Blue Dogs And The Health Care Debate

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Democrats don't need Republican votes to pass health care in the House of Representatives, but they do need conservative Democrats, called "Blue Dogs." Former Democratic National Committee Chairman Howard Dean and former Blue Dog congressman Max Sandlin of Texas discuss how they view key aspects of their own party's health care plan, and how to get a bill passed.

NEAL CONAN, host:

This is TALK OF THE NATION. I'm Neal Conan in Washington. President Obama hoped to get a health care bill approved by Congress before the August recess, but there's now no chance of that. The House decamped last week, the Senate leaves on Friday, and there is still no consensus. Democrats enjoy large majorities in both houses. They would like Republican support, but they don't need it. However, Democrats are divided. Liberals argue that any real reform must include a strong public plan to provide coverage to as many people as possible, while many conservative Democrats disagree. There are also disagreements about the price tag and concern about estimates that none of the plans proposed so far would bring the spiraling cost of health care under control.

Today, we want to hear from the Democrats in our audience. What's most important to you in this debate? Our phone number, 800-989-8255. Email talk@npr.org, and you can also join the conversation on our Web site. That's at npr.org. Click on TALK OF THE NATION.

Howard Dean joins us now from the studios of the Christian Science Monitor here in Washington. The former governor of Vermont ran for president in 2004. He later served as chairman of the Democratic National Committee. He's also a medical doctor and the author of "Howard Dean's Prescription for Real Health Care Reform." And it's nice to have you on TALK OF THE NATION today.

Dr. HOWARD DEAN (Former Governor, Democrat, Vermont): Thanks for having me on, Neal.

CONAN: And we're told one of the most important things in this debate is timing, that the best opportunity to get this through is this summer and fall.

Dr. DEAN: I think that's true. Once you get into the campaign season, the lies and stuff that are going on now are going to get even more heated, and so I think this is really the opportunity. This is an opportunity for members of the House and the Senate to be part of a historical change. And they were elected to give historical change, as was the president, and now we're going to find out if they're going to do it.

CONAN: Your prescription in your book includes a public plan. That's one of the major elements of disagreement.

Dr. DEAN: Well…

(Soundbite of coughing)

Dr. DEAN: …actually, interestingly enough, the Congress is not where the American people are. Seventy-two percent of the American people think they ought to have the choice between the private system and the public system. They have experience with both. Medicare is a public system. It's been in effect for 45 years. Interestingly enough, we're having the same sort of rhetoric that we had 45 years ago about socialism and killing old people and all this kind of nonsense from the right wing. And of course, they have experience with their private systems, as well. In general, the private systems of big groups do reasonably well, except for the outrageous costs. Individuals - the individual insurance market is pretty bad, and so people want a change.

Fifty percent of Republicans think they ought to have a choice between the public plan and the private plan. And so the Congress is really - what the Congress is really battling over is whose side are you going to be on, the private insurance industry's side, which of course has lavished them for years with donations, or the American public's side, and that's what this debate is about. It's really not about conservatives and liberals and Democrats and Republicans. It's about: Are you going to side with insurance companies, or are you going to side with the American people?

CONAN: Well, nevertheless, that's the way the people are voting in Congress. And what's wrong with the kind of co-ops that some Blue Dog, the conservative Democrats in the House, prefer and we're told that the Senate Finance Committee may prefer, too?

Dr. DEAN: I think there's wide agreement among both conservative and liberals on this one, outside Congress, that that's not going to work. And the argument goes something like this: Co-ops are well-intended, but they're much too small. They'll never have any kind of market share. We've tried sort of a co-op-type affair in the past, many of your listeners will recall Blue Cross Blue Shield. Well, Blue Cross Blue Shield is no longer Blue Cross Blue Shield. Most of Blue Cross has been taken up by a for-profit - become for-profit either under the name of Anthem or some people still hold on to the Blue Cross name.

So the private insurers are licking their lips over the ideas of co-ops because they can't perform any real competition, and they'll eventually be taken over by the private insurance industry. They're not going to have any kind of clout in the marketplace.

