"What a Difference Five Years Makes"
With Howard Dean scheduled to speak at Netroots Nation shortly, I think it’s worth taking a brief look back and making the point that the health reform agenda he campaigned on in 2004 is pretty different from what’s in his new book or the kind of things he’s likely to talk about nowadays.
In particular, if you look at his 2004 campaign plan you’ll notice that it’s missing any semblance of the “public option” of today’s debate. Instead, it relies on an incremental expansion of existing public programs by opening up CHIP and Medicaid to “cover all kids and young adults up to age 25 — middle income as well as lower income” while making it that “Adults earning up to 185% of the poverty level — $16,613 — will be eligible for coverage through the already existing Children Health Insurance Program.” Beyond that, Dean proposed some ideas that are near the present-day consensus. He wanted to establish something that would be similar to what we call an “exchange” in 2009 that people working for small businesses or shifted into the individual market could use. He wanted to use tax credits to subsidize the purchase of insurance for those who needed help with affordability. And he hinting around at an employer mandate for larger insurers.
This was a pretty good health plan. But it wouldn’t achieve truly universal coverage (he bragged, “It doesn’t have to be this way in America. In Vermont, where I served as governor for the last 11 years, nearly 92% of adults now have coverage”) and it didn’t include a public plan. The up to age 25 thing is a good idea that I’d like to see incorporated into present-day discussions. But basically this plan amounted to something that today would count as a squishy moderate proposal that would get you denounced by Jane Hamsher as an insurance company sellout. And yet reading it in 2004, everyone recognized that for all its incrementalism the Dean plan was, in fact, a series of progressive measures that would constitute a huge advance over the status quo. In the intervening five years, expectations have skyrocketed and the ambition of the progressive movement has gone up. And that’s fine. Heck, it’s good. Ambition is necessary, or you’d never get anything done. But it’s important not to confuse expectations with reality; the way to judge a piece of legislation is whether it makes things better than they are, not whether it lives up to what you’d once hoped would happen.
The 2004 Dean proposal would have been a boon to poor Americans, would have given the insured middle class peace of mind about our ability to stay insured even if our job situation shifted, and in principle could have laid the groundwork for the further evolution of the system in a positive direction. That would have been pretty nice to do five years ago, and it’d still be nice to do today.