During the summer of 1991, I was serving in the part-time position of lieutenant governor of Vermont while also continuing the internal medicine practice I shared with my wife, Judy Steinberg Dean, in the town of Shelburne. One morning that August, during an appointment with a patient, I learned by telephone that Gov. Richard Snelling had passed away.
Stunned by the news, I returned to complete the physical, called my wife in to take care of my afternoon patients, got into my car and rushed to the state capital of Montpelier to be sworn into the office of governor.
I walked into the governor's office that August day knowing that tens of thousands of Vermonters lacked health insurance. As both a public official and a doctor, I knew all too well the effects that lack of insurance has on our citizens.
During my tenure in that office (I did not seek re-election last year), I was able to guarantee health insurance to nearly every child in Vermont and more than 90% of adults through a combination of public and private insurance programs. We phased in this coverage so that it was affordable, sustainable and, most importantly in the political world, incredibly popular.
I've traveled to so many states since I launched my current campaign for the White House, and have seen the effects of having so many Americans-more than 40 million now-being uninsured. I know this is not news to readers of this magazine, many of you physicians like myself.
I have proposed a plan that guarantees coverage to most Americans without requiring a massive overhaul of the system or government takeover. I want states to provide coverage through an expansion of Medicaid to those under age 23; a drug benefit to Medicare for those over 65; and federal subsidies to small businesses, self-employed workers and companies without benefit packages to enable them to buy into basic coverage plans. The cost is equal to about half the president's tax cut.
As I watched the president's State of the Union address last week, I was particularly interested in any new ideas he had for solving the problem of the uninsured. I came away wondering if the Bush administration even understands there is a problem.
The bulk of his healthcare plan essentially privatizes Medicare, and requires seniors seeking a prescription drug benefit to enroll in an HMO plan. As a physician and a former governor, I recognize the unfortunate reality of that proposal:
* Seniors would be trapped by the regulations of their particular HMO-their rates, premiums, benefits, etc.
* Those who want to remain on Medicare will be denied prescription drug benefits.
* The high cap on catastrophic drug costs under the Bush plan would be a blow to many seniors, particularly those on fixed incomes.
I find it particularly amazing that the president is proposing these changes at a time when Medicare HMOs are dropping seniors from their programs in startling numbers-about 2.4 million have been forced out of HMO plans in the last five years alone.
I realize how critical this issue is to senior citizens, and while it has become almost a cliche, it is true nonetheless that many of them are forced to choose between paying their rent or their prescription drug bills. Drug costs are climbing at a rate of about 13% annually, forcing some seniors to simply go without their medications. Holding down drug costs and helping seniors pay for medications must be a priority.
After listening to the president's speech and reading newspaper accounts of the details, I shook my head in disappointment. At a time when we as a nation should be finding ways to provide insurance to every American, this president actually was putting forward a plan that would reduce benefits for millions of people.
Congress has devoted months (you might even argue years) to debating a patients' bill of rights. Bush administration officials have presumably spent months crafting a plan to cut seniors out of prescription drug benefits. And during all this time, not one more American has healthcare as a result. As a doctor and a former governor, I find that inexcusable.
In Vermont, we found a way to insure most adults and guarantee coverage for almost every child. At the same time, we retired an enormous state deficit, built up reserve funds, paid off state debt, lowered the income tax twice as the economy began to rebound and eliminated the sales tax on most clothing.
We built a health insurance program that gives families the comfort of knowing that a serious illness or accident won't result in bankruptcy. We expanded the program gradually, so that our state could afford to fund this through good economic times and bad.
If we can accomplish that goal in our state, we can accomplish it for the nation. That should have been the president's message to the nation last week.
Until most Americans have coverage for themselves and their families, the state of the union needs improvement.
Howard Dean, a physician, was governor of Vermont from 1991 until last month. He is seeking the Democratic nomination for president.