Being a doctor shapes Dean's politics, manner
Good take on how Dean " OPERATES "..LOL!
By Jill Lawrence, USA TODAY
MONTPELIER, Vt. — Candy Moot recalls an incident she calls "quite typical" of Howard Dean, when he was governor. It was in the late 1990s, she was president of the Vermont Ski Area Association and she was in a dispute with Dean's natural resources secretary.
Dean sat them down and asked each to state her view. "He said 'OK, Candy's right, my secretary's wrong, draft an agreement,' " Moot says. "It felt very much like being in a doctor's office. He says, 'What are your symptoms?' He listens carefully. He makes the diagnosis. He says, 'Here's the remedy.' And that's it."
Dean's medical training and career have shaped him and his presidential campaign in ways that reach beyond slogans like "The Doctor is In." Political associates, former patients and voters say they see in him the self-assurance often associated with doctors. Accustomed to medicine's brisk pace and practical demands, he can also be impatient and inconsistent.
Medicine has also influenced Dean's priorities as a politician: child health programs, land conservation and a balanced budget. The idea, Dean says, is to avoid illness, abuse, sprawl, deficits and other problems. "Prevention is everything in medicine," he says. "It's much more expensive to treat something than prevent it."
Dean's doctor-like manner and choices don't please everyone. He readily volunteers that his medical background has helped him and hurt him in politics.
But as he pursues the Democratic nomination, his biographical TV ad stresses his medical training and his family-medicine practice with wife Judy, also a physician. The ad also describes his transition from lieutenant governor to governor "under the worst of circumstances," the death of Republican governor Richard Snelling in 1991. Dean got a call in the middle of an exam, turned the patient over to Judy, traveled to the Capitol and within a day became what he had never been before: a fulltime politician.
Other M.D.s in politics
Senate Majority Leader Bill Frist,
R-Tenn., surgeon
Rep. Jim McDermott, D-Wash., psychiatrist
Rep. Vic Snyder,
D-Ark., family practice
Rep. Dave Weldon,
R-Fla., internist
Rep. Phil Gingrey,
R-Ga., OB-GYN
Rep. Ron Paul, R-Texas,
OB-GYN
Rep. Michael Burgess, R-Texas, OB-GYN
Gov. Ernie Fletcher,
R-Ky., family practice
"When he first became governor, he acted like a doctor," says Jeanne Keller, a health-care policy analyst who was president of a statewide employer coalition on health during most of Dean's tenure. " 'Accept our word for it. We know the answer.' It was like, 'Take this legislation and call me in the morning.' He developed the humility that non-doctors have later on."
Abundant confidence
Humility hasn't been Dean's hallmark in the race, but his rise to front-runner suggests many Democrats are in the mood for his abundant confidence. "You say, 'Here's what's going on. Here's what we do to fix it.' You lay out a plan," Dean says in an interview. "That's what I did as a doctor, and that's what I'm doing in this campaign."
Judy Steinberg Dean practiced internal medicine with her husband for 10 years. She declined to be interviewed for this article. In a fundraising pitch last year, she said she likes "helping people on a one-on-one basis," while "Howard is much more talented at improving things for people on a larger scale."
Former patients say Dean was no-nonsense but caring, a good listener open to questions. He made house calls. He counseled people about divorce and other troubles. "It wasn't always their ankle pain," he says. "About 25% of the practice was people with psychological problems."
Still, running the business taught him more about the need for efficiency than the schmoozing skills so prized in state capitals. "I always know there's another patient," he says. "So I tend not to be process-oriented. There are lots of stories of how abrupt I can be with legislators. That's not helpful in politics."
But some doctor traits are appealing, or at least can be presented that way, in a political arena. Here's what Dean and others say he brings from medicine:
•Clear speaking style. Dean is known for being blunt, sometimes to a fault. "I talk as simply and directly to people as possible," Dean writes in his book, Winning Back America. "As far as an individual's health is concerned, you're not doing anyone a favor by not being completely open or honest with them."
Channa Brigham clearly remembers that aspect of Dean, her doctor when she lived near his practice in the 1980s. "He spoke English," says Brigham, 60, a deli manager in Montpelier. "He used a lingo that the common person could understand."
•Quick decisions. Dean says he doesn't agonize over decisions "as long as I have as much information as I can possibly get at the time. You've got to make a decision when it needs to be made and move on. It comes from medicine. It's what you need to do when you face a really sick patient."
•Focus on results. If a mother is carrying a bleeding little girl who was hit by a car, "it's not the moment where you get all weepy," says Joe Trippi, Dean's campaign manager. "You've just got to find the facts out here really quickly or she'll die. It's not about feeling your pain, it's about solving your problem. He feels it, but he's trained not to show it." Sometimes, Trippi says, "that comes off with a little less warmth to it."
•Reliance on facts rather than theories. Dean, Trippi and others say this explains why Dean has a mix of ideological positions and sometimes changes his mind. He went from opposing to supporting programs that distribute needles to addicts after a 1995 study found that programs helped prevent AIDS and did not encourage addiction. Last year, he qualified his support for free-trade agreements after seeing communities reeling from losing their manufacturing jobs to other countries.
