Howard Dean on Health Care Reform 2

I have two items today for my write-up on Howard Dean's Prescription for Real Healthcare Reform.

1.  To be honest, the health care plan that Howard Dean prescribes for the entire country reminds me of Paul Ryan's plans for Medicare, which concern the elderly.  (And, by Ryan's plan, I mean the version that was described on ABC News on August 14, 2012.)  Howard Dean wants a system in which private health insurance companies would compete with a public option (which would be like Medicare), people would be free to select from a variety of options (or stay on their current plan), and people would receive subsidies based on need so they can purchase health insurance.  And Paul Ryan supports giving the elderly vouchers to purchase health insurance from government-approved private plans, while allowing them to choose traditional Medicare if they so desire.

The plans sound similar, but are they?  Howard Dean would probably say "no" and would argue that Ryan's plan is deficient because it puts on seniors a financial burden of paying for health care, greater than what seniors currently bear.  And Dean would probably have a point.  But it seems to me that both sides are inconsistent, at times.  During the health care debate, when the public option was on the table, Republicans were saying that the public option would be a terrible idea because private health insurance companies would not be able to compete successfully against it----they'd be run out of business.  And yet, Newt Gingrich, and now Paul Ryan, propose to have private health insurance companies compete with Medicare.

I still have questions about Ryan's plan, though.  Ryan's plan is designed to save Medicare and to make it solvent.  I am open to correction on this, but I think that Ryan hopes that more seniors will take their vouchers and enroll in private health insurance plans.  But what if most of them choose instead to stay in Medicare?  In that case, would Ryan's plan change anything, or simply land us back to where we were before?  But suppose that a sizeable number of seniors do choose to enroll in private plans.  Would Medicare then have enough money to help those who choose to stay in it?

2.  Howard Dean says that information should be provided to physicians about what are the most effective treatments, in terms of health and costs.  That way, they can make informed decisions.  Dean anticipates an argument that I have heard or read from conservatives when he states on page 54:

"To be sure, comparative effectiveness research cannot be applied too rigidly.  A small percentage of patients will respond to one drug better than to another, despite the similar chemistries."  In short, what is considered to be the most effective treatment----in terms of health and cost----may not work for everyone.  Consequently, for Dean, the decision should rest with the physician about what is best for the patient.

But I have a question: What would prevent physicians from choosing the costlier treatments because that would make them more money?  Perhaps Dean would respond that his plan promotes preventative care and rewards doctors who keep or make their patients healthy, and so doctors under his plan would do the right thing.

Welcoming a Debate on Policy: Romney Selects Paul Ryan as His Running Mate

As many of you may know by now, Mitt Romney has chosen Representative Paul Ryan to be his running mate.  Ryan is a conservative whose controversial budget proposal (particularly that on Medicare) has won him praise from many on the right (except for Newt Gingrich), and criticism from many on the left.

I think that Barack Obama will pan Ryan's stance on Medicare and ride that (as well as Bain Capital) to re-election. And yet, because Ryan is an ideologue, is intelligent, and is bold on policy, this election may turn out to be a good debate on the role of government.  Ryan does not strike me as overly charismatic, but he is a policy wonk, and Romney's selection of him could lead this election to be more about policy, even though I'm sure that it will still contain its share of personal attacks.


I recommend that you watch this video here, in which Ryan explains his proposal for Medicare (which has undergone revisions, so I am not sure if the one in this video is the latest version of Ryan's plan or not, but it still contains the element that most frightens people, namely, the idea to give people vouchers to buy private insurance).  Like Barack Obama, Ryan is good at breaking down complex ideas so that even I can understand them.  It will be interesting to see how Obama critiques Ryan's proposal, and how Ryan responds.

I hope that----in the course of the discussions, the attacks, and the counter-attacks----Barack Obama explains what he has done and plans to do about entitlement reform.  Of course, his campaign will most likely scare people with the claim that Ryan's plan will end Medicare as we know it.  And yet, Obama himself recognizes the weakness of the fee-for-service reimbursement model, which Ryan criticizes in the video.  Obama is not for Medicare spending getting out of control, for he has restrained its growth and has sought to tackle Medicare fraud.  I hope, however, that Obama responds to the charge by Ryan and other conservatives that Obamacare results in higher costs and denied care in that Medicare's restraint of its reimbursement leads doctors either to stop seeing Medicare patients, or to pass on the cost of treating Medicare patients to others.

Let the debates begin!