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Critical: What We Can Do About the Health-Care Crisis
A much-needed and hard-hitting plan, from one of the great Democratic minds of our time, to reform America’s broken health-care system.
Undoubtedly, the biggest domestic policy issue in the coming years will be America’s health-care system. Millions of Americans go without medical care because they can’t afford it, and many others are mired in debt because they can’t pay their medical bills. It’s hard to think of another public policy problem that has lingered unaddressed for so long. Why have we failed to solve a problem that is such a high priority for so many citizens?
Former Senate Majority Leader Tom Daschle believes the problem is rooted in the complexity of the health-care issue and the power of the interest groups—doctors, hospitals, insurers, drug companies, researchers, patient advocates—that have a direct stake in it. Rather than simply pointing out the major flaws and placing blame, Daschle offers key solutions and creates a blueprint for solving the crisis.
Daschle’s solution lies in the Federal Reserve Board, which has overseen the equally complicated financial system with great success. A Fed-like health board would offer a public framework within which a private health-care system can operate more effectively and efficiently—insulated from political pressure yet accountable to elected officials and the American people. Daschle argues that this independent board would create a single standard of care and exert tremendous influence on every other provider and payer, even those in the private sector.
After decades of failed incremental measures, the American health-care system remains fundamentally broken and requires a comprehensive fix. With his bold and forward-looking plan, Daschle points us to the solution.
240 pages, Hardcover
First published February 19, 2008
13 people are currently reading
228 people want to read
About the author
Tom Daschle
11 books6 followersThomas Andrew Daschle is a former U.S. Senator from South Dakota and Senate Majority Leader. He is a member of the Democratic Party. He is currently a Special Policy Advisor at the law firm Alston & Bird, visiting professor at the Georgetown Public Policy Institute at Georgetown University, a Distinguished Senior Fellow at the Center for American Progress, and a Richard von Weizsäcker Distinguished Visitor at the American Academy in Berlin, Germany.
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Displaying 1 - 30 of 53 reviews
February 2, 2009
He does (or his co-author does, not sure) a very good job of outlining the current state of health care and health insurance. Anyone who keeps current on such things will recognize a lot of the statistics he throws out but it is really nice to have it all in one place and, honestly, if I was going to try to hand someone a primer for where our health policy problems lie, this book (at least the beginning) would be excellent.
Like others have said, his policy recommendations are sort of weak. A weak cry for physicians to use more effective and less expensive procedures sounds hollow and poorly thought out. Right Tom. No one thought of that. Also, his thoughts along that vein almost seem anti-innovation, which is scary.
The book proceeds as if it is a foregone conclusion that a universal health care plan (NOT single payer) is to be established something like the Massachusetts' plan, and Daschle's role is to supply the missing piece: which he claims is the new Federal Health Board.
Now, I'm with him part way. I do think that the Massachusetts plan could have benefited from a more powerful board, but not a board like that envisioned by Daschle. His board is making coverage determinations, recommending procedures and writing formularies. Really, we need a board more like the Federal Reserve and less like the British model. To pull off an unwieldy, public/private hybrid health care reformation you need a board empowered to move with authority and to move nimbly. You need an entity empowered to do things like adjust market regulations on insurance products, jump in to anti-trust situations, and make emergency changes to tax code for personal mandates. If you're juggling 6-7 bureaucracies, the only way to pull this off is with an empowered entity like that, and not with a glorified UM committee.
A worthwhile read nonetheless, and I'm excited to see where Daschle takes HHS.
Like others have said, his policy recommendations are sort of weak. A weak cry for physicians to use more effective and less expensive procedures sounds hollow and poorly thought out. Right Tom. No one thought of that. Also, his thoughts along that vein almost seem anti-innovation, which is scary.
The book proceeds as if it is a foregone conclusion that a universal health care plan (NOT single payer) is to be established something like the Massachusetts' plan, and Daschle's role is to supply the missing piece: which he claims is the new Federal Health Board.
Now, I'm with him part way. I do think that the Massachusetts plan could have benefited from a more powerful board, but not a board like that envisioned by Daschle. His board is making coverage determinations, recommending procedures and writing formularies. Really, we need a board more like the Federal Reserve and less like the British model. To pull off an unwieldy, public/private hybrid health care reformation you need a board empowered to move with authority and to move nimbly. You need an entity empowered to do things like adjust market regulations on insurance products, jump in to anti-trust situations, and make emergency changes to tax code for personal mandates. If you're juggling 6-7 bureaucracies, the only way to pull this off is with an empowered entity like that, and not with a glorified UM committee.
A worthwhile read nonetheless, and I'm excited to see where Daschle takes HHS.
December 17, 2008
Enough to make one hopeful that as HHS Secretary under President Obama, Daschle might just pull off universal coverage. Oh, be still my heart.
