December 12th, 2008
Yesterday President-elect Barack Obama nominated Sen. Tom Daschle (D-SD) as his choice for Secretary of Health and Human Services. Additionally, Obama asked Sen. Daschle to lead a new White House Office of Health Reform and nominated Jeanne Lambrew, a senior fellow at the Center for American Progress, as the deputy director of the office. Lambrew has written a book on health reform with Daschle, served in President Clinton’s administration at the Office of Management and Budget, and was an informal adviser on health care to Sen. Hillary Clinton during the campaign. She wrote in Health Affairs with John Podesta on the challenge of extending and improving health coverage [free access article].
Last night, in an interview on the PBS NewsHour with Jim Lehrer, Health Affairs Editor-in-Chief Susan Dentzer noted that the nomination of Daschle to these dual health leadership positions may give policy watchers some indication of where an Obama administration is heading in thinking about health reform:
“I think it tells us a little bit about the substance of the proposal that could likely emerge and also about the process. On the substance, Sen. Daschle has very much been in-sync with the kind of thinking that was evident in the Obama campaign plan on health reform, that is to say around such concepts as shared responsibility, everybody has to pay into the system, employers, individuals, the government….
It also tells us something very important about the process, which is that, unlike what happened during the Clinton health reform, this is not going to be a plan that is cooked up in the White House and brought out and pushed on to Congress. Quite the contrary, it’s going to be a plan that emerges largely from the Congress. We know that key officials in Congress — Sen. Max Baucus, who chairs the Finance Committee, Sen. Ted Kennedy, who chairs the Health, Education, Labor and Pensions Committee — are working together already on a plan…. There’s going to be very, very active engagement.”
Linking Health Reform To Economy. In the press conference announcing the nominations, Obama linked the importance of tackling health reform to the economy, saying: ”If we want to overcome our economic challenges, then we must finally address our health care challenge.” Dentzer elaborated on this point in her NewsHour interview:
“First of all, just look at the job loss situation. More than 500,000 jobs lost last month. A lot of those people — if they’re lucky, they have employer-based coverage and they can continue to buy it, even though they’ve lost their jobs, under a program called COBRA. If they’re not lucky, their company is gone…. So we will see active increases in the uninsured numbers clearly this year. So that’s No. 1.
No. 2, many, many companies, not just the automakers, are straining under the costs of enormously high-priced health care. General Motors alone spent $5 billion last year on just its retirees’ health care. So everybody understands that part of getting the economy moving again is to get this weight of enormous health care expenditures that don’t achieve the value that we think we want to get out of health care off the backs of some of these companies and reform the system.
So… [with] everybody’s eyes now fixed on the size of the problem, they understood how it’s crippling many aspects of the economy and really hurting individuals, and that they really do need to move ahead [with health reform].”
The Process of Reform. Dentzer noted that even with the political willingness to work on health reform, it will still clearly require “a Herculean effort to pass it.” She explained:
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“It’s one thing to talk about a plan and broad outline; it’s another thing to get agreement on very technical details that are going to cost some people a lot of money and produce some instability in the system. There will be a long, long struggle to get any package enacted. There’s no question about that.
Also, [Obama’s] advisers are fully apprised of the fact that, even if something were to pass this year, it will have to be phased in. The costs of the Obama plan were priced out by people who were trying to do an honest cost estimate at $160 billion a year. There isn’t $160 billion a year to be had on that…. It would have to, in essence, be added to the budget deficit, if it were to be enacted this year. So that’s not going to happen.
So the advisers are beginning to talk about a phased-in process, where even a large step to expand health care coverage probably would not come about until the economy began to recover. So there’s a sense of realism, I think, about this that may be belied by some of the very upbeat, happy talk that one sees in public. A lot of these folks are smart people. They’ve been around the block a number of times, especially on the budget.”