Read more about the Oct. 4 Intelligence Squared U.S. debate on whether "Grandma's benefits imperil Junior's future," buy tickets, and see who else is debating.
Howard Dean was a doctor before he was governor of Vermont, a presidential candidate, or chairman of the Democratic National Committee. Now, he draws on his medical experience to argue that Medicare and Medicaid don't need radical surgery to remain solvent. And he'll draw on his 2004 presidential campaign experience to persuade the live audience at the Oct.4 Slate/Intelligence Squared U.S. debate to vote against the proposition "Grandma's benefits imperil Junior's future." (He's already proved he has the oratory prowess to rev up a crowd.) Dean, who now works as a consultant, says it's unnecessary to slash the benefits of Social Security, Medicare, and Medicaid in order to preserve the programs for future generations. I caught up with Dean earlier this week for a conversation about why America should avoid significant entitlement reform; what changes we can make to protect Social Security, Medicare, and Medicaid for posterity; and how his perspective on the health care system has changed since he stopped practicing medicine. Excerpts from the interview are below.
Slate: What question or issue will be at the core of this debate?
Howard Dean: The core question that people are interested in is, are we stealing from the next generation with our benefits structure? Of course, I'm going to be on the no side.
Slate: Can you give us a sneak peek of what you'll argue?
Dean: First of all, the Medicare problem, which is the biggest spending problem between Social Security and Medicare, is not a Medicare problem at all. It's a health care problem. The entire health care system does not control costs in any way. So the question is, how do you fix that? And the answer is, you have to fix the whole system. You can't just blame it on the beneficiaries. Everyone who uses the system is part of the problem. On Social Security, there's some minimal tweaking that needs to be done. It really is pretty solid. But I think this argument [to cut benefits] is essentially by the right wing to undo the notion of the social safety net. They're pitting generations against each other, and it's not necessary to do that. You can control the expenditures in these programs. But again, you can't focus just on these programs because it's a systemic problem. And, again, the right wing doesn't want to do anything about health care cost, but that's where the real problem is.
Slate: So how do we reform health care?
Dean: We have to stop using fee-for-service medicine. Right now, doctors get paid by the amount of things they do to people, which makes no sense at all. The more you do to people, the more you get paid, whether it does any good or not. You've gotta change that system and give people a budget for every patient. Then the physician needs to live within that budget. You should also give individuals the power to choose which plan they want to have. You have to fundamentally alter the way we pay for medicine in this country, otherwise it's going to continue to be out of control.
Slate: There have been attempts in the past through pilot programs and panels to reform Medicare, and to inspire collaboration and care coordination between hospitals and doctors. But those attempts haven't worked so well. What will be the mechanism this time around to make those kinds of changes stick?
Dean: Congress has been disgustingly irresponsible in the last two years, partly because the Republicans have decided that they're going to have it their way or no way. Probably what has to happen is [something like] this joint committee that they put together for deficit reduction: We need to take it out of the hands of Congress and just give Congress an up or down vote on a plan.
Slate: And how do we get rid of the "fee-for-service" system, or begin to encourage quality care over quantity of procedures?