Tom Daschle on Health-Care Reform: Keep the Pressure On

Earlier this year former senator Tom Daschle looked set to be a pivotal player in the president's plans to reform health care. A passionate health-policy expert, Obama wanted Daschle front and center as health and human services secretary. But problems with his taxes forced him to withdraw his name from consideration. Now Daschle is watching from the sidelines, hoping that Obama will be able to strike while the iron is hot. I spoke with Daschle this morning. Here are some excerpts from our conversation:  

Former Massachusetts governor Mitt Romney told me yesterday that he believes the president should take more time to pursue meaningful health-care reform. Why is it important to move this legislation quickly?

It is more important to get it done right. But keep in mind there have been efforts to resolve these issues for years and years. I think even in Massachusetts as they considered health reform they worked against deadlines. Most legislative bodies work better when they are cognizant of deadlines; otherwise there is always another speech or yet another amendment. I think that keeping the pressure on to do this in a timely way is by far the best approach.

One of the reasons why they are pressing forward is because 15 years ago, over a period of months, the bill languished. Over that time all of the special interests coalesced and were able to sow so much doubt and concern that the bill was defeated. I think keeping the pressure on with at least some appreciation of deadlines is a lesson learned [from previous attempts at reform].

What do you like and what do you dislike in the proposals currently before Congress?

I think that it is very important for us to accomplish what it appears everyone agrees on, and that is, at long last, coverage for all. I think that there is a widespread recognition that there should be an opportunity to keep your insurance if you like it. I think there is a far greater emphasis on wellness and prevention than ever before, and that is a good thing.

What I don't think they are doing enough of is what [Douglas] Elmendorf, the director of CBO, said last week: they're not putting enough emphasis today on cost containment. I think they are attempting to rectify that this week. In my view the most important cost-containment mechanism would be a board with the authority to make the cost-containment decisions that are so critical to success.

What do those decisions pertain to?

We need a good revision of our payment system. Today we pay for volume, and we really need to change that to pay for value. Making that transition from volume to value is a very important function of the board. Because it is so political and so difficult and complex, I think it is too much to ask members of Congress to do this on a regular basis.     

How realistic is it to anticipate a bipartisan bill that receives support from more than just a couple of Republican senators?

That's really up to the Republicans. I was disappointed that after offering over 250 amendments in the Health, Education, Labor, and Pensions Committee in the Senate─161 of which had been accepted by the committee ─Republicans still voted against the bill. I think it is unfortunate that, in spite of efforts to reach out and in spite of efforts to include them, so many Republicans have chosen not to be participants. I had the good fortune to work with Sen. [Robert] Dole and Sen. [Howard] Baker at the Bipartisan Policy Center to come up with a bill that the three of us unanimously endorsed, so I know it is possible. I am hopeful that we are going to see a lot more than three or four Republicans at the end of the day.

What do you think the American people need to hear from the president tonight?

That we're not going to give up until we succeed at producing a bill that provides real, meaningful health reform. I think it is important for the president to lay out with greater specificity tonight how he hopes to do that. It is critical in the context of both of those objectives that the president counter the criticism and the political attacks that have surfaced over the past few weeks by people who have opposed these efforts. And it is certainly important for him to reassure Americans that we all understand the status quo is unacceptable.

Paying for reform is a contentious issue right now. Do you have any redlines in terms of how legislation should be funded?

The first rule is that there can't be too much emphasis on cuts. We can only go so far with regard to cuts before you really gut the programs themselves. There has to be a good balance between revenue and reductions. I also think you can generate a certain degree of financing from the modernization that is being discussed, especially with regard to [health] IT.

With regard to the revenues, I think that all of the proposals work; it is just a question of which ones are the most politically palatable for certain members of Congress. That's still unclear, but you can get the revenue from [removing the tax] exclusion, and I think that is reasonably good public policy. You can perhaps get it from a tax on excessive benefits, which is being contemplated. You can get it from a tax on the insurance coverage itself or you can get it from the requirement for both employers and individuals to pay into the system. So there are a number of options. The only question is which one enjoys the broadest base of support, and I think that is unclear today.

There was a time commentators presumed you would be at the center of this reform effort. Is it difficult for you to be watching from the sidelines?

Oh, it sometimes can be difficult, but I also feel very fortunate to be able to play the role of what I would call a resource to members of Congress and to the White House and to others who are interested in public policy relating to health care. While I am not engaged in the same way, I feel very much engaged and very fortunate to have had the opportunity to play the role I am.

Several recent polls have shown support for Obama's health-care reforms slipping. Should he be worried?

Polls go up and down, and they are snapshots of what people may be thinking as of any given moment. But I think it would be a terrible mistake for any national leader to have his finger in the air trying to decide what popular political opinion might be before he makes a decision about what might be best for the course of the country. My hope is the president will continue to do the right thing. There is overwhelming support for health reform in this country. While there is some confusion over what constitutes meaningful health reform, I think the American people will know it when they see it, and they really believe we can't miss this window of opportunity.