Howard Dean’s Flip-Flops

I’ve heard the view expressed that people can agree to disagree about the merits of the health reform legislation, but progressive blogger types should refrain from attacking Howard Dean. I really don’t see the case. I like Dean. I’ve volunteered for Dean. I’ve praised Dean. Dean’s co-authors on his book are my friends and colleagues.

But he’s wrong about this bill. And just as it was wrong of Joe Lieberman to threaten to kill a good piece of legislation unless he got his way over the public option, it’s wrong of Howard Dean to advocate killing a good piece of legislation unless he gets his way over the public option.

Lee Fang has a good post at Tapped noting that one of Dean’s tactics in this effort is to start changing his mind about other elements of the bill. Now Dean says the bill “isn’t health care reform. It’s not even insurance reform.” Except when the Senate Finance Committee released its bill, Dean said the lack of a public option was a big problem, but did concede that “it will reform insurance. That’s a good thing to do.” And as Fang notes, the insurance reforms have gotten stronger:

Here’s the problem: The regulations in the current Senate reform bill are actually stronger than the SFC regulations Dean endorsed previously. The current reform bill has a medical loss ratio mandate of 85 percent — and the SFC Dean praised had no requirement for how much of each premium dollar should go to health care, only reporting standards. In the current bill, parents can keep dependent children on their coverage longer, up to age 27. In the SFC bill, there was no such provision.

The biggest kicker is community rating. In the quote from Tuesday night, Dean attacked the current bill for having a mere 3-to-1 age discrimination ratio. However, the SFC regulations which he praised earlier this year had a much weaker 4-to-1 ratio. The bill has been vastly improved in terms of regulations, but Dean still says the regulations are so terrible, “it’s not even insurance reform.” This argument to kill the bill simply rings hollow.


More broadly, as Ezra Klein noted some months ago, back in 2004 Dean campaigned on a health care plan that was broadly similar to, but definitely worse than, this current deal.

The Dean 2004 plan would provide a choice of subsidized private health insurance plans to basically all employed people, but not really do anything for the self-employed. And it didn’t contain any fleshed-out proposals for delivery system reform, for reforming insurance regulation s, or do much of anything to address long-term costs. And for all that, it was a good plan. I liked it at the time, and if it was the best bill that could pass congress in 2009 I would be happy to support it. But luckily for us, a better bill looks to have a good chance of passing.