Is Congress the Problem with Health Care?

By Ezra Klein, The American Prospect. Posted June 20, 2008.

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.

EK: But when you have a history, like you did in 1993, when people had bumper stickers saying, "If you like the DMV, you'll love government health-care," how do you sell both the politicians and the public on the idea that what we're going to do is turn health-care decisions over to a government-appointed, semi-accountable, vaguely shadowy institution? How do you make them comfortable with that?

TD: Well, first of all, that's not what we're doing. And so if we've not gotten our message better out, we will have failed. I don't think we have a government-run banking system. Most people believe we have a private banking system. But somebody -- the Federal Reserve -- is there to help set the guidelines within which this private banking system functions. Banks are free to do almost anything on banking practices if they want, just as long as it fits within those guidelines. And so it would be with the Federal Health Board. We would try to streamline the tremendous bureaucracy that exists today in our federal government when it comes to health-care. So this would really mean far less bureaucracy, not more. And I would simply ask the question, if you think our banking system today is reasonably regulated, why not try the same type of model for our health-care system?

EK: You mention in your book a couple of other examples where Congress has ceded authority on politically troublesome issues to commissions in order to pave the way for better decisions to be made. Can you talk a little bit about them?

TD: Well I think that probably the best example is the, in some respects, besides the Federal Reserve, which I think was the best model, is the FAA. You know, we don't make decisions on flight safety, the FAA does. We've designated the responsibility to create an infrastructure that I would say works pretty well. I knock on wood as I say that, we've gone a long time without an accident, in the FAA system. But you know, we lose the equivalent of one 747 everyday every two and a half days in our health -care system. Every two and a half days, the equivalent number of people, somewhere around 450 people, die because of medical mistakes in our health-care system, and we don't even hear about it.

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Ezra Klein is an associate editor at The American Prospect. His work has appeared in the LA Times, The Guardian, The Washington Monthly, The New Republic, Slate, The Columbia Journalism Review, and other outlets.

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