This is a quick read, but very informative. It of course opens with the obligatory heartwrenching stories about how our current system of health care delivery absolutely fails in various circumstances, and which rightly strike fear into your heart when you realize that but for the grace of God go you and your family. It includes a very useful history of attempts at universal coverage stretching back to the early 1900s, and an interesting retelling of the Clinton failure, including an insightful assessment of what went wrong. It concludes with Daschle's ideas for how to practically achieve universal coverage, which seems non-radical enough to actually pass. It is not a single-payor system and actually seems, to my very superficially informed mind, indistinguishable from Massachusett's system that passed under Romney. But man, I'd take it.
He also emphasizes one of Clinton's mistakes was not pushing his health care proposal immediately upon his election, even attaching it to his first budget proposal that demands a vote. Buckle your seatbelts, folks.
This is a quick read, but very informative. It of course opens with the obligatory heartwrenching stories about how our current system of health care delivery absolutely fails in various circumstances, and which rightly strike fear into your heart when you realize that but for the grace of God go you and your family. It includes a very useful history of attempts at universal coverage stretching back to the early 1900s, and an interesting retelling of the Clinton failure, including an insightful assessment of what went wrong. It concludes with Daschle's ideas for how to practically achieve universal coverage, which seems non-radical enough to actually pass. It is not a single-payor system and actually seems, to my very superficially informed mind, indistinguishable from Massachusett's system that passed under Romney. But man, I'd take it.
He also emphasizes one of Clinton's mistakes was not pushing his health care proposal immediately upon his election, even attaching it to his first budget proposal that demands a vote. Buckle your seatbelts, folks.
February 18, 2017
Health care in the U.S. not being solved after all, I thought it was past time I read Daschle’s ideas on the subject. This book was published in 2008, and although we’ve gotten much closer to universal coverage under the Affordable Care Act, it has not done enough to bring down costs. The underlying facts and assumptions are still valid.
Starting with Daschle’s assessment of the prospects for health care reform, he cites several barriers, which still obtain.
• Health insurance as it is now structured is difficult for the public to understand.
• There are many influential special interests, and any reform involves winners and losers.
• Americans will have to “overcome powerful and persistent myths” including “the mistaken belief that we have the best health care in the world” (p. 194), and also including the myth that reforming the system will cost more than what we now spend for inferior health care that doesn’t cover everyone.
Our health care system costs more and delivers less than other developed countries. One reason is consumers’ deference to doctors’ decisions about treatment, even if the benefits are small. Doctors have financial incentives to prescribe drugs and order certain treatments and tests, regardless of effectiveness. Americans have a can-do culture; we are reluctant to accept defeat, even if there is little chance of success, which in turn feeds more technologies, which, once established, stimulates more use of them. Increasing research and development provides new drugs and treatments for normal conditions of aging or social behavior that become medicalized (he cites restless leg syndrome; I thought of shyness, now treated as social anxiety disorder). Our complex, “fragmented and uncoordinated system” of insurance decreases insurers’ ability to negotiate for lower prices and administrative costs. Ongoing consolidation of the health care industry is another factor.
Because we can do amazing things with technology, that doesn’t mean that our system results in better care. The U.S. has higher rates of infant mortality, lower rates of vaccination, and lower rates of survival from certain cancers and organ transplants when compared to our “peer” countries of Canada, the U.K., Australia, and New Zealand. (Though we do excel at rates of Pap tests and survival of breast cancer.) Fewer people covered means less care of chronic diseases, resulting in unnecessary deaths and a sicker population. We are behind in mental health and long-term care. The lack of care affects minorities disproportionately because they are more likely to be uninsured.
Other countries have single entities to recommend treatment and coverage policies nationwide. We have multiple bodies and no standardization, even within Medicare. Case in point: the recent confusion around conflicting standards for who should get mammograms, at what age and how often.
If they don’t die first, many who are uninsured or underinsured do get care eventually. Care received when people can’t put it off any longer, when patients are sicker, costs more. It causes overuse of emergency rooms, making emergency care less available for other emergencies. These costs don’t disappear because insurance doesn’t pay, they just get shifted around. Hospitals raise costs (which to begin with are secret and arbitrary, according to recent reporting about hospital chargemasters) on those who have insurance coverage, which can push them into heavy debt or even bankruptcy. Insurers raise premiums and deductibles on those who can afford it, until those people can no longer do so, creating more underinsured and uninsured people. The high cost of health insurance puts U.S. employers at a competitive disadvantage with other countries, because in other developed countries the cost does not disproportionately burden employers but is spread across the population. It’s one factor in the trend to hire part-time or contract employees who don’t get benefits. Sick employees also cost employers.
Dashle goes into the history of health insurance and the efforts going back many administrations to provide universal coverage. Though interesting, how we got here is less important than where we go from here. It does matter, though, because of the concept of “path dependency,” a term I’ve started seeing lately. It just means that taking some actions forecloses others. However desirable in the eyes of some, a single-payer system for everyone cannot get enacted in the U.S., period—at least not now—despite the popularity of Medicare, which is a single-payer system.
