VOICES OF REFORM: Daschle on Health Care and the Global Economy

Joanne Kenen — Thu, 31 Jul 2008 16:36:00 -0400

Former Senate Majority Leader Tom Daschle spoke to a full house at New America yesterday about how our rising health care costs are hurting U.S. global competitiveness. (See our issue brief on health and the global economy here.) We blogged about Daschle and his health policy book "Critical" just days after we started this blog in March but a few things have changed since then. For starters, back in March, it was still primary season. Now we have an Obama-McCain race. As Daschle, an Obama adviser, pointed out, both candidates are talking about health care, and that's good. "This problem has to be addressed," Daschle said. But he cautioned that it won't happen without sustained leadership from the next president, whichever team wins. Daschle was the second-ranking Democratic leader in the Senate during the 1993-94 health reform debates, and he knows all too well what happens when the White House and Congress lose their focus or get distracted by other problems or crises. Once the momentum slows down, it's hard to recover.

Like us, Daschle sees cost, quality and coverage as inextricably linked. Although Obama has not endorsed mandates, Daschle didn't back off his belief that they will be needed (he didn't specify precisely when) to bring everyone into the system, although he shared Obama's concern that health insurance costs must be brought down and subsidies must be adequate for a mandate to work. Other solutions he put forth—more Health IT to help reduce medical errors and cut down the high administrative costs of our system; payment reforms so we stop rewarding quantity of tests and procedures and instead pay for treatment of an episode of disease or an injury; more transparency throughout the health-care system; another look at drug pricing; more prevention, and better treatment and management of chronic disease. We liked the geometric example he used. If you think of health care as a pyramid, with wellness and prevention as the broad base and high tech options like heart transplants at the narrow point, most countries start at the base and work up until the money runs out. In the U.S. we do the reverse.

Each time we hear Daschle, we're struck by how he departs albeit in modest ways from what on Capitol Hill would still be the party orthodoxy. A few months ago, he gave a fairly nuanced assessment of the Medicare prescription drug program. It was largely designed by Republicans and there are many things that Daschle would have done differently (in fact, he tried for years to do them differently) or would still change in a heartbeat if he could. But he also acknowledged that the program, however flawed, was doing more than he had expected to help people get their drugs. Yesterday he spoke about the need to address physicians' concerns about malpractice and defensive medicine, and put forth the idea of Health Courts that would avoid a lot of the current litigation problems but still make sure that injured patients were protected and compensated. It's not a brand new idea, but it hasn't had much traction, so it will be interesting to see if it gains any with a prominent Democrat like Daschle talking it up.

Daschle is a veteran of enough health care wars to know how hard it is to get from here to there, idealistic enough to want to try again, and pragmatic enough to know not to repeat the mistakes of 1994. He likes to quote Nelson Mandela, a hero of his: "Many things seem impossible until they are done."

IN THE STATES: Pennsylvania County Tries Talking Instead of Suing

Joanne Kenen — Tue, 04 Mar 2008 15:41:00 -0500

Malpractice reform has an honored place on the long list of health issues that Congress remains stalemated on, year in and year out. There are legitimate disagreements about the extent of the problem and how to address it -- and there are some political advantages in keeping malpractice reform on the political "red meat" menu. [slideshow] Encouraging more mediation and arbitration (instead of more lawsuits) has some appeal on both sides of the spectrum, but it hasn't gotten a lot of federal traction. One county in Pennsylvania has begun a pilot program. By teaming up doctors and lawyers to work together to resolve disputes amicably and putting the patient's interests first, hospitals hope to reduce patient anxiety, improve safety by addressing errors, and potentially cut costs. Here's an interesting account in the Philadelphia Inquirer.