Dean Interview in HIV/AIDS Magazine
- Here's a good story on Dean from A&U Magazine ("America's AIDS Magazine"). It has some powerful quotes from the good doctor. Also, there's an interesting piece in a Canadian daily that talks the Dean's ties to Canada and his extensive knowledge of Canadian politics. Apparently Dean was a regular commentator on a television news show in Canada called 'The Editors'...does anyone have tapes?? Wouldn't that be great... Here's the link:
White House Calls
Art & Understanding
Literally within days of making his transition out of office in January after having served an unprecedented six terms as Governor of Vermont, Howard Dean was on the road making appearances as the first announced candidate seeking the Democratic nomination for the 2004 Presidential elections. The plain-spoken physician took time during a campaign stop in Atlanta to talk with A&U’s B. Andrew Plant about healthcare policy, AIDS, and the limits of the Bush Administration.
It is sometimes difficult to get a potential interviewee to commit. More accurately, it usually takes some tenacity to navigate the egos and protocol of the people who keep the schedules of the people we need and want to hear from on the subject of AIDS. And scheduling an interview with former Vermont Governor Howard Dean was no easier than scheduling other interviews–but for different reasons.
Simply put, with Dean having just handed over his job as Governor to his successor the previous week, he and his advisors were busy putting the basics of a campaign for President in place. Dean for America had to create itself almost over night, setting up offices, getting computers up and running, adding more to the workloads of what is from any perspective a lean campaign team, hiring additional staff, organizing volunteers, and, yes, juggling requests for interviews and "photo opportunities" from pesky writers like me.
The key difference of these scheduling difficulties, however, is that there seems to be no real ego attached. Of course Dean wanted to do the interview; he is the "dark horse" candidate among a field of better-known, if-not-announced, contenders, who has the most to gain from exposure in the media. The lack of self-importance on the part of Dean that I observed while setting up the logistics of an interview exemplify the man the public is getting to know during these early days of his campaign.
The physician-turned-public servant "calls ’em as he sees ’em," as observed by an audience member during this Atlanta campaign stop. Indeed, Dean does not mince words. While he is articulate–well-versed on the issues and well-aware of the current trend of extreme political correctness–he prefers to break through the clutter and communicate clearly and directly via the power of his shoot-from-the-hip style. Yes, he wants to be Presidential, but not at the expense of his ideals.
Those ideals include the larger scope: "I am running for President because I believe this country is fundamentally headed in the wrong direction…it is time for change." Dean’s narrower "focus issues" are simple, and perhaps a bit radical, and draw distinctly from his successes in Vermont. "I am proud that virtually every child under eighteen and more than ninety percent of adults in Vermont are eligible for health coverage," he says. "…[A]s a country, the United States can do better on this front."
Answering questions at the conclusion of his address to the Atlanta Executive Network in January, Dean raised his voice over the early clapping of hands and explained more specifically what he means by our country doing better, and zeroes in very plainly on who he is criticizing.
"So, when some conservative group asks me about family values, I’m going to say, ‘Where are the family values that say black people can’t get into medical school? Where are the family values that make sure women have no say over whether they get pregnant or not? Where are the family values in changing scientific facts to make sure that teenagers have no idea how to avoid the contraction of AIDS and other diseases?’ If that’s what family values are, ladies and gentlemen, then this country is ready for something different!"
After several such strong declarations, one audience member urged Dean to "say something that you like about [President] George Bush." The reply was characteristically straightforward–and humorous. "When he was in Texas, he was relatively moderate," Dean said.
As Dean exited the ballroom this night in Atlanta and the crowd began to disperse, a woman who mistook my notepad and tape recorder for the tools of a newspaper reporter leaned close and conspiratorially offered, "Tell people who read your newspaper that this guy doesn’t talk about a program without talking about how to pay for it!"
As I wrote down her spontaneous offering, she asked what I was there to hear him talk about. When I told her, she said, "HIV and AIDS? From what I’ve heard [here tonight] that’s something he would know how to do something about. He at least mentioned it; the others won’t even do that!"