Daschle proposes a public-private system overseen by a board similar to the Federal Reserve for monetary policy. Another such board is the Base Realignment and Closing Commission, which Congress created to insulate itself from tough decisions about the closings of military bases, which all agreed were necessary but political considerations could not be overcome.
The Federal Health Board would have “the knowledge to make complicated health decisions and the independence to resist political pressures.” (p. 136) This board would set standards for coverage and review clinical evidence and the expertise of academics, professional organizations, and practitioners to decide best practices and train physicians. Policies should cover mental health equally with physical health, long-term care, and dental care. Though the Board would not set costs or lower them directly, this would happen as insurers could decide whether to cover tests and treatments without proven efficacy. Tax policy could also be set so that only insurance following the Board’s recommendations would be deductible expenses. Massachusetts already does some of this with the Commonwealth Health Insurance Connector Authority, which decides minimum benefits and financial subsidies for low-income people in the state.
Everyone must have health insurance coverage. Medicaid should be strengthened. There would have to be subsidies for those who could not afford health insurance.
Daschle recommends that anyone without employer-based coverage, Medicare, or Medicaid be allowed to buy insurance from the Federal Employee Health Benefits Program, which covers federal employees and members of Congress. Employers could also choose to offer it as their coverage. FEHBP offers several plans from private insurers from which to choose. Daschle recommends an option under the FEHBP for a government-run program similar to Medicare which “would have tremendous clout” to bargain for lower drug prices. It would also be more efficient, saving money in administrative costs, which Medicare does.
This is a short book, only 200 pages. In our current situation with everything up for grabs, the more informed we are when asking our elected representatives for what we want, the better. Essential reading.
Starting with Daschle’s assessment of the prospects for health care reform, he cites several barriers, which still obtain.
• Health insurance as it is now structured is difficult for the public to understand.
• There are many influential special interests, and any reform involves winners and losers.
• Americans will have to “overcome powerful and persistent myths” including “the mistaken belief that we have the best health care in the world” (p. 194), and also including the myth that reforming the system will cost more than what we now spend for inferior health care that doesn’t cover everyone.
Our health care system costs more and delivers less than other developed countries. One reason is consumers’ deference to doctors’ decisions about treatment, even if the benefits are small. Doctors have financial incentives to prescribe drugs and order certain treatments and tests, regardless of effectiveness. Americans have a can-do culture; we are reluctant to accept defeat, even if there is little chance of success, which in turn feeds more technologies, which, once established, stimulates more use of them. Increasing research and development provides new drugs and treatments for normal conditions of aging or social behavior that become medicalized (he cites restless leg syndrome; I thought of shyness, now treated as social anxiety disorder). Our complex, “fragmented and uncoordinated system” of insurance decreases insurers’ ability to negotiate for lower prices and administrative costs. Ongoing consolidation of the health care industry is another factor.
Because we can do amazing things with technology, that doesn’t mean that our system results in better care. The U.S. has higher rates of infant mortality, lower rates of vaccination, and lower rates of survival from certain cancers and organ transplants when compared to our “peer” countries of Canada, the U.K., Australia, and New Zealand. (Though we do excel at rates of Pap tests and survival of breast cancer.) Fewer people covered means less care of chronic diseases, resulting in unnecessary deaths and a sicker population. We are behind in mental health and long-term care. The lack of care affects minorities disproportionately because they are more likely to be uninsured.
Other countries have single entities to recommend treatment and coverage policies nationwide. We have multiple bodies and no standardization, even within Medicare. Case in point: the recent confusion around conflicting standards for who should get mammograms, at what age and how often.
If they don’t die first, many who are uninsured or underinsured do get care eventually. Care received when people can’t put it off any longer, when patients are sicker, costs more. It causes overuse of emergency rooms, making emergency care less available for other emergencies. These costs don’t disappear because insurance doesn’t pay, they just get shifted around. Hospitals raise costs (which to begin with are secret and arbitrary, according to recent reporting about hospital chargemasters) on those who have insurance coverage, which can push them into heavy debt or even bankruptcy. Insurers raise premiums and deductibles on those who can afford it, until those people can no longer do so, creating more underinsured and uninsured people. The high cost of health insurance puts U.S. employers at a competitive disadvantage with other countries, because in other developed countries the cost does not disproportionately burden employers but is spread across the population. It’s one factor in the trend to hire part-time or contract employees who don’t get benefits. Sick employees also cost employers.
Dashle goes into the history of health insurance and the efforts going back many administrations to provide universal coverage. Though interesting, how we got here is less important than where we go from here. It does matter, though, because of the concept of “path dependency,” a term I’ve started seeing lately. It just means that taking some actions forecloses others. However desirable in the eyes of some, a single-payer system for everyone cannot get enacted in the U.S., period—at least not now—despite the popularity of Medicare, which is a single-payer system.
