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Howard Dean's Prescription for Real Healthcare Reform: How We Can Achieve Affordable Medical Care for Every American and Make Our Jobs Safer

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Healthcare reform plays a major role in discussions and the media today, but it is confusing, overwhelming, boring and seemingly unsolvable to most people. Howard Dean presents the problems and solutions in plain language in his new book, Howard Dean's Prescription for Real Healthcare Reform. For Dr. Dean's appearance schedule please visit the publisher's website.

Hear someone utter the word Healthcare and the emotion that rises up and continues to spiral nearly out of control is anger. Dean writes, "according to a recent report from the Center for American Progress, in March 2009 alone almost 11,000 workers a day lost their health insurance." Do the math and the anger turns to outrage - 341,000 people lost their health insurance in a 31-day period.

There are "47 million Americans who don't have health insurance. But the healthcare debate should also focus on the fact that 25 million working-aged Americans have health insurance but still cannot' afford to see a doctor," states Dean in his introduction. Terrifying statistics compounded by information from the Commonwealth Fund, "many go without needed care, not filling prescriptions, and not following up on recommended treatment."

Howard Dean is eminently qualified to write about healthcare reform for several reasons. He is graduated from Yale in 1971 with a BA in Political Science. He received his medical degree from Columbia University during which he spent one month at the American Medical Association following Senators Jacob Javits and Ted Kennedy as they attempted to create a healthcare bill during President Carter's first term. His was elected the first Democratic Governor of Vermont since 1853. His efforts during his Governorship insured that 99% of Vermont citizens under the age of 18 had access to healthcare coverage, expanded prenatal care, community health centers and dental clinics in schools serving low-income children.

But it is his one simple statement at the end of the preface that says it all. "All change grows from the grass roots. Real healthcare reform won't happen without you." He is clearly directing his thoughts at the everyman/woman - he is writing for the people who need healthcare insurance or worry that their insurance will come to an end due to loss of job or steep rate increases.

Dean clarifies, finally a politician that realizes what the people want to hear and how they want to hear it, the difference between healthcare reform and health insurance reform. "So, the real debate about healthcare reform is not a debate about how large a role government should play. The real issue is: Should we give Americans under the age of sixty-five the same choice we give Americans over sixty-five? Should we give all Americans a choice of opting out of the private health insurance system and benefitting from a public health insurance plan?"

He further states, brilliantly making his point absolutely current, "Americans ought to be able to decide for themselves: Is private health insurance really health insurance? Or is it simply an extension of thing that have been happening on Wall Street over the past five to ten years, in which private corporations find yet new and ingenious ways of taking money from ordinary citizens without giving them the services they've paid for?" Does the Madoff ponzi scheme ring a bell here? Money invested with absolutely no return on investment not to mention complete loss of all funds. Who hasn't paid for insurance month after month and not received coverage when they needed it the most?

Dean details the profit vs. care issue and succinctly discusses the problems with private, for-profit insurances companies that "must meet two obligations that are often mutually exclusive." These private behemoths are responsible for maximizing profits for their shareholders while shouldering the responsibility for good service to their customers. Is this even possible given the way private health insurance companies are structured coupled with the lobbyists who ensure that they have more or less free-reign with blatant disregard for the welfare of their enrollees.

Chapters cover the trials of small business owners and individuals and uses real-life examples to drive home the point. He strongly states that "America most shift from an illness-based healthcare system to a wellness-based model." He writes of the necessity to change the national lifestyle toward one of prevention and healthier living. A goal that neither political party nor business or individuals could argue with - who wouldn't want to be healthy?

Dean covers the challenges briefly but completely and spends a good portion of the book providing solutions. "Americans need real healthcare reform, not just insurance reform, and nobody should mistake the two," he states. "Real healthcare reform should offer coverage to the employed, the unemployed, the sick, the healthy, the young, the old. Everyone."

He puts forth five sound and achievable principles that "real healthcare reform must include." Everybody In, Nobody Out; No more Healthcare Bankruptcies: Take it to Go; Choose or Lose and Improved Care, Quality and Efficiency. He reviews President Obama's healthcare initiative; how to control costs; developing a revenue stream to pay for the initiative; and "who's been standing in the way."

