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Friday, July 17, 2009 FULL SHOW | HEADLINES | PREVIOUS: GOP Won’t Filibuster Sonia Sotomayor Confirmation...
2009-07-17

Howard Dean on His Prescription for Real Healthcare Reform

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Guests

Gov. Howard Dean, author of the new book Howard Dean’s Prescription for Real Healthcare Reform. He is a medical doctor, former chair of the Democratic National Committee and former Vermont governor. He was a presidential candidate in 2004.

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"I don’t give a damn about the health insurance people being in business or out of business. I want a system that works," says Dean, physician, six-term Vermont governor, Democratic presidential candidate in 2004, and former chairman of the Democratic National Committee. We speak to Dean hours after the House Ways and Means Committee approved legislation to overhaul the nation’s healthcare system and expand insurance coverage. By a 23-to-18 vote, the committee backed key elements of President Obama’s blueprint for healthcare, including the creation of a new government health plan and requirements for employers to offer health insurance to workers or contribute to its cost. To help fund the changes to the healthcare system, the House committee also agreed to impose a surtax on families with incomes of more than $350,000 a year. Meanwhile, the conservative American Medical Association has just come out in support of the House bill, saying "the status quo is unacceptable." Howard Dean’s solution embraces President Obama’s healthcare plan but argues that the reform bill is "not worth passing unless the American people have the choice of signing up for a public option — a real public option." [includes rush transcript]

Transcript

This is a rush transcript. Copy may not be in its final form.

JUAN GONZALEZ: The House Ways and Means Committee approved legislation early this morning to overhaul the nation’s healthcare system and expand insurance coverage. By a 23-to-18 vote, the committee backed key elements of President Obama’s blueprint for healthcare, including the creation of a new government health plan and requirements for employers to offer health insurance to workers or contribute to its cost. To help fund the changes to the healthcare system, the House committee also agreed to impose a surtax on families with incomes of more than $350,000 a year.

The 23-to-18 vote was largely on party lines, with three Democrats joining Republicans to oppose the legislation.

Two other House panels, the Energy and Commerce Committee and the Education and Labor Committee, are also working on healthcare legislation.

AMY GOODMAN: There were two other major developments on healthcare on Thursday.

The chief of the nonpartisan Congressional Budget Office, Doug Elmendorf, said none of the healthcare legislation proposed so far will significantly curb federal spending on healthcare. Testifying before the Senate Budget Committee, Elmendorf said the legislation does not offer, quote, "the sort of fundamental changes that would be necessary to reduce the trajectory of federal health spending by a significant amount."

Some reports suggest the Congressional Budget Office did not fully analyze the House bill’s cost-saving measures. But Elmendorf’s comments are widely seen as a setback to congressional Democrats racing to meet President Obama’s August deadline for completing the legislation.

JUAN GONZALEZ: Meanwhile, the conservative American Medical Association has just come out in support of the House bill, saying, quote, "the status quo is unacceptable." AMA President J. James Rohack said they, quote, "look forward to additional constructive dialogue" as the bill moves through the House. Throughout its history, the AMA has opposed most efforts at healthcare reform, including leading the charge in the mid-1960s against the creation of Medicare.

AMY GOODMAN: Well, our guest for the hour is a man who is passionate about what he calls "real healthcare reform": physician, six-term Vermont governor, Democratic presidential candidate in 2004, and former chairman of the Democratic National Committee, Howard Dean. He’s now the author of a new book called Howard Dean’s Prescription for Real Healthcare Reform. Along with co-authors Igor Volsky and Faiz Shakir, Dr. Dean argues the current healthcare system not only leaves Americans at the mercy of the insurance industry interests, it’s also devastating the national economy.

Their solution embraces President Obama’s healthcare plan but argues that the reform bill is, quote, "not worth passing unless the American people have the choice of signing up for a public option — a real public option."

Well, Howard Dean joins us here in the firehouse studio.

We welcome you to Democracy Now!

HOWARD DEAN: Thanks for having me on.

AMY GOODMAN: It’s great to have you with us. So, Dr. Dean, your assessment of the proposal in Washington?

HOWARD DEAN: Well, it took a big step forward yesterday. And oddly enough, the AMA, which is certainly not what it was twenty years ago, for them to support this is an earthquake. It’s been a very conservative organization, generally not representing most primary care physicians, because it’s expensive and they were so conservative. It’s just a shocking thing.

And I think it actually would — the Republicans would do well to learn from this. Because the AMA has embraced this, including the public option — and there wasn’t any shilly-shallying around or these funny little words that the other industries have said, “Well, maybe on the one hand and the other hand” — I think they’ll have a seat at the table to really shape this bill so that it works for physicians. And I, frankly, wish the Republicans would get with the program. Seventy-two percent of Americans think they ought to have a choice between a public option and what they have today. If the Republicans were to get on board with that, then they could actually have some say in shaping it and making it work, because that’s the only way we’re going to have real healthcare reform.

JUAN GONZALEZ: And your — what is your sense as to why the AMA made this switch? There were some reports that the members of Congress agreed to not implement cuts in reimbursements to doctors through Medicare as part of the compromise.

