The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

Dashcle Appointment Puts Obama Health Care Reform on Fast Track

Posted by Alan on December 11, 2008

In case there was any doubt, President-elect Barack Obama made clear today that reforming the nation’s health care system will be an early priority for his Administration.  Hhealth care reform won’t wait while President Obama first focuses on fixing the country’s economic mess, but will instead be an integral part part of that effort. As he said during a press conference announcing the creation of a White House Office of Health Reform, to be led by his nominee for Secretary of Health and Human Services, former Senator Tom Daschle, “If we want to overcome our economic challenges, we must also finally address our health care challenge.” (Here’s a  video of the press conference — the comment is made at roughly the 2:40 mark).

The need to move quickly on health care reform was a central theme of the press conference. After reciting the usual litiany of the current health system’s shortcomings, President-elect Obama said, “We’re on an unsustainable course. The time has come, this year, in this Administration to modernize our health care system for the 21st century, to reduce costs for families and businesses and to finally provide affordable, accessible health care for every single American.” (This statement begins at about the 1:40 mark).

He then directly tied health care reform to addressing the current financial meltdown.  “Now, some may ask, ‘How at this time of economic challenge we can afford to invest in reforming our health care system’. And I ask a different question: ‘How can we afford not to?'” (About the 2:00 mark).

The creation of a White House Office of Health Reform, and the appointment of Senator-soon-to-be-Secretary Daschle as it’s Director is especially telling. By placing the locus of health care reform inside the White House, President-elect Obama elevates the importance of achieving meaningful change. By placing the leadership of the Office in the hands of his HHS Secretary he makes it easier for his Administration to speak — and negotiate — with one voice. By making that HHS Secretary Senator Daschle he assures the reform effort will move forward in a nuanced fashion, sensitive to the legislative process. 

This approach stands in stark contrast to the Clinton Administration’s health care reform initiative.  That fiasco, led by then First Lady Hillary Clinton, was a textbook example of insularity and insensitivity to political realities. It discouraged vigorous debate and excluded Congressional input.

Senator Daschle, who led Democrats for 10 of his 18 years in the Senate and who served in the House for eight years, will take a far different approach. First, he can’t help but reach out to members of Congress — it’s in his DNA. Second, at the press conference he pledged to work with “people from across the country to find a path forward that makes health care in this country as affordable and available as it is innovative.” As a member of the Obama Transition Team he is already coordinating thousands of small meetings across the country on the topic to bring the American people “into this conversation” in order to make “an open and inclusive process that goes from the grass roots up.”  (Beginning at the 7:10 mark).

Senator Daschle is no newcomer to the health care reform debate. He’s studied, and written about, the issue as a Senior Fellow at the Center for American Progress. He is co-author of Critical: What We Can Do About the Health-Care Crisis along with Dr. Jeanne Lambrew, who President-elect Obama named today as the Deputy Director of the White House Office of Health Reform.  Their prescription for reform is not dissimilar from that put forward by Senate Finance Committee Chairman Max Baucus which, in turn, reflects many of the principles put forward by candidate Barack Obama during the presidential election.

During the press conference, both President-elect Obama and Senator Daschle emphasized the many problems apparent in today’s health care system. This shouldn’t be a surprise. When rallying the nation to change a complex and critical component of government service reminding voters of its flaws and the need for reform is standard practice.

It would have been nice, however, if a bit niaive, to hope they would have noted, even in passing, that much of the current system works and is worth preserving. Such a statement would have been as refreshing as it would have been unexpected. And it might even have underscored the new kind of politics President-elect Obama promises to bring to Washington. 


7 Responses to “Dashcle Appointment Puts Obama Health Care Reform on Fast Track”

  1. I do think that Obama has stated that there are parts of the system that work given that the plan he put forward prior to being elected was not a single payer system. Private insurance is maintained for those who have access to it already. However, the question is, with a large government-funded National Health Care Plan will the private insurers be able to provide products that compete effectively. I have little faith in private insurers ability to emphasize preventive health and reform their own practice of putting cost cutting above providing care. Few people truly understand the impact that an effective and comprehensive preventive care health program would have on cutting costs in the system.

    More concerning to me, at this point in time, is Tom Daschle’s ties to lobbying by big corporate in the health insurance industry. His book has a message that is embraced by many medical providers in terms of the advantages of single-payer systems, however potential financial ties to big corporate are puzzling.

  2. hannahflynn said

    Health information network? I’m blogging in the UK and would be really interested if you could direct me to any more literature on the idea.

  3. Mark said

    I certainly don’t have a “fix” for the healthcare system but while one is being worked on I think there are some quick adjustments to help generate more money in the system for providers rather than administration of benefits. Some suggestions would be a little off the wall but realistically if everything is being considered then why not.

    Close the VA and issue veterans Tri Care cards. The cost of operating these facilities and the conditions of many of them don’t imply quality. In some areas of the country the wait that veterans have is similar to Canadian waiting periods.

    Convert Medicaid programs to S chip. The children’s program works well because providers are paid a standard fee as opposed to fees far below market rate that the Medicaid program pays. It eliminates much of the bureaucracy that eats the current Medicaid budget. This may cause layoffs in states since paperwork will be greatly reduced.