With that, she disappeared back into the crowd. No doubt Candidate Dean would be pleased that someone in his audience understood the way he is casting his candidacy–a balance of fiscal prudence and social responsibility. "I know I have been compared to [2000 presidential candidate] John McCain," Dean told the Atlanta audience, "for my directness, at least…but I am more progressive [in terms of social programs]."
And Howard Dean is a straightforward guy, as reflected in his talk I had heard this evening, and even more so when he sat down with me later in the evening for one of his first interviews of Dean for America 2004. Yes, it is tough to get a high-profile person to take time for an interview, but Dean understands the importance of doing so. He also realizes that he is sitting down for an interview about AIDS–something other presidential candidates might rather face in a more circuitous way.
Presidential hopeful and Congressman Richard Gephardt has talked openly about AIDS. So, did former Vice President Al Gore, though he has now bowed out of the race. The other candidates are slow to weigh in on issues at all–especially tough ones like HIV and AIDS. In fact, when Dean and I spoke, he was the first announced candidate for the election; he wants to start the race and be on the record, letting others leave the public to speculate on their candidacies and stands on issues. Typical Dean candor.
His candor–and his early entry into the 2004 Presidential Race–are likely to be credited with, as he jokingly told the Atlanta audience, doubling his position in polling over the prior two months. Dean laughed at the statistics because he had moved from a two percent recognition factor to a four percent recognition factor. He seemed to delight in both the valid progress and in the absurdity of the smallish numbers.
As a medical doctor, and as a governor who made improved access to healthcare one of his hallmarks, HIV/AIDS is an issue that is very much already on Howard Dean’s radar screen. "When I was training [in medical school], HIV/AIDS was not a big issue–around 1978–but by the time I got into practice it was," he says. "As a physician it is a fascinating disease, but, obviously, a horrible one for the community."
And it has just gotten worse, Dean notes. "Now teenagers are the fastest growing group that contracts HIV/AIDS," he says. "Straight teenagers are increasingly infected."
He also is quick to say that gay men–especially younger gay men–have forgotten how terrible AIDS is. "It is still a very bad disease. One of the things I worry about and that we need to cope with is the re-education process; young gay people who are engaging in unprotected sex because they think retroviral therapy will allow them to live a symptom-free life. Retroviral therapy is not pleasant. The gay community needs to focus…many gay men have forgotten how awful this scourge was when it first began."
It’s natural to ask the former leader of the state how Vermont’s healthcare system helped people with AIDS. "The fact that people have insurance in general is an enormous help. "Dean says. "As we all know, HIV/AIDS is a very expensive disease to deal with…."
Specifically, he says there are two aspects of the Vermont system that are somewhat unique. "First of all, so many people have insurance, and second of all, [Vermont] has such a well-developed hospice system," Dean notes. "That [hospice care] was an especially big deal in the beginning, because people contracted HIV, went downhill pretty rapidly and didn’t last too long. But now we are saving a lot more people–helping them live better and longer because of triple therapy and greater understanding about the disease in general. So the hospice end of things is not as big a focus, but paying for treatment and prescriptions is more important than ever."
But the "universal healthcare system" Dean often speaks of as being modeled on Vermont but applicable nationally is not what you might imagine. "No one would have to change their insurance if they don’t want to. I don’t want to change the whole system as we know it," he says. "We showed in 1993 that people won’t put up with that. Rather, we would work within an existing system to insure as many people as possible.
"Under the system that I propose, everyone would have access to healthcare, so a question of covering HIV and AIDS would not be a question," Dean says. "Because people would have healthcare coverage. Period."
He is quick to add that, "we do expect people to pay–they can’t expect healthcare to be free. But with guaranteed issue, they stand a better chance of having health insurance. Of course, if you don’t have any money, then you are going to get full public benefits. And we would need to broaden those."
Under the Vermont system, although insurers must offer guaranteed issue health insurance and they cannot refuse to cover someone, they don’t have to cover them for the first six months or something like that–a "pre-existing exclusion period," as it is called by most insurors. (Guaranteed issue insurance usually involves an insurance application which asks few or no health questions; or, in the case of Vermont, insurers may ask what they like, but they cannot refuse coverage based on the answers.)
