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Howard Dean and the Goal Posts


It was about five years ago now that Howard Dean was peaking in his campaign for the presidency. Dean's campaign is best known for the prescient foreign-policy progressivism -- or maybe it was common sense? -- and the refreshingly proud tone adopted by the candidate. But that was all an accident. Originally, Dean's campaign was about health care. Dean's claim to national relevance was having achieved near-universal coverage in Vermont, and, as a doctor and successful governor, he figured he had the credibility to advance the cause on a larger stage.

Re-reading Dean's plan is useful to anyone looking for a bit of perspective on the national debate. The Vermonter was, of course, one of the more liberal candidates in the race, and the most oriented toward health care. But there was no public plan in his proposal. There wasn't even a co-op. Dean's plan would have insured millions fewer people than the bills being considered in the House or the bill that we think we'll see out of the Senate. As I read the policy -- and it's possible there's a more detailed summary than the one I've dug up -- it didn't even include insurance market reforms like banning discrimination based on preexisting conditions or outlawing rescission.

For all that, it was a good and well-meaning plan. But it was a lot worse than what we're considering now. It was a lot worse even than the compromises we're considering now.

There are reasons for that. It was a less progressive moment. Democrats had fewer votes and a more constrained sense of the possible. There wasn't a candidate like the 2008 version of John Edwards, or an institution like Andy Stern's SEIU, that was forcing the Democratic field to the left. (Gephardt was the closest, but his plan was far worse than what Edwards offered.)

But it was considered, at the time, a good plan, and it was. It addressed the core issue in health-care reform: that so many people lack health-care insurance and so have to live in fear. It also had some virtues of its own, particularly in the way it reimagined and expanded the Children's Health Insurance Program. The heart of this is now, and has always been, providing coverage to the people who wait in line for hours because they can't afford relief for a rotten tooth, or because they haven't had a mammogram in years. Dean's plan did that, and the plans on the table today do even more of it.

The goal posts have moved in recent years. And they've moved in the right direction. This year, Dean is, as he was then, on the left of the conversation, arguing fiercely and persuasively for a public plan, and more generous subsidies, and an array of other improvements. On Thursday, he threatened that Democrats who don't support the public plan will face primary challenges. That's a healthy threat.

But you can't survey the landscape or read the polls without recognizing that the finished product might be worse than many of us, including Dean, hope. But reading his proposal from 2004 is a useful reminder that it's almost certain to be far better than what we had imagined only five short years ago. That may not be success. But it is progress.

Photo credit: Mark Wilson/Getty Images.

By Ezra Klein  |  August 14, 2009; 11:06 AM ET
Categories:  Health Reform  
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Dean has moved to the left since he was a governor. Plenty of his constituents were offended by his pandering to the right wing while in office, and deeply confused by pundits who pretended that Dean was a liberal. (Perhaps by standards where people well to the right of Richard Nixon are "centrists".)

Most of the difference in plans is the result of reality intruding. In 2004, millions more americans had employer-paid health insurance, hardly anyone had heard of rescission, and all that equity in our homes was going to pay for unanticipated expenses...

Posted by: paul314 | August 14, 2009 10:34 AM | Report abuse

The sellout continues, Ezra.

In the last five years, we have learned a lot more about what needs to be done. In particular, with the millions and millions of jobs lost to globalization in the last five years, we know that we must have globally competitive health costs, and outcomes, which requires much less coddling of the incredibly inefficient system we have today.

Finally, with the demonstrated failure of the Republican economic philosophy ("all things must be privatized to make my friends rich"), it is now possible to contemplate having moderately effective and efficient health care, covering almost everyone.

We should do all of that. It is mind boggling that America's business community opposes any of it. If Obama cannot get a public plan, he is a failure.

And you should not try to gloss it over.

Posted by: Dollared | August 14, 2009 10:45 AM | Report abuse

I just saw Howard Dean on C-Span in the Townhall at Netroots Nation. His instincts are quite good on health care policy. Number one issue- choice. People want choice. For that reason I think Ron Wyden's "Choice Amendment" that takes the choice from the employer and gives it to the individual has great merit, politically and otherwise.

