Hospitals and physicians are not very cost-sensitive, Dean says, but cutting back on Medicare simply transfers the problem to insurance companies, "so that doesn't really make any sense."
Hospital billing is one area that could use more stringent standards and clarification, Dean argues.
"My father died about two years ago. I couldn't figure out what the heck was going on in his hospital bills, and I'm a physician," he says. "There are no cost controls because (CMS) doesn't know what the hospital is doing."
One promise Dean says he will make to physicians is that they will have someone who has practiced medicine running the Food and Drug Administration and Medicaid and Medicare.
"I want people who have actually taken care of patients to be administrators in CMS," he says. A physician or a nurse, "somebody who has actually laid hands on patients."
With regard to cutting expenditures overall, Dean repeatedly mentions the work of John Wennberg, M.D., which Dean describes as "trying to get information to physicians about best practices with best outcomes because that will save money."
The two New England doctors have known each other for years, says Wennberg, director of the Center for Evaluative Clinical Sciences at Dartmouth College in Hanover, N.H. Wennberg is co-editor of the Dartmouth Atlas of Health Care, which analyzes geographic variability in how medical resources are distributed and used in the United States.
Dean is very aware of the practice variation problem and was helpful with implementing model programs in Vermont, Wennberg says.
"We both really do believe very strongly in a science-based (medical) system and also recognize the fact that much of it isn't," Wennberg says. "One needs to move toward a much more comprehensive evaluation of medical practice. It's a matter of science, not a matter of regulation."
Dean says the standard setting needs to be led by physicians with government support, not the other way around.
Dean acknowledges that so-called "cookbook medicine" is something to avoid, noting that if care is not taken in how standard parameters are set, teaching hospitals, which tend to treat sicker patients, will come out worse than community hospitals.
"So if you're going to do this, you've got to have people like Wennberg doing it right, not a bunch of insurance company actuaries," Dean says.
While not formally working as an adviser to Dean, Wennberg says they keep in touch and that Dean, as a physician, has a unique understanding of how the system works.
"I'm sure if he were elected he would have a very sophisticated understanding of the quality problems in healthcare and do everything he could to see that they're addressed," Wennberg says. "I have no doubt that Governor Dean will attract a very progressive group of advisers, clinical leaders and professional leaders to help in the whole next phase of healthcare reform, which almost inevitably is going to happen."
If he makes it to the White House, Dean says he will choose his counselors based on experience.
"I don't care what party my advisers come from, I just want them to be competent and qualified," he says. "I want them to be good administrators and I want them to be capable of carrying out programs that make sense. That's what I did when I was in Vermont. I never asked anybody that I ever appointed to the bench or that I ever appointed to a cabinet position what party they were in, and I didn't care."