CONAN: And the conservative Democrats who are, so far, blocking this, it goes on in the Senate as well as the House, but nevertheless, these are people who, well Howard Dean, you did a lot to elect a bunch of these people.

Dr. DEAN: You know, I've actually had some conversations with some of these folks. I am reluctant to say that they're blocking things just yet. Look, let me just be very clear about this. I think the Blue Dogs' compromise was a good thing. I am not where the members of the House Progressive Caucus is on this one. I think they made the bill a little less expensive. They moved the bill towards where the Health, Education, Labor and Pension Committee in the Senate is. You know, Ted Kennedy is the chairman. Chris Dodd has done a yeoman's work filling in for him. That's a very good bill in the Senate, a strong public option but a reasonable, thoughtful bill.

So I think we're in very good shape. I think the House is in very, very good shape. You know, frankly the Blue Dogs coming to the table made it a better bill, in my opinion. In the Senate, the Senate Finance Committee is a real problem. There's no question that they're struggling. The Senate is a very - it's sort of a clubby place. They focus really on the relationships between the 100 members and sometimes, unfortunately, more so than they actually focus on what's going on in the rest of the country. And I think when they get out into the rest of the country, they're going to see a different kind of response. Of course, they're going to see the - sort of the brown-shirt reaction to the right wing, which was in that memo the other day, was on the Internet, where they have people going and busting up meetings. But Americans have never responded well to that kind of thing, and I think the senators are going to see that people do want a bill, they want a thoughtful bill, and they want a choice for themselves. And they don't think the choice ought to be made for them by the insurance industry.

CONAN: Well, joining us now is Max Sandlin. He's here in Studio 3A, an original member of the Blue Dog Coalition. He served as a Democratic congressman for Texas's First Congressional District from 1997 to 2005. And it's good to have you with us today.

Former Representative MAX SANDLIN (Democrat, Texas): Thanks, Neal, good to be here.

CONAN: And first, for those of us who are a little confused, what's a Blue Dog?

Former Rep. SANDLIN: A Blue Dog is a Democrat that works within the Democratic Caucus. They're united by a desire to focus on fiscal policy, to enact good policy but to make sure it's reasonable, and that it fits within the budget and that it's - can be defended fiscally.

CONAN: And where did the name come from?

Former Rep. SANDLIN: There's several rumors about that. Most agree that finally the Democrats, some of the moderate and conservative Democrats and those that worked on fiscal issues, felt so choked from the far right and from the far left and from others, that they just turned blue.

(Soundbite of laughter)

Former Rep. SANDLIN: And it's kind of a takeoff on the Yellow Dog Democrats, where…

CONAN: I'll be a Democrat until the last yellow dog dies.

Former Rep. SANDLIN: Well, not even that. I'll vote for a yellow dog, as long as he's on the Democratic ticket.

CONAN: Mm-hmm.

Former Rep. SANDLIN: So they're loyal Democrats. They work within the party, within the structure. They focus on fiscal issues, and that's the thing that unites them. They're a very diverse group from all across the country. They're from Maine to California to Florida to Texas and all points in between.

CONAN: And there's about 51 currently in the caucus.

Former Rep. SANDLIN: Fifty-two, I believe.

CONAN: Fifty-two.

Former Rep. SANDLIN: So it's a very substantial group.

CONAN: Now, as you understand it, this group is not united, either, on this issue. There's a lot of divisions, but some of the more-conservative ones, well, some of their arguments sound like some of the Republican arguments.

Former Rep. SANDLIN: Well, I wouldn't really agree with that. It's a difficult issue. That's why we haven't been able to solve it in the country. I think first, it's important to realize that everyone has the same goal: that's access to affordable, quality health care.

Now, you know, there are a lot of options. There's the public plan. There's the co-ops that the governor mentioned a moment ago. Senator Wyden has a plan that I think has also been advocated to some extent by Congressman Cooper from Tennessee in the House. So I don't think that our focus should be on structure. It should be on results. It shouldn't be on whether we have plan A or plan B. It's: Are we able to make available a health care of higher quality at better costs to the American working families? And so, I don't think you should say it's a Democratic issue or a Republican issue. It's an issue of what can the Congress do, and the president do, to deliver access to good, quality health care for American families.