Dean avows that change is possible through the citizens, calling for change and action. He writes of how this affects people in different walks of life and details, "What you deserve, and should fight for." He staunchly recommends how citizens can and should take action; educate themselves; contact their local and national officials; contact corporations and organizations and keep the conversation going until change happens.

The last sentence makes Dean's position clear, "Fights like this are won by ordinary people who decide that they care enough about something to fight for it." Prescription for Real Healthcare Reform should be required reading for every American over the age of 18. This is the most comprehensive and accessible presentation of a situation that deeply affects each one of us.

About the author:

Physician Howard Dean is the former chairman of the Democratic National Committee. He served six terms as Governor of Vermont and ran for the Democratic Party's presidential nomination in 2004. Dean founded, Democracy for America, a grassroots effort that organizes community activists, trains staff and endorses progressive candidates.

So that you know my point of view: I'm a 56 year old family physician that has practiced on Indian reservations, in clinics that cater exclusively to Medicare and Medicaid patients, and for the last 14 years, in a private practice group of eight doctors in a small town in Central Oregon.

Howard Dean's Prescription for Real Healthcare Reform is an even-handed, even-tempered, well researched investigation of what options we Americans face regarding the future of healthcare in our country. With none of the stridency of either the free market advocates or the single payor systems devotees, Dean lays out some indisputable facts, and offers thoughtful solutions to decreasing costs. Here are some basics, all of which have been documented thoroughly elsewhere: the United States spends 15% of its Gross Domestic Product (GDP) on healthcare, 50% higher than what our allies France and Canada spend, 40% higher than what Switzerland spends. For this, we get a product that is ranked last in quality, access, efficiency, and health of citizens as compared to our European and Canadian counterparts. This isn't a liberal problem, or a conservative problem. It's a humiliating problem for a physician like myself that takes pride in my country and my profession. And it's a problem that I seeing play out in real life every day that I show up to work. It flies in the face of our image of ourselves as a can do, innovative people.

Dean's short (115 pages of fairly large print) book is a bit dry, reading somewhat like a lengthy white paper on healthcare reform. Dense in information, engaged but not enraged, Dean lays out solutions that have worked internationally much better than our own haphazard approach to national healthcare, yet solutions that Americans might improve upon with our hallmark ingenuity, inventiveness, and commitment to competition in the marketplace. He does NOT advocate a single payor system, he DOES insist that we need a "government based option". Option, as in Dean's belief that Americans insist on choice, and his belief that a single payor option that would compel Americans to belong is a non-starter.

If you're an archetypal "bleeding heart liberal", you'll get little sympathy from Dean: he's a pragmatist that bluntly advocates a practical approach to good bang for the buck healthcare for all. If you're a free market fanatic, you'll find out why the captains of industry (e.g. automakers) are crying "Uncle!" or "Uncle Sam!" to get out from under the $1400 per car cost of their employee health insurance. You'll also find out that Medicare spends about 10% of its revenue on administration, versus double that in the private insurance industry, and achieves markedly better results than private industry health care insurance.

In short, Dean's book provides a useful framework for the debate regarding what to do about an overly expensive, poorly performing, industry injuring, health care system, regardless of your political persuasion.

Am I willing to take a personal hit in my paycheck as a physician to see reform come to the U.S? You betcha, as in yesterday. Especially if they force me to take the salary those poor primary care blokes in the United Kingdom make: $220K/year. Which is roughly TWICE what I make here in rural U.S.A. :-))

Howard Dean's Prescription for Real Healthcare Reform: How We Can Achieve Affordable Medical Care for Every American and Make Our Jobs Safer

I thought I was a little smarter than the average bear when it came to understanding healthcare reform, since I worked in employee benefits for more than 10 years in the 70s and 80s when cost-containment (but not yet issues of denied coverage) had just become a major issue. However, I still learned quite a bit from Dr. Dean's book about the past history of healthcare reform, what is included in Obama's plan, and what other countries do. I highlighted huge portions to quote for my blog on healthcare reform.

