Claire McCaskill’s first move as she initiates her 2012 re-election dance? According to The Hill, she’s suggesting that if congress is willing to consider alternatives, it can achieve health care reform cost cutting goals without the individual mandate. She acknowledges that the move is politically motivated:

“I certainly noticed the vote on Prop C, the healthcare law, and: message received,” she told state reporters the day after the vote.

I admit to a certain chagrin that McCaskill apparently received that particular message so eagerly, emanating as it did from fewer than the 23% of all Missourians who bothered to vote in that particular primary election, while she ignores many heartfelt messages from her base – you know, those folks who donate money, make calls and perform other sundry electioneering tasks. Apart from such ignoble spleen, though, I would be willing to hear her discuss what she thinks the alternatives might be that could expand insurance coverage and still bring down costs.

Certainly, a politician I respect, Howard Dean, has also attempted to make the case that the mandate is not necessary to get most people to purchase insurance and keep it affordable. I am am not, however, persuaded by his arguments as long as the basis of our health care delivery consists of private insurers. To say, as Dean does, that something worked in Vermont does not necessarily mean that it will scale up.

On the other hand, The Center for American Progress (CAP)’s Michael Gruber developed a “microsimulation” model similar to the model the Congressioal Budget Office used to score the ACA in order to evaluate what would happen if the individual mandate were removed from the ACA.* He summarized his findings as follows:

Total insurance coverage would rise by fewer than 10 million persons rather than the

32 million persons estimated by CBO. The number of uninsured would be reduced by

less than 20 percent rather than by about two-thirds.

• Employer-sponsored insurance, which is projected to erode by about 5 million persons

under reform, would instead erode by over 20 million persons.

• The fully implemented cost of the legislation in 2019 would fall by only about 20 percent-

we would spend 80 percent as much to cover fewer than one-third as many people.

• Those who do not obtain coverage would be the healthiest individuals, causing enormous

adverse selection in insurance markets. The average individual premium in the

exchange would rise by about 40 percent without the mandate.

I’m fine with bringing the mandate up for debate before it is even put to a trial if political folks just really have to do so, but I would want to be sure that each of the points above were addressed – or that the entire approach be scrapped and we move to a public health care delivery system, an outcome so unlikely that it can safely be relegated to the realm of fantasy literature. Costs are a truly important issue, particularly when we’re hearing so much deficit rhetoric from politicians like McCaskill. While Social Security is demonstrably not part of the deficit problem, exploding health care costs are a huge part, and health care reform was designed to address exactly that issue, which should, in turn, ease the pressure to cut Medicare and Medicaid benefits. If the ACA is rendered unable achieve that goal, we will all pay the price down the road. We can only hope that McCaskill will tread carefully.

UPDATE: So is McCaskill afraid of the individual mandate? Maybe not. She appears to be walking back remarks she made during an MSNBC interview as reported by Politico and in The Hill snippet quoted above.

* Sentence edited slightly for clarity.  

Progressives never accuse Howard Dean  of being a sellout, so when he speaks favorably of the Senate compromise–dropping the public option in favor of expanding Medicare–as he did on Rachel Maddow’s show Thursday, that’s an opinion many of us respect.

But Jane Hamsher’s assertion that expanding Medicare is only worthwhile if it’s a mandate for everyone 55 and older is based on credible knowledge. She contacted Physicians for a National Health Program, who informed her that if it isn’t mandatory “it becomes the place where all the sickest patients get dumped.”

Is Dean’s optimism ill founded?  

Howard Dean is going to eat Newt Gingrich’s lunch in a debate about health care. Democracy for America (DFA), the outgrowth of Howard Dean’s 2004 presidential campaign, is sponsoring the event at SEMO in Cape Girardeau Wednesday evening, the 28th at 6:30.  

I’m about to see Gov. Dean in a health care townhall at Netroots Nation. No, I’m not going to liveblog this – I’ll post video when it’s available – but post your questions in comments, and I’ll ask him as long as it’s reasonable.

In 2003 as I was casting about for a Democratic Party candidate who I could support in a run for the Presidency I came across Howard Dean’s campaign. In May 2003 I showed up at a small dollar fundraiser in Fairway, Kansas and listened to what Howard Dean had to say (by the way, the stenographer was also in attendance). By that summer I was hip deep in keeping up with the campaign and attending meetings. By the end of December 2003 I was a volunteer “troll hunter” on the Forum for America. By the time the campaign was over I had sent almost 1000 hand written letters to primary voters across the country and contributed a pile of cash to his campaign. I stayed on for close to fifteen months before the Democracy in for America folks in Vermont and I parted ways. By that time Howard Dean was the Chairman of the Democratic National Committee.