AP
Dean
Dean aides say changes in facts were behind his shift on Medicare. He briefly supported a cut in Medicare's rate of growth proposed by Senate Republicans in 1995, when the senior health-coverage program was in fiscal peril. He later said the cuts weren't needed because President Clinton's policies had improved the economy and the outlook for Medicare.
But others say Dean hasn't always relied on facts.
State Sen. Jim Leddy, a Democrat, says facts did not get in Dean's way when he opposed methadone treatment during a state heroin epidemic in the late 1990s. "The attitude was, 'don't confuse me with studies,' " says Leddy, a frequent Dean ally who now supports him for president.
The Legislature sided with Leddy, a former drug treatment director, and in 2000 Dean agreed to a compromise.
A pound of prevention
Dean has never made any secret of what's most important to him: Prevention. In 11 years as governor, he enforced budget discipline on the theory that an insolvent program helps no one. He pushed the state to buy acres of wilderness "so we wouldn't be fighting sprawl later." And he made clear, he says, that two child health programs were "sacrosanct."
Everything else was negotiable, even other health programs. When the budget fell short, Dean often looked first to cut programs for the elderly and disabled, such as prescription drug aid. He says it was a scare tactic to get legislators to pay for them by raising the cigarette tax. However, advocates for these programs say they passed despite Dean and stayed intact despite Dean — even after he got the tax increase.
They chalk up his attitude to penny pinching. The prescription plan was expensive and a constant threat to Dean's balanced budgets. By contrast, services and insurance for children were cheap, consistent with prevention and often yielded big payoffs. His vehicles were "Success by Six" and "Dr. Dynasaur."
Con Hogan, Dean's human services secretary, says Dean embraced "Success by Six" the instant it crossed his desk. The program brought together local health and education groups to reduce infant mortality, test for lead and hearing, prepare kids for school and head off problems such as child abuse and teen pregnancy. New parents received home visits and information.
Hogan says Dean had "a broad view of what health was all about. I worked for five governors. This was a different way of doing business. It appealed to me enough that I worked for him for nine years."
"Dr. Dynasaur" is a child health insurance program begun by former governor Madeline Kunin in 1989. Dipping into state and federal resources, Dean expanded it to higher age and income levels, and now nearly every child in Vermont is insured privately or by the state. Only Rhode Island and Wisconsin can make similar claims, health research groups say.
That's one of Dean's proudest achievements. But it started as a fallback after failure, and is an example of how Dean's practical medical instincts can sometimes frustrate Democrats.
In the early 1990s, Dean was helping the Clintons write their health-care plan while pushing ambitious insurance reform at home. Vermont was studying whether to give low-income people subsidies to buy insurance or instead to offer state coverage.
To the dismay of liberals, both plans collapsed in 1994. Ralph Wright, speaker of the Vermont House at the time, asked Dean what could be done. "Nothing. It's dead," Dean said. Dean was "too quick to run up the white flag," Wright says in his book, All Politics is Personal. Others say Dean accepted reality, the way you have to in medicine, by moving to the incremental "Dr. Dynasaur" approach.
Both liberals and conservatives praise the expanded coverage. But conservatives say Dean went too far when he urged lower-income workers with private insurance to switch their kids to "Dr. Dynasaur." He saw it as help for families and small companies; they say it was government overreaching.
In addition, Dean gave thousands of people a benefit and "dramatically underpaid" providers such as doctors, dentists and hospitals to finance it, says John McClaughry, head of the free-market Ethan Allen Institute in Concord, Vt. That in turn has driven up private insurance rates, McClaughry and others say.
Dean and his former aides say the growing pool of insured patients helped doctors make money and hospitals save money. There's been a cost shift to the private sector in virtually every state, Hogan says, and in Vermont it must be weighed against achievements. "We chose to concentrate more on the results than we did on the money," he says.
Applying local solutions
For three years, 2001-2003, Vermont was named the nation's "healthiest state" in an analysis of health statistics compiled annually by the Morgan Quitno Press in Lawrence, Kan.
Dean often pledges in the presidential race to apply his health care solutions to national problems. One TV ad says more than 9 million children nationwide don't have health insurance, while almost every child in Vermont does. "If we can do that in a small rural state and still balance the budget, we can do that for every American," Dean says in the ad.
Some wonder if a state with so little racial and ethnic diversity is a realistic model. Keller, the policy analyst, admires Dean's work but says, "I've never agreed that if you can do it in Vermont, you can do it anywhere." Vermont doesn't have gang shootings, dangerous high rises and language barriers, she says.
Dean allies say his approach has promise for all states. Former state senator Cheryl Rivers was disappointed when the big insurance plans died and Dean did not revive them. She now appreciates the complexity of health issues and Dean's commitment.
"When you look around at the record in Washington and the other states," she says, "he's as good as it gets." |