Daschle proposes a public-private system overseen by a board similar to the Federal Reserve for monetary policy. Another such board is the Base Realignment and Closing Commission, which Congress created to insulate itself from tough decisions about the closings of military bases, which all agreed were necessary but political considerations could not be overcome.
The Federal Health Board would have “the knowledge to make complicated health decisions and the independence to resist political pressures.” (p. 136) This board would set standards for coverage and review clinical evidence and the expertise of academics, professional organizations, and practitioners to decide best practices and train physicians. Policies should cover mental health equally with physical health, long-term care, and dental care. Though the Board would not set costs or lower them directly, this would happen as insurers could decide whether to cover tests and treatments without proven efficacy. Tax policy could also be set so that only insurance following the Board’s recommendations would be deductible expenses. Massachusetts already does some of this with the Commonwealth Health Insurance Connector Authority, which decides minimum benefits and financial subsidies for low-income people in the state.
Everyone must have health insurance coverage. Medicaid should be strengthened. There would have to be subsidies for those who could not afford health insurance.
Daschle recommends that anyone without employer-based coverage, Medicare, or Medicaid be allowed to buy insurance from the Federal Employee Health Benefits Program, which covers federal employees and members of Congress. Employers could also choose to offer it as their coverage. FEHBP offers several plans from private insurers from which to choose. Daschle recommends an option under the FEHBP for a government-run program similar to Medicare which “would have tremendous clout” to bargain for lower drug prices. It would also be more efficient, saving money in administrative costs, which Medicare does.
This is a short book, only 200 pages. In our current situation with everything up for grabs, the more informed we are when asking our elected representatives for what we want, the better. Essential reading.
November 15, 2011
Former senator Tom Daschle has a greater command than many of the numerous complexities surrounding health care reform. 'Critical' examines the state of health care in the United States in 2008 prior to the election of Barack Obama. Although Daschle's role in the new administration was eliminated due to the surfacing of embarrassing failures to pay income tax, his memoir offers a telling look at why Obama decided to make health care reform his first major issue after TARP, and also why the resulting Affordable Care Act was considered a disappointment by many hoping for true health care reform.
A veteran of the Clinton years, Daschle writes that the previous failure to enact health care reform was due to two factors: Clinton failed to include key lawmakers in the legislation drafting process, presenting them instead with a finished product which they could easily pick apart, and Clinton's failing to take advantage of the political momentum which every new president finds when first taking office.
Until his tax fiasco, Daschle was a mentor to then-senator Barack Obama, and it is likely that he counseled the president-elect on the need to make health care reform a collaborative process which included congress, as well as on the need to act quickly during the early months of his administration.
But Obama, who later cut off Daschle's access to him, embraced these twin directives without reference to the wider political landscape. Given the economic crisis, reform of the financial sector and reducing unemployment should have trumped health care reform as the early causes of his administration. And collaboration with congress would only work if he were dealing with a group of reasonable people, rather than the radical Republican party of 2009 which announced early on its goal of making him a one-term president.
This failure to correctly read the political tea leaves led to a savage gutting of what might have been true health care reform. The GOP quickly seized the narrative from the green president, with its false trumpeting of 'death panels'. A policy-wonk at heart, Obama, found himself unable to clearly articulate the moral imperative for health care reform.
Daschle presents his idea of a Federal Health Board modeled on the Federal Reserve. Governors would be entrusted with analyzing the effectiveness of competing medical procedures, and distribute results to health care providers as recommended guidelines. Board members would be selected from among the nation's top health experts, and would therefore remain above politics.
O RLY?
What mechanism would prevent central officials from being influenced by the tremendous financial pressures of the hospital and pharmaceutical lobbies? Daschle offers no effective response to such questions, arguing that the academic atmosphere of the Health Board would allow it to remain indifferent to industry appeals to recommend certain products and procedures over others.
Holding up the Federal Reserve as the shining example of dispassionate policy-making is also problematic. It took a Freedom of Information Act to force the Fed to disclose the identity of the institutions to which it gave direct capital injections during the financial crisis, as well as the amounts involved. The coziness between the Fed and the institutions it is nominally there to regulate was captured in comments made by Fed governor Kathryn S. Wilde when she stated in August 2011: "Wall Street is our Main Street-- love'em or hate 'em. They are important and we have to make sure we are doing everything we can to support them unless they are doing something indefensible."
Is this the model Daschle seeks to follow for his National Health Board? If so, it seems designed to become the plaything of big pharma, the AMA, and other provider lobbies, who will attempt to influence board members to favor whatever treatment, procedure, or pill-of-the-moment will maximize their profits. With trust of government at an all-time low in 2011, what likelihood exists that the American public will repose literal life-and-death decisions into a central body of bureaucrats? And Daschle's belief that industry players will rationally come together to agree upon a course of action which maximizes public good while reducing each player's own private gain is naive to the point of ridicule. The very history of thwarted reform he outlines in the first third of the book amply demonstrates that when given a choice, the doctors, hospitals, pharmaceutical companies, and other providers will always protect their own self-interest at the expense of everybody else.
