UPDATE
Special Report

Dr. President?

White House hopeful Howard Dean shares his thoughts on healthcare—and the central role of physicians.

We've had an actor in the White House, a haberdashery salesman, a nuclear engineer, and, of course, plenty of lawyers. But we've never had a doctor. Howard B. Dean, internist and former governor of Vermont, would like to change that.

For months, Dean surprised nearly everyone by jumping ahead of then eight other Democratic presidential candidates. Polls indicate that Dean is among the leaders in Iowa and New Hampshire, and lately has also taken the frontrunner position in campaign contributions.

Medical Economics recently caught up with the candidate at a luncheon in New York City sponsored by the American Society of Magazine Editors. When asked how he'd provide a basic level of care for all Americans while keeping costs down, Dean outlined his "Healthy America" initiative.

The plan would expand two existing federal-state programs—Medicaid and the State Children's Health Insurance Program—to cover all uninsured children and young adults up to age 25. Adults between 25 and 64 who earn up to 185 percent of the poverty level (or $17,314) would also be eligible for coverage under SCHIP. Expanding access to federal programs is nothing new for Democrats, of course.

But Dean's plan is among those (count Kerry's and Lieberman's in this group) that also assign a central role to a GOP favorite—the Federal Employees Health Benefits Program, a popular public-private partnership that covers more than 8 million federal workers and dependents, including members of Congress. FEHBP offers its members a range of health-plan options, depending on their individual needs and pocketbooks.

The Dean plan would use a FEHBP-like model in two ways: First, working families who earn too much to qualify for government assistance would be able to buy into an appropriate private plan and their premiums would be supplemented with federal tax credits. Second, businesses with fewer than 50 employees that promised to insure their workforce would be able to choose among plans offering competitive small group rates.

Dean also wants to send a message to corporate America: Provide your workers with health benefits if you want to continue receiving non-health-related tax deductions. The Dean campaign thinks that—when fully implemented—the plan will cost $88 billion per year. To cover that not insignificant sum, Dean would rescind Bush's tax cuts—both those already enacted and those still pending.

In response to our question about the role of doctors in the Dean plan, the candidate said, "There's a disconnect today between the people who need care and the people who care for them." He blamed this rupture in the doctor-patient relationship on the "corporatization of American medicine"—which prizes bigness and efficiency over intimacy and communication. The result: Patients are routed through impersonal healthcare systems, rarely consulted about what they want done, and often end up receiving very costly and sometimes unnecessary care.

When confronted with end-of-life issues, Dean says, doctors and families speaking openly with each other will more often than not "make the right decision" about necessary and futile care.

—Wayne J. Guglielmo, Senior Editor

 

Wayne Guglielmo. Special Report: Dr. President? Medical Economics Nov. 7, 2003;80:16.