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Daschle Nominated To Head HHS, Health Reform Office



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:

“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.”

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1 Trackback for “Daschle Nominated To Head HHS, Health Reform Office”

  1. The Buzz » Blog Archive » Health Affairs Blog
    December 12th, 2008 at 9:52 pm

10 Responses to “Daschle Nominated To Head HHS, Health Reform Office”

  1. acavale Says:

    Very interesting, indeed. How two physicians in the same state have such different observation/views. Unfortunately, Dr. Hughes, being part of the PaMS brings down your credibility several notches, I am afraid. Which is why I quit PaMS in 2008 after trying (unsuccessfully) to make it work for the betterment of the physician-patient relationship.

    No matter how much you and the PaMS might try to remove the problem of litigation abuse from the discussion, it is very much an integral part of the problem with present-day health care crisis. And unless Mr. Daschle and Mr. Obama have the courage to stand up to their trial lawyer friends/contributors, there will only be sham reform. BTW, the only outcome I see from Act 13 is for us to provide evidence of extra “patient safety” CME credits every 2 years. This is the classic example of sham reform, because such “reform” only satisfies regulatory requirements, but does nothing to influence actual risk reduction or litigation in clinical practice. Unless one understands that risky practices and errors account for only a minority of law suits, policy makers will continue to tow this misguided line of argument. The potential fear of litigation is what drives practice of ‘defensive medicine”.

    It is easy for someone from the board of the PaMS to say “its going to take some time for Philly to improve”. But the situation is so grave that the city may not have that luxury of time. Incidentally, the impact of institutions like Drexel and Einstein on the care in the communities is so negligible that their efforts will have very minimal impact on community practice. Again, I’d like to emphasize my point that any reform efforts must come from the community and its physicians, not from the government or medical societies, if there has be any impact for the average population. Let’s see if the new administration has the guts to consider this avenue for reform

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  3. Christopher Hughes Says:

    Funny story: I’m from PA and sit on the PMS Board and am a practicing phsyician in PA. No ivory tower, no academic affiliation, just a practitioner, in the trenches like you.

    So, while I understand that there is a black hole of medical liability in Philly, the rule changes enacted by our state Supreme Court on venue changes and Act 13 requiring disclosure of adverse events and the patient safety movement ( the 1 million then 5 million lives campaigns) and the growth of ADR (University of Pittsburgh, Einstein, Drexel are leading the way) have all made for improvements in the liability climate in PA. Philly was so bad, it may take a while to see major improvements there, but unless we screw it up somehow, it will come. As an aside, while “tort reform” -as typically constructed – would be nice, I am personally convinced that we are fixing this without tort reform and will continue to do so.

    But this is really off topic, as far as I am concerned, as it does not materially effect the larger debate on healthcare reform.

    Cheers,

  4. acavale Says:

    I am finding this to be a very useful exchange. Finally there seems to be some ‘life’ on these blogs. I agree almost completely with C Hughes, even though I come from exact opposite direction. I believe this type of constructive discussion is the only way to come to a reasonable consensus.

    However, I must take exception to his idea that state medical societies are a source of remedy to the medical litigation problem or patient safety, quite the contrary, at least in my state of PA. I have been in practice for 14 years, in three different states. Our practice has actually implemented several patient safety measures and has been presented as a model in the latest educational DVD released by the ACP, documenting our use of advanced IT in delivering care in realtime and achieving patient satisfaction in a small practice setting. In fact, my liability carrier has given me a small discount on the premium due to our risk reduction techniques. Yet the premiums are far too high for my type of practice. I am not sure which state Mr. Hughes practices, but the liability insurance situation has not improved one bit in our state. Clearly his state must be one of those that has taken serious action on tort reform.

    One need not look any further than the status of Obstetric services in the city of Philadelphia to realise the devastation caused by rampant misuse of the tort system. For those unfamiliar with the situation, there are no Labor & Delivery services in the city apart from those at the 4 main university centers! So, for the expectant mothers of Philly, they have drive to neighboring counties to have their babies. So, I don’t need someone else to tell me that access to care (and we are talking any type of care) is not compromised due to the litigation issue. And, everyone should stop using the term “med-mal” as though every law suit is a result of malpractice.

    Possibly, coming out of “organised medicine” and into the community will provide a more realistic picture for Dr. Hughes so that he can truly understand the extent of “defensive medicine” being practiced. No wonder less than half the practicing physicians don’t belong to their local or national medical societies. We certainly can hope that Mr. Daschle’s team will bypass the big wigs at the medical societies and talk directly to community physicians and their patients, so as to achieve more comprehensive reform.

  5. Christopher Hughes Says:

    I think acavale and I are finding some common ground that I hope will not be lost in DC. Namely that the hassle factors and mind numbing bureaucracy of Health Insurers/Deniers has got to go. I think that is the one thing everyone, except the insurers agree on. IS there any special interest or group that disagrees with this? And yet, as was posted elsewhere on this site, we cower in terror at the prospect of going toe to toe with them and demanding an end to their inexcusable (well, morally inexcusable, very excusable from a fiduciary point of view) behavior.

