We caught Tom Daschle, the former Senate Majority Leader and newly-minted health wonk, discussing his new book "Critical" today. We were delighted to hear him take issue with the too-common refrain that "America has the best health care in the world." Politicians in both parties say that, and it was an effective slogan against the Clinton health care reform in the early 1990s. It drives us nuts. Yes, we have great doctors and great research and great medical schools and great technology but no, we don't have the best health care in the world available on a consistent basis to all Americans. Daschle's phrase was that we have "islands of excellence in a sea of mediocrity." Like Daschle, we believe that any initiative to expand coverage also requires us to acknowledge our quality gaps and address spending that doesn't buy value.

Daschle, as you may have heard, favors creation of a Federal Health Board, which is loosely to the medical world what the Federal Reserve Board is to the monetary world. It would not "ration" care but it would make rational decisions about care. Daschle recalled that when he was in the Senate, he would get lobbied about things like the cost of oxygen tanks or reimbursement rates for various medical procedures. He concluded that Congress should set overall health policy but not make those technical decisions, which don't belong in the political realm. "Congress doesn't have the institutional capacity" to make those decisions, he told a jam-packed audience at the Center for American Progress. His ideas have been attacked by some on the right already as a Big Brotherly bureaucracy, but Daschle said a "Fed Health" could provide some rational framework for what we should cover and how we pay for it -- even in a McCainiac market-oriented health policy.

Daschle, who is close to the Obama campaign, didn't utter the "M" word (mandates). Obama of course opposes the individual mandate; Clinton endorses it (as do some Republicans). We worry that the mandate fight can be unnecessarily divisive. Daschle's book doesn't dwell extensively on mandates but he doesn't mince words either: Page 166: "The only way we can achieve universal coverage is to require everybody to either purchase private insurance or enroll in a public program. As long as we can make health insurance affordable and accessible for everyone, this is a reasonable requirement."

Like everyone else who survived the health care wars of the early 90s, Daschle came away with a hefty list of Things Not to Do Again Next Time. Being more inclusive, more open to "a vital center" was part of his message. Trying not to squeeze thousands of complex, technical decisions in draft legislation is another. Maybe a Federal Health Board could let Congress hash out a national health policy, without having to worry so much about doctor's fee scales or the how the cost of oxygen will play in Peoria.