Yep, that Fifty State Strategy worked in 2006 and 2008, but oh, the irony:

…On November 7, 2006, all the top Democrats graced the stage of the Hyatt Regency ballroom in Washington for a big election-night victory party. All of them, that is, except Howard Dean, chair of the Democratic National Committee (DNC). The party leadership had accused Dean of spending too much money on rebuilding moribund parties in red states and not enough on key Congressional races where Democratic pickups could strengthen their narrow majority. The results that night, as Democrats recaptured Congress, seemed to settle the argument in Dean’s favor. But key Democrats, including Representative Rahm Emanuel, a former senior adviser to President Clinton, weren’t satisfied, and Dean opted to stay away from the celebration, doing TV interviews instead….

…And then the effort to marginalize Dean collapsed…

Jerome Armstrong at MyDD:

On the blow off of Dean

…Well, look. The numbers of us online and active that were around when Dean was big, in the ’03-’06 era, are a small minority compared with the numbers now engaged– even within the blogosphere. We know what Dean did, and that without his leadership and embracement of the netroots people-powered 50 state strategy, victory in ’06 would never have happened. It did, and it laid the groundwork for Obama’s in in 2008– that’s his legacy, and its a fine one….

And this is what Howard Dean said in November 2008:

A blogger conference call with Howard Dean, part 2

…Question: Hi Governor Dean. I was just wondering, you know, as you’re preparing to move on from the DNC if you, you know, have any preferences as to who you’d like to be as the next chairman, and, and the advice for that person, and, and also what you see as the future of the fifty state strategy under your successor and your own personal plans for [crosstalk]…

Howard Dean: Well, you know, I, I’ve done a transition memo for the Obama folks, so I know I’m not going to publicly say what’s in the transition memo, but I think I can broadly outline. First of all, the Obama campaign used a fifty state strategy in order to win this election. He, he had an office in places like Utah, which everybody knew we weren’t gonna win. So it’s extraordinary what he has done, not just for the country, but the Democratic Party. And I have no doubt that that will continue with the new chair. I don’t have an advice for a specific person for the new chair. I do believe that the party gets run differently when you have an incumbent Democratic president. I think he ought to have a person who’s very loyal to him as the executive director, because that’s where the decisions are really going to be made. And he will run the party, through his people, for the next four years, and hopefully the next eight years. And I think I guess that’s about all I can say, but I have every confidence that the fifty state strategy will continue and the map will be expanded even further in 2010 and 2012…

[emphasis added]

By all means smile, pat the guy on the back, and shake his hand. Don’t tell him, “Don’t let the door hit you in the ass on the way out.”

Oh, the irony. Right, Tara?

Part 1: A blogger conference call with Howard Dean: “…the next state on my list is Texas.”

Part 2:

…Question: Hi Governor Dean. I was just wondering, you know, as you’re preparing to move on from the DNC if you, you know, have any preferences as to who you’d like to be as the next chairman, and, and the advice for that person, and, and also what you see as the future of the fifty state strategy under your successor and your own personal plans for [crosstalk]…

Howard Dean: Well, you know, I, I’ve done a transition memo for the Obama folks, so I know I’m not going to publicly say what’s in the transition memo, but I think I can broadly outline. First of all, the Obama campaign used a fifty state strategy in order to win this election. He, he had an office in places like Utah, which everybody knew we weren’t gonna win. So it’s extraordinary what he has done, not just for the country, but the Democratic Party. And I have no doubt that that will continue with the new chair. I don’t have an advice for a specific person for the new chair. I do believe that the party gets run differently when you have an incumbent Democratic president. I think he ought to have a person who’s very loyal to him as the executive director, because that’s where the decisions are really going to be made. And he will run the party, through his people, for the next four years, and hopefully the next eight years. And I think I guess that’s about all I can say, but I have every confidence that the fifty state strategy will continue and the map will be expanded even further in 2010 and 2012…

…Question: Hey Howard.

Howard Dean: Hi.

Question: Hey, I, I blog out of New Orleans and we have a kind of special difficult circumstances here. And we’re in a deep red state. I’m curious as to how the fifty state, state strategy over the next couple years may make inroads in red states where Democratic Party infrastructures have been a hindrance.