CONAN: It's interesting. You both say that, and if this passes, it will have very few Republican votes, if any.

Former Rep. SANDLIN: Well, that's so. In the Senate, it does seem that there's been more cooperation or input from the Republicans. I know that Senator Baucus talked to them initially. I think they had some input in the HELP Committee.

In the House, there's been less active participation by the Republicans. I do know that Congressman Waxman, the chairman of Energy and Commerce, and Chairman Rangel from Ways and Means, and Chairman Miller from Ed. and Labor, did talk with Republicans initially concerning ideas. I don't know how much active participation the Republicans then responded with.

It seems to me, just as an outsider looking in now, that there's not been a lot of active, or proactive, movement by the Republicans. It's mostly been sitting back and taking political shots and making it more of a political issue than a policy issue. And I'm hoping that both Democrats and Republicans look at this as serious policy, not partisan wrangling.

CONAN: And Governor Dean, let me ask you. As a practical matter, is it important to get Republicans invested in this bill? If it passes, there will come a day when they will be back in power and may want to undo it if they have no investment in it.

Dr. DEAN: No, it's not important because they - look, the Republicans always oppose progressives. None - ideas. None of them wanted Social Security. In fact, Bush, 50 or 60 years later, still tried to get rid of it. None of them wanted Medicare. They'd get rid of that if they could, and they aren't going to cooperate here. You know, we may get one or two, but most of the people who are talking about this bill just want to kill it. And Jim DeMint was frighteningly honest a few weeks ago when he said look, this is Obama's Waterloo. If we can get him, we can kill his presidency, which is exactly the approach they took to Bill Clinton when they tried it. But this is a really substantive…

CONAN: So it is a partisan issue.

Dr. DEAN: Pardon?

CONAN: So it is a partisan issue.

Dr. DEAN: It's a partisan issue, absolutely. But not a - the substance is not partisan because there's no bipartisan discussion going on of any seriousness.

CONAN: Let's get listeners involved in the conversation. And we want to talk with Democrats today, since this appears to be an argument within the Democratic Party.

(Soundbite of laughter)

Dr. DEAN: It is, but that's okay because, you know, that's why I actually like what the Blue Dogs are doing. I don't agree with every single thing they do, but since we can't have conservatives from the Republican Party, because they're not interested in the bill and they really just want to kill it to get at Obama, we need some conservative input to that, and that's why I think the Blue Dogs are so valuable. And I have to say that if they'd taken their lunch and gone home last week when they made the compromise, then you could castigate them. But they sat down, they worked it out, and this bill is going to be closer to what the American people like because of the compromises that were made, I think.

CONAN: Well, so far - I'm sorry.

Former Rep. SANDLIN: I was just going to add, Neal, that I would agree with the governor. I don't see it as a fight within the Democratic Party. This is a difficult policy. It's an important policy. As I said, it's about delivering quality health care to the American public. Just because you debate the provisions of the bill and whether there's a public plan or not and whether there's - what the reimbursement rates are, whether or not there's negotiated rates, you know, how the mechanics work, is it tied to Medicare or not, those are good questions, important questions that have to be asked.

And I think it's good to talk about those things, to bring them out and say, how are we going to best deliver that quality health care. And while I don't see it as a partisan issue, I think it's always good to have bipartisan cooperation when you can, when you can.

CONAN: Max Sandlin is with us, one of the original Blue Dog Democrats, also Howard Dean, former head of the Democratic Party and, of course, a six-term governor of the state of Vermont.

We're talking today with Democrats. What's most important to you in the debate over health care? Is it the specific cost of the measure? Is it about how it's going to be paid for? Is it a public option? Is it important to have Republicans onboard, bipartisan support? Give us a call, 800-989-8255. Email talk@npr.org. Stay with us. I'm Neal Conan. It's the TALK OF THE NATION from NPR News.

