Monday, January 12, 2009

“Details kill.” That’s Tom Daschle, President-elect Barack Obama’s nominee for secretary of health and human services and the nation’s new “health-care czar,” explaining to the Associated Press why national health reform has failed in the past. Big, clumsy Clinton-style health reform bills, the size of a telephone book, read and analyzed by ordinary people - that, according to Mr. Daschle, led to fatal criticism.

Translation: If we hadn’t spelled out the specifics of what we really wanted, we could have gotten our schemes past the public without a lot of noisy and unpleasant dissent and safely enacted into law.

Ironically, Mr. Daschle has given us quite a few details in a short and very readable book, “Critical: What We Can Do About The Health Care Crisis.” He describes his proposal for a Federal Health Board, a powerful body that would make key recommendations on the kinds of medical technologies, treatments, drugs and procedures Americans should have.

Mr. Obama has also proposed an “institute” that would judge the “comparative effectiveness” of medical treatments, procedures and therapies, as well as drugs, devices and technologies. But, fortunately, Mr. Daschle outlined his proposal in much greater detail.

Mr. Daschle models his Board on the Federal Reserve Board, with a governing body of politically appointed experts. But he insists these special appointees would be “insulated from politics.” These appointees would “oversee the health-care industry” and have the power to make “complicated medical decisions and the independence to resist political pressures.” Additionally, they would “help define evidence-based benefits and lower overall spending by determining which medicines, treatments and procedures are most effective - and identifying those that do not justify their high price tags.” Translation: denied payment.

The Federal Health Board’s range of powers would be very broad. Its appointees would set rules for private health insurers who would participate in a new national pool. They also would recommend benefit coverage, including drugs and medical procedures, to be included in all government health programs, including Medicare and Medicaid, the State Children’s Health Insurance Program, and the Federal Employees Health Benefits Program, which covers more than 8 million federal workers and retirees and their families.

Mr. Daschle’s Board would also “rank” therapies and medical services based on what the board determined to be their “cost effectiveness,” and suggest priorities for medical research. It would establish payment rules and standards for doctors and other medical professionals to meet the board’s definition of “quality” care. Payment to doctors and other medical professionals would depend on how well they complied with government guidelines for medical practice.

Mr. Daschle is refreshingly frank about the enormous power of his Federal Health Board, which he says would act like a “Supreme Court of Health.” It would not only limit insurers in offering health benefits. Mr. Daschle admits it would further alter the already weakened doctor-patient relationship: “Doctors and patients might resent any encroachment on their ability to choose certain treatments, even if they are expensive or ineffective compared to the alternatives.” So forget about complaining to your congressman, even if he or she is funding your coverage with taxpayers’ money.

The decisions of this Federal Health Board would, at first, affect only those Americans enrolled in government health programs, such as Medicare and Medicaid. But Mr. Daschle suggests expanding its powers to health plans that cover all Americans. This could be done, he suggests, by linking “the tax exclusion for health insurance that complies with the board’s recommendations.”

In other words, if private-sector employers don’t comply, the price of that disobedience would be a severe tax penalty on employers and employees. So, don’t even think about noncompliance.

In short, Mr. Daschle’s prescription for health care reform is centralized government control over our health-care decisions by a powerful elite that will decide what’s good for us, and what isn’t.

Of course, the health-care sector of our economy is blessed with a treasure trove of professional expertise, from our finest universities to our world-class medical centers. But those men and women - regardless of how innovative their recommendations are, and no matter how impressive their achievements in medical science, biomedical research, technology or clinical experience may be - wouldn’t count. Only Mr. Daschle’s “Supreme Court of Health” would count.

Yep, details can kill.

Robert E. Moffit is director of the Heritage Foundation’s Center for Health Policy Studies (

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