Howard Dean: Well, in, the, the, in New Orleans, in Louisiana we don’t think the Democratic, there are some states where the Democratic party structure is a hindrance, but Louisiana is not one of them. The problem with Louisiana is because of Katrina. We basically had to support their party in ways that we didn’t have to do for anybody else. And, that, their, their difficulty, again, with Democratic poli..Party politics in Louisiana is it’s very hard to get the capacity to run the party without having, having a governor, and without having the ability that you have when you’re, in, in sort of a stable situation. I don’t think politically Louisiana has been a particularly stable situation since Katrina. What with the huge population changes and, and the change in the political climate because of the reaction to Katrina. That doesn’t mean we’re gonna give up on Louisiana. We’re not. I actually took a bus tour through Louisiana before we even decided which states were gonna be in the mix and I…Louisiana and Mississippi were two states that we thought might be in the mix. So, we’ll, that is, but you’re right, Louisiana is a special circumstance which is gonna require some special attention and we’ve done some of that but clearly there’s gonna have to be more of that from the next DNC chair…

…Question: Governor Dean, here in New Mexico we had a big swing this year and in votes, in votes, especially among Hispanics. I was wondering what kind of outreach you guys did specifically for Hispanics [crosstalk]…

Howard Dean: We had the largest Hispanic outreach in the history of the Democratic Party. I think we spent twenty million to start with, and more than that, reaching out to Hispanics all over the country. And a lot of it was the thing that you expect, Spanish language TV and newspaper and radio. Interviews. But we had an enormous number of Latino organizers on the ground in these key states making contact with, with prospective voters. Florida was the other place where we just spent enormous amount of money, time, and effort in the Hispanic population. Organizing in the community, in ways that I think have never been done before. We started, actually, before we knew who the nominee was gonna be. A couple of years ago I reached out to Hispanic evangelical ministers, Protestant ministers, who had been meeting with Bush, partly because of the faith based outreach. But immigration allowed us the opening to begin to talk with them and some of them have become our friends and they worked very hard for the Democratic ticket within the bounds of their tax exempt requirements. And that was a huge help to us. And so we did get big assist from the Republican immigration language. It wasn’t so much the policy but the language that they used to discuss American citizens who were Hispanic, let alone immigrants…

…Question: Hi, Governor Dean, happy birthday by the way.

Howard Dean: Thank you.

Question: How frustrating is it for you as DNC chair, with West Virginia, where every office from the governor on down is pretty much controlled by the Democrats, but we’ve lost the last three presidential elections. And what can be done about that?

Howard Dean: Well, actually, it’s much better to be in a position of West Virginia than it is, say, in Alabama where you have a Republican governor. We’ve got a great Democratic governor and Democratic office holders and now we’ve just got to figure out how to translate that into winning the presidency. We came back. We were way behind, we came back, hey Joe Biden made a last minute visit to West Virginia. So West Virginia is one of those states like Texas we just got, we can, we can keep working at it and we can win it again. And when we do, the whole political dynamic will have changed. This is it again, a generational shift that’s going on in West Virginia and, and other parts of Appalachia. And I think we just gotta work our way through it and keep working hard. But I don’t, I don’t, it’s not, West Virginia is not the least bit frustrating to me. I, I was very pleased by what happened in West Virginia. We didn’t win, but we really closed the gap in the last couple of weeks. And that means that the momentum will be with us in the next election…

…I just want to say thank you all. Look forward to, hopefully, seeing you all in person one of these, maybe at the convention, the Netroots convention next year…

I participated in a blogger conference call with Democratic National Committee Chairman Howard Dean today. He made brief opening remarks and then proceeded to take questions from bloggers in on the call:

Kombiz Lavasany: Hi guys, this is Kombiz Lavasany with the Democratic National Committee. I’ve got Governor Howard Dean here. I’m gonna go ahead and put him on and we’ll take your questions right afterwards.

Howard Dean: Hi guys. Which is the generic term, of course, meaning guys and gals. Let me just say, thank you for your incredible commitment to change. And your incredible commitment to making sure that ordinary Americans are empowered by empowering the grassroots. It was a great campaign, for a lot of reasons. And, as you may remember, there was a guy who ran for president in 2004 who had the slogan “you have the power”. Well, you really do have the power and you exercised it well. And I, and you helped a lot of people in the grassroots exercise it which is even more important. So I just wanted to say thanks. I am happy to take comments, questions, and field rude remarks. There are a couple of things I’m not gonna talk about, but you’ll find out what those are if you ask me any questions about ’em. So, with that we’ll just open…

…Question: Hi Governor Dean.