'Critical' offers the reader a succinct history of attempts at health care reform in the United States, as well as a ring-side seat at the defeat of Bill Clinton's efforts to provide universal health care in the 1990's. It also succeeds in arming the reader with the basic facts and lexicon of the health care debate-- no mean feat, given the volume's comparatively slim length. But Daschle fails to account for the strength of the health provider lobby, as well as the Republican party's continued scorched-earth policy of opposing Democratic initiatives without serious consideration. He therefore bears indirect responsibility for the disappointing final state of the Affordable Care Act.
A veteran of the Clinton years, Daschle writes that the previous failure to enact health care reform was due to two factors: Clinton failed to include key lawmakers in the legislation drafting process, presenting them instead with a finished product which they could easily pick apart, and Clinton's failing to take advantage of the political momentum which every new president finds when first taking office.
Until his tax fiasco, Daschle was a mentor to then-senator Barack Obama, and it is likely that he counseled the president-elect on the need to make health care reform a collaborative process which included congress, as well as on the need to act quickly during the early months of his administration.
But Obama, who later cut off Daschle's access to him, embraced these twin directives without reference to the wider political landscape. Given the economic crisis, reform of the financial sector and reducing unemployment should have trumped health care reform as the early causes of his administration. And collaboration with congress would only work if he were dealing with a group of reasonable people, rather than the radical Republican party of 2009 which announced early on its goal of making him a one-term president.
This failure to correctly read the political tea leaves led to a savage gutting of what might have been true health care reform. The GOP quickly seized the narrative from the green president, with its false trumpeting of 'death panels'. A policy-wonk at heart, Obama, found himself unable to clearly articulate the moral imperative for health care reform.
Daschle presents his idea of a Federal Health Board modeled on the Federal Reserve. Governors would be entrusted with analyzing the effectiveness of competing medical procedures, and distribute results to health care providers as recommended guidelines. Board members would be selected from among the nation's top health experts, and would therefore remain above politics.
O RLY?
What mechanism would prevent central officials from being influenced by the tremendous financial pressures of the hospital and pharmaceutical lobbies? Daschle offers no effective response to such questions, arguing that the academic atmosphere of the Health Board would allow it to remain indifferent to industry appeals to recommend certain products and procedures over others.
Holding up the Federal Reserve as the shining example of dispassionate policy-making is also problematic. It took a Freedom of Information Act to force the Fed to disclose the identity of the institutions to which it gave direct capital injections during the financial crisis, as well as the amounts involved. The coziness between the Fed and the institutions it is nominally there to regulate was captured in comments made by Fed governor Kathryn S. Wilde when she stated in August 2011: "Wall Street is our Main Street-- love'em or hate 'em. They are important and we have to make sure we are doing everything we can to support them unless they are doing something indefensible."
Is this the model Daschle seeks to follow for his National Health Board? If so, it seems designed to become the plaything of big pharma, the AMA, and other provider lobbies, who will attempt to influence board members to favor whatever treatment, procedure, or pill-of-the-moment will maximize their profits. With trust of government at an all-time low in 2011, what likelihood exists that the American public will repose literal life-and-death decisions into a central body of bureaucrats? And Daschle's belief that industry players will rationally come together to agree upon a course of action which maximizes public good while reducing each player's own private gain is naive to the point of ridicule. The very history of thwarted reform he outlines in the first third of the book amply demonstrates that when given a choice, the doctors, hospitals, pharmaceutical companies, and other providers will always protect their own self-interest at the expense of everybody else.
'Critical' offers the reader a succinct history of attempts at health care reform in the United States, as well as a ring-side seat at the defeat of Bill Clinton's efforts to provide universal health care in the 1990's. It also succeeds in arming the reader with the basic facts and lexicon of the health care debate-- no mean feat, given the volume's comparatively slim length. But Daschle fails to account for the strength of the health provider lobby, as well as the Republican party's continued scorched-earth policy of opposing Democratic initiatives without serious consideration. He therefore bears indirect responsibility for the disappointing final state of the Affordable Care Act.