(Soundbite of music)

CONAN: This is TALK OF THE NATION. I'm Neal Conan in Washington. We're discussing some of the key sticking points in the debate over how to overhaul health care. Almost all Republicans in Congress oppose the current Democratic proposals. Even Democrats are divided over costs, calls for a public option, even the importance of bipartisanship in any final bill.

Today, we want to hear from Democrats. What's most important to you in this debate: cost, a public plan? Give us a call, 800-989-8255. Email talk@npr.org, and you can also join the conversation on our Web site. That's at npr.org. Click on TALK OF THE NATION.

Our guests are Howard Dean, the former chairman of the Democratic National Committee, and Max Sandlin, who served as a congressman from Texas from 1997 to 2005, was an original member of the Blue Dog Coalition. And let's see if we can Lily(ph) on the line, Lily calling from San Antonio.

LILY (Caller): Hi, yes. I'm from Texas, too, but I agree totally with Governor Dean. I am for a public option. I tell you my story so you know about it.

I'm 58 years old. I am paying $1,100 a month to Blue Cross Blue Shield, and they are constantly coming between me and my doctor. And the Blue Dogs, or the Republicans, say that they don't want bureaucrats or government to come between us, but I tell you, they refuse to pay for my bone-density tests. They refused for my pre-diabetic strips, and they can get away with it because I don't have the big corporation behind me. And I am forced to keep this insurance because I don't know what else is coming up. I have a history of cancer. And I'm telling you, I had to go to a hospital in Canada. I had to go to a hospital in Britain, and I am not scared at all of a public health insurance. It was fantastic. And in Britain, in Guilford Hospital, they told me compliments of Tony Blair and dismissed me without paying a penny. And to me - I don't know. Do you have any questions for me? I am just so…

CONAN: Well, it seems to me that you're putting questions to us, and Governor Dean, it seems that she's making your case, that…

Dr. DEAN: Well, yeah. Now look. I don't necessarily think the Blue Dogs are against the public option. One of the reasons I liked the compromise so much last week is they signed on to a public option. They changed it a little bit. I think they frankly made it probably better. But the public option is critical for this reason: The insurance companies, over the last 15 years, have incredibly abused both physicians and their clients. There was a great piece of testimony in front of the House, a committee, about - I think it was Energy and Commerce - three weeks ago, where a former insurance executive came in and said, you know, the largest three health insurance companies in this country have kicked 20,000 people off who were really sick, who'd been paying - in the last three years had been paying premiums all that time by deliberately putting fine print in there that they could take advantage of later on. And that resulted in $300 million going to their bottom line. That's what wrong with the health insurance. That's why - industry in this country. That's why you have to have a public option, and then the American people can choose.

If we're going to have health-care reform in this country, it's not going to be done by Congress. It's going to be done by the American people making their own choices, but in order for them to make choices, they have to have choices.

Lily is the ideal person to sign up for the public option. It's health insurance you can't be denied. You can take it wherever you go. You can have it whether you have a job, or you don't have a job. You can't get kicked off it once you get sick. These are all things that the private insurance industry doesn't offer right now, and the only way they're ever going to offer it is if there's another entity competing with them that does offer it.

CONAN: Lily, thank you very much for the call, and we wish you the best of luck.

LILY: Thank you so much.

CONAN: Bye-bye.

Former Rep. SANDLIN: Neal, I might mention there…

CONAN: Max Sandlin, go ahead.

Former Rep. SANDLIN: Certainly, no one endorses the abuses that my fellow Texan there had to put up with. I think it's important to look at choice as exactly what that word means. There are many options. There are options, as the governor mentioned, on co-ops. There's a public plan - many that say that maybe we'll have a public plan, but we shouldn't start there.

You'll remember that Senators Baker, Daschle and Dole issued a report recently to say that we should have a five-year look-back. That's the same position that's been endorsed by the new Democratic coalition in the House.

CONAN: Also said that they ought to be considering taxing people's health benefits.

