Dean's Sunday discussion knocks Kerry's Health Plan back to boot camp

I watched Gov. Dean Sunday at Sen. Harkin's candidate forum. I saw a moment that defined why Gov. Dean's background as a physician is the most critical item on any candidate's resume in the 2004 election. More about that in a minute. Then, Sen. Kerry released his health care package Monday. Sen. Kerry showed why sailors should not manage health care. Kerry’s proposals endorse creation of a two-tier medical system, one for the insured, and system of community clinics that has proven highly inadequate in the past for the nation’s needy. Many of Sen. Kerry’s proposals seem to revolve as much around Kerry’s military years as the rest of his rhetoric. “More PT, LT., more PT, we like it, we love it, we want more of it…” Lots of talk about making Americans more healthy, which is not a bad idea, but still will not prevent Americans from dying eventually. I haven't seen even O’Really try to spin that Dubya can end death in America (well... not lately, anyway). Americans run up a vast portion of their medical bills at the end of their lives. Nothing in Kerry’s plan even takes a sideways glance at that issue.

In Sunday’s forum, Gov. Dean had a frank discussion with a questioner about making the hard decisions on how we will have to decide how to spend limited health care dollars. In it, he discussed how important family/doctor discussions about plans people should make about quality of life at the end of their lives are and the need for encouraging those discussions as a part of the national discussion on health care. Most people run away from listening to these “morbid” discussions. I started paying attention to the issue of death with dignity after having briefly been knocked into a coma after an act of random violence that ended up putting me on Social Security disability for the past decade. The idea of being hooked up to a rack of machines and tubes to lengthen lives isn’t just distasteful for most Americans. It’s horrifying. It’s that image that started the “death with dignity” movement in the first place.

So we have two issues here. Health care money is limited and a huge chunk of it is spent at the end of a patient’s life using extraordinary means to only marginally extend a patient’s life when that life has no possibility of being saved and the quality of life during that period is nightmarish and repulsive to the vast majority of Americans in study after study. Howard Dean is the first public figure I ever heard link these two concepts into the possibility of some public policy that makes real sense, costs almost nothing in it’s implementation, and saves a whole ton of money. Why shouldn’t the President use the bully pulpit of the White House to encourage Americans to make living wills? Here we have perfect public policy in action. Americans can make their own choices on quality of life issues at the ends of their life and choose to leave this Earth in the manner of their choosing, and because Americans have been encouraged to make these choices, health care costs in this country will drop dramatically.

Wow. That makes almost too much sense for the American political system to handle.

By the way, one last point on the Kerry proposal. Kerry goes through the entire 10-page policy paper pdf file without managing to mention disabled Americans even once. Excuse me?

Adam F. Smith

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