When President-Elect Obama nominated Tom Daschle to be his Secretary of Health and Human Services, he proclaimed the former Senate Majority Leader: "one of America's foremost health care experts." Obama stated Daschle will be the "lead architect" of the administration's health care plan. As a nurse, I am always concerned when the government announces it has plans for our health care, so I decided to investigate Mr. Daschle's ideas. I read his book Critical: What We Can Do about the Health-Care Crisis.
Senator Daschle wrote his book with 2 other experts, Scott S. Greenberger and Jeanne M. Lambrew. According to the flyleaf, Greenberger is a reporter and consultant. Lambrew is a senior fellow. Tom Daschle, of course, is a former US Senator and now a visiting professor and Distinguished Senior Fellow. The back cover of the book has advance praise from 3 senators, a former White House chief of staff, yet another senior fellow, and a professor/dean at a public policy institute.
To paraphrase a famous quote by Sam Rayburn, "They may be just as intelligent as you say. But I'd feel a helluva lot better if just one of them had ever emptied a bedpan."
In the introduction, the Senator recounts for us the many attempts by the federal government, beginning with Harry Truman, to guarantee health care to all Americans. Since none of these attempts have succeeded, Daschle diagnoses American health care as "broken." He pins blame on 3 areas:
The complexity of the health-care issue.
The limitations of our political system.
The power of the interest groups.
I realize that most of us skip introductions in non-fiction books, but this list intrigued me. What exactly is the Senator saying?
The complexity of the health care issue. Health care shouldn't be complex. Basically, it's a service. A cardiac surgeon once remarked to me, "Take a look at any hospital parking lot early on a Sunday morning and note how few cars there are. That's all you need to run a hospital. Everything else is just fluff." It's the fluff that's making American health care complex. One never hears about the "complexity in automotive repair", or the "complexity of the hair salon issue." Yet health care is deemed to be so complex that the entire system needs to be scrapped. Who's making it complex? Who's piling on the fluff? Certainly not doctors and nurses. If you answered "The Federal government," you are obviously not a Senator or a senior fellow.
The limitations of our political system. Another throwaway line by a politician that deserves some scrutiny. I'm no public policy expert, but what limitations is Senator Daschle bemoaning? Could it be the fact that once the American people learned what was involved in Hillary Clinton's plan they let Washington know in no uncertain terms what they thought of their "reforms?" The Senator learned his lesson well after that debacle. This time around, he plans on following the example of the TARP (Troubled Asset Relief Program) legislation. Forget those silly details that sunk Hillary Clinton's plan. This time Congress should pass a single page legislation that says, in essence, "Secretary Daschle: Please fix our health care. Signed, Congress." Voila! No more exasperating political limitations! We've all seen how well TARP is working as "foremost financial experts" are playing that hot new game, "Find That Trillion!" I predict if we give Daschle the same carte blanche, we'll soon be singing "Where Have All the Hospitals Gone?"
The power of the interest groups. This one is remarkable, because the first interest group Daschle names are doctors! He also includes hospitals, insurers, drug companies and researchers as those that have "contributed to the failure to solve the health care problem." For 30 years I've watched each of these groups jump through innumerable bureaucratic hoops just to practice their professions, and Tom Daschle dismisses them as "interest groups" that have actually caused the problem.
Senator Daschle devotes the next hundred pages or so to describing how bad health care is in America today and why all government efforts to fix it have failed. He recounts for us the experiences of Americans who have lost their insurance, never had insurance, or had insurance but it really cost a lot. As I read through their stories, it became clear that the crisis in health care today is not the care, it's the financing. (In this instance I agree with the late Senator Moynihan, as recounted on page 111.) There's the fellow who gambled that even though he earned $80,000 per year, he and his wife didn't need insurance because they were young. He lost his bet when he ended up in the cardiac cath lab with the resultant big bills. A man lost his wife to cancer after ten years of treatment; the medical bills nearly wiped out his bank account.
There are many more examples, all of them tragic. Reading through them, however, I have to conclude that Senator Daschle and his fellow experts believe the real crisis is that Americans have to pay for health care.
When did it become the conventional wisdom that paying $800 dollars for a car repair is lamentable but justified, but having a $500 health insurance deductible is highway robbery? That the exchange of money for health care is unfair? I have heard financial planners exhort senior citizens to come to a seminar to discover how they can prevent "losing" all their savings by actually paying for their medical care. So paying for a hospital or nursing home is "losing your money," comparable to being swindled by Bernie Madoff! Adults across the country hire lawyers to help them hide Mom and Dad's assets so their parents can jump on the Medicaid train.
Daschle assigns plenty of blame for the fix we're in, but for some reason never mentions, even in passing, the elephant in the room. Take an informal survey of doctors actively employed in American health care. Ask them what three things need to be "reformed" and I guarantee one of the items listed will be lawyers. Yet as I browsed the index of "Crisis" there is no mention of malpractice reform, tort reform, lawyers or defensive medicine. This glaring omission tells me that the Senator is no "foremost health care expert;" he's simply another politician.
Until Senator Daschle is willing to include the trial lawyers in his list of "interest groups," he will have a very difficult time persuading health care workers that he grasps the big picture of reform. As the future Director of HHS, his ideas, of course, must be examined. But the first half of his book does not inspire confidence.
Carol Peracchio is a Registered Nurse.