Governor Howard Dean, M.D.'s Health Care Plan for America

Columbia University, New York City, May 13, 2003

Thank you so much.

As some of you know, I took night classes at Columbia University General Studies prior to going to medical school.

In that respect, while I'm happy to be back at Columbia, I'm especially pleased to be here in the daylight.

This university was my first stop on the road to becoming a physician. Today, it's the latest stop in my campaign to ensure that every American has access to affordable, quality health care.

From the moment I entered this race, guaranteeing affordable access to health care, and balancing the budget have been the touchstones of my campaign. From day one, I've outlined how I'd achieve universal health care and challenged my opponents to do the same.

To me, health care isn't simply a policy issue. It's a moral imperative. Here, in the richest, most advanced country in the world in the 21st century, it's simply wrong for a sick child to go without seeing a doctor because her parents can't afford it.

Wrong for a woman to find out she has late stage breast cancer, because she couldn't afford a mammogram.

Wrong for elderly people to be choosing between prescriptions and food.

A few weeks ago, Congressman Gephardt spoke eloquently about the need for health care as the moral issue of our time. He and I agree on that and so does the Democratic party which, since the days of Harry Truman, has given health care a central spot in its platform.

Today, the Democrats have two distinct plans on the table for achieving health care for all Americans: Congressman Gephardt's and mine. I look forward to the time when all Democrats in the race have put their plans before the American people.

But we must remember that the important distinction in this election isn't between the details of the Democratic plans. It's the distinction between Democrats who view this as a moral imperative and President Bush, who for over two years has failed to address this issue.

Instead, he and the Republican party have pursued a misguided economic policy mortgaging our economic future for a set of tax cuts that provide, at best, minimal help to the average American working family.

In 1974, I was living here in New York City, volunteering in the emergency room at Saint Vincent's Hospital on 12th Street.

My life began to change.

I decided there was nothing more significant I could possibly do to help others than to become a physician.

Following my classes here at Columbia, I attended Albert Einstein School of Medicine in the Bronx.

And then, after my residency at the University of Vermont Medical Center, I joined a medical practice, and later was joined by an exceptional physician named Judith Steinberg who, I should add, is also my wife. In addition to my practice, I volunteered at the community health center in Burlington providing care to people who had no insurance.

That was in the early 80s.

Many of you will remember that it was a time of tremendous economic upheaval -- not unlike today.

Americans were suffering through a recession and Judy and I saw first hand the impact on Vermonters.

The patients we saw were often young parents who'd been laid off from their jobs.

Many of them had lost their health benefits. Drawing down savings just to pay their mortgages or their rent, they simply couldn't afford the cost of seeing a doctor.

Kids with strep, who should have been properly diagnosed and properly treated, were instead being given Tylenol by parents who gambled that it was only the flu... all because they could not afford to take their son or daughter to the doctor.

There were some patients we saw who might have never gotten ill to begin with had they received preventive care.

There were plenty of patients who came to my office who couldn't pay and, as best we could, we never turned away anyone who needed help.

But I understood that the real problem wasn't that there were too few physicians who were donating their services; it was that there were too many families going without the basic health care coverage they needed.

Today the United States is the only industrialized nation in the world that doesn't have health insurance for all its citizens; the British, French, Germans, Canadians, Israelis, Japanese, and even the Costa Ricans have health insurance for all their people. We have fallen 50 years behind the social standards of what we consider to be the civilized world.

That's a big reason why I got involved in politics in 1982 running for and serving as a State legislator, Lieutenant Governor, and then Governor.

I thought I could apply some of the same lessons to government that I learned as a physician.

And I'm very proud of the work we did in Vermont during those years.

For example, in 1989, we launched Dr. Dynasaur. That's our health program for kids. It covered children through age six whose parents didn't have enough money to buy health insurance, but who still earned too much to qualify for Medicaid.

Just as significantly we also provided coverage for pregnant women who had been ineligible for Medicaid. Today, Vermont has one of the highest percentages of women who get prenatal care than any other state.