Howard Dean: Hi.

Question: This is Amy Morton down in Georgia. Hope you’re well. We’re not quite done with elections [crosstalk] in Georgia…

Howard Dean: No, you’re not. How’s the early voting going? The early voting reports were pretty good.

Question: Early voting is okay. It’s not uniform across the state, though. It did not begin at the same time.

Howard Dean: Uh huh.

Question: But I wanted to ask you about what the DNC’s efforts are regarding our senate race.

Howard Dean: We’ve got folks on the ground. The Obama people have kept all their offices open. There’s a fair amount of money going in. I think you, you’ve seen that in the ads. And this is a test for us. And it’s a difficult test. Because, it’s you know, this, as you know, this business of runoffs is really crazy. Everybody gets worked up and then they, there’s a let down. And, but, business is not over in Georgia.

Question: Right.

Howard Dean: So, we clearly need to energize the same voters that went out and voted for Barack Obama, to vote for Jim Martin. Now, Jim Martin, in my view is a wonderful, wonderful candidate. He’s a great human being. And anybody who voted for Barack Obama should be very proud to vote for Jim Martin. But, you know, this is a turnout game and there’s lots of work to be done. And this is, this is a test for us.

Question: Yes, and, and for us, too. And we certainly appreciate all the help the, that we’re getting in terms of field, from not just the DNC, but from volunteers all over the country. And just want to encourage everybody to encourage their readership to keep the good thoughts and volunteers and phone calls and all that coming to Georgia.

Howard Dean: And they’re knocking on doors, which is really…if we can get out the big vote that’s gonna make all the difference in the world.

Question: Yes, I agree. It’s what it’s all about. But thank you.

Howard Dean: Thank you…

…Question: Hi, Governor Dean. I have a question about the fifty state strategy. Comparing the electoral math from 2008 to 2004 and 2000, it’s evident that Barack Obama over performed, out performed John Kerry and Al Gore in most states. But, there, there are regions in Appalachia and the inland south where he significantly under performed. I was wondering if you think that is any way a failure of the fifty, fifty state strategy or if that’s the result of not enough commitment on, on Senator Obama’s part, to campaign in those regions or what you think about that.

Howard Dean: The truth is we don’t know. Until we dissect all the exit polls we’re not gonna know. I, let me just tell you about my own experience in this is. People always want to dissect campaigns after they’re over, whether you win or lose. People did this when I ran my campaign. I, I hadn’t really figured it out until about eighteen months later, what the real problems with my campaign were. So, you know, clearly we would prefer to do better in the Appalachian regions. But the win in Florida, which is the most complex state in the country, to win in North Carolina and Virginia, and to win in the west is a huge, huge improvement over our position and playing defense in those states in 2012 is going to be very, very good for the Democratic Parties in those regions. So, again, I don’t know why we didn’t do better in the Appalachian regions, but I, over time we’ll figure that out. And, and we’ll try to go back in and do better the next time. But, again, I think the real story, at least for me, were, were Florida, the, the crack in the Confederacy, for the first time in a long time, other than a couple of states with Bill Clinton and Jimmy Carter. And, and the most importantly of all to me, not from a sort of a morale point of view, because the south is incredibly important that way, was, and so is Florida, but, was the west. Because we started out four years ago with a strategy that the road to the White House leads through the west and that you could win without Ohio or Florida if you had to if you could take those western states. We took all of the ones we intended to take except for Arizona, for obvious reasons. And we added Iowa to make up for that. And, and that’s very, very important. I think we can be a permanent presence in the west and I think we can be a permanent presence now in Virginia and North Carolina. And I tell you what the next state on my list is Texas. We’re getting closer and closer there. I think we can win there, too…

Part 2 of our transcript will follow.

I don’t think so. But I’m willing to listen, if someone can make a good case for McCaskill as DNC chair.

I’m a huge fan of Howard Dean. Huge. And Saturday afternoon, at SLUH, he showed me again why he deserves such respect. What he said to encourage the students in attendance to work at registering new voters was passionate, yes, and yet it was a carefully laid out argument against Republican ideology.

I couldn’t pick just one or two short sections out of the half hour, so I was planning to post all of it in five minute increments. Only one of them has successfully uploaded to YouTube, though. Here it is. If I can get any others to upload, I’ll post them.

Update: Part 2 finally uploaded. Here it is: