Though he's not yet confirmed, it looks like former Senator Tom Daschle will be joining President Obama (I so like saying that) in his Cabinet, heading up all the agencies that provide resources and oversight for America's health and healthcare dollars. In addition, he will wear another, related, hat: heading up the new White House Office of Health Reform. Just by using the word "reform", the President and Senator Daschle are sending a signal that things will be different. But how?
What do we know about Tom Daschle?
Well, we know a little bit about how he thinks, independent of the President (which he may or may not be able to be) from a book he wrote not too long ago titled Critical: What We Can Do About the Health Care Crisis. In it, he said a number of things--some I agree with, some I don't.
Like President Obama, Mr. Daschle says that Americans who want to keep their employer-based health insurance should be able to, but, in addition, he posits there should be a pool, maybe the pool that covers federal employees, or another, public, pool, where people could turn as an alternative to private insurance. He doesn't say whether he feels that will require all insurance plans to accept all people, without regard to pre-existing conditions, but it seems clear to me that such a requirement would be fundamental to any public pool. If not, insurance companies would simply skim the healthy and leave the expensive care to the public pool.
But no choice---he wants you to buy
He has argued that all Americans should be required to buy health insurance and, of course, I have never agreed with that. I think the reason so many, including Max Baucus, who may be carrying one of the major health bills in Congress, as well as (now Secretary of State) Hillary Clinton, have put this out as a necessity is so they can also sell the "no one can be turned away" policy. Share the pain and we'll increase your market. I have always felt that you can't require people to buy insurance from these same unaccountable private insurance companies without an enormous amount of regulation, or, better yet, get the insurance companies out of this business and go to a single payer model.
Actually, in one speech, Mr. Daschle did say that the best of all systems would be single payer. Perhaps those of us who agree with that will let him know we think he is right.
A New Federal Health Board
Mr. Daschle also wants to create a Federal Health Board, something like the Federal Reserve Board that manages (or used to manage!) fiscal policy. This is to, as Mr. Daschle wrote, to insulate them "from the politics and passions of the moment." One big flaw in this idea is that it would not have the power to regulate private insurance but would have power over Medicaid and Medicare, and also set the terms for the privates who want to participate in the big common pool. It would also look at costs and (somewhat vaguely) oversee cost-effectiveness of various treatments.
This is a pretty thorny issue and is actually better dealt with by the kind of medical evaluation boards we developed in the California single-payer bill.
Basically, he'll pull toward reform
It's possible, however, that Mr. Daschle's great contribution in President Obama's first term (I like saying that, too, thinking of the second) will be to continually pull the President toward universal health coverage. He has stressed over and over that any reform must create accessibility and affordability. But the Obama presidency has stressed that he wants input, input, input, from us and that's what each and every one reading this essay should do. Let him know what you think is important in this time of reform.
Mr. Daschle also made some very interesting comments at the Zocalo Public Square program at the Los Angeles Library on December 5, 2008, just a few weeks ago. He spoke for quite a while about the myths surrounding health care reform proposals, saying that there were four myths that needed busting:
The Myth That America Has the Best Healthcare System in the World
At best, he said, there are islands of excellence in a sea of mediocrity. He pointed out that over 180,000 Americans last year left the country for medical treatment in what we have come to call "medical tourism", 40,000 of them to Mexico. We must come to accept that our system desperately needs improving.
The Myth that any reform would involve rationing
Rationing, he said, is what we actually have today, but it's based on two of the worst possible indicators: wealth and physical condition. If you can afford it, you might get it and, even if you can afford it, you might not get it if you have a pre-existing condition. That, he said, is true rationing. We can only do better with a rational system.
The Myth that reform will be unaffordable
But what we have now is less affordable than any rational system. Nothing, he says, could be more costly than the run-away virtually unregulated system we have now.
The Myth that we must preserve the private system
We don't have a fully private system now, he says, because 45% of all Americans receive their healthcare through one of seven federal programs. We have a two-tiered system, public and private.
So What Can We Expect?
With cautious optimism, as always, I await the real meat on the bones of campaign speeches and yesterday's books. Mr. Daschle will be a member of President Obama's Cabinet and, therefore, held to whatever the President believes should happen. It seems clear that it will be better than what we have, but that, alone, is not enough. I believe that every single person should continue to push for what we think is the right solution. After all, there's a community organizer in the White House. Public action will be a familiar thing to him. And he won't let go of his Blackberry....so text him! (just kidding....my only point being, do something, and just keep doing it)
Sheila James Kuehl was appointed to the California Integrated Waste Management Board on December 1, 2008, after having served eight years in the State Sena te and six years in the State Assembly. During the 1997-98 legislative session, she was the first woman in California history to be named Speaker pro Te mpore of the Assembly. She is also the first openly gay or lesbian person to be elected to the California Legislature. A former pioneering civil rights attorney and law professor, Sen. Kuehl represented the 23rd Senate District in Los Angeles and Ventura Counties. She was the chair of the Senate Health Committee and sat on the Agriculture, Appropriations, Environmental Quality, Joint Rules, Judiciary, Labor and Employment, and Natural Resources and Water Committees. Sen. Kuehl was also chair of the Select Committee on School Safety and Chair of the Select Committee on the Health Effects of Radioactive and Chemical Contamination. Senator Kuehl served as chair of the Senate Natural Resources and Water Committee from 2000-2006.