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 that would be modeled on how the Federal Reserve Board and Securities and Exchange Commission oversee banks and corporations. Technically, it would only oversee the public health systems (Medicare, Medicaid, Veterans Administration, etc.) - which provide about 32 percent of health care nationwide.
Mr. Daschle 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 would technically have no say on the 68 percent of health care that is provided through the private sector, Mr. 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 was 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, every health insurance company.
Indeed, in the section in which he identifies "losers" under his plan, Mr. 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. That is to say, they can stay in business and deliver their services, but only as the government bureaucrats say they may. They would no longer be genuinely independent.
One of the things that Mr. 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 Mr. Daschle admits "help doctors estimate the spread of cancer or the extent of cardiac disease without surgery."
Of course, for Mr. Daschle, the problem with such high-tech diagnostics is that it leads to treatment. He cites a study approving 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 patient, 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 that would definitely and the 50 percent who might), and if I were one of them, I might want the procedure. But for Mr. Daschle, this is a waste of money and "the imaging test that shows narrowing of the arteries, was to blame [for the excessive treatment.]"
What followed is my favorite line in the book: "When the test revealed a narrowing of the artery, however slight, cardiologists couldn't resist doing something about it." Imagine a doctor trying to cure his patient.
Cardiologists might think they were carrying out their responsibilities. But under the Daschle/Obama plan, political hacks appointed to the health board will decide whether your cardiologist is allowed to image your arteries, and if they find blockage, try to successfully treat it.
But that is not all he doesn't like about private-sector health care. Mr. Daschle points out the dangers of letting drug companies advertise their products to the public: The public might want the drugs even if some Washington bureaucrat likes another drug instead.
He doesn't believe that Americans are entitled to just any care that might do some good. Yup: "Many patients with insurance want any care that might do some good, and plenty of doctors will oblige them."
Recognizing that some of these ideas might not be vastly popular, he recommends two basic legislative strategies. First, seek to pass the legislation early in the first year of the president's first term - when he is most popular and is least likely to be resisted. That is a valid analysis.
The other strategy, which is very smart, is to leave the nasty details out of the bill. He says that was one of President Clinton's mistakes in 1993. Mr. Clinton put too many details in the bill, thus alerting those who disagreed to mount an opposition. Mr. Daschle recommends passing a vague bill and then "a Federal Health Board should be charged with establishing the system's framework and filling in most of the details. This independent board would be insulated from political pressure," he writes.
By "political pressure" he means the democratic process of electing fellow citizens to Congress who then pass legislation about which the public is informed before final passage - and about which they may wish to petition their government for redress of grievances. Apparently we can end petty bickering and partisanship by not letting anyone know what the new laws will contain.
Tony Blankley is a syndicated columnist.