Speaking on MSNBC this morning, former Vermont Governor Howard Dean (D) made the wildly incorrect claim that the provision in the Affordable Care Act requiring almost all Americans to carry insurance is not “essential to the plan”:

DEAN: [T]he truth is the mandate’s not essential to the plan anyway. It never was essential to the plan. They did it in Massachusetts and had a mandate, but we have universal health care for kids in my state without a mandate. … I made this prediction before and I’m going to make it again: by the time this thing goes into effect in 2014, I think the mandate will be gone either through the courts or because it’s unpopular. You don’t need it. There will be two or three percent of the people who cheat. That is not enough to bring the system to a halt and people don’t like to be told what to do.

Watch it:

Sadly, Dean — who has been a leading progressive champion for health reform — is simply wrong about the mandate. As MIT economist Jonathan Gruber explains, this provision is essential to any health reform package that forbids discrimination against persons with preexisting conditions:

Insurance companies are also prohibited from excluding coverage due to preexisting illnesses.  This is a highly popular reform, but it doesn’t work in a vacuum. If insurance companies must charge the same price to people whether they’re sick or healthy many healthy people will view this as a “bad deal” and not buy insurance. This results in higher prices that chase even more people out of the market. The result is a “death spiral” that leads only the sick to purchase insurance at very high prices. Several states tried such community rating reforms—offering health insurance policies within a given territory at the same price to all persons without medical underwriting—in their nongroup markets over the past two decades, and sharp rises in insurance prices ensued along with rapidly shrinking market size.

An amicus brief that I co-wrote on behalf of seventeen disease and health organizations goes into more detail. It explains that seven states attempted to ban preexisting conditions discrimination without also requiring everyone to carry a minimum level of coverage, and all of them saw their premiums skyrocket. According to a scholarly study of Vermont’s health plan, Vermont’s premiums shot up after it enacted a ban on preexisting conditions discrimination but no mandate in 1993. Between 1994 and 1996, most of the country only experienced single-digit increases in its insurance costs. In Vermont, however, average premiums increased by 16 percent during this same two year period.

In Massachusetts, the one state to enact a minimum coverage provision along with its ban on discrimination, the numbers are very different. There, individual premiums fell a massive 40 percent in the years after Massachusetts’ minimum coverage law went into effect, while the rest of the nation experienced a 14 percent increase.

Dean’s claim that the courts may strike down the Affordable Care Act’s minimum coverage provision is also misguided. No one questions that a ban on discrimination against persons with preexisting conditions is constitutional, and, as even ultraconservative Justice Antonin Scalia admits, when Congress passes a constitutional law “it possesses every power needed to make that regulation effective.”

This morning, Howard Dean walked back from earlier statements encouraging Democrats to “kill” the Senate health care bill. On Thursday, Dean wrote that “this bill would do more harm than good to the future of America,” but during his appearance on Meet The Press, Dean argued that yesterday’s manager’s amendment significantly improved the legislation. “I would let this thing go to conference committee and let’s see if we can fix it some more,” Dean said:

Well, let’s start with the positive things. Over the last week, there were things that were improved. There were some cost containment mechanisms that were gutted. They got restored. I would certainly not vote for this bill if this were the final product, but there are, the House bill is quite a good bill. This bill has improved over the last couple of weeks, I would let this thing go to conference committee and let’s see if we can fix it some more…so there are a lot of things that need to be fixed, but if they are fixed you may actually get the foundation of a bill, coming out of the House. If most of the House provisions survive, then we can have a bill that we could work with….I hope this isn’t the compromise that’s been achieved. I think we have yet to see the compromise that we could achieve.

Watch a compilation:

Dean didn’t advocate for pushing the bill through the reconciliation process or restarting reform after the midterm elections, as he had suggested several days earlier. Instead, the former Vermont governor expressed optimism that the bill could be improved in conference, going so far as to say that some of the goals of the public option could be accomplished through regulatory means.

“Here is the major problem,” Dean said. “We have committed to go down a path in this country where private insurance will be the way that we achieve universal health care. That means we’re going to have a 30-year battle with the insurance industry every time we try to control costs and try to get them to do things.” “My position is let’s see what they add to this bill and make it work, if they can make it work without a public option, I’m all ears. I don’t think that’s possible,” he said.

DailyKos founder Markos Moulitsas, who strongly opposed the Senate bill, also appeared to soften his position. “This, this is not a done deal, we still have reconciliation to go to,” he said during a round table following Dean’s appearance.

Cross-posted on The Wonk Room.

Since Joe Lieberman demanded stripping the public option and Medicare buy-in provisions from the merged Senate bill, some strong progressives like Howard Dean have argued that without a public option or a Medicare buy-in provision, the bill is a giveaway to private insurers and should be killed. Other progressive leaders like Senators Jay Rockefeller, Tom Harkin and Sherrod Brown believe that the bill represents the best chance for passing health care reform in the foreseeable future. “I’m going to vote for it,” Brown told reporters. “I can’t imagine I wouldn’t. I mean there’s too much at stake.”

Change of the magnitude envisioned by health care reformers does not come easily. There have been many frustrations and there will be more. But, as a senior White House staffer with a ringside seat for the slow death of comprehensive care in 1994, I am keenly aware of the real alternative to the bills now before us: millions more Americans without health care and billions more for health care spending as the same challenges President Clinton tried to resolve continue to metastasize unchecked.

So while I have great respect for Governor Dean, and we have worked together to provide the strongest health care reform bill for the American people, I come down on the side of the Senate passing the bill.

