Howard Dean: Reform without a Public Health Insurance Option Is Not Real Reform

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(Editor’s note: the following is a chapter from Howard Dean’s book, Prescription for Real Healthcare Reform. Reproduced with the permission of the publisher, Chelsea Green).

For the great majority of Americans, staying just one step ahead of mounting medical debt is a constant struggle. Medical crises contribute to approximately half of all home foreclosure filings. According to a recent study published in The American Journal of Medicine, 62 percent of all bankruptcy filings in 2007 were partly the result of medical expenses; 78 percent of those who filed for bankruptcy actually had health insurance but found that insurance inadequate to cover their bills.

Even as skyrocketing healthcare costs are bankrupting millions of Americans, however, the earnings of private health insurance firms are rising. In most areas of the country, the insurance market is dominated by one or two large providers. Rather than bargaining for lower rates, large insurer conglomerates are transferring the high prices charged by hospitals to patients and padding their profits. As premiums soared, the profits of the top ten insurance companies grew by approximately 1,000 percent. During the same period, insurers merged more than 400 times, but employee premiums increased nearly eight times faster than average U.S. incomes.

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