    So where to go with this? More of the same, rearranging the deck chairs on our healthcare non-system Titanic? I hope not! Can we not agree on this: At the very least, an acceptable solution mandates a Social Health Insurance type model. that covers everyone and is NOT tied to employment? I think single payer still makes the most sense, but I am flexible enough not to be married to that as the only solution.

    So as not to be too conciliatory, however, let me disagree with the comments about medmal. I don’t think the rest of us are as concerned as he/she is. It is already improving as I discussed earlier. As to my naivete, I’ve been in practice 20 years, been sued 3 times, am on the Board of my state medical society and chair of its patient safety committee, and have completed Federal Mediation Training as part of my committment to ADR.

    Cheers,
    http://cmhmd.blogspot.com

  6. acavale Says:

    I am glad that more clinicians are beginning to participate in health policy discussions. In response to C. Hughes’ argument, I have the following counter-points…

    1) Coverage does not necessarily mean access to care because of two main reasons-very poor reimbursement levels and insurmountable hastle factors (see the article on Medicaid).
    2) I totally agree that the main organisation that claims to represent physicians has not been very helpful in promoting reform. This is exactly why policy makers should engage community physicians directly, and not through “organised medicine” channels.
    3) The notion of “medical liability canard” is one possibly coming from a naive individual. It is very obvious that medical litigation for the most part is unrelated to “errors” and further that it is usually the process of defending oneself that bankrupts most small practices, not the outcome of litigation. Any policymaker that does not address this problem adequately will not have the full cooperation of physicians and other clinicians, and hence will be unable to institute “reform” in the true sense.

  7. Christopher Hughes Says:

    To respond to acavale’s points:
    [BTW, I'm in private practice as well so share so I guess I can claim a similar 'comprehensive' view.]
    1. Coverage does equal access in most countries. Two common situations make them disparate: high out of pocket expenses and scarcity of providers. So, depending upon how we cahnge are system, they may become equal.

    2. I agree insurance should be uncoupled from employment. this is an accident of history and should be remedied.

    3. I don’t feel marginalized by Daschle, but often, when organized medicine presumes to speak for all physicians in a belligerent tone, then I feel marginalized by my own professional organizations. So while we should be the backbone of any reform, up until this year, we have been only obstructionist, so I can understand others reluctance to engage us.

    4. It’s time to let go of the medical liability canard. It is actually getting significantly better. It’s getting better because of error disclosure laws, alternative dispute resolution and the patient safety movement in general. If you can defend your practice, you do not need to practice defensive medicine.

    5. Moral hazard does not apply to most health care decisions. The free market has given us the system we have.

    If the plan that emerges out of this debate is similar to the 93 plan, then truly we are a nation of fools.

    Cheers,

  8. acavale Says:

    Jane, I am glad you agree with my ideas. I will review Jeff Goldsmith’s blog.

  9. Jane Hiebert-White Says:

    Thanks, Dr. Cavale, for your comment. It is indeed important for policymakers to hear from the physicians on the “front lines” of the health care system. For more even more insight on Sen. Daschle’s thinking, health care consultant and futurist Jeff Goldsmith offers a a new post today that delves into Daschle’s book on health reform.

  10. acavale Says:

    As a physician in private solo practice, I have the unique postion of being a care provider, a small businessman/employer and a patient, giving me a comprehensive view of the entire health care situation. Hence, I was quite dismayed at the tone and emphasis of Mr. Daschle’s first major speech on this topic last week. A few critical points to note…

    1) He continues the notion that having “coverage” equals “access” to care, which is totally untrue in real life.
    2) His reliance in continuing the employer-based insurance when it should be obvious to everybody that portable, individually-owned insurance policies would have been far better for all those millions of laid-off workers. This process is going to repeat itself in the future. Perhaps, Mr. McCain was correct after all.
    3) I found him struggling to even use the word “physician or doctor” in his sentences. He continues an effort to marginalise physicians even though they should form the backbone of any “reform” that the Obama administration might propose. He continues to pit one healthcare professional against another (nurses against doctors, Nurse Practioners against doctors, etc).
    4) He continues to repeat ad nauseum how his efforts will “reduce medical mistakes” while completely ignoring the devastating impact on clinical practice (and in turn loss of access to care) rampant misuse of medical litigation has caused. He can ask the expectant mothers in Philadelphia to know first hand. He also completely failed to acknowledge the true cost of “defensive medicine” and failed to provide any ideas to minimize such cost.
    5) Finally he failed to recognise that allowing a free market in medical practice will actually result in people getting higher value for their health care dollars, making more intelligent choices with regard to utilisation of care, as well as reduce overall cost to the system.

    Unfortunately, I heard the same old partisan ideas that have failed in the past. This time it may appear to be coming from the bottom towards the top, but I don’t expect the eventual plan to be much different than the one that failed in 1993. I can only hope that Mr. Daschle reads these blogs and has the courage to correct his course before its too late.

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