Let’s be fair: Barack Obama and Tom Daschle will not attempt to
immediately impose socialized health care on America.
Instead, they’ll just take us along the scenic route.
With the appointment of former Senate Majority Leader Daschle to
be his new Secretary of Health and Human Services as well as the
head of his new White House Office of Health Reform, Obama has
sent a clear signal that health care will be a top priority of
the new administration. Daschle combines vast legislative
experience with a passion for health care, as well as first-hand
knowledge of how the Clinton administration bungled the last
serious push for universal health care in 1993.
Liberals, for good reason, believe that the wind is at their
backs this time around. Democrats won the White House, took
control of both chambers of Congress and built a near
filibuster-proof majority in the Senate; Americans are as fed up
as ever with the current system; rising unemployment will expand
the ranks of the uninsured; many businesses would welcome
government taking over their rising health care costs; and even
traditional opponents of universal health care, such as the
insurance
industry and the American
Medical Association, have put out their own plans for reform.
Republican Sen. Jim DeMint conceded Thursday that it would be an
uphill battle. “Because of down economic times and the promise of
free health care, I think we’re in real danger of losing this,”
DeMint said.
The important thing to keep in mind over the next several months
is that for all the talk Democrats will do about choice and
public-private partnerships, the ultimate goal of any
Obama-Daschle proposal will be to put America on the pathway to a
single-payer health care system, which is a more academic way of
describing a socialized system in which government is the sole
purchaser of health care.
This is not some dark hidden secret, but something that both
Obama and Daschle have been open about in their speeches and
writings.
“I happen to be a proponent of a single-payer universal
health-care plan,” Obama declared in a 2003 speech to the
AFL-CIO. “[W]e may not get there immediately. Because first we
have to take back the White House, we have to take back the
Senate, we have to take back the House.”
During the presidential campaign, Obama refined the statement to
mean that he would set up a single-payer system if he were
“designing a system from scratch,” but said he supported working
within the existing system for pragmatic reasons.
When Daschle and Obama discuss public-private partnerships, the
“public” part is always touted as a way to improve our system,
but there’s never anything positive said about the private
aspects of American health care. Instead, private industry is
treated as something that has to be tolerated to make health care
reform more politically feasible at the moment.
“Supporters say single-payer is brilliantly simple, ensures
equity by providing all people with the same benefits, and saves
billions of dollars by creating economies of scale and
streamlining administration,” Daschle writes in his book,
Critical: What We Can Do About the Health-Care Crisis.
“But a pure single-payer system is politically problematic in the
United States, at least right now.”
Daschle goes on to ask, “If passage of a single-payer system
isn’t realistic, what should we do?”
His answer, which is echoed by Obama, is to craft a plan that
maintains the current mixed public-private structure while making
it function more like a government-run system. Over time, this
can seamlessly evolve into the single-payer model that both
Daschle and Obama clearly prefer.
Obama’s campaign health-care plan and Daschle’s book give us a
pretty good clue as to what they are likely to propose once in
office. Any plan would likely require insurance companies to
cover anybody who applies for insurance without taking into
account pre-existing conditions, and insurers would have to
charge rates that the government deemed affordable. Individuals
would be given subsidies to purchase insurance in a
government-run exchange, choosing either a government plan
modeled after Medicare, or private plans that would have to meet
certain government standards. Large employers would likely be
required to either provide health insurance to their employees,
or pay into a government pool to purchase coverage for the
uninsured.
But Daschle’s hope is that with all the money it spends,
government will be able to throw its weight around and arm-twist
private industry into behaving in a way that the bureaucracy
wants them to — just like in a single-payer system.
“Through Medicaid, Medicare, and its other health programs, the
federal government is responsible for a huge proportion of total
health-care spending,” Daschle writes. If it were to create a
national insurance pool, he argues, “[t]he federal government
could exert tremendous leverage with its decisions on covered
benefits and payment incentives. In choosing what it will cover
and how much it will pay, it could steer providers to the
services that are the most clinically valuable and cost
effective, and dissuade them from wasting time and money on those
that are neither.”
The central pillar of Daschle’s health care vision, as set forth
in his book, is a Federal Health Board. “Like the Federal
Reserve, the Federal Health Board would be composed of highly
independent experts insulated from politics,” Daschle explains.
“Congress and the White House would relinquish some of their
health-policy decisions to it. For example, a shift to a more
effective drug service would be accomplished without an act of
Congress or the White House.”
Daschle believes that the Federal Health Board will manage health
care just as the Federal Reserve “skillfully managed monetary
policy for decades…” Unfortunately, I’m not making this up.
While the Federal Health Board wouldn’t technically be a
regulatory body, Daschle writes that “its recommendations would
have teeth because all federal health programs would have to
abide by them, and those programs account for 32 percent of all
health spending and insure roughly 100 million Americans.”
Furthermore, any private insurer that wants a piece of all the
money the federal government will be throwing around in the new
insurance exchange would have to abide by their recommendations.
And, Daschle explains, “Congress could opt to go further with the
Board’s recommendations” by passing legislation that would coerce
more insurers into abiding by them.
Conveniently enough, the entity would be comprised of a Board of
Governors that would be appointed to ten-year terms, subject to
Senate confirmation. In other words, any Obama appointments would
be allowed to serve until at least 2019.
Its unclear whether the Federal Health Board concept will be part
of any final Obama proposal, but in a blurb on the back of
Daschle’s book, Obama praised the idea. “[Daschle’s] 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,” Obama wrote.
Obama and Daschle don’t like to use words like “socialized
medicine” and “government-run health care” because they are smart
politicians who know that such ideas aren’t popular in the United
States. But the American people should understand that if Obama
and Daschle have their way, that’s exactly what Americans will
get — even if it will take a long march.