Then, one day in 1991, I was at my office giving a patient a physical when I received a call telling me that our Governor, Dick Snelling, had just died of a heart attack.

It was shocking news.

One of my first thoughts, of course, was that as the new Governor, I ought to get to the State Capitol in Montpelier as soon as I could.

But, as a doctor, I knew I'd better complete that patient's physical because I knew it would be a long time before we could reschedule.

In 1992, we gradually expanded coverage to include all kids under 18 and families earning the equivalent of $55,200 for a family of four.

But we went beyond offering care for kids.

In 1995, we launched what we call the Vermont Health Access Plan. By combining federal and state dollars we were able to offer basic health insurance to working people with incomes up to $27,600 a year for a family of four.

And we didn't stop there.

We expanded our plan to provide a prescription drug benefit. Low income elderly and disabled people now can get limited coverage up to 225 percent of the federal poverty level. They also have access to all the medicine they need at a discount of 41 percent off of the retail price.

I'm proud of our results.

Because while the number of uninsured Americans has been climbing, over the last ten years the uninsurance rate in my state has actually dropped from 17 percent to just under 8 1/2 percent.

Almost 92 percent of our people now have coverage!

But here's what makes me proudest: 99 percent of all Vermont children are eligible for health insurance and 96 percent have it.

We coupled our success in insuring kids with a new early childhood initiative that we call Success by Six. As a result, nine out of ten parents with a newborn baby, regardless of income, get a home visit from a community outreach worker who's there to help them with parenting skills and put those parents in touch with the services they may need or want.

Thanks to Success by Six, we've cut our state's child abuse rate nearly in half, and child sexual abuse for kids under 6 is down by 70 percent.

Now, when I tell people about our record I often get this response:

   "I want to move to Vermont. Can you help me get a job there?"

If we can do this in a small rural state which ranks 26th in income in the country, surely the most powerful and wealthy society on the face of this earth can join every other industrialized nation in the world to make sure that all its citizens have health insurance.

Today, 41 million American men, women and children lack health insurance.

The number of uninsured is soaring at the rate of nearly one million people every year.

Over 40 percent of uninsured adults postponed seeking medical care last year alone.

The impact is far more personal than the statistics:

Over 25 percent of the children living right near here in central Harlem have asthma: How are they going to get treated?

Young children aren't getting the care they need to treat infections... or pneumonia... or even broken limbs.

Adults with diabetes and hypertension, lacking routine care, end up in hospital rooms.

Women diagnosed with breast, or even cervical cancer, are dying who could have been treated if they had seen a doctor sooner.

I know we can do better

At a time when insurance costs paid by working families are increasing exponentially each year, we can do better than President Bush's plan to cut taxes for people that make a million dollars a year, which he will pay for by slashing veterans health care benefits and children's health insurance.

At a time when 1,300 babies are born in this country without health insurance every day, there is no excuse none for the President's plan to slash funding for Medicaid and the State Children's Health Insurance Program by $2.5 billion dollars.

I believe America deserves better than that.

We all know what President Bush hasn't done. Well, let me tell you what I will do.

Since the Bush administration has taken office, we have lost over 2.5 million jobs. I'll begin by putting our country's fiscal house in order by balancing the budget.

If we don't restore fiscal integrity to our government we will simply not have the dollars it takes to offer the health care coverage America needs.

We can do this if we take part of the Bush tax cuts and use it to create a practical system giving every American an affordable way to purchase health insurance.

Now I am not naive. If you ask Americans whether they would like to get rid of the President's tax cut, they will say no. If you give Americans a choice between having health insurance that can never be taken away, or keeping the President's tax cuts most Americans will choose health insurance since many of them never even received a tax cut.

We'll help families get health insurance, and help small businesses provide it to their employees. And we'll ensure that those large companies that avoid their responsibility to provide insurance lose some of the special tax breaks and benefits that Congress has given them.

