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Doc Daschle
One cook in the health-reform kitchen.


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James C. Capretta

Former Senate Democratic Leader Tom Daschle is poised to become the Obama administration’s Secretary of Health and Human Services, according to several news stories.

That’s not surprising. For a time, Daschle contemplated running for president himself, but he quickly pulled his name from the list of contenders and endorsed Sen. Barack Obama instead. His early support of the relatively unknown freshman senator, at a time when most other high-profile Democrats were lining up behind Sen. Hillary Clinton, means Team Obama now owes him “big time” (to use a quaint Bush-era term).

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But Daschle apparently never had his sights on any of the “big four” slots (State, Defense, Treasury, or Justice) which are typically the biggest prizes. No, for months now, he has let it be known that his only interest was in becoming the HHS Secretary.

Why, one might wonder? After all, running HHS well will be no picnic. It’s a sprawling bureaucracy, which means the Secretary is often accountable but not always fully in control. And HHS’s most important day-to-day responsibilities are not at all glamorous: ensuring drugs entering the marketplace are safe without unnecessarily delaying access to life-saving medicines; protecting the food supply, including food imported from abroad; and ensuring vigilance against all manner of potential public-health threats (natural and man-made). The reality is that the only time anyone notices what HHS is doing in these areas is when something goes wrong.

Daschle is apparently eager to take the assignment not so much because he relishes the challenge of managing the vast HHS enterprise but because, like many of his former colleagues in Congress, he wants to cap his career by being closely associated with passage of a nationalized-health-care plan. And he senses, as others do, that the moment may have arrived.

And it very well may have. With 58 Democratic votes in the Senate (and counting), there will be a strong push from Democrats to seize the political momentum and pass something very big next year.

That’s why there has been so much jockeying for position in recent days to be health-reformer-in-chief in the 111th Congress. In the House, Congressman Henry Waxman is trying to unseat current Energy and Commerce Chairman John Dingell. Much of the speculation regarding Waxman’s motives has centered on disputes with Dingell over energy and environmental issues. But Energy and Commerce also has jurisdiction over a large portion of health-care policy. Certainly Waxman would also relish holding the gavel when a governmental-health-care plan is being considered by the Committee.

In the Senate, Finance Committee Chairman Max Baucus released his own blueprint for reform just eight days after the election, making it clear as he did so that he has no intention of letting Sen. Ted Kennedy have the health-care stage to himself.

For his part, Kennedy seems to be taking the opposite tack, avoiding any mention of legislative details while setting in motion processes he hopes will build consensus by sharing the credit. He has directed his staff to meet with all manner of interested parties and ask for their input, and he recently deputized Sens. Clinton, Tom Harkin, and Barbara Mikulski to oversee the drafting of various components of the emerging legislation.

Daschle, of course, will have his say before all is said and done. That’s why he wants the job. And what he seems most likely to push is his pet reform idea: creation of an independent body to oversee the most important decisions in American health care. In the past, he has suggested that such a body would do for health care what the Federal Reserve Board has done for the banking and financial sector. (He may be rethinking that talking point.) Still, he is unlikely to abandon the contention that decisions regarding what should or should not be available as a universal benefit to all Americans should be decided by an independent body of experts and wise men, not the marketplace or the political process. A powerful, unaccountable über-regulator of health care would be exactly what proponents of market-based health care dread.

Daschle will also urge President Obama to avoid the mistakes he perceives the Clintons made in 1994. He has long argued that the Clintons would have won the health-care fight if they had tried to pass the legislation in 1993, when the president was still popular, instead of 1994. Moreover, even in 1994, a bill could have been passed if the Clintons had been more open to compromise and securing two-thirds of what they were seeking. Instead of a deal to vastly broaden insurance coverage, they got nothing.

With Daschle at HHS, and Kennedy desperate to secure his legacy, it would seem the odds of something like an Obama-Kennedy-Daschle-Waxman-Baucus-Clinton health-care plan getting passed in the next Congress are very high indeed. Right?

Perhaps. But there remains at least one potential stumbling block: the reform plan itself. It’s got many problems, substantively and politically. For starters, the Obama framework would impose massive new costs on workers. The “pay or play” employer mandate and costly new minimum-benefit rules would destroy hundreds of thousands of private-sector jobs in the middle of a steep recession. That would seem to be a hard sell. Moreover, Obama would create a new public-insurance option that would draw tens of millions of people out of private insurance and into public coverage. Voters who heard Obama say his plan is not government-run health care may find this surprising, and disconcerting.

And then there is the matter of costs. All of the Democratic reform plans contemplate vast new subsidy arrangements for millions of households. But there is nothing in these Democratic plans that would substantially slow the pace of rising costs. Consequently, absent other changes, the Democratic plans would make what is already a challenging budgetary outlook much, much worse.

In the end, budgetary reality is likely to force the would-be Democratic reformers to choose between two unpleasant options. They could either impose government-enforced cost constraints, and thus implicitly ration care, or they could pay for rapidly rising health-care spending with a massive tax increase.

Whichever way they go, it won’t be popular. Faced with this reality, perhaps it will be possible to introduce into the discussion a third, more rational option: building a true marketplace for health care.

James C. Capretta is a fellow at the Ethics and Public Policy Center and a health policy and research consultant.



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