Thursday, September 24, 2009

Here's to Your Health

Howard Dean with Igor Volsky and Faiz Shakir. Howard Dean’s Prescription for Real Health Care Reform: How We Can Achieve Affordable Medical Care for Every American and Make Our Jobs Safer. White River Junction, Vt.: Chelsea Green Publishing Co., 2009.

Dean moved to Vermont as a recent medical graduate to work with the University of Vermont ambulatory care program. In 1980, he also volunteered for the Carter campaign and was elected a Delegate to the National Convention. The Democratic County Chair was ill and the State Chair asked Dean to run to take over the position. Although Dean had only been in Vermont for about two years, the State Chair found he was the only person accepted to both the Carter and Kennedy factions. Dean continued working in both medicine and politics, even practicing medicine while serving as Lt. Governor. The Republican Governor suddenly resigned and Dean found himself Governor. As Governor, he recalls the advice Governor Jim Hunt of North Carolina told him that “90% of what we do is urgent. 10% is important.” Among the important things Dean writes he achieved as Governor was expanding health insurance to 99% of Vermonter aged 17 and younger, creating dental clinics in low income schools, increasing the availability of prenatal care, and creating more community health centers.

Dean was distressed to see how often health care insurers stopped covering someone once they became ill. He notes the Congressional Budget Office calculates that, in the individual health care insurance market, that 29% of premiums pay for administrative costs. He found most insurance companies use of to half their expense on executive salaries, administrative costs, and profits to shareholders.

Dean notes 47 million do not have health care insurance. 25 million have such insurance but can’t afford their share of the costs to see a doctor. Many face either bankrupting themselves to pay for health care or doing without.

Many states have weak laws regarding health insurance, which is regulated by state laws. Many states allow premiums to increase drastically. Many allow coverage to be denied to health conditions that arise later, sometimes upon review and sometimes even more than a year after purchasing the policy. Some policies only provide minimal coverage, such as up to $50,000 in lifetime costs or $1,000 for hospitalization. It is hard for the public to understand health care insurance policies. They are deliberately written in technical language the public finds trouble understanding.

Dean notes that Canada’s national health care system attracts businesses to locate there. Establishing instead in the U.S. entails employers making large enough health care expenditures that it is cheaper for them to locate in Canada.

Health care insurance should be available to everyone, Dean writes. It should be affordable, rather than something that contributes towards half of all bankruptcies. Health care should stay with an individual and not be dropped when a person changes jobs. People should be allowed to keep their existing coverage, if they wish. A tax credit should be provided to small businesses to help them pay for their required health care insurance. Our efforts on disease prevention, health care research, and health information technologies should be increased.

A public insurance option would have lower administrative costs. It would drive private insurance to compete by lowering their expenses and their costs to customers. This system would preserve the wishes of Americans consumers to have choices.

Americans deserve informed choices. This is particularly important when it comes to the public being able to understand their choice on pharmaceuticals and how different brands of similar drugs work and what their possible side effects are.

Dean states a 5% gas tax would pay for health care insurance costs. The costs of the public insurance could by transferring excessive Medicare payments to the public insurance system.

Private insurance and business interests are fighting to protect their own interests against health care reform that would be in the public’s interest.

The U.S. spends $5,711 per capita on health care compared to $2,989 in Canada and $2,317 in Great Britain. The U.S. spends 15.2% of its GDP on health care compared to 9.9% in Canada and 7.8% in Great Britain.


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