Posted by: cmpnwtr | August 14, 2009 10:45 AM | Report abuse

too be fair the problem has gotten a lot worse since 2004,

Since when is "We'll establish an affordable health insurance plan people can buy into" not a public option.

Secondly even if there is no "public option" in Dean's plan, he would have expanded government programs to cover another 23 million. That is more than any proposal right now.

Posted by: JonWa | August 14, 2009 11:09 AM | Report abuse

What Dean's campaign is actually best known for:

Posted by: dawsnville | August 14, 2009 11:13 AM | Report abuse

Things are worse now, far worse. It may be that Dean was suggesting what he thought could pass in 2004 with the repiglicans in control. Anyway, Dean 2009 is right that reform with no robust, affordable, public plan is health insurance reform not health care reform. Personally I am very disappointed that I can't get out of my employer plan and have my AND MY EMPLOYER'S contribution go toward the public option, if indeed it is robust and provides me with some choices. Right now, we get to pick from the company plan and nothing.

Posted by: srw3 | August 14, 2009 11:14 AM | Report abuse

Nitpick: five years ago, John Kerry was already the 2004 Democratic nominee for President, and Dean's campaign for the nomination had died in Iowa seven months earlier.

So I think you mean SIX years ago, and 2003, rather than five years ago, and 2004.

Posted by: rt42 | August 14, 2009 11:32 AM | Report abuse

There's nothing "Progressive" about giving over more of your life to government control. In fact, it's quite "regressive". The Soviets tried it, it didn't work. The only place Dean could have ever become Governor was a place like Vermont that STILL wants to leave the Union, even with a Leftist in office.

Posted by: websterr1 | August 14, 2009 11:53 AM | Report abuse

If you want to see Howard Dean's plan, just read his book. Among other things, he says a plan without a public option is worthless.

Posted by: tstoutjr | August 14, 2009 11:59 AM | Report abuse

You know, you could interview Howard Dean and ask him about the shifting goal posts. After all, you interviewed Lindsey Graham and now Karen Ignani. The interview with Graham was very interesting, even from an opposing position, and I bet Dean would provide some illuminating answers, too. Ignani's a lobbyist, so hardly anything she says can be heard over the pieces of silver jangling in her pockets.

Posted by: brightside | August 14, 2009 12:21 PM | Report abuse

"If Obama can't get a public plan, he is a failure." And statements like that are helpful? Reform in this country has never gone from 0 to 60 in 4 seconds. As has been pointed out, SSI didn't cover everyone originally. The Emancipation Proclamation didn't free all the slave.
If there's not a public option, I'll be disappointed. I'm already bummed that we're not looking at single payer. But Obama's fighting like hell to get reform, and I'll do everything I can to help.
Of course, I guess we could let it fail because it's not perfect. I'm sure a few folks might die, but who knows? Maybe we'll get another swing at it in 16 years.

Posted by: kevinray | August 14, 2009 12:39 PM | Report abuse

No Tort Reform.

No Health Care Reform.

It's that simple.

Posted by: hclark1 | August 14, 2009 12:54 PM | Report abuse

So moving to the left and favoring a bigger, more intrusive government presence in health care represents progress? Increasingly, I have trouble telling the difference between this column bearing the Washington Post logo across the top and any of the leftist propaganda coming from Center for American Progress.

Posted by: FreeMas | August 14, 2009 1:42 PM | Report abuse


More than two thirds of the American people want a single payer health care system. And if they cant have a single payer system 76% of all Americans want a strong government-run public option on day one (85% of democrats, 71% of independents, and 60% of republicans). Basically everyone.

AND NO INSURANCE MANDATES WITHOUT A STRONG GOVERNMENT-RUN PUBLIC OPTION ON DAY ONE! An insurance mandate without a strong government-run public option choice on day one, would be a DISASTER! And it would be worse than the GREED DRIVEN PRIVATE FOR PROFIT HEALTH INSURANCE HORROR! SHOW you have now. YOU MUST MAKE CERTAIN!! THAT DOES NOT HAPPEN AMERICA.