    Lastly I would get rid of 50 states worth of mandates. Federal, state discussions have journals written as to why and why not as to who should do what. Years ago (think 19th Century) it could take hours, days or weeks for information to get to where Washington needed it to get to. It made perfect sense to decentralize decision making. With information traveling at the blink of an eye and arriving in someone’s hand I don’t think the bureaucracy that has been built up is realistic. Cancer, heart disease, knee surgery, etc. in Maine isn’t much different then the same in Arizona. Why do we have 50 different regulatory agencies making decisions?

    If employers or individuals want additional benefits an insurance company would create a market.

    The idea behind the above is to generate more money on a federal level to help insure more of the uninsured who don’t have capacity or health to purchase on their own.

  4. Jac Higgins said


    I have only recently found your blog and find it very informative and well-reasoned. I would like to hear your opinion of the probability that Secretary Daschle will be able to establish the Federal Health Board he talked about in “Critical”, and likewise the chance that Ms. Lambrew will have success with her Health Information Network.

  5. Jon said

    The front page of the “Outlook” section of the Washington Post on January 5, 1975 features two pieces: “American Force: The Missing Link In the Oil Crisis,” and, “Dr. Paul: The Dinosaur of Poseyville.” I know this because a tattered, yellow copy is nicely matted under glass hanging above the battered medical bag Doc Paul carried with him on thousands of housecalls made in this small county in southern Indiana over decades of devoted care to a rural farming community. The medical bag, complete with hand-wrapped items, labeled in my grandmother’s Parkinsonian scrawl (“sterile towel, exam room 3”) was the only thing I inherited from him. After 40 years’ practicing medicine all he had was the house, his office, 80 acres of soybeans and a $10,000 insurance policy. My great-grandfather, Doc Sam, practiced before him and for a time with him out of the same office. The town hall in Poseyville is dedicated to my grandfather, the man who called himself “a dinosaur” as a country doc over 30 years ago, just prior to his retirement. My father retired from medicine much earlier than he would have intended in 1994. He retired as the psychiatrist-in-chief and medical director of the Institute of Living in Hartford, CT, the oldest and one of the most respected psychiatric hospitals in the country. He was medical faculty at Yale and Uconn. When he retired he said to me, solemnly, the he “could not in good conscience recommend that anyone he cared about, much less a son or daughter, have anything whatsoever to do with American medicine.” His eldest daughter (an RN and EMT), his youngest daughter (a neurosurgical PA outside Boston), and his only son (a primary care PA serving the medically underserved) all found this admonition more unsettling than most casual observers of the current state of affairs in American medicine might. Soul-shuddering it was and remains according to the dusty little heart that houses mine.

    I carried Doc Paul’s medical bag on scheduled housecalls, Sunday after church, sultry July and August afternoons brimming with little old ladies needing blood pressure and sugar checks, too blind or infirm to drive, their bacon-eating, cigarette-smoking husbands long since deceased. I heard my father teaching groups of residents that he trained in psychiatry year after year about the great honor of assisting people with that possession we were all told was most important by our grandmothers: our health. There is none of that now. Not a whit. Fifteen years and a dozen jobs later I can say unhaltingly that I understand why my father retired early, that I understand his admonition. Doctors talking all day about patient “volume” and billing codes, calling certain groups of patients “dead weight” (patients with diseases or problems that don’t have a billable diagnostic procedure or treatment modality – economically unfeasible patients), and others “cash cows.” It is simply abysmal.

    Health care quality will increase as exponentially as health care costs will decrease when the rewards for patient education and thorough, thoughtful evaluation and treatment adequately “incentivise” (another horrible business neologism bandied about it modern American medicine) health care providers to do what my father, grandfather, and great-grandfather did quite instinctively: take care of people and help them to take care of themselves to the best of their abilities. There is profound value in a multiplicity of preventive medical “therapies” with sound and growing support but the bedrock of applying this knowledge is patient education and patient education takes time and time is not reimbursed by Medicare, Medicaid, United, Cigna, Humana, etc. There is only one consistent message that echoes across my fifteen years in American medicine, across the HMO’s, private practice offices, Medicare and Medicaid clinics I have worked in: no good deed goes unpunished. And, like other helping professions – teaching, social work, et al. – the good get ground down to nubs of their former selves or simply the leave their chosen professions. And the bad learn to work the system infiltrating a noble tradition with grime and slime to the point that American medicine may as well be an unscrupulous transmission repair shop.

    God speed, Barack, I’m here if you need me.

    Stay healthy folks –


  6. Ron M said


    In your post of December 11, I found the following, “It would have been nice, however, if a bit niaive, to hope they would have noted, even in passing, that much of the current system works and is worth preserving,,,etc.” a provocative comment. Additionally, you went on to say that you were hoping that President-elect Obama would bring a new kind of politics to Washington. Could it be that the political reality may prove different? About 16 years ago, someone wise enough to pique my interest told me that perception is reality at certain points in the political cycle. And campaigns are filled with rhetoric of inspirational ‘blueprints’. Lest you think me the cynic, clearly all candidates engage in this practice. As for Health Care -Reform, the question, I believe of more import is; Will Secretary Dalsche be made aware of how much of the current system works and is worth preserving?

    Reform, as we know, takes on a life and energy all its own, what is new seldom makes room for what is tried and true.

    Happy Holidays Alan


  7. Jacob C. said

    Hi Alen
    Now that you see the direction the next administration is going, kindly tell me, is now the time to switch career to become a health insurances broker? is any thing in the reforming of health care that will affect the income of a broker ,also which area of health insurance will be best to broker in?
    Kindly Reply also to my email address
    J.C. Brooklyn NY

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