Review: Dean's prescription for real health care reform

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Book Review

Howard Dean’s Prescription for Real Healthcare Reform By Howard Dean, with Igor Volsky and Faiz Shakir Chelsea Green Publishing Company 132 pp., $12.95

To be sure, the American people are feeling a bit confused by the prospects of health care reform in this country. A troubling article that appeared in the July 23 edition of the New York Times illustrates the fact, offering up the mostly negative reactions of several different types of people—the poor, small business owners, well-to-do suburbanites—after President Obama’s prime time press conference on the issue.

Unfortunately, one is hard pressed to find the answers to the assorted questions that arise: How can we insure everyone while lowering costs overall? (Lowering costs is one of Obama’s three core principles; the other two are universal coverage and choice.) How can we pay for this? Who will pay? Who should pay? Why is the public option so important?

Healthcare for America Now, the huge coalition that represents literally millions of people, has done exceedingly admirable work in pulling together the fight for the public option, and Obama’s Organizing for America has done equally estimable work in mobilizing public opinion for the three core principles.

The misfortune is this: While there is a lot of work being done in organizing, there has been a dearth of information as to what all of this actually means. And this truly is unfortunate, given that the health insurance and big pharmaceutical industries are pouring millions of dollars into disinformation campaigns. At the same time, various proposals have been coming out of Congress, some of which are quite alarming to the American people.

Of course, a few proposals, such as one to tax employer-provided health benefits, are alarming for good reasons, others need not be. For example, a plan to save millions or billions of dollars by “trimming waste from Medicare” seems to be a very right-wing proposal. (In fact, a number of well-meaning people on the left have suggested that this would mean “gutting” Medicare and Medicaid.) But the fact of the matter is that there is actual waste in Medicare, and getting rid of it doesn’t necessarily mean denying anyone—anyone—quality care. Obama hasn’t proposed an across-the-board cut on these programs; instead, he wants to appoint a board of genuine medical professionals to look and see where savings can be made.

One identifiable way to cut costs overall is to simply improve information that doctors have available to them. The process, “comparative effectiveness review,” would study the range of treatments that are available for different conditions, and, if done in a systematic way by a federal board, like that proposed for Medicare, could give doctors information as to which treatments are better or worse, and which are more or less expensive. If two treatments both have the same success rates, why use the more expensive one? This comparative effectiveness review would save money—up to $100 billion—and, more importantly, up to 150,000 lives—yearly.

This reviewer certainly didn’t find the above information in the Times, on the HCAN or Organizing for America websites, though it is valuable and necessary information. Instead, it was found in Howard Dean’s indispensible little book—and at 132 pages, it is a very little book— Prescription for Real Healthcare Reform.

The previously-mentioned Times article’s headline was “For public, Obama didn’t fill in health blanks.” Luckily, Dean’s book fills in all of them.

While the situation in Congress is still very fluid, and we don’t know what the final bills arising from it will be, we are able to know what the optimal reform, as envisioned by Obama, HCAN and so on, is. Dean’s book, published earlier this month, is the single best vehicle I’ve seen so far to get a good sense of what this health care reform means. He describes in prose that is, at once genial, straightforward and simple, the whole range issues. All of the questions above, and more, are answered in a clear fashion. The book is remarkable for taking a reform plan that has befuddled so many Americans, and making it seem incredibly simple.

Some on the left will be unhappy with Dean’s quick dismissal of single-payer health care. That is, perhaps, too bad, but it is in no way any reason to dismiss this book’s usefulness. With every part of the optimal plan broken down and explained in simple terms, as well as a description of both the opponents of health care reform and the coalition necessary to win it, this book is simply to valuable to ignore.

Right now, the U.S. is in the midst of a week of action sponsored by Organizing for America, in which thousands upon thousands of people will canvas, phone bank and do various other things to press Congress into action. For anyone who’s unsure whether or not to take part—or worried that they won’t be able to answer people’s questions—because they like the general principles but don’t understand how they could work in practice, this book is essential.

One would have hoped that the shelf life of Dean’s newest work would have been more limited but, given the stumbling blocks set in Congress by Republicans and Blue Dog Democrats, doing the work of big insurance companies, it seems that this book will be valuable for some time.