The healthcare reform bills released by the first two committees of the House Of Representatives are excellent bills as I understand them. They are bills with a strong, robust, government-run public option, and an intelligent, reasonable initial funding plan to cover almost all of the American people. They are carefully written, and thoughtfully constructed, informed, prudent and wise. These bills will save trillions of dollars, and millions of your lives. They are also now supported by the AMA.

These are the type of bills that all Americans can feel good about. And these are the type of bills that have the potential to dramatically improve the quality of healthcare for all Americans. Rich, middle class and poor a like. Democrats, Republicans, Independents, and all other party affiliations. These bills have the potential to dramatically improve the quality of life of every American.

The house healthcare bills released by the first two committees should be viewed as the minimum GOLD STANDARD by which all other proposed healthcare legislation should be judged. All supporters of true high quality healthcare reform should now place all your support behind these healthcare reform bills released by the first two committees of the United States House Of Representatives, as the minimum Gold standard for healthcare reform in America.

You should all now support the first two committees bills with all your might, and all of your unrelenting tenacity. These first two House committees healthcare bills are VERY, VERY GOOD! bills for all of the American people. Fight tooth, and nail for every bit of these bills if you have too. Be aggressive, creative, and relentless for these bills.

From this time forward, go BIGGER and DEEPER with the American people every day until passage of healthcare reform with a robust, government-run public option.

FIGHT!! like your life and the lives of your loved ones depends on it. BECAUSE IT DOES!


Senator Bernie Sanders on healthcare (

God Bless You

Jack Smith — Working Class

Posted by: JackSmith1 | August 14, 2009 2:06 PM | Report abuse

"The Soviets tried it..."

I think we have the new Godwin here.

Posted by: leoklein | August 14, 2009 2:52 PM | Report abuse

If you would like to help pressure Congress to pass single payer health care in a democratic and constructive way please join our voting bloc at:

Posted by: letsgobuffalo | August 14, 2009 3:14 PM | Report abuse

Most Democrats who are likely to vote against a public plan are worried about Republican opponents. Howard Dean's track record is excessive ideology, poor management that wrecked his own campaign, and the inability to manage fair primaries that lingers as a black mark against the Democratic Party. The two most prominent recent Democrats in my state, John Edwards and Mike Easley are both under federal grand jury investigation for potential malfeasance. There is no rational argument that better health care is dependent on government management or that government management can be expected to perform better than a regulated private insurance industry. Those people who are lost in ideological abstractions or belief is some magical free lunch that can deliver unbounded medical care to anyone who wants it make it more difficult to arrive at some generally supported practical plan that might significantly improve our current system at a price our society can afford and is willing to pay.

Posted by: dnjake | August 14, 2009 3:43 PM | Report abuse

"No Tort Reform.
No Health Care Reform.
It's that simple.
Posted by: hclark1"

You forgot to say that stupid stuff you always say about how North Carolina is going to beat the Terps 100 to nothing in every known college sport.

It's about as intelligent as your opinions on healthcare.

Posted by: Samson151 | August 14, 2009 3:47 PM | Report abuse

There is some truth in what Klein writes regarding the "finished product" being
"almost certain to be far better than what we had imagined only five short years ago. That may not be success. But it is progress."

Yeah, the "finished product" that is shaping up will be "better" and "progress" - but not for the American people. It will only be real progress and better for Big Insurance and Big Pharma and their lobbyists and legislators on the take.

No public option, No real reform.

Posted by: ophelia3 | August 14, 2009 3:50 PM | Report abuse

"But it was considered, at the time, a good plan"

By who? Other left wing nuts like you with absolutely no experience in the private sector?

You really want to save money in healthcare? Have a go at your trial lawyer buddies.

Good God. Most people learn to write in the third grade and move on to bigger things.

Posted by: IUT1 | August 14, 2009 4:05 PM | Report abuse

Howard Dean is a political hitman who engineered the criminal theft of Hillary's Florida and Michigan Democratic primary vote wins. He deserves to rot in heck, and will.
His trumped-up excuse - the week difference between when the states held primaries and when the committee wanted them to - was used to ram The One down our throats.
His machiniations at the Memorial Day weekend meeting devaluing the two states' votes by 50% were nothing short of amoral, and chargeable crimes.
Delighted to see him sidelined and marginalized by the party.
Howard Dean deserves to be tried, convicted and deported for his behavior. POS.

