Dean: Public insurance a must
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By Louis Porter VERMONT PRESS BUREAU - Published: July 10, 2009
MONTPELIER — Former Vermont Gov. Howard Dean said Thursday that without a public health insurance option – a federally run program that would be offered in addition to private plans — the health care reform effort now being debated in Washington would not be worth supporting.
"There is no point in doing health care reform unless you have a public option people can choose from," Dean said. "I think it is a waste of time and money to do it."
The desired reduction in the cost of health care will not happen without such an option, he added.
"Cost containment is not going to be successful without a public option," he said.
Not everyone agrees. Dean's successor, Gov. James Douglas, has said he does not think a public option is necessary or advisable. Cost containment can be achieved through better management of chronic care and other medical services, says Douglas, who has made several trips to Washington on the issue recently.
Dean, former head of the Democratic National Committee and a medical doctor, spoke to reporters in Montpelier via a conference call.
Dean earned a more pragmatic and less liberal reputation in Vermont than he has nationally — including on health care reform efforts. One round of such efforts at the state level took place in the early 1990s when he was governor.
But Dean said Thursday he does not believe the state should have gone further than it did during that period for the simple reason that it could not — legally. That's because of a federal law, the Employee Retirement Income Security Act, which preempts and limits how much states can be involved in the relationships between employers, workers and their health benefits, Dean said.
"We couldn't go further. We were stymied by ERISA. ERISA makes it virtually impossible to do (a single payer insurance plan) in your state," Dean said during the call Thursday about his new book, "Howard Dean's Prescription for Real Healthcare Reform," just published by Chelsea Green Publishing, a White River Junction company.
Only Hawaii is exempt from the ERISA mandates because of when its health care reform measure was implemented, Dean added.
Instead Vermont expanded health care insurance for children when Dean was governor.
"I don't think our plan would ever be called revolutionary," Dean said. But it did help insure nearly 99 percent of minors in Vermont. "It still leads the rest of the country, which is kind of a sad commentary on the rest of the country after 16 years."
But not everyone agreed then, or now, that ERISA prevents rethinking the health care system at the state level.
"That is not proven," said Deborah Richter, a primary care doctor and health care advocate.
Richter points to a January review of legal cases around the issue by Patricia Butler, a lawyer and doctor, who indicated that states could craft such a program that would not violate ERISA.
For example, a system in which all Vermonters were in one insurance risk pool, sometimes called single-payer, would work if that plan allowed employers to add their own supplemental coverage, Richter said.
"If you have a broad based tax and out of that tax you guarantee everyone health care, their employees would be included in that," she said. In fact, the state's current Catamount Health program — supported in part by fees on employers who don't provide insurance — is more likely to violate ERISA than such a system, she said.
And the system of maintaining the private insurance system with a public insurance option as advocated by President Barack Obama and Dean is not likely to get rid of the massive expense of having multiple insurers and multiple plans, Richter said.
"I am sitting here with a pile of charts on my desk. That is not going to go away with a public option," she said.
Instead, the current proposal is "a political solution," Richter added.
Those choices may well have been part of the reason for Dean's decision on health care reform when he was Vermont governor, as well.
"At the time we had a disagreement about whether ERISA prevented us from going further, but we never found out because we didn't try," said Cheryl Rivers, a former state senator and the leading single-payer advocate of the time who tried to convince Dean to support such a plan.
"I don't know. Maybe he was right," she said. "My assessment of Howard's leadership on health care has gotten kinder over the years."
It remains to be seen during the current national health care debate if a public insurance option — much less single-payer, which nobody expects to pass — will get through Congress.
Dean said Thursday that the insurance reform parts of the proposal — for instance instituting community rating to prevent insurers from insuring only healthier customers, as Vermont has — would still be worth putting into law without a public insurance option.
However, such a bill would not be true health care reform, he said.
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