I was reading an article on line at the New York Times and was caught by one paragraph, which I've been mulling over all day regarding the absence of two key participants, Sen Kennedy and Tom Daschle, in our current health care debate.
I think in this whole debate on health care the absence of two leaders, who have put a great deal of thought and effort into outlining what the future of American health care should be has really hindered our chances at reform.
More below the fold.
The following paragraph got me thinking about what we lost in trying to reform healthcare due to Sen. Kennedy's illness and Tom Daschle's withdrawal as HHS Secretary:
IN THINKING ABOUT HEALTH CARE as a candidate, Obama expected to rely on two close allies who carried enormous influence on the issue with the Democratic Senate. The first was Tom Daschle, the former majority leader and a mentor of sorts, whom Obama considered as a chief of staff and ultimately nominated, instead, to the dual post of health secretary and "health care czar" in the West Wing. But then Daschle ran into tax issues during the prelude to his confirmation hearings (he failed to pay income taxes on a car and driver), and Obama, after some hesitation, rather bloodlessly cut him loose. The second man was Ted Kennedy, whose decades-long dedication to health care reform remains, like his stature, unrivaled on the Hill. Kennedy, of course, grew gravely ill during the presidential campaign, and while his staff remains deeply engaged in negotiations on a bill, the senator himself seems in no shape to muscle it through.
http://www.nytimes.com/...
Tom Daschle
First let me start with Tom Daschle. What I learned about Daschle's positions on health care come mostly from reading his book Critical: What We Can Do About the Health-Care Crisis, which brought up one key feature of what he envisioned any future American health care system - single payer, public / private options, etc. - would have a (semi) independent board set up to review, offer guidelines and maybe implement best practices.
The basic idea of the board would be to give oversight to health care that would be able to act without direct political involvement, like Federal Reserve Board and base closing commissions.
His idea for a Federal Health Board, to set standards for the health care industry, is one reform which isn't even being suggested or contemplated, from what I've read. As Sen. Daschle wrote, last year in the Huffington Post:
I have proposed a Federal Health Board that would be a foundation from which we could address all three problems. In many ways, the Federal Health Board would resemble our current Federal Reserve Board for the banking industry. Just as the Federal Reserve ensures certain standards, transparency and performance for our banking industry, the Fed Health would ensure harmonization across public programs of health-care protocols, benefits, and transparency. Ultimately, the Fed Health would offer a public framework within which a private health-care system could operate more effectively and efficiently.
The Fed Health could help reduce administrative costs. Roughly 30 cents of every dollar in health care is spent on administration rather than health benefits. Our administrative costs, on a per capita basis, are seven times higher than that of our peer nations. Each state has their own system for Medicaid and insurance regulation. We have different health-care systems for active duty military members versus veterans. And private insurers spend billions trying to enroll the healthy and avoid the sick. A Federal Health Board that sets evidence-based standards for benefits and quality for federal programs and insurance will lower this complexity and thus costs.
The Fed Health could also promote quality and save money by making the health-care system more transparent. Today, the lack of transparency in the system makes it virtually impossible for people to grasp what they are paying for and who provides them with the best care. This shroud of secrecy allows for wildly different prices for similar quality care. For example, a Pennsylvania report on heart surgery found hospitals with similar outcomes charge from $20,000 to $100,000. The Board, by ensuring transparency, would increase competition based on price and quality rather than cream skimming and cost sharing.
Additionally, the Fed Health could set standards for quality and coverage, promoting best practices and identifying the trade-offs on services. It would use information on the comparative clinical and cost effectiveness of different treatment options to set standards for Federal programs. The Congressional Budget Office recently credited this idea with the potential to produce substantial system-wide savings.
http://www.huffingtonpost.com/...
What I find appealing about the a Federal Health Board is a list of best practices for doctors, who are drowning in information, advertising, and marketing promotions of medical equipment and drug manufacturers.
A co-worker of mine said he was paying "through the nose" for 90 days supply of prescriptions. He went back to the doctor with a list of generic or lower cost alternatives the insurance company recommended and the doctor checked off a couple that seem to work just as well.
The lack of uniformity in pricing, practices, and the information the doctors have at their disposal creates great disparities in care and a Health Insurance Board to set guidelines for health care, I think is something we need to consider.
Single payer, for those who are proponents of the idea, works because countries invest in a health board to oversee practices and set guidelines. Even France, with its mix of public and private cost sharing has a board to oversee pricing of drugs and other aspects of health care.
For all the talks of Triggers, public options and denial of single payer advocates at the table, the lack of dialogue coming about any proposed national health board, is due largely to the absence of Sen. Daschle as a key player in this for the Obama Administration.
I think any reform, without a health board to set standards and pricing, will only be a patch work solution, at best, without giving our health care system the ability to overcome the seemingly arbitrary differences in care and costs.
