Hail to the ... Doctor?

One August afternoon back in 1991, Howard Dean, MD, was examining a patient in the medical office he managed with his physician wife, Judith Steinberg. An urgent phone call interrupted him: Vermont Governor Richard Snelling had died unexpectedly. Dean, then Vermont's lieutenant governor, was asked to come to the Capitol immediately. 

Nearly a dozen years later, as he campaigns for president of the United States, Dean recalls that day during a recent interview. "I knew it would be months before this patient could be scheduled again, so I finished up and then went over to be sworn in." Thus ended his days as a practicing physician.

As governor, Dean eased the state's fiscal problems and saw major healthcare reforms enacted. For example, in Vermont there's a safety net for children and adults who cannot afford health services. "We increased access; we didn't try radical reform," Dean explains.

Dean left the governor's office this past January, garnering considerable praise as a "frugal crusader," and is now one in a crowded field of Democrats vying for the party's 2004 presidential nomination. Political insiders labeled Dean a long shot with a capital "L" -- until he began grabbing attention and headlines for his strong opposition to the Bush Administration's foreign policy.

Regardless of your politics, if you have an MD after your name, you should give Dean careful consideration.  

Sure, it would be simple to minimize his successes in Vermont. With a population just over 600,000, and a state budget around $2 billion, Vermont is tiny. Many American cities dwarf it several times over. But speaking with the self-confidence of a seasoned physician, Dean presents himself as a pragmatic visionary who knows how to govern.  

Dean says he would ease the country's healthcare problems the same way he did in Vermont. "Focus on access first. Give everyone a basic level of coverage: not free, but subsidized care." Then, he jokes, "once everyone is in the system we can have a big fight about all the other issues."

Physicians would be better off if his approach to reforming healthcare became law, Dean asserts. "Medicare reimbursement rates will rise, and there will not be uncompensated care." Dean would pay for this plan by repealing President Bush's tax cuts.

And, Dean says, changes to the healthcare system will succeed when bureaucrats recognize the impact so many regulations have on physicians and patients. "I will make sure that a physician with real practice experience heads up CMS [the Centers for Medicare and Medicaid Services]. That's a horrible system that is poorly run. They have no sense of how to manage healthcare."

Clearly, Dean is a politician who keeps up with the plight of physicians. His wife continues to practice, and plans to do so for the foreseeable future, "either in Vermont or Washington, D.C.," he says.

You may not agree with Dean on all the issues. Physicians don't walk in lockstep when it comes to politics. But a president who once treated patients and shares his life with a practicing doctor would probably be the most likely candidate to improve the circumstances of clinicians in this country. If you agree, visit Dean's web site, www.deanforamerica.com. This could be a golden opportunity that's long overdue for physicians.

Politics and Your Practice is written by Ken Karpay, JD, CMC, associate publisher of Physicians Practice and a management consultant. He can be reached at kkarpay@physicianspractice.com.

This article originally appeared in the May 2003 issue of Physicians Practice.