Daschle to lead Health Reform Office and Health and Human Services

President-elect Barack Obama’s choice of Tom Daschle to head up the Department of Health and Human Services and to be his point man on health-care reform suggests that, despite the economic turmoil and the challenges of the wars in Iraq and Afghanistan, the incoming administration plans to move ahead on health-care reform quickly.

First in a series of LocalHealthGuide reviews on books about health-care reform

In his book, “Critical: What We Can Do About the Health-Care Crisis”, Daschle, a former Senate Majority Leader and veteran of health-reform battles, points to two key reasons why President Bill Clinton’s health-care reform proposal failed in the early 1990s.

The first, Daschle says, was that despite having run on the promise of health-care reform in 1992 election, Clinton put off submitting a plan to Congress in order to deal with the economy and the North American Free Trade Agreement first.

As a result, the bill, a 1,342-page behemoth, was not delivered to Congress until late November 1993, by which time the bill’s opponents had built an impressive organization that crushed the initiative with a barrage of attacks.

“The health-care debate might have played out differently if President Clinton had launched it in the spring of 1993 when he still had some momentum from is election victory,” Daschle writes.

That was a mistake that Daschle and Obama are are not likely to make again. 

The second reason for failure of the Clinton initiative, Daschle writes, was that proposal was far too detailed, allowing its opponents to undermine its support by attacking specific items, picking it apart, even though there was broad public support for health-care reform in general.

With so many competing special interests, ranging from patients groups to insurers, Congress is essentially incapable to instituting responsible health-care reform, Daschle writes.

So much is at stake, Daschle says, that short-term, and short-sighted, political jockeying will inevitably trump sound, far-sighted policy making. 

Sen. Tom Daschle

To bring that kind of judgement into play, Congress needs to create a National Health Board that will have the independence to make difficult and politically dangerous decisions that Congress is often incapable of making, Daschle writes.

This board would be modeled after the National Reserve Board, which as created by Congress to manage monetary policy with the charge to keep inflation in check and unemployment low.

Though by no means perfect, the Board has arguably done a better job at attaining those goals than Congress could ever have hoped to do, Daschle points out.

Daschle, like Obama, proposes reform that builds on the existing health-care system rather than a major overhaul. The current system of employer-based insurance would remain as would Medicaid and Medicare. 

The biggest change would be the creation of a insurance-purchasing pool, similar to Federal Employees Health Benefits Program, where individuals and small businesses could purchase insurance plans with defined benefits from competing insurers.

No one could be excluded from purchasing from this pool so that no one would be unable to get insurance because they had a pre-existing condition, such as diabetes. 

One of the main jobs of the National Health Board would be place conditions on those insurers who want to participate in this insurance pool by drawing up guidelines of best practices, promoting drugs and treatments of proven cost-effectiveness, and ranking services and therapies by their health and costs.

The Board’s standards would likely influence the policies and practices of other insurers as well, Daschle argues, improving the quality of care and reducing costs overall.

Daschle’s book not an exhaustive analysis of the the U.S. health-care system. But it is a highly, readable outline of one approach to health-care reform, an approach that is very likely to be similar to that taken by the new administration in the coming year.

Critical:What We Can Do About the Health-Care Crisis
Sen. Tom Daschle
St. Martin’s Press
Hardback: $23.95
Paperback due out August 2009