SAN ANTONIO—Governor Howard Dean told a crowd of brokers—who had slammed the former presidential candidate’s position on health care—that the individual mandate provision is “one of the very large blunders” of the Patient Protection and Affordable Care Act and predicted the Supreme Court will rule it unconstitutional.
“It was never necessary in the president’s bill; they should have never put it in,” Dean told attendees Thursday morning at the Benefits Selling Expo in San Antonio, Texas. “Both Republicans and Democrats are all essentially libertarian; we hate to be told what to do by the government.”
But he’s unsure what will happen because court lawyers made a brilliant case trying to convince the justices that without the mandate, the bill will fall apart.
Still, Dean said he expects the rest of the bill will remain intact as the court will be “very reluctant” to get rid of all of it.
Despite Dean’s history of support of universal health care, he said he wasn’t “a terribly big supporter of the president’s health reform bill. But we have what we have.”
His lack of support for the PPACA is due to a lack of cost control in the bill.
Health care in the United States has long been plagued with unsustainable costs increases.
“There is almost no successful economic incentive to drive the cost down,” Dean explained. “And it’s simple: I’m a physician, you come to me, I tell you what to buy, we send the bill to the third party and I get paid for everything I do whether it works or not. The more I do to you, whether it works or not, the more I get paid.”
The entire incentive in this system is to spend as much as you possibly can, and that’s why health care cannot continue as it is.
The solution? Pay by the patient and not by the procedure, Dean said.
“It saves us money if we invest in prevention,” said Dean, who is a former physician and former chairman of the Democratic National Committee. He noted Kaiser Permanente as an example of a system that does that. He also said large corporations who self-insure are also successful in that because with low turnover, they invest in their young employees health-wise because it will benefit them in the long-run.
Small and middle-sized companies don’t have those same incentives, he noted.
“Today we have an illness system—you don’t come and see [a doctor] unless you get sick. Now we’re going to have a real wellness program if we make this change,” he said.
If Obama wanted to be serious about cost control, he would have capped Medicare in the PPACA. “They didn’t have the nerve to do it because it’s political dynamite,” he said.
Some of the unintended consequences of the PPACA will be most effective, Dean said.
For one thing, “the president’s bill leaves a chance for the private sector to actually reshape health care reform.”
Dean also mentioned the controversial McKinsey report, which came out last year stating that employers would drop their coverage at record numbers due to the PPACA. Though the government had said at the time the “flawed study” was an “outlier,” Dean said employers dropping their coverage to employers “will absolutely happen.”
“By droves, small business owners will get out of the health insurance business …pay the fine…and go to the exchanges.”
And at some point, large employers will follow suit.
“[The PPACA] is going to get employers to do get out of the health insurance business, and I think that’s a good thing.”
That’s because health care inflation is disadvantaging American businesses when competing against other global businesses who don’t have that same problem, he explained.
Though it will help make an “economic impact,” he told brokers for them it will take “an enormous change.”
After admittedly “pleasantly surprising” brokers in the audience on his views on health reform—as The American Worker’s Jon Duczak said—one broker asked if his fellow Democrats would agree with him.
But Dean said that’s not likely—at least publicly. “It’s an election year, they say what they think they have to say to get elected.”
He also doesn’t expect presumed Republican presidential nominee Mitt Romney to overrule the PPACA as he promised if elected because Obama will win reelection.
“The election is over,” he said. For one thing, Romney hasn’t won support of Hispanics, without which, he won’t be able to win. Dean, though, said “Romney is a good man and would have been a good president.”
During his roughly 55-minutes on stage, Dean touched on the importance of personal connections (despite the younger generation’s reliance on the Internet, “there is never a substitute for personal contact”), death panels (“The only death panel you need is the family… they make rational decisions about people they love”); and tort reform (“It’s not as big of a problem as the Republicans say it is, and not as small of a problem as the Democrats say it is. But it is a problem.”).
He also talked about the trend of consumer-driven plans and reiterated the importance of personal responsibility.
On health savings accounts, he said, “I don’t think HSAs are a bad thing but they certainly won’t get us anywhere close to solving the problem.” Though they help with “the little stuff,” they’re not helping with the major expenses or surgeries.
The most important thing Americans can do at this point is think about long-term consequences to daily decisions—from choosing what to eat to exercising.
“We have to understand we can complain about the bureaucracy of the insurance companies and the doctors and the drug companies, but essential problem in health care is us…It’s very hard to look at someone else’s expenditures when you aren’t willing to limit your own.”
VIdeo by Jenny Ivy