Senator Tom Daschle
(Read Part 1 of this piece.)
How to Fix a Broken System
So our challenge is to overcome ideology with a new pragmatic paradigm for reform. To be sure, there is an important role for vision and ideology in our system. It grounds incremental actions and serves as a compass toward the vision of an ideal healthcare system. But this is not an academic debate: Millions of Americans have suffered; thousands have died due to purely preventable public policy choices while we criticize good plans that are not good enough.
I believe that the way forward is to embrace pragmatism, in both the substance and approach to reforming the health system.
Starting with policy, we have three serious problems in the system: unacceptable access, quality, and costs. Each could be addressed by building on what works.
Although we have 47 million uninsured and growing, we have roughly 250 million insured through some type of health insurance. We can ensure access for all by extending public and private group health insurance to all Americans.
Although we have medical errors that result in nearly 100,000 unnecessary deaths a year, we have some of the best minds and best practices in the world scattered throughout the nation. We need to promote best practices through propagating them, paying for them, and ultimately demanding them.
And although we have the most expensive healthcare system in the world, most experts believe that we can significantly reduce costs without affecting health through:
- Promoting research on what works and what doesn’t
- Prioritizing prevention
- Harnessing the potential of IT
- Reducing administrative costs through simplifications
Such solutions are not perfect, but neither are they radical. They can move toward the ideal system without invoking the fears and partisanship that have been barriers in the past.
There is a difference between a concession and structural compromises. Building support and coalitions to pass legislation requires concessions, even though experts and the press love to hate them. For example, I’m open to some compromise on medical malpractice, some way to keep the drug industry at bay, and other policies that build a larger and stronger coalition. The plain truth is that no major legislation has been enacted without such “gives,” and we need to be tolerant of such policies.
We also must look to new models. In 1991, I first proposed the creation of a federal health board to govern the healthcare system the same way the Federal Reserve Bank governs our banking system and monetary policy. Like the Fed, the Fed Health would be a board composed of independent experts. Its main job would be to develop the standards and structure for a health system that ensures accessible, affordable, and high-quality care. It would, for example, develop model benefits, rules for insurers, and best practices for clinicians. These would apply to federal health programs and contractors and serve as a model for private insurers.
Congress and the White House would relinquish some of their health policy decisions to it. For example, a shift to a more effective drug or service could be accomplished without an act of Congress or White House political support. Delegation of power rightly raises concerns. But imagine the outcomes if Congress revoked the Fed's power to set interest rates and instead took it upon itself to enact them each quarter. It would be a disaster, similar to the consequences of our mismanaged health system.
Last, we need leadership on this issue.
In the SCHIP debate, even with a lame duck president who is verifiably the weakest and least popular in modern history, you are seeing the negative power of the White House. With his veto threats and refusal to engage in a negotiation toward a solution, we may well see millions of children in this country go without health insurance.
I hope with the next president you will see the positive power of the White House to create and act on a sense of urgency on this matter and to forge a consensus for where we go. The power of the White House is unmatched in this regard. But we should also not fool ourselves that there is any one magic bullet here. We could have as many health reform plans as there are Americans, and each would score better on one dimension than another. Yet each of us insisting on our own plan not only fails to advance reform, but could even set it back.
Leadership also means going on the offensive. Advocates for reform cannot wait for the next Harry and Louise ad--they must pre-empt it. They cannot assume that the public recognizes the liabilities of the other side’s proposal--they have to educate the public, for example, about the emptiness of health savings accounts. And we cannot limit the options available for us to act--which is why I am becoming an advocate for using the reconciliation process in Congress to enact healthcare reform. Acting swiftly and in the early--and strongest--days of the next presidency will be the best way to not get caught in the stasis of the status quo.
More than anything, we need to finally put good ahead of perfect. Congress should fulfill its commitment financially to covering all low-income, uninsured and put its money behind this commitment. If it does not take this opportunity, we will be back here debating this issue again in 20 years, still bedeviled by a broken system that is not giving us what we pay for.
Sen. Tom Daschle completed 26 years of public service in January 2005, having represented South Dakota for eight years in the U.S. House of Representatives (1978-86) and 18 years in the U.S. Senate (1986-2005). He served as Minority Leader of the Senate from 1994 to 2001 and from 2003 to 2005, and Majority Leader from 2001 to 2003. Today, Daschle is an adviser to the law firm of Alston & Bird, Washington, D.C., and a Distinguished Fellow at the Center for American Progress, Washington, D.C.
This piece will be published in print in the November issue of hfm magazine.
