(previously posted to Daily Kos
Imagine a presidential candidate pushing this three-tiered national health care plan:
- States should be required to guarantee coverage for all children under age 23. In return, the federal government should assume responsibility for drug and acute medical care for Americans over age 65.
- Older Americans deserve a pharmacy benefit under Medicare (an unaffordable impossibility under Bush's current fiscal policies). This would cost $450 billion over 10 years, a little more than 1/4 of the value of Bush's tax cut. With a pharmaceutical package, Medicare becomes a decent insurance program.
- Finally, to cover those between the ages of 23 and 65, we should use the present employer-based system with refundable tax credits and federal subsidies to cover low- and moderate-income Americans who lack insurance.
Imagine this candidate's rivals for the Democratic nomination assailing his plan from the left as not comprehensive enough.
The year was 2004, the candidate was Howard Dean, and the attacks came from people like Dick Gephardt.
In 2004, I supported Howard Dean because he struck me as a pragmatic, rational individual. I was attracted to him for things that had nothing to do with Iraq (although that was a plus). These included his sane stances on issues such as gun control, drug legalization, and health care, with the last as his intended centerpiece issue before he pragmatically jumped on the anti-Iraq train. Dean's plan stemmed first from experience but also seemingly from a mindset that sought first to establish a budget for health care (based on repealing the Bush tax cuts) then determining how he could cover the most people within that budget as part of a plan that could actually pass Congress.
The last part is important. As this past year has shown us, a Democratic Congress isn't a rubber stamp for progressive programs. Howard Dean's health care was doable. Other's ween't. The good doctor said:
"All we do is make it easier for people to buy health insurance. We don't control the health insurance market. Nobody has to change their insurance company or their doctor if they don't want to in this plan, and that's what people objected to in the '90s."
Arguably, candidates who put forward much more ambitious health care plans are either politically naive or pandering to people who want to hear about universal health care without regard to practicality and cost.
Barack Obama has a plan that looks similar to Dean's. If anything, it feels as if it might have been cribbed a bit from Howard Dean's plan, but Obama lacks Dean's over-arching emphasis of fiscal responsibility. And, like Dean, Obama has faced criticism from the left for his plan. But it's a plan which definitely has a place within the boundaries of progressive mainstream thought.
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