Though obviously put together quickly, including a few typos and awkward sentences, it is still quite interesting and easy to read. At the same time, I'd say it is as objective as it needs to be in this fight that has turned into a shouting match. When opponents of reform are spouting outright lies--which they are--there isn't room for much deference. On the other hand, what some are touting as a plan from the far left, actually pays great homage to our free enterprise system. Dean repeats over and over that Americans wouldn't accept a plan without choice, though I'm not so sure that is true.

However, as originally a strong advocate of single payer, I was amazed to learn that most of the countries providing universal healthcare are not single payer but a system of competing private plans with guaranteed coverage and community rating with most either providing some form of public option for those who can't afford private coverage or a mandate on what private insurers can charge. As I can't see anyone in this country accepting regulation of what a private insurer can charge as premiums, the public option now appears to me as the most reasonable way to go.

I was a little vague on how much of what Dean outlines is actually part of the Obama reform plan and how much is what he, Dr. Dean, would like to see. But there's no doubt that, as a physician and former governor who successfully reformed Vermont's healthcare system, he is knowledgeable on the subject and his ideas should be considered seriously.

Even if you think you already know where you stand on this subject, I suggest you read this book. It could change your mind.

As an ICU nurse, in a county hospital, I've had to take classes on health and social polciy as part of my core curriculum, and I work on a dialy basis with people whom have lost their health insurance for myrad reasons.

In the last few weeks, I've had to distill my education about the Canadian, French, Swiss, German, Japanese, British and other health care systems down for anyone who's approached me with an argument against Obama's health care reform.

There isn't a Nurse, Doctor, Orderly, Lab technician that I know who is against the single payer health care system, or the health care reforms we have in store for us, yet it's shocking to me to see how many lay people (non health care workers) simply do not understand the real issues. It's as if the whole picture and the real facts have been hidden from them in order to keep this issue divisive.

Dr. Dean distills an entire semester of health and social polcy down for the layman to understand, TRUELY understand, what the real issues are, and why this will work.

It seems that fear and a lack of all the facts are what most people opposed to a government run health care system are armed with. This book is easy to understand and a very quick, single afternoon read. I think everyone should read it to better understand the whole issue, without any bias, without any party politics, without any "us and them" sort of things thrown in.


In the mean time, I will keep correcting people when they say Canadians have to wait for surgery (yes, elective surgery, they have a bit of a wait, but not for important surgery) and how we spend something like 16% of our GDP on health care in administration costs, while Japan spends something like 8% and every man, woman and child is covered for life. If you love your health care coverage, it's only because your insurance company hasn't tried to cancel your policy once you really need it--like most of my patients. It shouldn't be this way.

Please read this book, if not to change your mind about government run healthcare, to at least arm yourself with the facts so that you have them and you'd like to argue with someone like me, who's had to study this topic in school--but my guess is, once you get the facts, you'll agree with me, your MD, your nurse, your lab tech, and Dr. Dean.

"Howard Dean's Prescription for Real Healthcare Reform" makes crystal clear that the healthcare status quo is not only undermining our nation's health and driving more and more of us into bankruptcy every day, but failing to truly reform healthcare now will only insure the following:

1. More jobs WILL be lost to foreign workers.
2. More American businesses WILL fail.
3. America's innovative and competitive edge WILL be lost.
4. Real human beings WILL suffer needlessly.
5. For-profit healthcare, without an efficient competitive element, WILL bankrupt America.

Dr. Dean's book is written so clearly and simply, even a child can understand it. It becomes obvious that America is going to go down the tubes if strong healthcare reform (not just insurance reform) is NOT passed by the Congress this year. That means a strong, unfettered public option as one of our coverage choices. Without that, the idea of competition between insurers is laughable; it will be like credit card companies competing with each other to charge us 29% interest.

