February 01, 2009
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Daschle and Baucus: Two players in the new era of health care reform

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While you probably know that President Obama tapped former Senator Tom Daschle to serve as secretary for the Department of Health and Human Services during his administration, you may not be aware that in February 2008 Daschle co-authored a book with Jeanne M. Lambrew, called Critical: What We Can Do About the Health-Care Crisis.

Douglas W. Jackson, MD
Douglas W. Jackson

Lambrew, who is a noted health care scholar, has worked in a liberal think tank and played a role in Former President Clinton’s failed health care reform attempt.

The book points out many efforts made, going back to the Truman administration to the present day, to reform health care in this country and provide insurance for all. The goal of the publication is to impart the lessons learned though these failed attempts and help the new reformers avoid the events that resulted in “Hillary care” being beaten down so badly in the 1990s.

In early press releases publicizing the book, then-Sen. Obama is quoted, “The American health care system is in crisis, and workable solutions have been blocked for years by deeply entrenched ideological divisions. Sen. Daschle brings fresh thinking to this problem, and his Federal Reserve for Health concept holds great promise for bridging this intellectual chasm and, at long last, giving this nation the health care it deserves.”

Federal Health Board

In the book, Daschle proposes a Federal Health Board that would address skyrocketing costs, lack of access, and disparity of quality care. He notes that this Federal Health Board would function like the Federal Reserve Board for the banking industry. He understands that Congress cannot run health care anymore than it can set interest rates for the banks. This board will allay many of the fears that the American public, particularly senior citizens, had during the Clinton Administration over a government-run health care system. Remember those classic advertisements showing the elderly couple questioning how the government could manage their health care?

Who is Senator Baucus?

You may not know or have heard of one of the other major players. He is Sen. Max Baucus (D-Mont.), who is chairman of the Senate Finance Committee. He will be influential in whatever reform is legislated and work closely with Daschle. He has outlined some lofty goals for the coming health care reform. Some statements attributed to him include:

  • “Affordability, but prices will not be set”;
  • “Congress will not prescribe, but the changes will be managed by an independent council of presidentially appointed ‘health-care experts’”;
  • “The new program will slow the escalation in health care by utilizing evidenced-based medicine, rewarding quality care and spending more efficiently”;
  • “This will be a public plan that no private insurance company can ever offer”;
  • “Price controls will not be used as heavily, but reimbursements will entail … balancing increased competition”; and,
  • “The new plan will provide affordable, access to quality health care.”

What is different?

Daschle knows the political process well and wants to short-circuit it as much as possible. He understands that much of Clinton’s opposition was rallied among a confused public and the lack of a well-framed debate. Therefore, he will carefully define the new debate.

The democrats have already started courting the business community, appeasing the American Association of Retired People and making concessions to the business roundtable. They have reassured the insurance companies that everyone will be insured and not just purchase health care when they are sick.

Insuring everyone will distribute the risk pool and offer the potential for a significant increase in business for private insurers. Obama’s Administration will continuously repeat that the new plan will not be managed by government but by appointed experts. This board will be a new layer once removed from the ultimate bureaucracy of Congress. This will not be an elected board and potentially will have control over what types of care can be provided and at what reimbursement levels.

Economic factors

Another difference is that we are in a period of financial instability and deep recession. More people and businesses need health care coverage and relief. The opposition will not have the strong support of the masses as it did in 1993.

A real concern as we make these changes is that once a large federal program is established and implemented, it cannot be taken away or even easily revised.

The national debate has turned and health care has now become a right. The more something is a given right — something to which the people are entitled — the fewer people are going to be willing to pay what it really will cost.

Funding questions

The good news is many more Americans will have coverage. However, who and how we will pay for this affordable “high-quality care with immediate access” and control-escalating costs will be a challenge, especially after a few years when all the new dollars to pay for it and other programs will result in significant inflation.

The Congressional Budget Office is responsible for projecting the costs of new legislation. My interpretation of its last two reports is that the health care reforms proposed will cost much more than the proponents are stating and that the savings will not come close to the stated expectations.

We will have more insight into some of these projected costs by the end of 2009. The future of our health care reform remains unclear, but we will all be part of it.

Douglas W. Jackson, MD
Chief Medical Editor