Right For The Room

I would say that Howard Dean's message, arguing strongly for a choice in health care and saying that the only element in the entire bill that can be credibly called health care reform is the public option, makes a lot more sense in this environment than Bill Clinton's "accept half a loaf" speech last night. Somebody has to make this argument, and if we don't, absolutely nobody will and there will be no progressive counterweight to the manic-obsessive centrism that too many Democrats are kind of dying to perpetuate.

Dean's also talking about the psychology of anger among the right wing in these town halls, and how it's not about the bill, but a major generational change in America, and the sense among a certain element that things are slipping away. This of course doesn't totally help us right now unless that new generation advocates for something worth doing.

...I'm glad Tanya Tarr talked about reproductive rights in the bill. Dean correctly argues that an independent panel of experts will decide the benefits package in the public insurance options, but obviously there can be some advocacy around that.

"We're doing good on this bill, the press never covers substance so you'd never know it..."

A very good point from Dean: nurse practitioners can perform about 60% of what he did as a primary care physician, and they should be able to work independently from primary care operations. We're just going to need to do that, because adding 30-35 million people to the health insurance rolls and emphasizing prevention will require so many doctors, probably much more than we can muster. So empowering nurse practitioners would help this out pretty well.

I'm very hopeful about Gov. Dean's remarks about ending fee-for-service medicine. He thinks the primary care physicians who make less than their counterparts in Britain right now will demand it.

He's also big on moving us from an illness system to a wellness system. The best groups doing this are the self-insured corporations like Safeway, who get crappy food out of the break room and give health club memberships and essentially emphasize prevention because it's better for their bottom line.