As President-elect Obama's apparent choice for health and human services secretary and as White House health care czar, it is a fair guess that Tom Daschle's view on health care legislation may be decisive.
So it is worth reading his book "Critical: What We Can Do About the Health-Care Crisis," in which the gracious former Senate leader lays out without equivocation both the policy he recommends and the tactics for how to pass it.
He proposes setting up a board to establish standards for health care delivery in the United States that would be modeled on how the Federal Reserve Board and Securities and Exchange Commission oversee banks and corporations. Technically, it only would oversee the public health systems (Medicare, Medicaid, Veterans Health Administration, etc.), which provide about 32 percent of health care nationwide.
On Page 179, he writes, "The Federal Health Board wouldn't be a regulatory agency, but its recommendations would have teeth because all federal health programs would have to abide by them." But here is the kicker: Although his board technically would have no say on the 68 percent of health care that is provided through the private sector, at the bottom of Page 179, Daschle modestly adds: "Congress could opt to go further with the Board's recommendations. It could, for example, link the tax exclusion for health insurance to insurance that complies with the Board's recommendation."
Those last 19 words would spell the end of independent private-sector health care in America. Obviously, no health insurance would be sold if it were denied the tax deduction. Thus, every policy, every standard decided by this board would be the law of the land for every drug company, every hospital, every doctor and every health insurance company.
Indeed, 20 pages later, in the section in which he identifies "losers" under his plan, Daschle is admirably candid. Among the explicit "losers, he includes: "Doctors and patients might resent any encroachment on their ability to choose certain treatments, even if they are expensive or ineffectual compared to alternatives. Some insurers might object to new rules that restrict their coverage decisions. And the health-care industry would have to reconsider its business plan (emphasis added)." That is to say, they can stay in business and deliver their services, but only as the government bureaucrats say they may. They no longer would be genuinely independent.
One of the things that Daschle says will have to change is the "technology arms race" he claims hospitals are engaging in "to attract aging baby boomers with the latest diagnostic imaging machines." Imagine that, offering customers the latest technology, which, as Daschle admits on Page 125, "help(s) doctors estimate the spread of cancer or the extent of cardiac disease without surgery."
Of course, for Daschle, the problem with such high-tech diagnostics is that it leads to treatment. On pages 123-124, he cites a study approvingly for the proposition that there are too many angiograms being performed. By too many, he specifically cites a study of 828 angioplasties in which only a third were likely to benefit the patients. Another half might or might not, and 14 percent were not likely. Now I might conclude that if 85 percent of the patients receiving the treatment might benefit (the one-third who definitely would and the 50 percent who might) and if I were one of them, I might want the procedure. But for Daschle, that would be a waste of money, and "the imaging test that shows narrowing of the arteries was to blame (for the excessive treatment)."
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