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Eric Davis: Howard Dean presses on health care reform

Earlier this week, The Politico, a publication with a wide readership among Washington insiders, ran an article entitled “What Is Howard Dean Thinking?” The article noted that Dean recently made a speech in Iowa, the first caucus state, and will be speaking soon in New Hampshire, the first primary state.
Although some Washington-based pundits see these speeches as evidence that Dean might be testing the waters for another presidential run in 2016, I believe Dean intends nothing of the sort. Making speeches in early primary and caucus states keeps Dean’s name in the news, a goal which can be a challenge for people who currently hold no public office. Dean’s speeches will also help raise money for his grassroots political organization, Democracy for America. DFA plans to get involved in congressional and state races in Iowa and New Hampshire, both of which will be very competitive states in next year’s midterms.
Dean has told the press that he intends to support Hillary Clinton for president in 2016, and that he believes she is the most qualified candidate for the office. I see no reason why Dean should not be taken at his word. If Clinton were to decide not to run, or if her campaign were to falter badly in early contests, there are many people other than Howard Dean who would likely emerge as presidential candidates. Vice President Biden has been trying out possible themes for 2016 in recent speeches. If Clinton were not to run, several Democratic governors — including Andrew Cuomo of New York, Martin O’Malley of Maryland, and Deval Patrick of Massachusetts — would all seriously consider presidential campaigns, as would Sens. Kirsten Gillibrand of New York and Elizabeth Warren of Massachusetts.
To go back to the title of The Politico article, “What Is Howard Dean Thinking?”, the former M.D. turned governor has some very interesting ideas about health care reform. Dean is concerned that introducing a single-payer system in Vermont without changing the health care delivery system will neither restrain increases in health care costs nor significantly improve the health of Vermonters. Dean is not opposed to a single-payer system, but he wants to see health care delivery reform accompany health care payment reform.
Dean believes the Green Mountain Care Board’s attempt to use hospital budget caps to keep health care costs down is likely to fail. Dean argues budget regulation will fail because it assumes the continuation of the fee-for-service system as a way of paying hospitals and doctors. Providers will try to make up revenue losses resulting from budget caps by increasing the volume of their services.
Dean wants to see Vermont replace hospital budget caps with a global budget for all health care providers in the state. Dean said, “What’s going to happen in a global budget is you can’t make more money by having more MRIs and more cardiac catheterizations. You’ll make your money by hiring more nurse practitioners and internists to keep people out of the ICU (intensive care unit), rather than putting them in the ICU.” Dean believes that Vermont health care providers should be paid according to a capitation system, where providers receive a set amount of money for each patient, regardless of how much care each individual needs.
Under Dean’s model, a single-payer system would collect the revenues that would fund the state’s global health budget. Existing insurance companies and claims processors such as Blue Cross-Blue Shield would go away and would be replaced by non-profit groups of providers that would deliver care and be paid according to a capitation system.
Eric L. Davis is professor emeritus of political science at Middlebury College.

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