HOWARD DEAN: Well, yeah, and that’s smart for both sides. The truth is that you’re getting fewer and fewer primary care physicians in this country. Nine percent of the current graduating classes indicated they’re going into public — to internal medicine and primary care. And that’s because — in part because of these enormous cuts. It’s also because of the disgraceful behavior of the insurance industry in interfering with doctor and patient relationships. So, you need to have more primary care people, not just physicians, but also nurse practitioners and so forth. In order to do that, you can’t cut reimbursements. So it was a win for both sides. The AMA got what it needed to serve the — continue to — for doctors to continue to serve the public. And the House got a very powerful advocate because of the surprise of this conservative organization now coming out and supporting the public option.

AMY GOODMAN: Explain what is the public option, as it’s been presented.

HOWARD DEAN: For the average American, they should best think of it as Medicare. Now, there’s an upcry. You know, the administration doesn’t want us to talk — but just, we’ve had a single payer in this country for forty years; it’s called Medicare. The Republicans didn’t like it then. We’ve had what the Republicans call “socialized medicine” in this country for forty years; it’s called Medicare. Everybody over sixty-five has it.

The only other group besides the disabled people and those over sixty-five that have socialized medicine is Congress. All these people who are yelling and screaming about socialized medicine have it themselves. They go downstairs, and they see the doctor, they don’t get a bill, there’s no line, and it works great for them. So — and veterans. So, the truth is, this is all nonsense, all this posturing and this spinning and all so forth.

This is an attempt to bring order to the healthcare system. We have no order. This is a chaotic, quote-unquote, “system.” The reason for the public option is it — like Medicare, it’s certainly not perfect, but the cost has gone up much less rapidly than the private sector costs, and their administrative costs are four percent, and administrative costs in the private sector are 20 percent, sometimes more, depending on the return on equity these public healthcare insurance companies get. And so, Medicare is just a lot more efficient than the private sector healthcare is.

JUAN GONZALEZ: Now, in your book, you talk about the public option as in many ways preferable to the single-payer system, only because of, you say, the historical sense of Americans that they want to have choice. Could you talk about that?

HOWARD DEAN: Well, it’s hard to define — here’s the — you get into a very sort of a delicate game about single payer. I think what single-payer advocates mean is that everybody should be in a government-run system. But if you’re going to argue, as the book does, that we shouldn’t have politicians and bureaucrats and insurance companies making this decision, this decision belongs in the hands of the American public, which is why this movement for — to change the healthcare system is so much more powerful this time around than it was fifty years ago, if you’re going to make that argument, then it’s pretty hard to turn around and say, “Well, on the other hand, the government can make a choice and put you all in their system.”

The other problem is, nobody really knows what a single payer is. Single payer, I said, is Medicare. But there are a lot of private insurance and private dollars in Medicare. The British, which have arguably the most, quote-unquote, “pure” single payer or socialized system in the Western world, 15 percent of all the dollars in healthcare in Britain are private dollars. So there is no such thing as a pure single-payer system.

And what the President is arguing, what I argue, is give people a choice. Let them choose whether they want a government system, or they would like what they have, they can keep it.

AMY GOODMAN: One of the critics of President Obama’s call for a public option has been Quentin Young, a personal friend of the Obamas from Chicago, former doctor of the Reverend Martin Luther King. Young says the public option just doesn’t go far enough.

    DR. QUENTIN YOUNG: This public option is not a slide toward single payer, unfortunately. This is a bugbear that has haunted American medicine debate, and we have to bring it to an end, because it’s too costly, the whole idea that this is socialized medicine, government medicine. We have magnificent examples of government medicine; reactionaries would never dream of calling them back. I speak of the VA system for veterans; the public hospitals, the safety net for the very poor. We have a variety of public systems. Medicare. Is anybody here advocating an end of Medicare? And that’s the government medicine that they’re making a fuss about.

    We haven’t got much time left. The system, as Obama aptly notes, is running amok, and it’s up to $2.5 trillion and, as we all know, rising at a rate two or three times the rate of inflation. And he’s right in saying the economy can’t tolerate it.

    Where he’s wrong is his unwillingness to do the serious job of getting the multi-payer insurance companies out of the mix. They add nothing; they subtract a great, great deal. Public experience with this system is horrible. We have a million people having personal bankruptcy due to unpaid medical bills, and that just went up from 50 percent of personal bankruptcies to 60 percent — 62, to be accurate. And this country, rich as it is, in this economic downturn cannot tolerate it.

AMY GOODMAN: Dr. Quentin Young, a close friend of President Obama’s when he was, well, back in Chicago, one of the leading advocates of a single-payer government-paid universal healthcare in the country. Dr. Dean?

HOWARD DEAN: Yeah, look, I don’t position myself against single payer, but I position myself for giving the American people a choice. I think what the President understands is the country is a conservative country with a small "c." That is, they want change, but like most human beings, they don’t want so much that they’re uncomfortable. And so, the genius of the Obama healthcare plan is it’s not the healthcare plan that an academic would write in the ivory tower, but it starts from where we are, not where we would have been.

The Europeans all have single payer, because essential their healthcare systems were destroyed during World War II. And they went to a single payer during the war as a necessity, and then it turned out they loved it and didn’t want to get away from it afterwards. Winston Churchill was the person who put in single payer, essentially, in Britain, who was a conservative prime minister.

