Daschle Hasn't Killed Health Care Reform

Personal Health

What does Tom Daschle's departure mean for the future of healthcare reform? I would submit that it is not a serious setback. In fact, it may have little effect.

Granted, Daschle was uniquely positioned to serve as the Obama administration's liaison to Congress. Well-liked on both sides of the aisle, Daschle might have been able to broker some of the differences between conservatives and progressives. But the fact that the vote on the expansion of S-Chip turned out to be such a bruising battle suggests that that those are who are ideologically opposed to universal coverage are not ready for a truce.

With or without Daschle, bipartisan compromise will go only so far, and then reformers will hit issues where many feel they just cannot compromise. The idea of tightly regulating the private insurance industry, for example, will be contentious. Insurers are fiercely opposed to the idea of competing on a level playing field with a public-sector healthcare plan that some call "Medicare for all". A battle seems all but inevitable – unless Democrats simply give up on the idea of a public-sector alternative to private insurance.

It is worth remembering that as a Democratic leader, Daschle was hardly a strong figure. He did not stand up to President Bush on either the war in Iraq or tax cuts for the wealthy. (A friend refers to Daschle, somewhat uncharitably, but not inaccurately, as "a wet noodle".) Granted, Daschle is a skilled, experienced politician. But from a progressive point of view, he may not have been the healthcare tsar we wanted.

Centrists were counting on Daschle to "manage the president's left flank", observes health policy consultant and blogger Bob Laszewski. Laszewski points to "pushing on things like a public health plan to compete with the private sector" as just the sort of behaviour that could create "a big hurdle". But do we really want a healthcare tsar who, from the outset, would be ready to concede on an issue that many see as essential to meaningful reform?
Observers who lament Daschle's departure argue that reform has lost its momentum. According to the New York Times, Daschle's withdrawal "could slow the president's drive to reshape the nation's healthcare system as the White House searches for a replacement, and it could allow Congress to step into the vacuum during that delay."

But Max Baucus, the Senate finance committee chair, is still in Congress, and he has pledged that congressional committees will continue to work on developing legislation. It is important to keep in mind that Baucus's own white paper for reform is not very different from Obama's plan. Meanwhile, senator Ted Kennedy also remains committed to moving forward. Max Baucus and Ted Kennedy both in Congress – this hardly constitutes a "vacuum".

Moreover, even if Daschle had remained in his post, the Obama administration was not going to rush into rolling out national health insurance. This is not to say that the administration won't try to pass an over-arching piece of legislation sometime this year, a bill that will promise to work toward universal coverage over the next four years. But even while campaigning, Obama always said that he hoped to provide healthcare coverage for all Americans only "by the end of my first term" (pdf).

When Baucus issued his white paper in November he, too, stressed: "It will take time. At least three years ... to make sure that we get it right."

As Harvard's Atul Gawanade argued in the New Yorker last week, overhauling a system that hundreds of millions depend on is just not something that can be done in a single stroke.

We need to proceed in a way that allows for continuous learning from mistakes, Gawande suggested, constant tinkering with reform. Grand plans to reform the system in a single sweep are "siren songs". "Grand plans admit no possibility of mistakes or failures, or the chance to learn from them. If we get things wrong, people will die. This doesn't mean that ambitious reform is beyond us. But we have to start with what we have."

For as the Obama administration continually emphasises, reform isn't just about promising access to care. It is, as his spokesperson reiterated in the New York Times today, about "covering the uninsured and reining in health costs". Unless we do both, we cannot deliver on the promise.

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