Former Rep. SANDLIN: That's one of the recommendations they made, but I think you bring up a good point. There are many issues here, you know: What sort of plan? What sort of choice? If you have choice, is there a level playing field? Would there be the same requirements of providing benefits, of transparency, of negotiated rates, as opposed to Medicare and Medicaid?

Medicare and Medicaid, while it's a tremendous program, also creates challenges in some parts of the country due to reduced reimbursement rates. They reimburse about 20 to 30 percent less than the private pay in many parts of the country and some places more.

So there are a lot of issues to consider. And I hope my fellow Texan there does better. And certainly, there are not many champions right now for the insurance industry, and that's one of the reasons we're having the debate.

CONAN: Here's an email from Dan(ph) in Chicago: Controlling the exploding cost of health care, I believe, is number one priority. It's for this reason, I believe reform should be financed within the health-care system by taxing lavish health plans to encourage responsible spending by users, creating a public option to keep insurance companies in check and mandated employer-provided health care to eliminate the crowding-out of private insurance.

And Governor Dean, the way at least the Congressional Budget Office has looked at the measures proposed - none of them do particularly well in controlling the costs of health care.

Dr. DEAN: I think that's right, and I don't think you - well, the public option will, eventually, because Medicare does a much better job of controlling its increases. Now, Medicare goes up too fast, but it doesn't go up nearly as fast as the private health insurance industry does. So the public option does open a window, partly because their overhead is four percent of every dollar.

CONAN: Mm-hmm.

Dr. DEAN: The overhead in the not-for-profit is about 12 percent, and the overhead in the for-profits is at least 20 percent because they've got to pay a return on equity to their investors. That's all money that your premium dollars - that doesn't get spent on health care.

So by nature, you know, Republicans go crazy when I say this, but - I'm a big capitalist. I think the private sector is fantastic, but there are two things that they don't do better than the public sector. One is defense, and the other is health care. They just don't do a good job on health care. And we would be better off, I think, if you could at least give people a choice of what's potentially a much cheaper system.

I do think the caller has some very good points. The - and one of the things - although I disagree with him about taxing health-care benefits, and I'll tell you why, interestingly enough, because I think that if you want to have reform, you've got to have it be gradual reform. If you start taxing health-care benefits, you're going to force people out of the employer-based system, which I actually say, I don't think the employer-based system is a good system for America's competitiveness. I think it's hurt our businesses terribly, vis-a-vis European and Canadian businesses. But people like what they have, and I don't want to be forcing Americans into one choice or another. And if you eliminate the - excuse me. If you add taxation of health insurance benefits, then you're going to force people out of the employer system, into the public option, I think, before the public option is ready to accept them.

So I do have some concerns about forcing people into either side, and I don't want to force them into the public option. I don't want to force them into the private sector, and I do think taxing benefits is going to force them into the public system before they're ready to go.

CONAN: And Max Sandlin…

Former Rep. SANDLIN: I think the caller has a critical point to make, and that's cost. That's got to be a critical concern and a priority with the government. The president said that he wanted a plan that's deficit-neutral, that bent costs…

CONAN: He said he wouldn't sign any plan that wasn't deficit-neutral.

Former Rep. SANDLIN: Well, it's not. That's right. He wanted to bend the cost curve, and he wanted a bill that works. The Blue Dogs have led the fight and carried the mantle for the White House on making sure that we have a plan that's deficit-neutral. Without those cost reforms, it's estimated that the cost to the budget, it would grow about one-third - to about one-third of the budget by 2020, and the government can't keep that up. So I think it's important to look at things such as the Cadillac plans, to look at finding…

CONAN: Look at taxing them, in other words.

Former Rep. SANDLIN: To look at that. Everything's on the table, but you know what? I think that more important than that is savings. I know that the Blue Dogs and some of the moderates found about $100 billion in savings out of Medicaid, and it's estimated about one-third of the $2.3 trillion that's spent on health care each year is unnecessary or duplicative. So if you can continue to work, continue to look at the options, and let's find out something that - a policy that works, it delivers quality health care that's affordable and accessible.

CONAN: Let's go…

Dr. DEAN: I need to add one thing to this.

CONAN: Very quickly. I wanted to get another caller in.