In this country, we didn’t have — we had exactly the opposite. Not only was our healthcare system not destroyed, but it was driven towards a private sector system, because it was the only way that you could give your employees wage increase in the price control and anti-inflation atmosphere around World War II. So here we are. We have something we like.

Look, healthcare is like Congress. People hate Congress, but they like their Congress people, and they keep reelecting them. Well, they don’t like the healthcare system, but they like their doctor, and they like the kind of healthcare they get if they have insurance. And in a democracy, 80 percent always trumps 20 percent.

The thing I love about Obama’s plan is it’s politically practical. Instead of saying, “This is the right thing to do,” as Dr. Young said, “and this is what we’re going to do,” he says, “Look, you decide for yourself. We’re going to give you an example. We’re going to allow people under sixty-five to sign up for what people over sixty-five have. And you make the choice.” And what we’re all betting is that the private — and I agree with his comments about the private insurance industry. Their behavior has been reprehensible, cutting people off when they have illnesses and charging huge — executive salaries of the big three are over $20 million. The guy that runs CMS, which has a billion claims a year, probably makes $150,000 or $200,000. I mean, it’s ridiculous. Let the American people choose. If they make the choice themselves, they will invest emotionally in this system, and I think that the insurance industry will be forced to behave in a much better way, or they will be put out of business. But it will be themselves that’s putting themselves out of business, and the American people, not the Congress, doing it.

AMY GOODMAN: We’re talking to Governor Dean, Dr. Dean, former head of the Democratic National Committee, Howard Dean. His new book, Howard Dean’s Prescription for Real Healthcare Reform. We’ll be back with him in a minute.

[break]

AMY GOODMAN: We continue our conversation with Dr. Dean, well, with former Governor Dean of Vermont, former presidential candidate, has now written a new book, Howard Dean’s Prescription for Real Healthcare Reform: How We Can Achieve Affordable Medical Care for Every American and Make Our Jobs Safer.

I want to ask you, Dr. Dean, about an editorial that appears in today’s Wall Street Journal about the Democrats’ plan to increase taxes on the wealthy to help cover the costs of expanding healthcare coverage. The piece is called "Reckless Congress."

And it reads, in part, “The surtax starts at one percentage point for adjusted gross income above $350,000 in 2011, rising to two points in 2013; a 1.5 point surtax at incomes above $500,000, rising to three in 2013; and a whopping 5.4 percentage points in 2011 and beyond on incomes above $1 million. This would raise the top marginal federal tax rate back to roughly 47% or 48%, if you include the Medicare tax and the phase-out of certain deductions and exemptions. With the current top rate at 35%, this would be the largest rate increase outside the Great Depression or world wars...

"This tax, which Democrats say could raise $100 billion or so, would make it even harder for private plans to compete with the government plan, which would already benefit from government subsidies and lower capital costs.” And they say, “Democrats want to ram through one of the greatest raids on private income and business in American history.”

Just part of the Wall Street Journal editorial today.

HOWARD DEAN: Well, you know, I don’t — I think the Wall Street Journal is a great paper, but I never read the last two pages, because, you know, you can’t trust anything they write. It’s all propaganda, and it has been for years. But it’s a great paper as long as you skip the last two pages.

The truth is, is, of course, there’s no such thing. Here’s how this works, and this is actually a great deal for business. The first thing is, both parties always talk about they’re going to do this and that for small business, and neither party ever does, partly because it’s hard to help small business and partly because a lot of politicians talk big and don’t deliver a lot during elections — after the election is over. Obama’s plan does more to help small business than anything I’ve ever seen. What they say is, small businesses no longer have a responsibility for healthcare. That will be taken care of with a federal subsidy based on income and the employee themselves. Why does that matter? Eighty percent of all the new jobs in America are created by small business. That’s why I subtitled it “...and How to Save Our Jobs.” Eighty percent of all the new jobs in America are created by small businesses. Health insurance is the bane of their existence. It goes up two or three times the rate of inflation reliably every year. It is a huge expense. If they can’t afford it, then they lose their employees. As soon as they get good at what they do, they go and find some job with a benefits package. This is a monumental improvement in our economy.

And this figure of a trillion dollars, or whatever the number is — the CBO actually scored the House plan as a lot lower than that — that’s not money that we’re just taking out of the private pockets. That — it is increase in taxes, but it is also money that business doesn’t have to pay. We’re losing jobs to Canada, for God sakes, not just China, because the Canadians have a system that’s not paid for by business.

AMY GOODMAN: Isn’t it partly why GM went under?

HOWARD DEAN: Yes, absolutely. They went under partly because of their retiree healthcare costs. And it’s true that Canadian companies pay more taxes in order to have this universal healthcare system they have, but their taxes don’t go up at three times the rate of inflation. And our companies’ premiums go up at three times the rate of inflation. The system that we have is crazy, and it is killing America. It is putting money into the health —- hands of health insurers and taking it out of industrial complexes and small businesses, which we need to create great manufacturing jobs.

JUAN GONZALEZ: In your book, Howard, you had a sort of different proposals in terms of raising -—

HOWARD DEAN: Yes.

JUAN GONZALEZ: — the revenue. You talked about a carbon tax and a ten-cent-a-gallon increase in the gasoline tax —-

HOWARD DEAN: Right.

