Saturday, December 27, 2008

Obama team gets serious about healthcare legislation

The Obama team is setting the stage to revamp America's health care system and avoid the mistakes the Clinton administration committed in 1993.
WASHINGTON - President-elect Barack Obama and his team have signaled that they plan to work jointly with Congress to overhaul the healthcare system, rather than produce a separate White House bill that would be sent to Capitol Hill, according to people involved in healthcare strategy discussions.

The Obama team is determined to avoid the mistakes of the early 1990s, when the Clinton White House created a healthcare policy team that had more than 500 members and spent months secretly developing a 1,342-page proposal with minimal input from Congress. A lack of investment among congressional leaders helped doom the bill, which never even went to a vote.

Obama and his team - headed by former Senate majority leader Tom Daschle, who will serve as a bridge to Congress - have already begun privately engaging with congressional leaders and have emphasized that they intend to work more collaboratively on healthcare than the Clintons did, said the two leading Democratic senators on healthcare reform.

"Congress did not want to be told what to do," said Max Baucus, the Senate Finance Committee chairman, whose committee will determine whether a healthcare overhaul is fiscally feasible. "They're very cognizant of that and they don't want to make the same mistake."

"The only way for this to work is to have both ends of Pennsylvania Avenue working hand-in-glove," Senator Edward M. Kennedy, chairman of the Health, Education, Labor and Pensions Committee, said in a statement. "And all signs are that's how it will proceed. It's not Congress or the White House, it's both together."

Len Nichols, a health economist at the New America Foundation and the senior manager of health policy at the White House budget office in 1993 and 1994, said he believed the Obama team would probably set broad parameters but let Congress work through the details and write the legislation, giving guidance both privately and publicly on what would or would not be acceptable to the president.

"That is the right strategy," he said. "Clinton tried the alternative, which is to go write it yourself in a hotel room and drive it up there and plop it down" before Congress, he said. "It didn't work too well. Daschle was here and he paid attention - he knows you can't do that."

Daschle's low-key style and legislative background contrast sharply with his counterparts in the Clinton administration - Ira Magaziner, a consultant charged with running the healthcare reform effort, and Donna Shalala, an academic who served as Clinton's secretary of health and human services - had little political experience and few relationships on Capitol Hill upon which to draw.
The reason that Clinton's effort failed is that Congress did not buy into the program, which allowed an opening for the insurance companies to persuade the public to barrage their Congressional representatives and Senators to simply not act. The Clinton plan never got a vote.

The Obama team needs to avoid that fate, and they know it.

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Thursday, December 11, 2008

Obama, Daschle and health care financing

One major thing about the election of Obama as President will be the effort to break the health insurance lobby and allow Americans to get universal health care. The announcement that ex-Senate majority Leader Tom Daschle will become Secretary of Health and Human Services as well as director of the new White House Office of Health Reform indicates that Obama is serious about health care reform.

Ezra Klein has a really interesting article about how Tom Daschle and Barack Obama are connected. The connection is the previously very powerful chief of staff to Daschle as Majority Leader (Pete Rouse) who came to work for the most junior Senator in the Senate after Tom Daschle was defeated for reelection in 2004. Here is Ezra Klein's description of the Daschle - Obama connection and it's implications for the coming battle to get universal health care.
Obama's campaign was built off the plans Rouse wrote for Tom Daschle's Senate run. It even used the same people. His deputy campaign manager, Steve Hildebrand, managed Daschle's 2004 campaign. His director for battleground states, Jennifer O'Malley Dillon, and his director of communications, Dan Pfeiffer, were both deputy campaign managers for Daschle in 2004. Obama's foreign-policy director, Denis McDonough, was Daschle's foreign-policy adviser, and his finance director, Julianna Smoot, was head of Daschle's PAC. And in February of 2007 -- which is rather early for this sort of thing -- Tom Daschle, who had served with Joe Biden and Chris Dodd and John Edwards and Hillary Clinton, stepped forward and endorsed Barack Obama, giving Obama crucial establishment credibility, a powerful emissary to elite Washington, and a key adviser. And since then, other Daschle confidantes have entered Obama's inner circle, namely Phil Schiliro, formerly Daschle's policy director and now Obama's legislative liaison.

Which is all to say that Daschle is rather better integrated into Obama's political structure then your everyday appointee. And he has the relationships and the information to have made an informed judgment on whether the president-elect was serious enough about health care to merit Daschle's full-time involvement. Which is again why I urge people not to underestimate the importance of this pick, either as a signal of intentions or a signal of strategy. Though this point is argued in greater detail below, the distance between Ira Magaziner and Tom Daschle could not be greater. Magaziner knew nothing of the Congress. Daschle knows nearly everything. If the Clinton plan failed because it was too much the product of a policy process and too little the product of a congressional process, Daschle's involvement is the strongest evidence possible that Obama's plan will not suffer from the same mistakes.
The American health care crisis was supposed to be the major reason why Obama needed to be elected President. People are dying for lack of timely access to health care, while the people are are getting health care are paying a great deal more per person than people in other countries do, and in return getting health care that is not even up to average international standards.

Add to that situations like the health care expenses of the Detroit auto makers have made Detroit automobiles too expensive to compete with those from Japan and South Korea. So health care finance reform is critical to America.

This should not be put on hold because the American economy is collapsing into the worst recession since the Great Depression. The problems of the economy cannot be dealt with effectively without also dealing with the problems of health care financing. So it looks like Obama is going into the Presidency to deal with both health care financing and the economy. Tom Daschle as Secretary of HHS is a sign that the health care financing is going to be dealt with.

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