Dr. DEAN: This reform is going to change a lot of things. And in itself, in itself it's not looking at cost-control as much as I think it should be, but we've got to get the reform done.

This month, or last month, in Massachusetts, they have a system which has brought their uninsured rate down to 2.5 percent. It's extraordinary. It doesn't have a public option. It's one of the reasons I think their costs are out of control. A panel of physicians, hospital people and other medical-industrial-complex folks voted to eliminate fee-for-service medicine. If you eliminated fee-for-service medicine, which I have no doubt will happen sometime if this reform passes with a public option, you will: A, pay primary-care doctors better than they're paid in Britain, which is not the case today, and B, you'll save a fortune because you won't be - the whole system won't be geared towards rewarding us doctors for doing more things than are necessary to do. That'll save a tremendous amount of money.

CONAN: Well, Kevin, I think, has a call on that point from Raleigh, North Carolina.

(Soundbite of coughing)

KEVIN (Caller): Good afternoon, gentlemen. I work as a medical-records coder. I'm a certified coder affiliated with the American Health Information Management Association, based in Chicago, Illinois. I've worked for a state hospital, and I currently work for a private hospital.

I think you've pretty much addressed my primary points that I was going to raise as questions, so I'll move to a third. I think one of the additional ways you could cut costs would be to do the following.

In Medicare, a lot of people don't realize, because they're not (unintelligible) - Medicare strictly mandates that if you order a test or procedure done like a head scan or CAT scan on someone, that the results or the diagnosis of that scan be - fall within the certain parameters of being considered medically necessary. Like the person suffers from things as dizziness, headache or they have some sort of brain atrophy.

Now, if you were to mandate that all insurance companies had to be just as strict, and they had to have medical necessary diagnostic codes to justify the procedures, then the procedures couldn't be just prescribed willy nilly, and you come up with nothing, and then this - and then, the doctors or hospitals expect that the insurance companies will have to pay for it, just because they have a Cadillac plan. Secondly…

CONAN: And very quickly, if you would, Kevin, we want to give some other people a chance.

KEVIN: Sure. My second point is that, had - the situation here in North Carolina for state employees with Blue Cross Blue Shield is ridiculous. There are doctors now down here who won't even take patients with that insurance because Blue Cross is conniving and wiggling their way out and refusing payment of things that they should be paying for. And I think any kind of changing or rearranging of a plan that benefits private insurance like Blue Cross Blue Shield is just a total waste of time because they're going to bring it to - always been (unintelligible) by a moron.

CONAN: Well, I don't think we're talking about anything in any of these plans that would…

KEVIN: Right. (Unintelligible)

Dr. DEAN: Yeah. You are. If you don't have a public option, you're going to force millions of millions - trillions of American dollars into the private insurance industry where they're going to be wasted just the way the caller - I mean, that's why the public insurance option is so important. The idea of putting a trillion dollars into - or 600 billions is what it's been scored at, I guess, in the House - into the private insurance industry is crazy. It's throwing money out the window.

CONAN: All right, Kevin. Thanks very much for the call.

KEVIN: Thank you.

CONAN: Bye-bye. And we're talking with Howard Dean, a former Democratic National Committee chair and a six-term governor of Vermont, and the author of "Howard Dean's Prescription for Real Health Care Reform," which came out last month; and Max Sandlin who served as Texas' first congressional district representative for eight years and original member of the Blue Dog Coalition.

You're listening to TALK OF THE NATION from NPR News.

And let's get Dale(ph) on the line. Dale, calling us from Wisconsin.

DALE (Caller): Hi. I was - went to a congressional meeting last night that my congressman had sponsored to talk about the health bill. And the room was packed. There were seats for 300 people, and they actually had to turn people away. But the crowd that packed that room was not there to listen to him at all. They were there to shout him down. There was absolutely no respect to let him speak, to let him explain what was in the bill. And civility had totally gone out the window.

CONAN: Can you tell us who the representative was and what the debate was about?