Here’s why:

The Senate health care bill is not without its problems. But if enacted, it would represent the most significant public reform of our health care system that Congress has passed in the 40 plus years I have worked in politics. The bill will give health care coverage to a record 31 million Americans who are currently uninsured, lay a foundation that will begin to lower costs for millions of families, and provide all Americans with the access to adequate and dependable coverage when they need it most.

All of us are anxious to see the final language from the Senate. And a final bill must ensure that the subsidies provided are sufficient to make insurance truly affordable for working families. But based on what we know, here are my top ten reasons for why progressives should support the Senate passing the bill:

1. Largest Expansion Of Coverage Since Medicare’s Creation: Thirty-one million previously uninsured Americans will have insurance.

2. Low/Middle Income Americans Will Not Go Without Coverage: For low-income Americans struggling near the poverty line, the bill represents the largest single expansion of Medicaid since its inception. Combined with subsidies for middle income families, the bill’s provisions will ensure that working class Americans will no longer go without basic health care coverage.

3. Insurance Companies Will Never Be Able to Drop or Deny You Coverage Because You Are Sick: Insurers can no longer deny coverage because of a pre-existing condition. They can’t rescind coverage or impose lifetime or annual limits on care. Significantly, the bill also ends insurer discrimination against women — who currently pay as much as 48% more for coverage than men — and gives them access preventive services with no cost sharing.

4. Lowers Premiums For Families: The Senate bill could lower premiums for the overall population by 8.4%. For the subsidized population, premiums would decrease even more dramatically. According to the CBO, “the amount that subsidized enrollees would pay for non-group coverage would be roughly 56 percent to 59 percent lower, on average than the nongroup premiums charged under current law.”

5. Invests in Keeping People Healthy: The bill creates a Prevention and Public Health Fund to expand and sustain funding for public prevention programs that prevent disease and promote wellness.

6. Insurers Can’t Offer Subprime Health Care: Insurers operating in the individual and small group markets will no longer sell subprime policies that deny coverage when illness strikes and you need it most. Everyone will be offered an essential benefits package of comprehensive benefits.

7. Helps Businesses Afford Coverage: Small employers can take advantage of large risk pools by purchasing coverage through the bill’s state-based exchanges. Employers with no more than 25 employees would receive a tax credit to help them provide coverage to their employees. The bill also establishes a temporary reinsurance program for employers providing coverage to retirees over the age of 55 who are not eligible for Medicare.

8. Improves Medicare: The bill eliminates the waste and fraud in the Medicare system, gets rid of the special subsidy to private insurers participating in Medicare Advantage and extends the life of the Medicare trust fund by 9 years. It also closes the doughnut hole that affected 3.4 million seniors enrolled in Medicare Part D in 2008.

9. Reduces The Deficit: Not only would the bill expand coverage to 30 million Americans without adding to the nation debt, it would also reduce the deficit by up to $409 billion over 10 years.

10. Reduces National Health Spending: A CAP-Commonwealth Fund analysis concludes the bill could reduce overall spending by close to $683 billion over 10 years – with the potential to save families $2,500. Even the most conservative government estimates conclude that the bill would reduce national health care expenditures by at least 0.3% by 2019.

The Senate is considering expanding the Medicare program to Americans under 65 years of age alongside a public option compromise that would allow the Office of Personnel Management to regulate competition among private nonprofit insurers. Former Vermont Gov. Howard Dean “injected the buy-in concept back into the negotiations two weeks ago,” Politico reports. And “the turning point in the debate occurred over the past few weeks, as some progressives began to question whether the public option had been watered down too much for it to even be effective. Dean called Reid and Sen. Chuck Schumer (D-N.Y.) to suggest that they revisit the Medicare buy-in proposal, which he pushed during his 2004 campaign.”

In a statement issued to ThinkProgress, Howard Dean — a longtime proponent of the public health insurance option and co-author of Howard Dean’s Prescription For Health Care Reform — explains why he supports expanding the Medicare program:

Proponents of the public option should be happy to hear that the Senate is considering a provision that would allow Americans to buy into the existing Medicare program. Throughout this debate, advocates of a strong public option have had to repeatedly compromise with lawmakers who continue to protect large for-profit corporations and ignore the well being of their constituents. Allowing younger Americans to buy into Medicare represents the best and possibly final opportunity to truly reform the health care system as a whole.

I’ve been a long-time strong supporter of opening up the Medicare system to any American who wants to enroll in it, and I continue to believe that Medicare is a proven success story that delivers quality care efficiently. Allowing Americans under 65 to enroll in this program would generate the kind of competition that lowers costs and improves the delivery of care within the private sector. In order to be effective, however, this option must be available to Americans from day one and should be offered as an option within the exchanges, once they become operational.

Ultimately, if Democratic health reform forces Americans to purchase coverage from private insurers and does not give everyone the choice of a public plan, Democrats and the President will have to face the consequences of their watered down proposals at the voting booth.

Offering younger Americans the option of purchasing Medicare coverage could lower costs, improve the delivery of health care and strengthen Medicare over the long-term. Medicare’s administrative efficiencies and greater bargaining leverage has led the program to spend less per enrollee than private health insurers, suggesting that the program could control costs over time. A recent study found that “since Medicare payment controls were put in place in the early 1980s, Medicare spending has grown much more slowly than in the past.” Medicare has also been the source of important payment “innovations that private plans have generally adopted.” An expansion of the Medicare program would allow policymakers to spearhead the kind of payment reforms that would gradually change the incentives in the health care system from quantity to quality care.

The current proposal would expand Medicare eligibility to individuals age 55 and up, but policymakers may also consider a provision that would trigger a reduction in eligibility age if national health care expenditures don’t decrease by a set amount over time.