Political Hay

Daschle’s Long March

Obama's new health-care czar and the path to socialized medicine.

By 12.12.08

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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.

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About the Author

Philip Klein is The American Spectator's Washington correspondent. You can follow him on Twitter at: http://twitter.com/Philipaklein