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Daschle: Incremental Health Reforms Won’t Work

Former Senate Majority Leader Tom Daschle was nominated by President Barack Obama to be secretary of Health and Human Services and the White House’s point person on health reform.  Although Daschle withdrew his name after reports that he had not paid some taxes, the South Dakota Democrat remains a close adviser to the president and continues to work for a health care overhaul. 

He is a co-author of the 2008 book, “Critical: What We Can Do About the Health-Care Crisis” and recently became a policy adviser to DLA Piper, a law and lobbying firm in Washington.

KHN editors and reporters interviewed Daschle yesterday. Here are edited excerpts:

Q: Where do the Democrats go from here? Is reconciliation the strategy they should use?

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Former Senate Majority Leader Tom Daschle discusses the congressional health reform effort, how polls factor into the debate and parallels to the 1993-94 effort.

A. I think it is. If I had the magic wand, I would complete the work that is now underway to find what would be the most suitable corrections or alterations to the Senate bill that would accommodate a successful vote in the House. I think that process is underway and I am encouraged by the reports I hear to the degree to which that could be done.

Q. Do you think there are political risks to the Democrats with that approach?

A. I think there’s even more risk in doing nothing after all of this. I’m very concerned that after the tremendous effort to get to this point, we’d have nothing to show for it. I really believe that once this legislation is passed and people can see what it could mean for them, the impact it could have, the opportunities it presents to lay the foundation for significant change in our health care marketplace that it would be a net positive by November.

Q: How does Speaker Nancy Pelosi get the votes to pass a bill for reconciliation?

A. Speaker Pelosi has proven herself over and over again as a leader capable of organizing a strategy to get to the requisite votes, and I’m confident she can do it again in this case. I think there’s just too much at stake. I’m one of those who believe that far more important than any short-term political consideration is the historic opportunity this represents.

Q: If things don’t go the way she is hoping, at what point do you think Democrats go into fallback mode and start considering a pared-down bill?

A. I really don’t think it’s going to be necessary. I think it’s so important that they focus on one strategy at a time. I think it would be very hard to put a fallback together in the remaining months of this year. It’s just the consensus challenge is very, very hard. Just take one example, insurance reform and the tremendous difficulties that exist with regard to just putting together an insurance reform package that the insurance companies themselves wouldn’t fight and wouldn’t have huge premium implications if that’s all they did. I think there are complicated policy questions and repercussions to these issues and it’s somewhat misguided to think that somehow it’s going to be easier to pass something smaller.

Q: You mentioned affordability as one of the issues that still has to be resolved, do you think something needs to be done to the Senate bill to make insurance more affordable?

A. Well I believe in [an individual] mandate and I believe that if you are going to have a mandate you also have to have adequate levels of support for those who otherwise may have difficulty meeting their obligations under the mandate. And I think that the Senate bill probably fell short on affordability. Bumping it up, making it a little more supportive of families struggling to pay their premium is something we should do.

Q: Are you satisfied that the Senate bill does enough to control costs?

A. I don’t think that either version of the bill does enough. I look at this whole effort as having three components: insurance reform, payment reform and delivery reform. And all three components have cost containment elements in them. Not nearly as much as I’d like, but I think a lot of the building blocks are going to be in place. But you can’t expect one bill to comprehensively deal with each one of these components to everyone’s satisfaction. I tell audiences all over the country, that if this passes I think we’re on the 30-yard line, that we’ve got 70 yards to go to accommodate really significant change in the system, adequate enough to be able to say we’ve addressed cost, access and quality in a meaningful way.

Q: How do you think they can resolve the abortion issue?

A. I don’t think it will ever be resolved to the extent that there will be unanimity. I mean there are going to be people on either side that will not be happy with the ultimate approach that is decided.

Q: Did you feel as though the summit accomplished anything?

A. I think it accomplished three things. I think the American people benefited from a very honest discussion about many of these issues. I mean there was a pretty clear indication that there are significant philosophical and ideological differences between the parties with regard to this issue. But the discussion, I think, was a healthy one overall. The second thing, I think, that came out of that was an elevation of the issue once again. I think this probably energized the debate a little bit more. The third thing it did, is to a certain extent it was clear from that discussion that it is unlikely we can count on very much Republican support for any effort to do something this year. I think by and large that the message out of that seven-and-a-half-hour discussion is that this issue is probably not going to enjoy the broad bipartisan support that I wish it had, and Democrats might have to move more unilaterally to get this done.

Q: In terms of the polls, it looks like people are either split or leaning toward being opposed on health reform. How does that play in with whether something happens in Congress?

A. It’s human nature to be concerned about the unknown, and there’s been a lot of fear generated, I’m not saying that the Republicans necessarily did it intentionally, but one of the consequences of this debate is to generate a tremendous amount of uncertainty and fear for the implications this could have for people.

But then you break it down, as many organizations have, to individual issues: do you think there ought to be insurance reform? Of course. Should we close the donut hole? Of course. You know, you go through the list and as soon as you talk about specifics and more directly the components of the reform, you find there’s pretty broad support. I think we put way too much emphasis on polling as a factor as how we make our decisions. Should it be a factor? Of course. Should it be the sole factor? Of course not.

This is also an issue of governance. I think that we’ve got to demonstrate as a country that we’re able to tackle the big issues of the day.

Q: What are the parallels or contrasts between the Clinton administration’s efforts to get a health care overhaul in 1993-94 and now?

A. I think the biggest non-parallel factor is that you’ve got stakeholders who are much more supportive of reform now than ever before. You look at the AMA position, that’s probably the best example of any. They’ve been fairly persistent in their support. I know that there are internal divisions, but as an organization they’ve done it. And so have the pharmaceutical manufacturers, they’ve hung in there. And even the insurance industry has indicated support for reform, just as there are aspects to this that they would not support.

You’ve got a lot more recognition that we don’t have a luxury this time to fail. Per capita costs were $3,400 in 94, they’re $8,000 now. The level of uninsured was 37 million, and now I think it’s over 50 million.

Whether it’s quality, access or costs you can look at all the numbers, they’ve dropped precipitously, and we’ve been able to demonstrate, if anything, out of these last 15 years that incremental reform doesn’t work. We’ve tried incremental reform with SCHIP and with the passage of Part D and maybe portability, a couple things here and there. We’ve seen everything go south, and it’s going to continue to do that until we put in place the corrective policy building blocks to address this more comprehensively.