February 10, 2009
As a rule, I don't read books "written" by politicians. I find them self-serving, self-aggrandizing, slanted, ghost-written, and aimed at turning public service into quick cash while prolonging the politician's fame on a book-signing tour for pretty hardbacks destined to sit unread on coffee tables. However, when a copy of Former Senate Majority Leader Daschle's diagnosis of health care reform ended in my lap, I thought I should read what insights my future Boss would have on the imminent national health care debate. Too bad I was only halfway through when tax troubles ended Daschle's nomination for HHS Secretary. I think he actually would have been good at the job. "His" book was surprisingly informative, though inherently outdated (though published in 2008, it was clearly written mid-2007 so legislation on mental health parity had not yet passed, and of course the ramifications of the 2008 election and the economic crisis could not have been discussed). Nonetheless, he captures the essence of the health care debate and illustrates its complexity for a lay audience. The best part of the book is the history of health care reform that is paraphrased and summarized here from other (more scholarly) sources (although he does inflate the impact of his own small roles, but what do they say about people who write history...) As one might expect from a politician, the strengths of the book are the anecdotes he uses to demonstrate the crisis for ordinary Americans, and he does better at defining the problem than articulating the details of the solution. In fact, his "solution" specifically is to take the problem out of the political arena and create a Federal Health Board that is "empowered" to resolve the thorny issues, just like the Federal Reserve Board or the Base realignment and Closures committee shields Congress from having to make unpopular policy decisions. However, he envisions his board not as a regulatory agency but as a structure to issue guidelines for government provided health care programs (Medicare, Medicaid, FEHBP, VA, IHS). Although these programs cover 1/3 of the country, this solution may not actually solve the problems as elegantly as he hopes short of tax code based enforcement powers from Congress. The other health care solutions in the book (health information technology, comparative effectiveness research, covering the uninsured, etc) are nothing new to anyone that knows health care. But overall, this book is a decent easy-to-ready primer for anyone wanting an introduction. Of course the book has a slight political bias, but in my humble opinion, he's right on the issues and he avoids being overtly partisan. Although this book was written as Daschle's job application as health care reform czar in the Obama administration, at least I feel confident that co-author (and current nominee for HHS deputy Secy) Jeanne Lambrew has a stereoscope on the heart of the issue.
October 9, 2011
If you really want to know who is really responsible for dragging their feet, slow to come to the table, and even resisting health care reform then this is the book you want to read. For those of you who are not in the medical profession let me spell it out for you: Lobbyist representing powerful physician groups, pharmaceutical companies, and some hospitals. Why?: THEY WANT MONEY/GREED! It is all about turning a profit for these big three. Yes, there are a lot of physicians and especially hospitals who prefer to focus on getting paid rather then focus on what their jobs really should be: improving the health of individuals. In addition to reading this book I also suggest that you rent and watch the PBS documentary entitled "Sick Around The World". If you have Netflix then you can watch it on 'Play It Now.' In America people don't realize that if you are poor and can't afford certain test then the physician is not going to order expensive test that could have helped the individual. They will do the minimum and least expensive tests that are within the hospitals best interest when it comes to saving money. To them the hospital is the one that needs saving and needs to stop the bleeding of money so to speak. We all know that healthcare cost a lot of money at least in this country, but shouldn't we be doing what is best for the patient like some other countries are doing instead of what is best for profit margins?!
September 17, 2008
This is a broad overview of the state of American healthcare that is perfectly accessible to someone like myself that doesn't have much background in the area.
Daschle starts off by rattling off statistic after tragedy after heartbreaking story of how American healthcare is unreliable, not comprehensive, and hugely over priced. He really drives home how many people are left out, and how "the best health care in the world" only applies to the richest among us and even middle class Americans are at risk of being stuck with fairly awful coverage.
He moves on to describe efforts to reform the healthcare system stretching back almost a century, focusing the most attention on the Clinton administration's attempt in the 1990's. He details what went wrong with these efforts and why they failed.
Finally, he lays out a possible solution to the problem. He suggests expanding the FEHBP (Federal Employees Health Benefits Program) to allow non-governmental employers and individuals to participate, as well as installing the healthcare equivalent of the Federal Reserve Board to oversee it.
(Side note: The staffer says this is Daschle's bid for HHS secretary, as he is apparently BFFs with Obama.)
If you have any interest at all in American healthcare, this is a great, quick overview.
Daschle starts off by rattling off statistic after tragedy after heartbreaking story of how American healthcare is unreliable, not comprehensive, and hugely over priced. He really drives home how many people are left out, and how "the best health care in the world" only applies to the richest among us and even middle class Americans are at risk of being stuck with fairly awful coverage.
He moves on to describe efforts to reform the healthcare system stretching back almost a century, focusing the most attention on the Clinton administration's attempt in the 1990's. He details what went wrong with these efforts and why they failed.
Finally, he lays out a possible solution to the problem. He suggests expanding the FEHBP (Federal Employees Health Benefits Program) to allow non-governmental employers and individuals to participate, as well as installing the healthcare equivalent of the Federal Reserve Board to oversee it.
(Side note: The staffer says this is Daschle's bid for HHS secretary, as he is apparently BFFs with Obama.)
If you have any interest at all in American healthcare, this is a great, quick overview.
March 13, 2017
If you want a great history lesson on how the patch work quilt of legislation has created the US healthcare system that we experience today then this is a good read. I appreciate that Senator Daschle went beyond espousing many of the challenges with the healthcare system and offered ideas on solutions that might address the issues that exist.
