Barack Obama has now made official the appointment of Tom Daschle to Secretary of Health and Human Services. I’ll have a lot more on this (including some more from Tom Daschle’s book on health care, which I just finished) but just a few quick things to emphasize.
Daschle is not reentering the public sector to run the daily bureaucracy of HHS. He played a key role in Obama’s campaign and was rumored to be a candidate for chief of staff. The only reason he would accept this position is if he received assurances from Obama that health care would be a major priority of the new administration, and that he would lead the reform effort.
In his book, Daschle discusses the unraveling of the Clinton health care push in 1993-94 in great detail, and will try to learn from the mistakes that were made at the time. By having him lead the health care effort (somebody with vast experience moving legislation through Congress) Democrats will already be a step ahead of where they were with Hillary Clinton in 1993. He realizes that he’ll have to involve members of Congress in the process, rather than huddling in secrecy, coming out with a plan, and telling Congress how it’s gonna be. He also recognizes that one of the major problems with the original bill was that it was so long and detailed, that it was too complicated to explain to the public, and easy to pick apart by opponents.
The Obama-Daschle proposal will likely include some of the following elements: a requirement that insurers cover those with preexisting conditions; subsidies for individuals to purchase insurance in a government-run exchange that will include a new Medicare-like government insurance program as well as a choice among private plans that would have to meet certain government standards as far as price and benefits; a requirement that large employers either provide health coverage or pay taxes into a pool that would be used to purchase health care for others; and cost saving measures involving the use of electronic record keeping. What’s not yet clear is whether any plan would include Daschle’s idea of a Federal Health Board, modeled after the Federal Reserve Board, comprised of “experts” who would supposedly be insulated from the political process, and able to make judgments as to what drugs and medical procedures were necessary, and which ones we could do without in order to save money. The Health Board was also a key part of Daschle’s vision for how to pass health care reform – by punting the complex medical questions down field, Congress could craft legislation that was less complicated.
Also, in 1993, there was a lot of opposition from insurers, but just last week, America’s largest group of insurers agreed to accept a requirement that they accept enrollees with preexisting conditions as long as government mandates that individuals purchase health insurance. Many businesses, struggling with high health care costs, are also likely to welcome government action. And the American Medical Association is eager to see everybody covered, though their proposal achieves that in a different way than Obama would.
I asked Sen. Jim DeMint about the health care battle this morning, and he warned, “Because of down economic times and the promise of free health care, I think we’re in real danger of losing this.”
I’ll reiterate that conservatives really need to get up to speed on this issue. If conservatives lose this fight, it’s the end of the battle over the size of government.