Let me tell you how we'll do it by describing what my plan means for four groups: for children, for working families, for small businesses and for large employers. I will walk you through the details in the question and answer session to follow.

First, and most important, we'll extend health coverage to every uninsured child and young adult up to age 25.

To do this, we'll redefine and expand two essential Federal/State programs Medicaid and the State Children's Health Insurance Program. Right now, they only offer coverage to children from lower income families. Under my plan, we cover all kids and young adults up to age 25. Not just low income people, but middle class people, too.

Doing this will give 11.5 million more kids and young adults access to the health care they need.

Access to immunizations. Access to preventive care. Access to better, healthier lives.

We made this happen in Vermont and we can make it happen for the rest of America, too.

Second, we'll give a leg up to working families struggling to afford health insurance.

We'll make adults earning up to 185 percent of the poverty level eligible for coverage by making the children's health program the Families and Children Health Insurance Program. By doing this, an additional 11.8 million more people will have access to the care they need.

A lot of working families have incomes that put them beyond the help offered by government programs. That doesn't mean, though, that they have an affordable health care option. We'll establish a health insurance plan that they can buy into, providing coverage identical to what members of Congress and federal employees receive.

To cushion the costs, we'll also offer a significant tax credit to those with high premium costs. By doing this, another 5.5 million adults will have access to care.

Third, we need to recognize that one key to universal health care is making health care affordable to small businesses.

We have to agree that we can't turn our back on the employer-based system we have now.

But, by the same token, we shouldn't simply throw money at it, either.

Instead, we need to modernize it so employers will have an option beyond passing rising costs on to workers or bailing out of the system entirely.

And modernizing it begins by modeling it on this country's best example of efficient, affordable and user-friendly health care coverage: it's the one I mentioned a moment ago; the federal employee health system.

With my plan, we'll organize a system identical to the one federal workers and members of Congress have. And we'll enable all employers with less than 50 workers to join it at rates lower than are currently available to these companies-- provided they insure their workforce.

I'd also offer employers a deal: the federal government will pick up 70 percent of COBRA premiums, but we'll expect employers to pay the cost of extending coverage for an additional two months.

Two months may not sound like a long time, but we know that those two months are often the difference between workers finding the health coverage they need, or joining the ranks of the uninsured.

This is a sensible way to help small business afford to offer health care to their employees.

Finally, a word about corporate responsibility.

There are a lot of corporations today that could provide health care to their employees but choose not to. This is unfair, because ultimately it's the public who pays every time our health care system is used by someone who doesn't have the insurance.

We pay in the form of increased hospital costs, higher physician fees and bigger insurance premiums.

That's why the final element of my plan is a clear, strong message to corporate America that providing health coverage is fundamental to being a good corporate citizen.

I look at business tax deductions as part of a compact between American taxpayers and corporate America. We give businesses certain benefits, and expect them to live up to certain responsibilities.

One of those responsibilities is this: if you operate a business that can afford to pay its executives large salaries and provide them with generous bonuses and benefits, then you ought to be prepared to pay for health insurance for your employees.

If you are not, we're not going to give you the same generous tax benefits we're giving to those businesses that are providing health insurance to their workers.

This is not a mandate. In fact, you won't find significant mandates in my plan. That will only lead to another decade without coverage for 41 million Americans.

The plan I've laid out for you today to cover all children, to make insurance affordable to working families and small businesses, and to ensure that large employers who can afford to are providing coverage is not simply a health care plan. It's an important part of my economic plan as well.

Consider these impacts:

  • Small businesses will be able to buy into larger insurance pools, lowering their health care costs and freeing up valuable working capital.
  • Refundable tax credits will be in the hands of working families. Let me ask you: who is more likely to spend the money they receive in tax relief, working families who qualify for these credits or people reporting dividends and capital gains on their returns?
  • The workforce will be healthier, and our employees will have healthier children resulting in fewer sick days, fewer days off to care for sick children all of these are important parts of the economic stimulus health insurance will bring.

