis, we're essentially investing in what we already have, and only fools believe that you can keep doing what you've been doing for 35 years and get a different result.
But it's so Washington to think that. When I first got to the DNC chairmanship, that's all the Democrats wanted to do - continue to be like Republicans, hope people wouldn't notice the difference, work in 26 states, and we changed all that over the objections of people in Washington.
Well, I think the president's trying to change the way Washington does business. That's what he said he was going to do to get elected. And if you want to change the way Washington does business, you've got to change what we've been doing for 35 years. And putting $60 billion into the health insurance industry is not any change.
That's why the public option matters, not because somebody's liberal or progressive or left. It matters because that's real change, and the rest of the stuff isn't.
Tavis: Speaking of matters, what you say matters and if it didn't matter you wouldn't have been elected governor of Vermont, you wouldn't have been DNC chair, you wouldn't be a best-selling author. People take some regard in what you say. So you've said, by my count now, three times in this conversation, one way, shape, or form, "I could quibble, but I'm not." I'm going to make you quibble.
If you were going to quibble about what this bill is not what it appears to not going - what it appears that it will not be, what would you be quibbling about?
Dean: The only thing I think I might quibble about is the funding source. I'd use a carbon tax. Now, that's not going to happen. That's out of left field. But the climate change bill's in a little trouble, cap-and-trade's in a little trouble, even though I think cap-and-trade's a good program, so you could basically do two things in one bill - use the carbon tax.
The people who get hurt the most by the carbon tax, other than the oil companies, which not many people have sympathy for, are people who have to drive long distances because they can't afford to buy a house where their jobs are. Those people, of course, are the people who are most likely not to have health insurance or to lose their health insurance, and of course this would guarantee them health insurance for the rest of their life that was affordable.
So I think that's the best way to fund it, but I'm not getting into all that stuff. This is a tough job these Senators and congresspeople have. They've got to make tough choices, and again, I'm not quibbling about the funding source.
I am going to quibble about whether it's real reform or not, because you don't want to raise a whole lot of money at the taxpayers' expense, give it to the health insurance companies, and not get anything done.
Tavis: You mentioned a moment ago that not many Americans have any sympathy, necessarily, for oil companies. I hear your point. And not many Americans necessarily have empathy or sympathy for persons who happen to be wealthy - those who make $1 million or more a year.
But there is this conversation now that's starting to grow about whether or not the Obama administration is really going to make this happen by raising taxes - significantly raising the cost, significantly on the backs of those who happen to have money. If you do that, one could argue that those persons, many of whom own businesses, are going to see those businesses, those small businesses hurt.
So you've got a nasty circle here. What's your thought about making this happen by raising premiums by raising taxes on the wealthier in the nation?
Dean: Well, I don't know too many small businesspeople that make $1 million a year, first of all. Secondly, this bill does a lot for small business that nobody ever talks about, and this is also - the Blue Dogs did this, Chris Dodd did this. Right now, if you have a payroll in a small business of less than $500,000, or if you have less than 25 employees, you no longer have to be concerned about getting health insurance for your employees because the government will help the employees do that based on their income.
Either in the private sector or the public sector, that'll be the choice of the employees. Now, I actually talked to Senator Dodd and we talked about raising those limits. If we could help small business in that way, that would be a tremendous boost to the economy.
So again, I don't think this is a small business issue. If you're making $1 million a year at your small business, my guess is you can probably afford to do something. And don't forget, President Bush cut taxes, mostly on people making $1 million a year. So I think we can put those rates back to where they were - that's not such a bad thing.
Tavis: Since we're in the money conversation, you suggested earlier how you think it ought to be paid for, but you also conceded that's not how it's going to be paid for. What say you, then, about this $1 trillion figure over 10 years we keep hearing that's going to have to come from somewhere to pay for all this?
Dean: Well, it's not $1 trillion figure anymore, Tavis, it's about $600 billion over 10 years, which is $60 billion a year, which is less than we're spending in Iraq. I think the Senate finance one has been scored most recently at $80 billion a year. So the number are a lot less enormous than people have thought, and that's again one of the good influences of the Blue Dogs. And actually, even the Republicans have pushed back on the costs, and I think that's a good thing as well.