Posted by: mrcrister3 | August 14, 2009 4:07 PM | Report abuse

Mr. Klein looks like a 'younger' man... Pity.

He is rushing headlong into devastating his future with wildly irresponsible debt acquisition.

If he foolishly chooses that for himself,OK... but why does he want to condemn his friends & neighbors to a lower standard of living & healthcare? Doesn't he care about them?

Posted by: wilsan | August 14, 2009 5:53 PM | Report abuse

I consider myself a moderate. However, Gov. Dean speaks much sense. I listened to him today on CSPAN in a town hall meeting. He answered the questions forthrightly and with great insight.

I liked him when he ran for the presidential nomination. His 50-state strategy eventually worked. The guy knows medicine, and he knows how government works.

Those who see him moving farther to the left need to check their own movement. With the Republican Party moving closer and closer to the extreme right each week, those in the Republican Party will think that others are moving to the left.

Howard Dean was excellent today. And so was President Obama!

Posted by: EarlC | August 14, 2009 6:24 PM | Report abuse


You have just made an exaggerating fool of yourself:

"There is no rational argument that better health care is dependent on government management or that government management can be expected to perform better than a regulated private insurance industry. Those people who are lost in ideological abstractions"

Actually, there are at least two arguments that a government plan is better than our current system: 1) there are at least a dozen countries, including UK and Canada, that have lower costs, better outcomes and higher user satisfaction than our private insurance system; and 2) the #1 health plan for outcomes and user satisfaction is VA; the #2 is Medicare, and all others are below.

So the only one who favors ideology over facts is somebody who would believe free market fantasy in the medical market in the face of the two rational arguments above, and the complete failure of our current market.

Posted by: Dollared | August 15, 2009 12:31 AM | Report abuse

Obama care is a very bad proposition. If the Democrats continue to refuse to put in solid measures to insure that government funds won't directly or indirectly pay for abortion, the it bearable. It deserves the scorn that has been heaped on it so far, and much, much more.

Posted by: yourstruly1991 | August 15, 2009 3:12 AM | Report abuse

Really? Then why did most people spend all that phantom equity on things like vacations, cars, and women's jewlery in 1999-2006?

"............ and all that equity in our homes was going to pay for unanticipated expenses...

Posted by: paul314 | August 14, 2009 10:34 AM"

Posted by: andrewp111 | August 15, 2009 5:53 AM | Report abuse

Occurs to me that the public plan, aside from being a good in itself, is important for other reasons...while Ezra pre-sells the relative tastiness of a less putrid excrement sandwich, the point is that the public plan is certainly no LESS viable than the all-private-sector-all-the-time alternative reform scheme. At least I don't see where this is argued with any seriousness.

So it begs the question of why should it be, POLITICALLY, that the more intuitive, broadly understandable and, yes, progressive policy solution should be the one collapsed in the spirit of 'git-r-done'.

What's at stake is the building of a narrative of viability and strength and leadership--essential if this 'new era' is to be more than a 'V shaped recession' of conservative rule--about the blue team's vision and what it can and DOES accomplish when it gets a turn at bat.

If the Dems, push to shove, are simply a GOP-lite, watered down version of a free market conservative party...then this isn't really a party in a meaningful sense (thus nor could this be really a democracy in a meaningful sense), and certainly not one worth the bother of public engagement.

Posted by: doorworker | August 15, 2009 6:16 AM | Report abuse

I think Ezra makes a good point about the direction the discussion has moved on health care since Dean's state plan- so why do many on the left feel we need to hit a home run on reform this very moment? If a public option is not now created does that mean it can never be created? Granted, the Dems will not forever enjoy the control they currently have, but trying to railroad a public option right now really threatens to scuttle any meaningful reform.

Posted by: slo_MO_tion2 | August 16, 2009 2:24 PM | Report abuse

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