The plan I've presented here today marks the beginning not the end of a process for me. If laying out a plan were enough, we would have solved this crisis long ago.

We have to do something else: we have to take our case to the American people. Meet with them. Discuss the issues with them.

And, I'll tell you something else: we ought to listen to them, too.

Because Universal health care will never come to pass if the only debate is between politicians inside the Beltway.

I'm convinced that it can -- and will happen -- if the American people are part of the conversation and that's what I'll be doing in this campaign.

I'll take these ideas to every state and every town I visit. To every union hall and every workplace. To every family farm and every neighborhood diner.

But I want to be clear with you, the plan I've laid out here this morning is only a first step in solving our health care crisis. Universal access is fundamental, but it's not enough on its own.

Over these coming weeks and months, I'll be speaking out on the other aspects of this crisis.

Take Medicare. Everyone will tell you they want to protect Medicare. I do, too. But I also want to improve it.

For example, it's shortsighted for Medicare to punish some states by paying medical providers less on a per patient basis than they do providers in other states.

It also makes no sense that Medicare doesn't offer a prescription drug benefit.

You know, at the time Medicare was created neither President Johnson, nor anyone else, could have imagined the role prescription drugs would eventually play in health care.

That generation had an excuse for not including a drug benefit under Medicare; our generation doesn't.

Now that President Bush and the Republicans control both houses of Congress as well as the White House I'm interested in seeing what their long-promised prescription drug plan finally looks like. I appreciate that the President has set aside $400 billion dollars in his budget to provide prescription drugs,

But I can tell you this: as president I would not propose... could not consider... and will veto any prescription drug benefit that requires Medicare recipients to give up the right to see the doctors they want -- to get the medicines they need!

And there are other important issues I'll be addressing, too:

  • The need for cost containment, including a change in the law that closes the patent loopholes used by brand name drug companies to unfairly extend their patents; anti-competitive practices; and allowing international imports of drugs.
  • In addition we must also ask physicians to adopt best practices that lead to high quality care delivered more cost effectively to patients.
  • Safeguarding patient safety and health care quality.
  • Guaranteeing the confidentiality of medical records.
  • Setting fair reimbursement rates for providers. Including the $3.6 billion dollar appropriation for Medicare so that we stop under funding our nursing homes around the country and stop jeopardizing the health of our seniors.
  • Providing mental health services and quality dental care.
  • Carrying on the fight against breast cancer, HIV, AIDS and other diseases.
  • Restoring and revitalizing our public health infrastructure.
  • Ensuring our medical research keeps pace with our ethics. (For example I will fully fund our ability to do stem cell research based on medical facts -- not religious ideology.)
  • And finally, eliminating racial disparities in health care in part by training more members of minority communities as physicians and nurses.

I'm not running for president in spite of the fact that I'm a doctor.

In a very real sense, I'm running because of it.

I'm in this race because I'm convinced that America's strength can't only be measured by the power of our military, but by the depth of our compassion and our humanity.

Many years ago, a plainspoken man observed that:

"Millions of our citizens do not now have a full measure of opportunity to achieve and enjoy good health.

Millions do not now have protection or security against the economic effects of sickness.

The time has arrived for action to help them attain that opportunity and that protection."

It was 1948 and the man who said those words was a Democrat named Harry S. Truman.

He believed that winning health care for every family was at the core of the Democratic Party's compact with the American people.

It was true then...and I believe it's still true today.

Honoring that compact and keeping faith with America's working families: That's really what this election is all about.

When I graduated from medical school and set off to begin the practice of medicine I took an oath in which I pledged to practice my profession with conscience and dignity and to always make the health of my patients my first consideration.

In my practice, I honored that oath by treating families who needed my care, even when they couldn't afford to pay.

As a Governor, I honored that oath by seeing to it that parents could take their children to see a doctor, guaranteeing that older people need never worry whether they could afford to buy their medicine, and making my state one of the best insured in America.

This is the great moral imperative of our generation and I will not rest in this campaign or as your President until we have achieved our goal.

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