Dean's diagnosis

Former presidential candidate and DNC chair uses prime WaPo space to oppose HCR bill

Published December 17, 2009 5:12PM (EST)

Howard Dean got some prime real estate on today's Washington Post op-ed page to express his dissatisfaction with the healthcare reform bill. He opens with a pretty concise summary of the main objections of liberals and other critics who oppose it for it insufficiencies:

If I were a senator, I would not vote for the current health-care bill. Any measure that expands private insurers' monopoly over health care and transfers millions of taxpayer dollars to private corporations is not real health-care reform. Real reform would insert competition into insurance markets, force insurers to cut unnecessary administrative expenses and spend health-care dollars caring for people. Real reform would significantly lower costs, improve the delivery of health care and give all Americans a meaningful choice of coverage. The current Senate bill accomplishes none of these...

Then, around some suggested changes, he gets to the politics of its passage or rejection:

To be clear, I'm not giving up on health-care reform. The legislation does have some good points...

Improvements can still be made in the Senate, and I hope that Senate Democrats will work on this bill as it moves to conference....

In Washington, when major bills near final passage, an inside-the-Beltway mentality takes hold. Any bill becomes a victory. Clear thinking is thrown out the window for political calculus. In the heat of battle, decisions are being made that set an irreversible course for how future health reform is done. The result is legislation that has been crafted to get votes, not to reform health care.

I'm not convinced that Dean's voice carries as much weight as it once did. Opponents will undoubtedly rally behind him; as a doctor and former presidential candidate who excited key elements of the Democratic base, he lends credibility to critics that those who are dismissing them as looney lefties.

Ezra Klein, who is taking a lot of guff from conservatives while at the same time disappointing liberals for supporting the Senate compromise--calls Dean one of the hostage-takers in the debate:

In his op-ed, Dean names John Kerry as the senator who has been working hardest on this question. This morning, I spoke to Kerry's staff, who got me a statement from Kerry himself. "The prudent purchasing provisions in the Senate health bill will lower costs and increase affordable options for consumers," Kerry says. "It’s strong language that will allow the exchange to deliver competitive prices and offer high quality care, and I’m thrilled to see national reform honor the best innovations already succeeding in Massachusetts.”

I'm sure there's some theoretical way in which the language could be stronger. Dean doesn't say what it is, but I don't doubt it exists. But now we're talking about killing the Senate health-care bill -- with its $900 billion in subsidies and its delivery system reforms and its Medicare Commission and its Medicaid expansion and its exchanges and its regulations on insurers -- unless we make the exchanges slightly stronger prudent purchasers, when they're already strong enough to "thrill" the original sponsor of the prudent purchaser amendment?

I guess this is the logical outcome of a system in which the greatest gains accrue to those making the most credible and severe threats. But it's not healthy.

By Thomas Schaller

Thomas F. Schaller is professor of political science at the University of Maryland, Baltimore County and the author of "Whistling Past Dixie: How Democrats Can Win Without the South." Follow him @schaller67.

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