December 25, 2008
Mindless dribble from the incoming Secretary of Health and Human Services. Daschle outlines many of the obvious flaws with American healthcare system (although he fails to mention the excessive regulation that exists). He then proposes some recommendations, specifically creating a Federal Health Board (akin to the Federal Reserve Board). Basically, he wants an unelected board to control most aspects of the health care system. He states: "We must emphasize the fact that unlike the decision-makers at insurance companies, the members of the Federal Health Board will serve at the pleasure of elected officials." This is supposed to be a comforting statement? As an elected official this is terrifying. People are free to choose whether to do business with an insurance company. People are compelling in all interactions with the government. Why would I want to arrogant elected official handpicking their supporters to regulate my healthcare?
April 11, 2009
Daschle provides a good historical review of attempts at health care reform, assesses the current state of health care in the US, describes the challenges for achieving reform and provides insights about what's necessary to get the job done. He argues that a primary reason for Clinton's failure is that he lost momentum when a series of foreign affair emergencies claimed his attention. I wonder if Obama's efforts will be sidetracked similarly as he deals with the current financial crisis? This is a timely read because although Daschle was not confirmed as Secretary of Health and Human Services it appears that Obama has embraced many of his ideas. And there's evidence that in some forward looking communities folks are moving ahead with reform on their own. Just last night there was a news piece about how one hospital in PA is "guaranteeing their work" for certain procedures. Building in quality control is a Daschle suggestion, one I think might be a very tough sell.
May 13, 2011
A clearheaded diagnosis of the many ills of the American healthcare system, replete with the expected horror stories and some concepts for improvement, as well as a legislative history of various plans for universal healthcare coverage (especially President Clinton's effort). This book was written before Daschle was nominated for and subsequently withdrew from consideration for HHS Secretary under President Obama, and also of course written before the Affordable Care Act became the law of the land.
So, I hope a lot of these statistics will be getting less offensive as Obama's healthcare plan becomes law--but for now, this is still a decent primer, though I am not completely sold on Daschle's idea for a Federal Reserve-like board for matters related to healthcare. As a South Dakotan, I always have liked and admired Tom Daschle and even briefly worked on his campaign staff, so take this review with the required grain of salt.
So, I hope a lot of these statistics will be getting less offensive as Obama's healthcare plan becomes law--but for now, this is still a decent primer, though I am not completely sold on Daschle's idea for a Federal Reserve-like board for matters related to healthcare. As a South Dakotan, I always have liked and admired Tom Daschle and even briefly worked on his campaign staff, so take this review with the required grain of salt.
April 7, 2009
A very well thought out book. An easy read considering the subject matter is anything but accessible. This affects all of us and Tom Daschle's book becomes all the more important given his nomination to be HHS secretary. Unfortunately, the book has its share of hyperbole and biased research evidence - although, can a politician ever write a book that is free of exaggeration? The ideas are more realistic than revolutionary. The wounds of past wars lost seem to have tempered the writer's thinking.
P.S. The current scandal about Senator Daschle's tax non-payment and more importantly, his "not a lobbyist" influence-peddling have greatly diminished my appreciation for his progressiveness and clarity of thought. Alas, he will likely be another reason why health care in America will continue to be TERRIBLE.
P.S. The current scandal about Senator Daschle's tax non-payment and more importantly, his "not a lobbyist" influence-peddling have greatly diminished my appreciation for his progressiveness and clarity of thought. Alas, he will likely be another reason why health care in America will continue to be TERRIBLE.
January 6, 2009
Discusses our nation's complicated health care problem in easy to understand terms and without finger pointing (or with equal finger pointing at all sides....) It was eye opening to learn about the evolution of our current healthcare system as it paralells the call to reform it. Former Senator Daschle's suggestion for a Federal Health Board is the best I've heard so far- we must form an independent panel of experts removed from the pressures of partisanship and pressure from special interests in order to get ACTION towards reform and to avoid imminent disaster. I believe that healthcare is a right for all Americans- and I think this book outlines a plan that, if adopted, may make that a reality in the near future.
January 20, 2009
The good news is, the wheels are moving and health care reform is likely. The more I learn about health reform, the less confident I feel about any solution. This book does a fairly good job of catching me up to speed on reform attempts since Franklin Roosevelt.
But I wonder if more bureaucracy in the form of a Federal Health Board is really the best way to control costs and expand coverage? I fear a reduction in the autonomy of the physician, transforming them from the independent thinkers I aspire to join, to simple cogs.
The elephant in the room is still the exponentially growing costs of useful care, which must lead to rationing. How we ration should be the focus of this Federal Health Board if it ever comes to fruition.
But I wonder if more bureaucracy in the form of a Federal Health Board is really the best way to control costs and expand coverage? I fear a reduction in the autonomy of the physician, transforming them from the independent thinkers I aspire to join, to simple cogs.
The elephant in the room is still the exponentially growing costs of useful care, which must lead to rationing. How we ration should be the focus of this Federal Health Board if it ever comes to fruition.