JUAN GONZALEZ: —- because you saw that as not only dealing with the financing of health insurance, but also in terms of goals in terms of reducing emissions, greenhouse emissions.

HOWARD DEAN: Right. And you can expect the Wall Street Journal will have an editorial against that, too, if it gets any traction in Congress. This is where I departed from Obama. And I don’t really mean this as a criticism in any way, because I resolved about three months ago, as I was writing this book, that I would focus solely on the one critical item that has — is required for reform, which is a public option. If you don’t have a public option, this is not reform, and you shouldn’t pass the bill, because it’s a waste of a trillion dollars, or $600 billion in the case of the House’s bill. So I’ve decided I was not going to take issue with any of the things that the Congress did on tax policy or any of that other stuff, even though there are some things I disagree with, because the focus on the public option was all the difference between the — you could fix the tax policy later if you don’t like it, but you can’t fix whether there is or is not a public option.

On the other hand, if I were writing the plan, I would use a carbon tax. And here’s why. When I was governor, I always resisted increases in gas taxes, because my state is a rural state. Like many rural states, the people who drive the farthest to work are the poorest working of the poor. They can’t afford housing in the area where they have good jobs, so they drive fifty miles each way to work, or more in places like California or Texas. So, if you raise the gas tax ten cents a gallon, who does it hurt the most? It hurts those working people. On the other hand, this is the first thing that I’ve seen that gives them a great deal. If you asked any of these working poor people — or they’re not all working poor — working people, but certainly not at the upper end of the income scale. If you ask any of them, “If you could have health insurance at an affordable rate that could never be taken away, whether you got sick or whether you got laid off or whether you had to take a different job, would you be willing to pay ten cents a gallon in gas?” I bet you’d get 90 percent say, “Absolutely, yes.” This is a regressive tax that helps those at the bottom more than it does at the top, and therefore I think a regressive tax in this case is acceptable.

AMY GOODMAN: Governor Dean, yesterday, on Thursday —-

HOWARD DEAN: And, of course, it does have the environmental benefits.

AMY GOODMAN: —- Democracy Now! aired an extended interview with a former healthcare executive, Wendell Potter. For years, he served as chief of corporation communications at CIGNA and as the company’s main spokesperson. I asked him about the relationship between his industry, the health insurance industry, and key lawmakers, like Senator Max Baucus, chair of the Senate Finance Committee.

    WENDELL POTTER: Well, one thing to remember is that the health insurance industry has been anticipating this debate on healthcare reform for many years. They knew it was inevitable that it would come back. And they knew that if a Democrat were elected president, undoubtedly it would be on the top of the political agenda. So they’ve been positioning themselves to get very close to influential members of Congress in both parties, and Max Baucus is certainly someone they knew, a long time ago, was going to be critical for their interests. So, yes, they — the insurance industry, the pharmaceutical industry and others in healthcare — have spent, have donated lots and lots, millions of dollars, to his campaigns over the past few years.

    But aside from money, it’s relationships that count. And that’s why the insurance industry has hired scores and scores of lobbyists, many of whom have worked for members of Congress and some who are former members of Congress, to lobby on their behalf. Some of Max Baucus’s former staff members work for — in the health insurance industry as lobbyists these days. That is very important. It helps to open the door, and it enables people who are aligned with the industry, who have good associations or close associations with members of Congress, to pass along the talking points or to express the industry’s points of view.

AMY GOODMAN: And I want to follow that up with, in mid-May President Obama held a town hall meeting in New Mexico. This is just one question he took from a local resident named Linda Allison.

    LINDA ALLISON: My question is, so many people go bankrupt using their credit cards to pay for healthcare. Why have they taken single payer off the plate? And why is Senator Baucus on the Finance Committee discussing healthcare, when he has received so much money from the pharmaceutical companies? Isn’t it a conflict of interest?

    PRESIDENT BARACK OBAMA: If I were starting a system from scratch, then I think that the idea of moving towards a single-payer system could very well make sense. That’s the kind of system that you have in most industrialized countries around the world. The only problem is that we’re not starting from scratch. We have historically a tradition of employer-based healthcare. And although there are a lot of people who are not satisfied with their healthcare, the truth is, is that the vast majority of people currently get healthcare from their employers, and you’ve got this system that’s already in place. We don’t want a huge disruption as we go into healthcare reform, where suddenly we’re trying to completely reinvent one-sixth of the economy.

AMY GOODMAN: As for the question about whether Max Baucus, key in the Senate, head of the Senate Finance Committee, has a conflict of interest, President Obama didn’t address it. But what about what the CIGNA spokesperson said?

HOWARD DEAN: Well, I am going to address it, not specifically to Chairman Baucus, but let me just be very clear about this. This has been cast in the media, and probably seen by Republican consultants, as a Republican versus Democrat issue or conservative versus liberal issue. It’s not. When 72 percent of the American people, including more than 50 percent of Republicans, believe that they ought to have the choice between a public or a private system, this is not a liberal-conservative thing. This is whether you’re going to vote with the health insurance companies or whether you’re going to vote for what 72 percent of your constituencies want. That is what this vote is about.