As I read through this book, knowing I would be reviewing it, I was marking sections I thought would be especially strong to quote in this review. I soon realized that the entire book is an especially strong quote. This one sums it up pretty well, however: "In other words, Americans get to make the choice of what kind of healthcare plan they want for themselves. Obama's plan does not leave the choice up to Congress. It does not leave the choice to insurance companies, employers, governors, or other politicians. You get to choose." This is a book that you will read--and want to buy copies for all your friends to read--and then pass it on and on and on.

Dr. Dean's book made me realize why the insurance lobby is spending over A MILLION DOLLARS A DAY trying to scare Americans into believing that the Obama administration's proposed healthcare reform is pure unadulterated demonic socialist kill-all-the-old-people/flush-America-down-the-toilet PURE-EVILness. They're afraid too many of us are going to read this book and share it with everyone we know, and their only hope is to close as many minds as possible before that happens. (God forbid that anyone should read this book because, if they do, the might just start demanding that private insurers actually provide what we've been paying them so dearly for.)

Did you get that? Insurance companies are spending more than a million dollars A DAY of OUR premium dollars to dupe us into thinking we have the "best healthcare system in the world" and that we'll all turn into commies if true reform passes. Let your senators and representative in Congress know you aren't going to be manipulated and bullied by powerful interests into letting them slide on healthcare reform. They DO listen to what the American people have to say. We just have to educate ourselves and then SPEAK OUR MINDS. Loudly. NOW.

If I had not gotten the book for free from Amazon Vine, I would have stopped reading at page 25 because I was convinced.

Governor Dean defines the reform as two types - insurance reform and healthcare reform.

A) Insurance reform costs the budget nothing and has two components:

1) guaranteed insurance - everyone is entitled to health insurance and cannot be dropped
2) community rating - insurance rates are based on the community profile and not on the health of the patient - no insuring just the healthy


B) Healthcare reform - the most important part of the effort , it provides a public option similar to medicare. Anybody who wants to can get their health insurance through the government in a fashion similar to medicare.



The key facet to these proposals is that the citizen will still have access to all the existing health care plans or may opt for the public option. If the health care consumer feels private is best they can have that. If they prefer the public option they can have that. If they want the public option and to buy extra private insurance they can do that as well.


Some other interesting points in the book:

1) Currently over 1/3 of health care dollars are not spent on health care
2) Competitiveness of American companies are being hampered by health care costs.
3) In ten years health care costs are up 120% for businesses.
4) The new proposals give health insurance to those under 30 for free because they are cheap to insure.
5) Small business will not have to provide health care , their employees will receive assistance to do so from the government. Health care is an onerous burden for the small business.
6) Data will be gathered to determine which treatments are actually effective. Amazingly this is not already done.
7) Most bankruptcies have large unpaid health care bills a a partial or total cause. The earnings of health insurance companies have been rising dramatically.
8) A majority of primary care physicians back a government insurance plan because they are inundated with a huge number of forms and dishonest insurance companies that do not want to pay.
9) Some hospitals have almost as many people processing claims as they do health care practitioners.
10) General Motors is one of the largest health insurance companies in the world. It is a huge distraction from making cars. Foreign car companies benefit from government run health insurance plans. Foreign manufacturers do not want to manufacture here because of health costs.
11) World Health Organization ranks the French Health care system as the best in the world. Much of the advantage is because universal health care provides much better preventative care.
12) There is no single model for universal health care , every country is different.
13) France spends 10.4 percent of GDP on health care, USA spends 15.2%.
14) The Republican approach to Healthcare reform is to shout "reform" followed by fear mongering about fictional drawbacks so as to prevent any progress.

This book is clear, concise and easy-to-read. It discusses the pros and cons of various alternatives to health care reform, including a short discussion of health care systems in other developed countries, making clear that there are a variety of different approaches to providing universal health care, not just the Canadian or the English system as the Republicans and the right-wing media would have your believe.

In fact, though I'm personally in favor of a single-payer system, Dr. Dean explains why, in his opinion at least, continuing our private insurance system -- together with a strong public option -- makes the most sense.

The only problem I have is I wish the book had come out a month or two earlier so it could have been discussed by the media during the debate on health care reform and to refute some of the ridulous claims of the opponents of reform.