May 20, 2008
As Barack Obama slowly but surely moves into the presidency, and as his quote "Sen. Daschle brings fresh thinking to this problem" is printed on the front cover, above the title, I couldn't resist this little gem. It offers a sparse but fair history of efforts towards universal coverage and some interesting but minimally fleshed out ideas for reform. As a doctor interested in a single payer system with an adjunctive role for private insurance, this was right up my alley. Though the arguments have been made in other places, and perhaps more in depth, it is good to hear them from someone of Tom Daschle's prestige.
August 3, 2009
I read this when it looked probable that Daschle would be the point man for health-care reform. Not only was he denied the job because of questionable tax practices, but his main model for a smart reform of American Health care was the Federal Reserve. Thanks to the banking crises, that particular theory has crashed and burned. So yeah, at the time it was an intriguing, if optimistic and somewhat vague, read. At this point I would say your average romance novel would have more influence on health care reform than this tome.
December 15, 2008
A prescient read considering Daschle's nomination as HHS Secretary. He did a great job of detailing the history central issues regarding health care in America. He did not go into detail about proposed solutions other than to describe a FED-type entity overseeing health care, but I think that was wise in this case -- he admits he doesn't have all the answers, but he seems to be smart about how to go about finding them. A highly recommended read.
February 3, 2009
An okay read - the first half was a quick (although understandably biased) history of US health reform, followed by some proposals. (The main proposal being a Federal Health Board similar to the Federal Reserve Board.) It may be because he and the other authors were trying to keep it short and accessible, but I'm not entirely sure I buy it. And if a relative policy noob like me can poke holes, I'm not sure how likely it is to fly.
April 22, 2009
Author admits Congress and Pres. are too political to resolve U.S. Health Care problems, so he suggests a National Health Board, with single-payer system i.e. Federal Govt. This board would make decisions on who gets what care, who pays how much, and what providers are paid.
Taschle tauts FED and SEC as examples of how the Health Board would be in charge...Good Luck! We see how well these agencies did (NOT!) do in regulating the economy. And they are not answerable to anyone!
Taschle tauts FED and SEC as examples of how the Health Board would be in charge...Good Luck! We see how well these agencies did (NOT!) do in regulating the economy. And they are not answerable to anyone!
May 4, 2009
WOW! This book is excellent. I truly appreciate the education I received from Mr. Daschle. I am getting ready for my first courses in Health Administration and feel like I'm truly prepared for my "Insurance and Managed Care" course because of all the excellent research Daschle put into this book. I completely agree with his reasoning and his plan for universal healthcare coverage. Everyone should be required to read this book.
July 22, 2009
This book outlines the loss of competitive edge our country faces dues to the high cost of health care as well as the risk involved with employer based insurance (i.e. high cobra costs when jobs are eliminated). Daschle provides a history, begining with Truman, on the struggle to legislate a solution to the health care problem. I'm not sure I agreed with his solution, but I'm glad I read the book.
June 16, 2008
Wanted to read this and see where he is on the issues and what this Federal Health Board is all about. Not a whole lot of substance but he delivers his point fairly loud and clear. For all it's lofitness about transcending the political noise, he sure doesn't hesitate to take snipes at certain constituencies.
Read
December 19, 2008The Federal Health Board that Daschle proposes would, among other things, rate the relative merits of all treatments. This would generally improve outcomes and give us more bang for the buck. Shannon Brownlee called for such an agency in Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer.
August 13, 2009
Some helpful information about the big picture of healthcare in the US. A modest effort to refrain from attacking viewpoints other than his. ALMOST enough to help one forget that he deprived himself of the opportunity to be at the center of the decision-making process by avoiding paying taxes for limousine liberal 'entitlements.'
July 27, 2010
Written for an uninformed audience. If you think have a good handle on the healthcare debate, don't read it. But it does well presenting the liberal view on healthcare and government programs. Largely based on the plight of the poor, the have-nots, who become that way because of powerful, heartless social institutions.
December 25, 2008
It's best we know what he'll be up to as Sec. of Health and Human Services...
This book is an easy read. I give it only two stars because I distrust much of what he says and he doesn't do a very good job of documenting what he claims. But, like I said, it's good to know what his ideas are.
This book is an easy read. I give it only two stars because I distrust much of what he says and he doesn't do a very good job of documenting what he claims. But, like I said, it's good to know what his ideas are.
December 24, 2008
I just reread this book in light of Senator Daschle's recent nomination. I am again impressed by what a quick, easy read it is, yet it manages to provide a wonderful overview of the many problems with our health care 'system' and succintly offers the Senator's recommendations for changing it.
February 1, 2009
Not much new information here. Daschle's main point, his call for a Health Review Board, could have easily been summed up in a chapter. I'm not sure that is the answer to the problem. I was hoping for more.
January 24, 2009
Interesting introduction to Daschle's ideas on health care. This was the first I've heard of Daschle's federal reserve board style independent oversight agency. Not too in depth on the policy ideas, but a good read.
March 6, 2009
In spite of my disappointment in Tom Daschle's tax status, he seems to really understand health care. To those of us who have been in the health care field, it is refreshing that he 'really gets it."
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