Health Reform
Critical, What We Can Do About the Health-Care Crisis, Tom Daschle, 2008
Obama and Daschle in Better Times 
With Barack Obama’s endorsement of and attempted appointment of Daschle to the post of secretary of Health and Human Services, this book, published before the election, is essential reading for anyone interested in the possible of direction of health care reform under an Obama administration. The book is a detailed history of failed efforts of past administrations from FDR to Truman, through JFK and Johnson, including Nixon and Carter. The most detailed discussion is of the failed efforts of Clinton and Hillary when Daschle was a key player in the Senate. This book seeks an approach that is pragmatic and, most importantly, politically feasible.
Daschle’s proposal avoids the extremes of a European or Asian style single payer system which has virtually no chance of political success in our interest group lobbyist dominated political environment. Similarly, it avoids the continuing move toward privatization and individual responsibility, which has no chance of offering necessary universal coverage and equally necessary cost containment and control.
Essentially, Daschle proposes a Federal Health Board (FHB) along the the lines of of the Federal Reserve, empowered to study and recommend best practices, openly, but in a politically protected environment. The government would mandate universal electronic medical and accounting records standards and would require every individual citizen to have insurance. Insurers would no longer be allowed to deny coverage for pre-existing conditions, to set different rates for different classes of insured, or to discriminate by type of illness such as limits on mental illness. The government would expand the Federal Employees Health Benefits Program (FEHBP) to allow any American to buy into the coverage. The FEHBP would have enormous power to negotiate services and drugs and would be required to follows the guidelines set down by the regulatory FHB. The FEHBP would serve as competition to the private insurers and employers would be able to opt for FEHBP coverage if it made sense. State Children’s Health Insurance Program (SCHIP) would be expanded to provide universal coverage for children, and Medicaid programs for low income citizens would be standardized and expanded as to income requirements, for example to 150% of the poverty level.
For this reader, the discussion of Medicare fell short. Will the Part B supplemental programs be reigned in or eliminated. Today the supplemental insurance companies drain most of the money out of Medicare leaving few doctors willing to accept pure Medicare Part B patients and senior citizens with the nightmare of dealing with private insurers rather than Medicare for their coverage and treatment. Daschle hardly mentions the awful nightmare that is the Part D drug benefit program except to talk briefly about the notorious doughnut hole in the coverage. It is virtually impossible for seniors to navigate the Part D mess and constant changes in the program costs mean that yesterdays best option may be today’s most costly.
Reading this book, one gets the sense that Daschle has a good grasp on what may be politically feasible in today’s environment, but less optimistic that the reforms will truly fix the mess that is the health care system in the country.