Howard Dean on American healthcare …

… in Esquire magazine. A sample below the fold.

ESQUIRE:Your book really lays everything out in a very simple, clear way. It’s obvious this is something you’ve been thinking about for a long time.

HOWARD DEAN:It was one of the reasons I ran for president.

ESQ:One thing I’ve never seen before is when you say, “Much is made of the 47 million without insurance, but nothing of the 25 million who have insurance but don’t go and see the doctor.” I’ve got one of those high-deductible catastrophic plans myself, so I don’t go to the doctor unless I’m bleeding. Why have I never seen this argument before?

HD:Because 99 percent of the discussions among reporters, policy wonks, and politicians focus on the uninsured — which is, frankly, why nothing is passed. They don’t focus on the majority of Americans who have health insurance that doesn’t work.

ESQ:Boil it down, if you would. Why isn’t it working even if you do have insurance?

HD:Because it’s too expensive. The private sector can’t manage costs. Health care is one of the few places — defense is another — that the government works more efficiently and more effectively than the private sector. That’s just a fact.

ESQ:Why is that?

HD:Because there is no feedback in the private health-care system. When I was practicing medicine, nobody with substernal chest pain ever got off my examining table and said, “The guy down the street does it for $2,000 cheaper, I’ll see you later.” That’s why we’ve had 40 years of costs that increase between two and three times the rate of inflationevery single year. It’s breaking our economic system. People are yelling and screaming about jobs going to China, but they’re not yelling and screaming about jobs going to Canada. But they are. Because the right-wingers can scream and yell about rationing if they want, but economically their system works much better than ours does.

ESQ:I’ve seen nothing about that during this debate. But in the book you talk about GM and — or was it Toyota? — moving their new factories just across the bridge to Ontario to take advantage of the Canadian health-care system.

HD:Toyota did also, but GM and Ford were the big ones.

ESQ:It seems pretty obvious. They save money. So why are businesses so completely resistant to this?

HD:They’re not. Some businesses — and the Chamber of Commerce — are resistant because they’re ideological. They are part of the right wing. Then there are lots of businesses that aren’t particularly ideological but genuinely believe that if they keep doing the same thing, they’ll somehow get a different outcome. That’s human nature. They think they can manage health-care costs even though it’s been 40 years since any of them ever have. That’s why I think Obama’s plan is so great: If you like what you have, you can keep it.