And it is a very clear, bright line and is a — I believe that if we don’t pass a healthcare system with a public — a strong public component, not a fake public option, as I call it in the book — co-ops or — you know, we’ve had co-ops. It was called Blue Cross Blue Shield. They basically got taken over by the private industry. A trigger mechanism — “Well, someday we’ll have a public option if you behave yourself” — we’ve tried that stuff in the past. It doesn’t work. A real public option, if you don’t have it, I predict the Democrats are going to lose huge numbers of seats, and President Obama’s reelection will be in danger. And why? Because it will be clear that we didn’t get change, the change we promised. We were promised change where the insurance industry wasn’t able to override 72 percent of the American people. Now we have a vote: are you with the 72 percent of the American people, or are you with the health insurance industry? Each person is going to get a chance to vote on that, and they’re going to be held accountable.

JUAN GONZALEZ: One of the most fascinating things I found about your book was the chapters where you compared the various health systems in Europe and other parts of the world, showing that actually healthcare reform and guaranteeing universal health insurance has many possible avenues. And you compared the Dutch and the French, and not just England and Canada, which are the —-

HOWARD DEAN: Right.

JUAN GONZALEZ: —- examples often raised here when dealing with the question of universal health insurance. Could you talk about that?

HOWARD DEAN: Yeah, let me say first, I’ve spent a lot of time in Europe because of my political campaigns. People want to know how they can do that, and so I spend a lot of time and I talk to a lot of expatriate Americans in Europe who work for big American companies, but they get their health insurance in Europe. They love it. The Americans who are over there think their system is much better than ours in Belgium and France and places like that. So let’s just be clear about this. All these things that these right-wingers are saying about other systems, they’re trying to scare the American people. But the American people that I know that have experience with these systems love them.

Secondly, there are lots of different ways to do this. There are two countries that I always like to point out: the Netherlands and Switzerland. They do not have government-run single payers. They have private sector insurance, universal. But the reason it works is something the health insurance industry would hate even more than what we’re proposing, which is, they treat insurance companies like regulated utilities. They cannot make more than a certain amount of profit. They can’t spend money without the OK of the government. The government gives them money to even off the risk. So they are basically private for-profit entities that are very heavily regulated, like the utility business. And it works. But I don’t think the insurance industry would — I think they would prefer what we’re proposing, rather than what they have in Switzerland and the Netherlands. And the rest of the system is — in most of Europe, is mostly public, although every single system has a significant private component to it, as ours will if this bill passes.

JUAN GONZALEZ: And in France, which has the best satisfaction rate of all of the systems?

HOWARD DEAN: Right, France has the best satisfaction rate of all the systems. The medical care is rated the highest of any Western country by its own citizens.

AMY GOODMAN: Dr. Marcia Angell, the former chief — editor-in-chief of the New England Journal of Medicine, says the Obama plan is unsustainable, that it will break the bank, that only single payer saves money and covers everyone. And why haven’t the Democrats demanded that the Congressional Budget Office score single payer?

HOWARD DEAN: That’s a good question. I would not have taken single payer off the table, because I think there — look, as I said in the clip, I’m not a huge advocate of single payer on ideological grounds, nor am I against it. But I — and I have some experience with this. But let me make — just as a not a particularly wild-eyed advocate of one, let me just make this point. The single payer — you’ve got to look at what the facts are. Here’s one of the facts about single payer. It is by far the most economically efficient system. There’s no — it has the lowest overhead.

AMY GOODMAN: Why?

HOWARD DEAN: Because their administrative costs are virtually nothing. They’re four percent of a single payer.

JUAN GONZALEZ: Whereas most private insurers are about 20 percent or —-

HOWARD DEAN: The best -— well, the best for-profit ones are around 20 percent, and the best not-profit ones are 12 percent. The difference there is return on equity for the shareholders. Now, you know, we know insurance companies that take 50 percent of your premium dollars and put it in their pocket, either through administrative costs, advertising. Huge return on equity. In fact, you get rewarded if you’re in the insurance business for taking more out from your clients’ pockets, your customers’ pockets, and putting it in your own. That’s what you get, reward.

There was a shocking piece of testimony on the Capitol Hill a couple of weeks ago with a former insurance executive who said that over the last three years, 20,000 customers had been denied payment deliberately by the top three insurers of the country at a savings right to the bottom line of $300 million for the insurance industry. They just plain — I think, illegally — decided, found some fine print in their insurance policy, which stopped them from having to pay the claims. That’s outrageous! So, it is more effective to have a single payer.

Now, there’s reasons not to have one. I think people deserve a choice. If the system gets too bureaucratic — it’s not that Medicare is so great; it’s that the insurance industry is so awful. Most doctors now, primary care doctors, would prefer single payer, not because Medicare has gotten better. It’s because the private insurance system has gotten so awful. You know, the rhetoric you hear from the Republicans, “This is going to cause an interference with a bureaucrat between you and the doctor,” that’s what’s going on now in the insurance industry, but it doesn’t go on under Medicare. It does not. There is no insurance between the government and the patient in the single payer Medicare, but there is interference in the private sector.

AMY GOODMAN: Can we go to one of your fellow Vermonters? Yes, the Senator Bernie Sanders, we just talked to him, and he spoke about single payer.

