An Experienced Hand

by dday

Roll Call is reporting that Tom Daschle will be the next Secretary of Health and Human Services. That's wholly unsurprising. Obama's Senate staff was basically Daschle's former staff after he lost re-election. The two have been close since Obama got to Washington. What's notable is that his jurisdiction will not just be that of a normal HHS chief.

Daschle, who served in the Senate until he lost his re-election bid in 2004, also is set to take on the position of "health care czar" in the Obama White House, ensuring that he does not get bigfooted on matters relating to health care policy, according to this source.

Daschle was a close adviser to Obama throughout the Illinois Democrat's presidential campaign, and has been outspoken about his desire to enact a government-funded health care insurance program to help cover the approximately 40 million Americans who do not have coverage.

Ezra Klein explains why this is huge news:

You don't tap the former Senate Majority Leader to run your health care bureaucracy. That's not his skill set. You tap him to get your health care plan through Congress. You tap him because he understands the parliamentary tricks and has a deep knowledge of the ideologies and incentives of the relevant players. You tap him because you understand that health care reform runs through the Senate. And he accepts because he has been assured that you mean to attempt health care reform.

From the standpoint of getting something done, this is definitely positive. The most recent past effort at health-care reform was run in a top-down fashion which made it more susceptible to being torpedoed by industry. Now there appears to be a great deal of consensus. Ted Kennedy is back in the Senate and yesterday he set up a bunch of health care working groups with key leaders in each post, one of them Hillary Clinton, which is obviously subject to change. It's significant that everyone will have their piece of the reform pie to shape. Congresscritters like the feeling that they're putting an imprint on things, I imagine. Most important, Congress wants to move forward in a comprehensive way, and now the new White House is signaling that as well.

But it's important to note that, while this may be a great step forward for HOW health care gets done, it's still unclear WHAT that reform will look like. The how is quite important because the cost of doing nothing is too great. But the what is crucial as well. Daschle's most recent book, Critical, is about how to fix the health care crisis, and there's a lot of talk about process and getting a bill through Congress, but the "what" he comes up with is a kind of Federal Reserve board for health care, one that can administer, without being subject to political pressure, a public option health care consumers can purchase. That's a very different vision than what is currently in the Obama plan or the consensus plan in the Senate, and it's kind of murky and based on what may be an unrealistic set of assumptions about political power. I don't know how far Daschle would go in shaping the policy, but what is important is that the mass of citizens who care about health care reform start pushing their legislators right now to move in the direction of serious reform. If the end goal is to get something, anything done, the product will probably be much different than if the end goal is to hew to certain core principles, like the idea that health care is a human right and not a privilege, and companies that seek profit over treatment are highly unlikely to work in the best interest of the consumer.