Is Congress the Problem with Health Care?

The first thing you notice when you sit down with Tom Daschle is that he's got some really funky glasses. Like, surprisingly funky. Fire-engine red with odd edges and varied trim, the sort of eyeglasses you'd see perched on the nose of an art dealer, not a former Senate majority leader.

But despite the incongruent accessorizing, Daschle is a former Senate majority leader, through and through. After losing his South Dakota Senate seat to John Thune in 2004, he halfheartedly attempted to return to private life, joining a law firm and taking some teaching gigs. But soon enough, he was pulled back into public policy by the Center for American Progress, which convinced him to become a senior fellow. Soon after that, he began working with well-regarded health-policy researchers Scott Greenberger and Jeanne Lambrew on a book about the health-care system.

Critical: What We Can Do About the Health-Care Crisis, is now out, and most of it is fairly familiar. Costs are up, and coverage is down. Taxes are up, and quality is down. Anxiety is up, and access is down. We're paying more than we can afford for a system no moral person could countenance and no disinterested researcher could praise. As Daschle and his co-authors conclude, "Health-care is a complex topic, but we have to face a simple truth: We're paying top dollar for mediocre results."

If the analysis is standard, however, the solution is considerably more surprising. As a longtime veteran of Congress, Daschle has watched the proverbial sausage being made, and concluded that complicated health-care decisions shouldn't be left up to butchers. "We have to look harder at the exceptional nature of the health-care problem," he writes, "and reconsider the political process we've followed in trying to solve it. The stakes are extraordinarily high in health-care -- literally life and death -- and the issue is incredibly complex. The number of stakeholders and special interests involved is extraordinarily large, and their influence is immense ... perhaps it isn't surprising that the traditional legislative process has failed to deliver."

Daschle's solution is something he calls a Federal Health Board. I sat down with him recently to talk about his proposal and his vision of the future of health-care.

Ezra Klein: So, to begin, the Federal Health Board. Why is it needed and what does it do?

Tom Daschle: I ask audiences frequently, what would have happened if the Congress had been the ones responsible for trying to figure out what to do with the Bear-Stearns crisis, the sub-prime crisis? Or what would happen if Congress were asked to raise or lower interest rates once a month? That's why we have a Federal Reserve. We need an insulated, accountable and credible decision-making board to take that responsibility.

The Federal Health Board would have some of the same roles as the Federal Reserve board, in that it would create a management infrastructure to integrate our public and private health-care systems. About 45 percent of the people in our country get their health-care from public sources, 55 percent from private sources, but there's no integration, either among the public programs or between the public and private sectors. Somebody has to do that. We need a board -- just as we have needed commissions in the past for base closing or Social Security -- to focus and to create the kind of decision-making process that allows us to make the tough decisions. That's why we have these commissions, and that's why we need the Federal Health Board. It also has a secondary purpose, which is that as we pass the legislation, it precludes the need for Congress to get too far into the weeds and be getting so mired in the minutia of details that would never really get to the larger questions. It allows us to stay out of the details. We delegate that detail to the board.