    SEN. BERNIE SANDERS: Single payer has been excluded, because if we are successful through a single payer effort in providing quality, comprehensive, universal healthcare to every man, woman and child, there are no more private insurance companies in this country, and the prices that the pharmaceutical industry charges us — charge us will go down. So you have the drug companies, the insurance companies, the medical equipment suppliers, who today make huge amounts of money, billions and billions of dollars, off of healthcare, fighting us in an unrelentless way through lobbying, campaign contributions, and advertising to make sure that the system — the function of the system is to make profits for the private insurance companies rather than quality healthcare to all people. And, Amy, you cannot begin to imagine the power of these special interests who spend hundreds and hundreds of millions of dollars in lobbying and campaign contributions on the process.

    We are wasting close to $400 billion every single year on unnecessary administration, on high CEO compensation packages, on outrageous profits for the insurance industry. A few years ago, a guy named William McGuire of United Healthcare, he was given $1.6 billion in stock options at a time when 46 million Americans have no health insurance and the cost of healthcare is soaring. So, I think what more and more Americans understand is we need a fundamental overhaul of our system, we need one payer to provide comprehensive, cost-effective healthcare to all of our people.

AMY GOODMAN: That’s Vermont Independent Senator Bernie Sanders, your fellow Vermonter.

HOWARD DEAN: Let me just say one thing about this quickly. One of the things that has made this possible, that we’re on the verge of real change, is that there has not been the kind of bitter split in the center-left between single payer and not single payer. And I think Obama has successfully bridged that bitter bridge, by giving — that gap, by giving individual Americans the choice between whether they would like a single payer for themselves and their families or whether they would not. So the last thing I want to do is get into an argument with Bernie Sanders or anybody else about whether we should or shouldn’t have a single payer. We ought to have a public option that Americans can choose from, and it may evolve into a single payer after that. That’s what the Republicans keep saying. If the insurance companies do their job properly and satisfy their customers, it won’t evolve into a single payer, and that’s fine. But if they don’t, it will. Let the American people choose.

AMY GOODMAN: Governor Dean, we’re going to go to break. Then we’re going to come back to you. Howard Dean’s Prescription for Real Healthcare Reform: How We Can Achieve Affordable Medical Care for Every American and Make Our Jobs Safer is the title of his latest book. Stay with us.

[break]

AMY GOODMAN: Our guest today is Dr., is Governor Howard Dean. Stay with us.

JUAN GONZALEZ: Governor Dean, I’d like to ask you again about the public option. Republican — House Republican Steve King of Iowa and Louis Gohmert of Texas also railed against the public option on the floor of the House this week, blaming what they called "socialized medicine" for killing people.

    REP. STEVE KING: Here’s another place where they think they’re going to save. They’re going to save money by rationing care, getting you in a long line. Places like Canada, United Kingdom and Europe, people die when they’re in line.

    REP. LOUIS GOHMERT: Well, if you go to the socialized medicine countries, you find about 20 percent worse results. You get it? One in five people have to die because they went to socialized medicine! Now, I’ve got three daughters and a wife. I would hate to think that, among five women, one of them is going to die because we go to socialized care, and we have to have these long lists.

JUAN GONZALEZ: Your response?

HOWARD DEAN: Yeah, that’s just hooey. They’re either making it up, or they know nothing about what they’re talking about, and/or both. I mean, it’s just, look — but you’ve got to fight against it, because we know now, from our experience in the last eight years, that people believe that stuff. It is absolutely not true at all. In fact, the honest truth is that those countries rank ahead of us in outcomes.

JUAN GONZALEZ: Now, the health insurance companies are obviously arguing that the public option creates what they consider an unfair playing field and that the mere size of the public option will make it difficult for them to compete. Of course, you could argue the same about Wal-Mart or Home Depot —-

HOWARD DEAN: Sure.

JUAN GONZALEZ: —- or any huge, huge business in the private sector, as well.

HOWARD DEAN: Look, this is not — our primary concern here is not whether the public insurance — I mean, the private insurance industry makes a lot of money or doesn’t make money. That’s not what this is about. What this is about is delivering good healthcare. And the private sector has totally failed to do that in the health insurance business. They have failed to deliver the kind of healthcare at the price that we deserve.

We spend 70 percent more than the next most expensive nation taking care of our people, and we rank behind all of them, all the Western democracies, the so-called “socialized” system that these guys were raving about, ranting and raving about. We need results. You know, the tax — if you want to talk about the taxpayers deserving results for their money, that’s what this is about. And it’s about giving the American people the choice, instead of Representative King and Representative Gohmert. And that’s what we want. We want a system that works. This is not about trying to drive the healthcare business into — healthcare insurance people out of business. I don’t give a damn about the health insurance people being in business or out of business. I want a system that works. And if they can give us one, great.

JUAN GONZALEZ: I wanted to ask you, how committed, do you think, is the Obama administration to the public option? Because there have been reports. Obviously, Rahm Emanuel was claiming, well, maybe we should agree to a trigger, that it would come into play if the private system could not deliver.

HOWARD DEAN: Look, I think the President clearly wants a public option. The President is an exceptionally bright guy. He gets that you can’t have real reform without a public option. So what’s the point of going through this and spending all this money if you’re not going to have real reform? There are those in Washington, as Washington always does, who would just like to sign a bill in the signing ceremony, and that will be a victory. It’s not a victory. It’s a huge loss, unless you do real reform. The President understands that himself. I think the President personally is driving this fight. And it’s hard. This is the toughest thing that the President is going to do, unless, God forbid, we should be attacked from somebody, which is to drive real reform through the most reform-resistant city in America, which is Washington, DC.

