For the last three days, former Vermont Gov. Howard Dean, M.D., has been rousing crowds by questioning why America doesn't have universal coverage and naming nearly a dozen countries that do provide healthcare insurance to all their citizens.
On what he calls the "Sleepless Summer Tour," the internist-turned-politician chastises President Bush for sleeping soundly at his ranch in Crawford, Texas, this summer while Americans lie awake with worry.
"There are an awful lot of Americans that are sleepless these days," Dean said Saturday at the first rally in Falls Church, Va., attended by about 4,000 supporters. "They're sleepless about wondering where their job went. They're sleepless about wondering where their health insurance went or whether they're going to have health insurance if they lose their job."
His rhetoric appears to be catching fire. According to recent polls in New Hampshire and Iowa, Dean, who had been considered a long-shot candidate, is leading the field of Democratic presidential hopefuls.
Today, Dean will wrap up his four-day, 10-city campaign tour with visits to Navy Pier in Chicago and Bryant Park in New York. He has invited the press to ride with him on a chartered plane dubbed the "Grassroots Express" in an effort to build on his early momentum.
Only off the stump does Dean get into any details of how the current healthcare system could be improved. He says he is dubious of Bush's support of a national cap of $250,000 on medical malpractice awards for pain and suffering, a proposal backed by the AMA and others in the medical community.
"This is phony politics," Dean says. "What the president is doing is wrong. He knows Congress has no ability to tell state courts what to do. It's just a way to appeal to physicians' emotions."
Dean says malpractice reform should be addressed state by state and that the best system is in Maine, where he says panels of doctors, lawyers and judges screen cases before they get to court.
"It eliminates the nuisance suits," he says.
Dean says the trial lawyers are right to blame rising premiums on decreased insurance company investments, and that insurance reform should be examined as a way to control premiums that subsidize investment losses.
"I also believe that one of the resolutions of the malpractice problem is to have the law essentially say that if you adhere to quality standards, you can't be sued," Dean said in an interview Monday afternoon on the flight from Spokane, Wash., to Austin, Texas. "Or you can be sued, but an absolute defense against malpractice is to have adhered to the quality standards that are required by some kind of uniform quality indicator.
"I don't want to go to a position where all medicine is cookie-cutter," he said, "but I also don't want to continue doing what we're doing now where you can do basically anything you darn well please."
Back at the rallies, Dean points to his record of building near-universal coverage in Vermont as the blueprint of what he will do if elected President.
"In my state, everybody under 18 has health insurance," Dean says. "Ninety-nine percent of our kids are eligible, 96% have it. Everybody under 150% of poverty has health insurance. All of our working, low-income people have health insurance. Seniors under 225% of poverty get help with their prescription benefits."
Dean says that if it can be done in a small rural state, 26th in income in the country and with a balanced budget, the United States should be able to join other industrialized nations in doing the same.
"I'm tired of being a second-class citizen," Dean said at gathering after gathering--from Boise, Idaho, on Sunday morning, attended by about 300 people, to Seattle, where the crowd was 8,000 to 15,000 according to campaign staff estimates.
Dean's plan calls for expanding Medicaid and enlarging the states' Children's Health Insurance Program (CHIP) to all children and young adults under age 25 up to three times poverty level. It also would require employer health plans to offer coverage to employees' dependents up to age 25.
For those at lower income levels, Dean would extend programs for children to include parents up to 185% of poverty. And he would allow people with incomes above that to buy into a health plan similar to the one for government employees, offering a tax credit to those who face premiums greater than 7.5% of their adjusted gross income.
Dean says reform of the delivery system will have to take a back seat to expanding health insurance coverage.
"We don't have to have a complicated government-run system," he said Monday morning at a town-hall style meeting in Spokane. "I'd love to go after the insurance companies and the pharmaceutical companies. It makes you feel good, but you'll never get the plan passed. We'll have the big fight about how to reform the system after everyone is covered."