Is Daschle right for HHS?

During the GE Healthcare national user conference in Washington this August, the keynote speaker for the Executive Forum was former senator Tom Daschle. You may have noticed his name in the news recently, so I went back and took a look at some of the notes I’d taken.

He had recently published the book he’s co-authored with Jeanne Lambrew and Scott Greenberger and was there to talk to a room full of healthcare IT execs about the state of healthcare.

I came away from his talk favorably impressed with his grasp of the issues and feeling as though his proposals had a possibility of working- given the chance to do so.

He predicted that, regardless of who won the election (still in doubt at the time), we were about to begin another discussion about healthcare in this country. He also pointed out the fact that those conversations are 0-6 in the last 100 years when it comes to their track record for leading to significant change.

The question he posed was whether or not the circumstances have changed enough to make things different this time.

The problems that he cited are no big surprise to anyone- cost, access, and quality. And I think that we would all agree that two of the biggest contributors to our failure to fix things- complexity and the influence of special interests- have not changed.

He took on what he identified as three “myths” that have contributed to the inaction.

1. We’ve got the best health system in the world! Truth is that our quality and outcomes are incredibly poor compared to countries that spend far less than we do.
2. Any changes will lead to the rationing of healthcare! Health care delivery is already rationed in this country. The only question is the basis on which we choose to determine the allocation. (Remember the Oregon lottery?)
3. It costs too much! We can’t afford it! We are already paying for it, just with no transparency and little control. Can we afford not to address these problems?

Daschle’s comprehensive list of recommendations included these building blocks:

1. Eliminate adverse selection- This requires a universal system
2. Include the universe of care- acute, preventative, long term, mental, dental
3. Move from a sickness system to a wellness system
4. Transparency- When an airliner crashes we investigate the cause, publish the results, and work to avoid similar occurences. Our medical system “kills” a 747 worth of people every day and a half.
5. Standardization of care- Give providers immunity from malpractice if they are following established care guidelines.
6. HIT- The VA has reduced their costs 50% over the last 10 years with IT. Clearly we’re preaching to the choir on this one.
7. Pool all the healthcare spending resources of the state and federal governments.
8. Eliminate unnecessary care.
9. Payment reform- based on episodic payments rather than procedural payments.
10. Make better use of providers- including nurses, nurse practitioners, pharmacists, etc.

And the most distinct observation and recommendation was that a political entity- like, say, the US Congress- cannot deal with the special interests and micromanage the complexity of this or any future version of a healthcare system.

Instead, he proposes an independent federal board, modeled after the Federal Reserve and made up of governors pulled from the key constituencies, to make policies and administer programs.

For what it’s worth, at the reception after his talk, I found him to be non-pretentious, approachable, and able to listen and hold his own.

Talking to my wife about it later, I suggested that if Obama were to win, I’d like to see him make Daschle his secretary of HHS. I guess great minds think alike.