Two-thirds of that money comes from savings, and it's real savings. They've already made deals with the various healthcare providers that money is going to be saved from various programs. I think that's a very positive thing. So we're really talking now about funding about $20 billion a year in the House bill, or a little bit more than that in the Senate bill, and I think that can be done.
Tavis: What's at stake here as you see it if this doesn't happen? At stake, one, for the country, and at stake for the president?
Dean: Well, it's bad for the economy if it doesn't happen. We're losing jobs not just to China, we're losing jobs to places like Canada and Germany and France because their healthcare systems are much cheaper and better run than ours. But it's also bad for the Democrats, and that's why the Republicans are not interested in being at the table.
They made it very clear over the weekend that even if we make really big concessions they're not going to be involved with this.
So they've made their choice and they know it's going to be bad for the Democrats if we don't pass the bill, but it's going to be bad for the Democrats if we pass a bill that does nothing, and that's what we have to be guarding - look, I say be bold. That's how we got in power. We were doing nothing for 20 years, and we got in power by being bold, by changing things, by shaking things up, by standing up for what we believed in.
That's what we've got to do, is stand up for what we believe in again. And if we do that, the American people give you enormous credit. And I've said this before - the best political mind in this country is still Bill Clinton, and he has said two or three times in the last week, when Barack Obama signs that bill in December in the White House his numbers are going to go right back up again and we're not going to lose many seats, and probably pick a few up in the off-year election.
Tavis: To your point about President Obama, is he still being bold or has he shifted his position on this issue from last year till now?
Dean: Well, I think they're trying to struggle. I think they really - some of them really believed they were going to get Republican votes and it's very clear that they're not. And now I think it's time to go back to the original blueprint in the campaign, which was bold and which is a terrific idea and was well-thought-out, and that's what we need to proceed.
Barack Obama was elected because of change we can believe in. We need real change and I think we can now do that.
Tavis: Where's the evidence, though, in his career, even in his short time in the White House, that he's prepared to go it alone, to make something a partisan issue? His whole thing has been about working across the aisle and changing the way Washington works. Where's the evidence he's willing to go it alone here?
Dean: The stimulus bill. That's probably the biggest piece of legislation he's gotten through, and if there was any Republican votes - there was only one or two in the Senate, or maybe three; I don't think there was a single one in the House. And that's having some success. The Republicans are big on saying it doesn't work. Well, the stock market is about 40 percent higher than it was at its lows now.
We've got a ways to go. The unemployment is still going up a little bit, but we're starting to stabilize and I think we're - this is a terrible recession that we've had because of the policies of the past administration and the laxness on Wall Street, the gross risk-taking at our expense.
But the fact of the matter is we're getting better and we are going to get better, and the business community has figured this out, and so that was a huge piece of legislation, and he did that - he didn't flinch. When the Republicans made it clear they weren't going to be helpful, he did it anyway because it was what was right for the country, and we can do that with healthcare too.
Tavis: The last four words of the subtitle of your book are "Make Our Jobs Safer." Make the link for me between healthcare and our jobs being made safer.
Dean: Give you a great example - Canada's government pays for their healthcare. Their businesses pay extra taxes, more than we do, but the government pays for their healthcare. Now, that used to be a problem for them, for Canadian businesses; their tax rate was higher. But our businesses pay for the taxes, pay for the healthcare here. In Canada, the taxes don't go up two and a half times the rate of inflation every year, but our healthcare has gone up two and a half times the rate of inflation every year for 30 years.
So finally, we're not becoming competitive. General Motors pays more for the healthcare that workers who build the cars make than they do for the steel that goes into the car. Now, that tells you something about how uncompetitive our industry is, and one of the reasons I believe our industries are becoming increasingly less competitive is because our health system, which business pays for, is out of control. That will change under President Obama's system.
Tavis: Dr. Howard Dean's new book is called "Howard Dean's Prescription for Real Healthcare Reform: How We Can Achieve Affordable Medical Care for Every American and Make Our Jobs Safer." Of course, former chair of the DNC, former governor of Vermont. Dr. Dean, as always, nice to have you on the program, sir.
Dean: Thanks for having me on.
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