Remember when Howard Dean was a rabble-rousing progressive, the one who ran for president railing against special interests? Remember when he insisted health care reform include a public insurance option, at one point suggesting that a plan without a government-run plan was “worthless”? Ah, good times…
Now Dean is back talking about health care. But this time he’s doing it on the opinion pages of the Wall Street Journal, in an essay called “The Affordable Care Act’s Rate-Setting Won’t Work.” As the venue and title suggest, he is making a different sort of argument this time. It's enough to make those of us who defended Dean during his 2004 campaign wonder what the heck we were thinking.
Oh, Dean says he still supports health care reform—or, at least, its goals. And, despite his well-known qualms about Obamacare, he continues to think it will make America a better place. “When fully implemented the law will move America closer to universal health coverage—something many progressives have sought for years,” Dean writes today. But, he goes on to say, “the law still has its flaws, and American lawmakers and citizens have both an opportunity and responsibility to fix them.” The rest of the article focuses on one particular “flaw”: The Independent Payment Advisory Board, or IPAB.
IPAB is the commission that, under Obamacare, has the power to adjust Medicare payment policies in order to hold down the program’s cost. It’s been controversial from the get-go, with conservatives crudely claiming that it would ration care and Sarah Palin famously calling it a death panel. It was a ridiculous accusation. As a briefing from the Kaiser Family Foundation explains, Obamacare explicitly prohibits IPAB from “submitting proposals that would ration care, increase taxes, change Medicare benefits or eligibility, increase beneficiary premiums and cost-sharing requirements, or reduce low-income subsidies under Part D." (This Kaiser Health News briefing has more on the basics and the political controversy over it.)
More sophisticated conservatives make a more sophisticated version of the argument—namely, that IPAB might set payment policies in ways that ultimately reduce access or quality. I don’t happen to agree with that view, but it’s a legitimate argument and one that serious people can make. What’s weird is to hear it coming from Dean. After all, the whole point of the public option that Dean once championed so tirelessly was to introduce a government insurance plan that would help set payment rates. The idea was that government would end up paying less to the producers of medical care. Doctors, hospitals, along with device and drug makers would make less money. But the government would also spend less subsidizing insurance for people. It’s the same method of controlling costs that Medicare already uses, and that IPAB will reinforce.
Or maybe it’s not so strange to hear Dean say this. Since his career in politics ended, Dean has found a home in the K Street establishment he once held in such disdain. He’s a strategic adviser to McKenna, Long, and Aldridge, a major Washington lobbying firm whose clients have included health care and pharmaceutical companies. Dean has never registered as a lobbyist, as far as I know, but the distinction is largely illusory. In 2009, one CEO told the publication BioCentury that Dean was “very helpful” in their efforts to loosen federal regulations on drug development.” Another said that “Dean has been a great addition to our team.”
It looks like he still is.
Jonathan Cohn is a senior editor at the New Republic. Follow him on twitter @CitizenCohn