A few weeks back, I sat down with Tom Daschle to talk about his new book on health care, his idea for a Federal Health Board, and the difficulties of reform. The interview is up at The Prospect today. Easy political lede thought: Daschle, who's close to Obama (his former Chief of Staff is Obama's current Chief of Staff), would make an excellent secretary of Health and Human Services. he knows Congress, knows the issue, and knows the candidate. If he gets appointed -- not out of the realm of possibility -- you can presume that Obama is serious on health reform. More substantively, the benefit of Dachle's vision is that he proposes a system with a real claim to legitimacy. Among the problems currently bedeviling health care is that few of the decision-makers are actually trusted to work towards the public good. Insurers, who make money by denying care, are broadly loathed, and they lack the public trust to make hard decisions. Providers can’t stand the government’s meddling, and resent the attempts of know-nothing politicians to set payment rates and dictate treatments. And patients are increasingly skeptical of hospitals and providers, who they know make money each time they order a test. What Daschle is offering is a decision-making body insulated from political pressures and profit consideration, imbued with the power and funding to gather real evidence, and run by trusted authorities, and thus able to lay claim to real legitimacy. It is, in that way, an appealing vision. But the political dangers are manifold: Patients may not like the current system, but at least they know how it works. Telling them that future health care decisions will be made by a politically insulated board stocked by Congress, appointed to 10-year terms, and akin to a shadowy banking authority they know very little about, well, that’s a hard conversation. The attack ads almost write themselves. Daschle is curiously sanguine about these pitfalls. “If we’ve not gotten our message out,” he shrugs, “we will have failed.” True enough. But for a veteran of the 1994 health reform wars, who laments his party’s “difficulty in getting our message across,” a bit more attention to the politics of the issue would be valuable. If I were Daschle, I'd be selling something of a triangulating communications strategy. Build in a provision ensuring that a doctor will always be chair of the board, and then run ads saying, "We've seen what happens when insurance companies run health care. We don't want the government doing it. Isn't it time we had a health system run by doctors?" In doing, you can at least try and make the insulation of the board an advantage rather than a weakness. Daschle is onto something interesting by integrating legitimacy concerns into his policy proposal, but he's got to embed them in his political approach if they're to be effective.