"You don’t want people taking advantage of it…moving in from out of state or such…," Dean says, so you keep safeguards in place, but you do get everyone insured eventually.
Regarding this universal coverage and our social obligation to put such in place, he is fond of saying that, "[w]e ought not to be the last industrialized country in the world to guarantee health insurance to all of our citizens."
Guaranteeing coverage to all Americans would involve a mix of state and federal programs, Dean says, in addition to existing private sector programs. States would be required to guarantee coverage to all children (including all persons under twenty-three, he says). Federal programs would have responsibility for acute medical care and prescriptions for anyone over sixty-five. Employer-based systems–much as they exist now–would cover everyone else.
How would President Dean pay for this everyman healthcare coverage? That’s where his mantra of fiscal responsibility comes into play. Repeal President Bush’s tax cuts and balance the national budget, for a start, Dean told his Atlanta audiences. "We cannot have the social programs we want and need without solid financial grounding."
Specifically, he notes that just one quarter of the tax cuts he wants to see repealed would pay for an expansion of Medicare that could see a much broader prescription benefit for people over sixty-five for ten years. Ramping up Medicare’s pharmaceutical package in this way would make it "a decent insurance program," Dean says.
But what about working-age citizens who fall through the cracks of employer-based systems and governmental benefits programs? "We would look to things like refundable tax credits and federal subsidies to cover low- and moderate-income Americans who lack insurance."
And he definitely casts himself as more progressive than the current President. "The Bush Administration is really backsliding on AIDS issues because these people are ideologically driven, not driven by thoughtfulness," he says. Referring to ongoing allegations that followers of the current administration have done things like remove condom information from federal Web sites, he notes:."[Its] foolish. All it does is increase the number of people with HIV/AIDS."
He continues, saying that, "it is a very backward approach in terms of public health. Yes, we need to teach responsibility, but we have to educate people too…as much information as we can get and give." Dean reiterates that, "in Vermont we concentrated most on public health education and that helps everybody. It is doing things with a long-term outlook. You not only help people dealing with challenges like AIDS right now, but you foster children who will be healthy and who will be good citizens as adults."
Zeroing in just on the AIDS crisis again, but continuing on one of his favorite themes–health education, Dean shares an anecdote about spending a week in Burkina Faso, the African country where an international AIDS conference was held just a few years ago.
"The African countries that are really serious in trying to deal with AIDS are really so far ahead of Americans in terms of public education," he says. "We really need to be much more frank in a national discussion about sexuality because that’s how AIDS is principally spread."
"And we’ve got to stress things like condom use. It makes me ill to see the [U.S. Presidential] Administration doing things based on religious sentiments rather than scientific facts….It’s hurting so many people. It is hurting so many kids," Dean says, shaking his head. "I am all for teenage abstinence. But you have to educate kids and teach them how to protect themselves from unwanted pregnancy and HIV/AIDS. It’s naive to not do that! It is depressing to me that the Bush Administration is catering to the Religious Right and sending kids to their death while they are doing it."
Dean shrugs again and says he knows he is repeating himself but that he firmly believes some of the answers are that simple. "I think public health and education are the parts really being ignored right now in Washington," he says. "Of course, [we already know that] prevention is far more effective than treatment. We have a better chance of winning against AIDS if we can stop the spread. Slow the infection rate. Lessen the number of people who have it that we have to care for [medically]."
Dean is fond of saying that frank discussion–about finances, sexuality, human rights, abstinence, condoms, who influences whom politically and other subjects–"is critical if we are going to stop the increase in [AIDS] cases."
What call to the people does Presidential-hopeful Dean make in regards to the AIDS pandemic? "I hate to sound like a broken record," he says, shrugging a bit, "but education, education, education. Bring people with HIV/AIDS into classrooms to talk about it. Do whatever you can to make people understand AIDS prevention and what we must do for people who already have it. Public-health education and some kind of health care coverage for everyone."
B. Andrew Plant is an Atlanta-based freelance writer and is Editor at Large of A&U. He interviewed U.S. Congressman Richard Gephardt for the November issue.