At an August rally in San Antonio for Democratic presidential candidate Howard Dean, M.D., cardiologist Randall White, M.D., said Dean lacked time at such events to delve into what most doctors likely are listening for.
"The devil is in the details," Randall says. "I think most physicians would like to hear the details."
So, in his own words, here are some of Dean's positions on specific healthcare issues.
"I don't pretend to have all the answers. I would be highly skeptical of anyone who said they did. So I've built 'seeking the counsel of skilled physicians'--and others--into my healthcare plan. I will convene a White House Conference on Health Care Quality that reaches out across all disciplines of medicine and research to bring together the best minds in the nation."
"When you're talking about reimbursement, the levels aren't the only thing that's screwy. The rules for what procedures are and aren't reimbursable provide no incentive whatsoever for doctors to emphasize preventive strategies or proper management of chronic conditions," Dean says.
"He has committed to the fact that we need to do something about reimbursement rates for physicians," adds Dean's health policy director, Peter Van Vranken. "It is exceptionally difficult to find out which physicians need help most immediately. Specialists are the ones who seem to be getting hurt the worst."
"I oppose the Republican medical malpractice bill now before the U.S. Senate (referring to a proposal for a national $250,000 cap on noneconomic damages, supported by President Bush). It represents unwarranted and probably unconstitutional federal interference with state tort laws. It is essentially being used for political purposes and will never be enacted. I favor real solutions at the state level and federal support and guidance for states to implement those solutions.
"For example, the federal government might support experimentation with alternative compensation systems, enterprise liability systems or pretrial expert panel review systems such as the one enacted in Maine.
"One of the resolutions of the malpractice problem is to have essentially the law say that if you adhere to quality standards, you can't be sued. Or you can be sued, but that an absolute defense against malpractice is to have adhered to the quality standards that are required by some sort of uniform quality indicator."
"I believe--and we do this in Vermont--in allowing the records of doctors who get sued and those that have disciplinary actions to be available to the public. That will help. Secondly, in order to have quality, you have to have quality standards." (See main story.)
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Dean says he would:
- Sign the federal Wellstone-Domenici mental health parity bill
- Integrate mental health care with other social services
- Improve access to community care to prevent people with mental illness from being imprisoned or abandoned
- End rules that discourage people with mental illness from working
- Improve school-based screening and treatment for at-risk children
- Increase the use of peer support networks
- Improve public education to decrease stigma and raise awareness
"It's a risk-benefit analysis that you have to do. Some pretty respected public health people that I know--in this country and elsewhere, such as Israel--would not do smallpox vaccination. I'm sure the government has good, qualified experts, but that's a very controversial decision, and I, as a physician, would not have a smallpox vaccination right now. Nor would I recommend it to anybody.
"I think an anthrax vaccination for the troops that might be exposed is worth doing. But I think the likelihood of smallpox being used as a biological weapon is very, very, very small."