DALE: Well, it's a little embarrassing because, you know, I hate to say the name of the city, but it was Congressman Kagen's debate. And he, you know, he wanted to talk about bill. He was there to listen to what people had to say. But that never happened in a civil manner because this group that packed the room obviously had an agenda to just shout him down and not let him speak.

CONAN: Shouting him down, saying what - no government-run health care, that sort of thing?

DALE: Exactly. And no bill - just, you know, they wanted to keep things the way they are because, you know, whether it affected their jobs or whatever. But they didn't want to hear what he had to say at all.

Rep. SANDLIN: You know, that's happening.

Dr. DEAN: In fact, that's the Republican strategy that's on the Internet right now. There's a guy named - I think his name is Mac Interf(ph) or something like that, or Maggot or something. Anyway, that's all over the net. And this is -you know, that's what I was talking about when I talked about brown shirts. You know, they don't care about the bill at all. They want to embarrass the Democrats, and it's an embarrassing for them. I don't think the public is going to put up with this for a minute. I think people are disgusted with the right wing. And these are the same people who put on the tea parties.

DALE: Yes. Yes. (Unintelligible)…

Dr. DEAN: You know, the experience is very badly for the other side. And that's why I don't think the Republicans are serious of any kind of bill. They unleash this kind of people on these meetings and nobody gets a word in edgewise or just to hear about it.

Cong. SANDLIN: If I might add something to that, Neal. Oftentimes, people that go to these meetings as your caller is indicating are just the activists for one party or the other. In this particular case, they're interested in advancing a political agenda. They're not interested in policy. They're not interested in health care. They're interested in a political agenda. And there's obviously, right now, a political and a policy tension.

And if - as I was mentioning earlier, briefly, if the goal is to enact health care reform that makes health care available and affordable and of a quality nature, if it's - if that's the goal, that's where we need to work toward. And we need to work to get the votes to get that done, whether that's bipartisan or not. If that's the goal, that's the way we need to work. And this is serious, important policy for the country.

CONAN: Dale, thanks very much for the call. Appreciate it.

And Howard Dean, we just have a couple of minutes left. But I wanted to ask you about this slippery slope argument, the idea that a strong public (unintelligible) would inevitably drive out private insurance and bring everybody in and become, over time, the equivalent of a single-payer system.

Dr. DEAN: Well, first of all, if that's what the American people want, so what. It seems to work pretty well in other countries. But I don't think that's going to happen, because there is no such thing as a pure single payer. Medicare, which is a single payer has private insurance in it. Britain, which is probably the most socialized system in the Western World, has 15 percent of all its health care dollars and private dollars.

The Netherlands and Switzerland use 100 percent private dollars. But they regulate their insurance industry like private utilities - like the public-utility regulation. They tell them how they can make and how much salaries they can pay and all this kinds of stuff.

So, I often think we ought to introduce that for reform and see how fast the insurance companies embrace the public option. They'll make money but they'll have to behave themselves a lot better.

And again, there'll always be people, significant numbers of people who want -have their insurance in the private sector, and I think that's their right. But I don't think it's their right to bust up meetings and I don't, you know, as this - the gentleman talked about, which is going on all over the country - I don't think it's their right to deny choice to the American people.

I think the American people deserve an honest, open debate. I do think conservatives have something to say, and I think the Blue Dogs have been, for the most part, very constructive. While we may have some disagreements, I think they've made this bill a better bill. And I wish the Republicans were genuinely engaged, instead of being the party of no, and now, being the party of rudeness, disruption and encouraging violence.

CONAN: Howard Dean, thanks very much for your time today. Appreciate it. And Max Sandlin, I apologize, we're out of time.

Mr. SANDLIN: Thank you. That's okay.

CONAN: And thank you for your time today too.

Mr. SANDLIN: Thanks for having me.

CONAN: We're going to continue this conversation as this legislation makes its way through Congress. And, well, the next few months are going to be quite interesting.

Coming up, Ferris wheels, fried Oreos on a stick, cows sculpted in butter - the joys of the state fair. Garrison Keillor will join us.

Stay with us. I'm Neal Conan. It's the TALK OF THE NATION from NPR News.

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