AMY GOODMAN: And Max Baucus — I keep naming him as a key player, obviously, in this debate, because he is head of Senate Finance — calling for the taxing of health insurance premiums.

HOWARD DEAN: Well, again, I personally don’t favor that for a variety of reasons. We’ve talked about how I think it should be done. But again, I have said to myself, and I’ll say publicly, I am not going to go to the mat for anything else except the public option, and then two insurance pieces of reform, guaranteed issue and community rating. But if they’re not going to do the public option, they can at least do guaranteed issue and community rating and not spend any money, because we did that twenty —- fifteen years ago in Vermont. It works great.

AMY GOODMAN: Let’s go back to the CIGNA spokesperson, because, truly remarkable, has become a whistleblower right now

HOWARD DEAN: Right.

AMY GOODMAN: —- for so long, represented CIGNA. His name is Wendell Potter. And we asked him about the healthcare industry’s game plan to fight reforming healthcare.

    WENDELL POTTER: Well, the game plan is based on scare tactics. And, of course, the thing they fear most is that the country will at some point gravitate toward a single-payer plan. That’s the ultimate fear that they have. But currently — and they know that right now that is not something that’s on the legislative table. And they’ve been very successful in making sure that it isn’t. They fear even the public insurance option that’s being proposed, that was part of President President Obama’s campaign platform, his healthcare platform. And they’ll pull out all the stops they can to defeat that.

    And they’ll be working with their ideological allies, with the business community, with conservative pundits and editorial writers, to try to scare people into thinking that embracing a public health insurance option would lead us down the slippery — excuse me, slippery slope toward socialism and that you will be, in essence, putting a government bureaucrat between you and your doctor. That is — you know, they’ve used those talking points for years, and in years past they’ve always worked.

AMY GOODMAN: Your response?

HOWARD DEAN: Well, again, we talked a little bit about that. The only place that there’s a bureaucrat between you and your doctor right now is in the private health insurance industry. It does not happen in the government-, public-run option. So, you know, I think that he’s right. He is a whistleblower. And this is true. The insurance companies don’t want this, because they know it’s —- look, the insurance companies, unfortunately, are about making money for themselves. They really don’t care very much about patient care. And that’s been -—

AMY GOODMAN: The problem is, they are paying — what was the Washington Post exposé – “The nation’s largest insurers, hospitals and medical groups have hired more than 350 former government staff members” —-

HOWARD DEAN: Right.

AMY GOODMAN: —- “and retired members of Congress in hopes of influencing their old bosses and colleagues.”

HOWARD DEAN: Right, but this — but, you know, there’s reason to be cynical. We’re on a — we’ve really gone through the most extraordinary election in my lifetime. More people under thirty-five voted in this country than voted who were over sixty-five to elect Barack Obama president of the United States and ask for a real change that we can believe in. This is the test. Are we in charge of the country, or are the insurance executives in charge of the country? And everybody gets to vote on this in Washington. Watch their votes. Watch their votes.

Ask Steven King and Louie Gohmert, are you in favor of the insurance — are you going to vote for the insurance companies, or are you going to vote for your people? Because I guarantee, in their very conservative districts, people want the public option. Republicans want the public option, not because they’re going to sign up for it. I think they won’t. There was a CBO score, said only five percent of the people will sign up for the public option.

Let us try it. What’s working now doesn’t work. It doesn’t work. We need to be able to try something different, something that’s succeeded for people over sixty-five. Let people under sixty-five try it, too.

JUAN GONZALEZ: You mentioned the most significant election of your lifetime. I’d like to sort of, if we can, just shift a little bit, in the few minutes we have left, about this election. You, as chairman of the Democratic Party, pressed strenuously for a fifty-state strategy that in many ways worked. But some people feel you haven’t gotten the credit that you deserve for that strategy. And I’d like to get your sense of the impact of that strategy on the election.

HOWARD DEAN: Well, you know, it helps to have a tremendous candidate with a very disciplined campaign, the most disciplined Democratic campaign I’ve ever seen. But yeah, you’re going to go into states and ask for people’s votes in places like Nebraska and Virginia and North Carolina. And we had a very specific strategy aimed at Colorado and Nevada and New Mexico. You know, they’re all Americans. And when I was governor, and when I ran for president, I believed you should ask everybody for their vote, including those people who probably aren’t going to vote for you, because when you win, you need to be the president of all of America, including those people who didn’t vote for you. And it’s a sign of respect to ask people’s votes.

And I think what Barack Obama wanted to do more than anything is bring the country together. And I think he’s succeeded. The younger generation wants us to be brought together. It’s the older generation of Republicans who haven’t figured any of this out. They haven’t figured out there’s a new demographic in the country. They haven’t figured out that saying no is no longer an acceptable political operation. They haven’t figured out that putting their party in front of their country, as they’re doing today, by refusing to cooperate with the President in any way, is not what people under thirty-five want in this country. And that’s — until they figure a different way of doing business, they’re not going to succeed as a party. But we’re going to succeed as a country, anyway, because this group of people under thirty-five is not going to lie down in front of the lobbyists and get cynical and give up.