Edward Kennedy
From the same New York Times piece quoted at the top of the diary:
This strange sequence of events has suddenly elevated the profile of Max Baucus, a senator little known outside Montana. (It’s a circumstance made all the more striking by his longstanding disdain for Daschle, going back to a dispute over tax cuts.) Low-key and slightly nervous, Baucus has emerged as the pivotal Democrat on what is once again the most pivotal debate in Congress. He is the man charged with designing a plan that can win broad support in the Senate.
So how does getting Sen. Baucus in charge of health care, instead of Sen. Kennedy hurt us? Well it leaves us with a gaping hole in leadership on this topic in the Senate. Senator Kennedy has made health care one of his "causes" and brings 45 years of seniority to bear on fellow Senators. As this New York Times piece shows, Sen. Kennedy can be highly effective in getting legislation passed or onto the floor for debate:
Mr. Kennedy has become known as one of the last lions of liberalism, a full-throated defender of the policies the Democratic party pursued in the 1960's and 1970's. But within the Senate he has a reputation as one of the most effective members at building bipartisan coalitions.
When President Bush's No Child Left Behind bill was floundering in 2001, it was Mr. Kennedy he turned to and who saw it into law. In 2007, with the bill's renewal stalled, it was Mr. Kennedy Mr. Bush turned to again, despite bitter disagreements in the years in between on a wide range of issues, most notably the war in Iraq, which Mr. Kennedy opposed. When the Senate that spring seemed poised to pass a bipartisan bill on immigration, one of the names on it was Kennedy's.
http://topics.nytimes.com/...
From a July 2008 article, highlighting Sen. Kennedy setting up meetings to have health care reform legislation ready to go for who ever was going to be elected President:
Senator Edward M. Kennedy's office has begun convening a series of meetings involving a wide array of healthcare specialists to begin laying the groundwork for a new attempt to provide universal healthcare, according to participants.
The discussions signal that Kennedy, who instructed aides to begin holding the meetings while he is in Massachusetts undergoing treatment for brain cancer, intends to work vigorously to build bipartisan support for a major healthcare initiative when he returns to Washington in the fall.
Those involved in the discussions said Kennedy believes it is extremely important to move as quickly as possible on overhauling the healthcare system after the next president takes office in January in order to capitalize on the momentum behind a new administration.
Kennedy was an early endorser of Senator Barack Obama, the presumptive Democratic presidential nominee who is also a member of the Committee on Health, Education, Labor and Pensions, which Kennedy chairs.
SNIP
The initiative also suggests that Kennedy, who has made healthcare his signature issue in his 45-year Senate career and who is fighting an aggressive brain tumor, is considering his legacy as a new administration arrives in Washington - a moment many see as the best chance for widespread changes in the healthcare system in 15 years.
"You have got to think this will be the Ted Kennedy Health Reform Act, because he's a beloved figure and he's championed the issue for so long," said John Rother, policy director for the AARP, which has been involved in the discussions. "There are a lot of unknowns right now, but what we do know obviously is he is very close to Obama, and he also has quite a network of health policy experts that he can draw from."
http://www.boston.com/...
The loss Sen. Kennedy's leadership in the Senate not only causes us to face health care reform without a Senator who has wanted to bring about universal coverage for decades, but someone with the clout and seniority to stand up to industry lobbyists and get a truly equitable plan in place for the American people.
Sen. Kennedy's staffers are working on his legislation and are working with other Senators to get them on board, but without the Liberal Lion of the Senate to be their in person, there's only so much his staffers are able to do.
In the end what will emerge as health care reform will be shaped as much by the loss of Tom Daschle as HHS Secretary due to his own lack of care in filing his tax returns and underpaying his income taxes and Sen. Kennedy's battle with brain cancer and out of the Senate receiving treatment, while the health care debate moves on.
I think both these figures have critical insights and leadership skills into what would be effective and without their ability to fully participate in the current debate we are left without two people who have put a lot of time and effort into trying to come up with serious, equitable, alternatives to the current mess we have in health care.
Unfortunately President Obama seems to be so worried - and maybe rightly so - of not having a repeat of Pres. Clinton's health care debacle, President Obama isn't laying out (publicly, at least) what his goals are for health care reform. During his campaign he mentioned giving everyone the opportunity to buy into or for those who cannot afford it, have subsidized, inclusion into a public health care system, similar to what federal employees have.
Right now, I don't know what is going to happen. No Child Left Behind, in theory, has a noble goal of improving America's education system, but it was poorly implemented, with money going to well connected people and standards being arbitrarily set.
I fear without the leadership and stature of people like Tom Daschle and Sen. Kennedy on the issue of health care reform, legislation with the best of intentions will get hijacked by special interests and will be made a mockery of what health care reform should be.
I'd like to thank the people who have been working to make sure health care reform doesn't get hijacked by the industry lobbies because we need all the push back against them we can get.