Howard Dean makes an easily understood presentation of the crisis in health care and what he proposed will resolves these problems. Dean was distressed to see how often health care insurers stopped covering someone once they became ill. He notes the Congressional Budget Office calculates that, in the individual health care insurance market, that 29% of premiums pay for administrative costs. He found most insurance companies use of to half their expense on executive salaries, administrative costs, and profits to shareholders.

Dean notes 47 million do not have health care insurance. 25 million have such insurance but can't afford their share of the costs to see a doctor. Many face either bankrupting themselves to pay for health care or doing without.

Many states have weak laws regarding health insurance, which is regulated by state laws. Many states allow premiums to increase drastically. Many allow coverage to be denied to health conditions that arise later, sometimes upon review and sometimes even more than a year after purchasing the policy. Some policies only provide minimal coverage, such as up to $50,000 in lifetime costs or $1,000 for hospitalization. It is hard for the public to understand health care insurance policies. They are deliberately written in technical language the public finds trouble understanding.

Dean notes that Canada's national health care system attracts businesses to locate there. Establishing instead in the U.S. entails employers making large enough health care expenditures that it is cheaper for them to locate in Canada.

Health care insurance should be available to everyone, Dean writes. It should be affordable, rather than something that contributes towards half of all bankruptcies. Health care should stay with an individual and not be dropped when a person changes jobs. People should be allowed to keep their existing coverage, if they wish. A tax credit should be provided to small businesses to help them pay for their required health care insurance. Our efforts on disease prevention, health care research, and health information technologies should be increased.

A public insurance option would have lower administrative costs. It would drive private insurance to compete by lowering their expenses and their costs to customers. This system would preserve the wishes of Americans consumers to have choices.

Americans deserve informed choices. This is particularly important when it comes to the public being able to understand their choice on pharmaceuticals and how different brands of similar drugs work and what their possible side effects are.

Dean states a 5% gas tax would pay for health care insurance costs. The costs of the public insurance could by transferring excessive Medicare payments to the public insurance system.

Private insurance and business interests are fighting to protect their own interests against health care reform that would be in the public's interest.

The U.S. spends $5,711 per capita on health care compared to $2,989 in Canada and $2,317 in Great Britain. The U.S. spends 15.2% of its GDP on health care compared to 9.9% in Canada and 7.8% in Great Britain.

Senators and Representatives, Republicans and so-called Blue Dog Democrats, bought by Insurance companies and pharmaceutical conglomerates, are out to kill any and all bills attempting to disturb their oh-so-comfortable status quo. Their buddies are spreading lies and fomenting un-civil disruption of meetings designed to disseminate the truth about pending Health Care Reforms. These uprisings are not impromptu Grassroots displays - they are astroturf incited and produced by all those folks I mentioned above.

Get Dr./Governor/Chairman Howard Dean's book. Read it. Act. If you don't, we will all be sold down the river. Again.

I am a solo private practitoner attorney who represents people who have been wrongfully denied Social Security and SSI Disability benefits. and I could go on and on about the horrors of our current "system" - unless my client happens to be a Veteran, and is therefore eligible for the Best Care Anywhere: Why VA Health Care is Better Than Yours - (see, the Government CAN deliver good care!)
I am just me - no employees.
I find myself constantly paying more and more for less and less health insurance coverage from Blue Cross/Blue Shield so that they can pay their employees more and more obscene perks.
This is very, very wrong.

The Democrat(?) president now appears to be throwing out the baby AND the bath water in an attempt to garner "bi-partisan" support from folk (again, see above) who ain't not never gonna vote for any of it - not no way, not no how.

Dean explains the mess we are currently in and what YOU can do about it.

The abandonment of the "Public Option," which is itself a compromise from the more sensible single-payor system (it works for my clients! i.e. Medicare,) would totally gut "Health Care Reform" and then allow Obama to take credit for health care reform that isn't reform at all.

Stand Up! Stand Firm.

/TundraVision, Amazon Reviewer

Howard Dean should keep shouting it out. I think he sums up the situation clearly and concisely. He presents a rational approach for resolving the health care crisis we now face in the United States.