AMY GOODMAN: Governor Dean, we let people know that you were going to be on our show today, and we have been getting calls and questions, emails, tweets, everything from all over the country nonstop for the last twenty-four hours, and we hardly have time for any. But this is one from David Swanson. He asked, do support Representative Kucinich’s amendment to allow states to create single-payer healthcare, if they so choose?

HOWARD DEAN: Sure, absolutely. I’ve always believed that states ought to be able to try different things, and the states — our state was the first state, I think, to have universal healthcare for kids, 99 percent eligible. Massachusetts — actually, Hawaii technically was the first state to do universal healthcare in its entirety, because they were — for technical reasons, it had to do with the Employment Retirement Insurance Security Act [sic]. Massachusetts, most recently, has done some groundbreaking things. I absolutely believe that if the people of a state want to try something different, that they ought to be able to try, within the federal framework. And that’s certainly within the federal framework.

AMY GOODMAN: This is a question from Chester McQueary. How do assess the media system, from NPR to PBS to corporate TV and print, that almost never even uses the words “single-payer system” or “Medicare for All” and thus exclude the option that polls show the majority of US citizens and healthcare professionals both favor?

HOWARD DEAN: You know, I think that is obviously a question with a point of view. I think I disagree with the polling. I’ve seen the polling, and — but nonetheless, you know, I think we’ve spent a lot of time here talking about a single payer, so I think the criticism is unfounded.

JUAN GONZALEZ: In terms of the — to get back again to other issues right now, I’d like to ask you about the continuation and expansion of the American war in Afghanistan. Do you have concerns about — that this is becoming really President Obama’s war —-

HOWARD DEAN: It is.

JUAN GONZALEZ: —- and the impact on our country in the future?

HOWARD DEAN: Look, again, you know — and I don’t have to say anything nice; I’m not in the administration. But I’m with Obama on his conduct of the war. I always said, when I was running against the Iraq war, that Afghanistan was different.

Let me tell you what the stakes are now. And what I find incredibly refreshing about this president is he uttered words that Lyndon Johnson never said, which is that we cannot win this war militarily. He knows that from the get-go. Here’s what’s at stake. It’s not just the Taliban. I think we could probably control the Taliban and the al-Qaeda in the Northwest territories by doing some of the things we’re already doing — drones and air power and so forth. Roughly 50 percent of the Afghan people are women. They will be condemned to conditions which are very much like slavery and serfdom in a twelfth century model of society where they have no rights whatsoever. So, I’m not saying we have to invade every country that doesn’t treat women as equal, but we’re there now. We have a responsibility. And if we leave, women will experience the most extraordinary depredations of any population on the face of the earth. I think we have some obligation to try and see if we can make this work, not just for America and our security interests, but for the sake of women in Afghanistan and all around the globe. Is this acceptable to treat women like this? I think not.

AMY GOODMAN: We just interviewed an Afghan parliamentarian, Dr. Wardak. She said the opposite. She said, yes, she agrees with you on the way women are treated, but that this is worsening the treatment, that the increased number of civilian deaths in Afghanistan, the huge number of troops that are coming in right now, are alienating the Afghan population.

HOWARD DEAN: Well, that — and that is the clear challenge for this president and for the generals who are over there, is can they stop that? Because if they don’t, we’ll be out of there much faster than we ought to be, and we will be leaving behind 50 percent of a population who are going to experience horrendous depredations and set back the cause of women’s equality around the world by decades.

JUAN GONZALEZ: And finally, we have about a minute. EFCA, the reports today that several Senate Democrats, supported apparently by the labor leaders, have agreed to give up the card-check portion of the labor reform bill.

HOWARD DEAN: And this is a hard issue to do in a minute or less. But, OK, EFCA, the Employee Free Choice Act, was basically a product of the horrendous attacks on the National Labor Relations Board and on unions in general and on working people in general over the last eight years under Bush. They basically perverted the labor law and allowed companies to do outrageous and illegal things in terms — so you could actually win an election and never get a contract.

There are ways — so it was this — EFCA was the solution, but it’s not the only solution. Now, I know nothing about this. I just found out about this on the show this morning when I walked in the door, so I don’t know what’s behind it. But there are other ways that you can make the labor law fair again, after it’s been attacked so badly for the last eight years. And maybe they have come to a compromise and figured out a way to make the labor laws work so that ordinary people can make a decent wage again.

AMY GOODMAN: Why do you think you were passed over for, oh, Health and Human Services, Surgeon General, when you were the author of the fifty-state strategy?

HOWARD DEAN: Well, I wasn’t passed over for Surgeon General, because I didn’t want that particular job. You know, who knows? I’ve learned in Washington that it’s better not to speculate about other people’s motives. But, you know —-

AMY GOODMAN: Now you’re chair of the Progressive Book Club?

HOWARD DEAN: Now I’m chair of the -— yes, the book club, which is much different than being secretary of HHS. But the truth is, I’m really enjoying my role as an advocate. I can say things and do things and rally audiences, that I could never do. So, you know, people make contributions, and sometimes you don’t make one the way you’d like to, but sometimes it turns out to be OK.

AMY GOODMAN: Howard Dean, thank you so much for joining us. Howard Dean’s Prescription for Real Healthcare Reform.

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