With Tom Daschle slated to become the next HHS Secretary, there has been a mad rush to get a copy of his book, Critical: What We Can Do About the Health Care Crisis, which apparently no one had previously read. Since booksellers can't possibly meet the demand, here is my brief attempt to satisfy your curiosity.

The main ideas: Medicaid expansion, Federal Employee Health Benefits Program (FEHBP) for everyone who wants to enroll, Medicare for the nonelderly as a FEHBP option, a play-or-pay mandate for individuals, income-based, refundable tax credit subsidies (both at work and away from work), a play-or-pay mandate for employers, electronic medical records, a national health board ("to establish a single standard of care for  every other provider and payer"…covering every disease from cancer to diabetes  and even depression), preventive care, dental health, mental health, long-term care, home care, community health centers and combating obesity.

Not on the list: Health Savings Accounts, although Daschle was once an advocate, and even cosponsored HSA legislation.

Not on the list: Single-payer health insurance, but only because it is not politically practical.

Not on the list: Any way to pay for any of this. (The issue is not, can we afford reform?  The issue is, can we afford not to?) I'm not kidding.

Comments (24)

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  1. John Goodman says:

    There is a lively discussion about Sen. Daschle’s national health board at the National Journal health blog here:


    There are comments by yours truly, Stuart Butler and others.

  2. Joe S. says:

    The British health board (which rations care to British patients and denies them accesss to drugs routinely available to Americans and people on the European continent)is called the National Institute for Clinical Evidence, or NICE.

    How’s that for an oxymoronic name?

  3. Bruce says:

    Sounds like Daschle has never met a health reform idea he didn’t like (at least if it comes from the left). I think it’s good he doesn’t know how to pay for any of this. That means it’s less likely to happen.

  4. Greg Scandlen says:

    Thanks, John.

    The timing of Mr. Daschle’s Health Fed idea could hardly be worse. I doubt many Americans will embrace leaving all health care decisions to a panel of “experts” after the hash the experts made of the credit markets. The Washington and Wall Street Elites just ain’t making it anymore. As William Buckley once said, I would rather be governed by the first two hundred names in the phone book than by any number of experts.

  5. Dave Racer says:

    I read it as part of my literature review for my Masters’ thesis.

    Given the dismal results of the Federal Reserve Board, I wonder how Daschle’s idea of a Federal Health Board will fly?

  6. Mike Korbey says:

    Thanks John, for keeping us all informed.

  7. Jim Johnston says:

    All of his ideas are very good and would help to provide universal health care. BUT ! there is NO way it could be paid for. The biggest problem with Health Care is the Federal Government and the mandated costs that are required. HIPPA etc. The FDA is way out of date and must be fixed. There are health care procedures being used in other countries that are being overlooked that would greatly reduce costs. FDA should be actively explored.

  8. June says:

    Tedious. Bromide. Unorignial. Banal. Boring. These are only a few of the thoughts that come to mind on reading this book

  9. Wright Lassiter says:

    I was in Baltimore this past summer and attended a book signing and he gave a nice concise talk about its contents and some of his views.

  10. Shannon Cagnina says:

    Wow, John. This is extremely helpful. Thank you so much for adding me to your list. I look forward to hearing your voice on healthcare in the upcoming year.

  11. Matt says:

    If the cost of healthcare wasnt an issue then the majority of us would not be talking about national healthcare. The first step in reducing cost thus offering healthcare to self employed, small business owners and the sick with no coverage is to have the hospitals compete like every other business competes…PRICE, QUALITY and SERVICE. Hospitals hide behind their managed care contracts and are the first to say that the insurance companies and Medicare are underpaying them. The hospitals in the four major markets in TX had a net profit of $2.5 billion last year alone. These are both for profit and not for profit (go figure) and includes hospitals that made and lost money.

  12. Gary says:

    It’s the end of the world as we know it,
    It’s the end of the world as we know it,
    And I feel…uh, er and, I hope I don’t get sick…

  13. Catherine Daniell says:

    The New York Times editorial board also weighs in with a review on Daschle’s book, and some pointed questions.

  14. John Leppard says:

    Ever since Sen. Daschle’s book first appeared on the shelves I was concerned this idea would be considered as serious policy. Almost six months ago I wrote a piece on it over at Healthcare Manumission (www.healthcaremanumission.com) which can be found here.

  15. Natalie says:

    John Goodman wrote this about Tom Daschle’s plan, “Medicaid expansion, Federal Employee Health Benefits Program (FEHBP) for everyone who wants to enroll”

    But this is a GOOD program. Do you think he is serious about this? Obama has mentioned it but very quickly before moving on to another point, twice in candidate forums, so I couldn’t take him seriously.


  16. Natalie says:

    John Goodman writes, “a national health board (‘to establish a single standard of care for every other provider and payer’…covering every disease from cancer to diabetes”

    What will the national health board do? Will it impede creativity? Advances are made by researchers who move beyond the barriers that might be erected by a national health board. And is such a board needed?


  17. John Leppard says:

    Just a little extra tidbit of information:

    “Nothing in this title shall be construed to authorize any Federal officer or employee to exercise any supervision or control over the practice of medicine or the manner in which medical services are provided, or over the selection, tenure, or compensation of any officer or employee of any institution, agency, or person providing health services; or to exercise any supervision or control over the administration or operation of any such institution, agency, or person.”
    – Social Security Act, Sec. 1801, Title XVIII

  18. Chris Ewin, MD says:

    A national health board????

    Am I going to have to take yet more exams to maintain my board certification like I do with the American Board of Family Practice’s Maintenance of Certification Program for Family Physicians?

    Over 35 years ago, when the idea of FP as a specialty evolved, FP’s were ready and willing to adopt the highest ethical and clinical standards. Now, FP’s are burdeoned and badgered.

    This will not boost moral.

  19. Don Simborg says:

    As one of those who rushed to order Tom Daschle’s book, I appreciate your summary and agree with your comments. I want to expand particularly on electronic health records (EHRs) which seems to be a part of everyone’s solution. The CBO report of last May pretty well deflated the biased predictions of massive savings from EHRs published by RAND and CITL. Peter Orszag who oversaw the CBO report will now head OMB. As one of the pioneers of EHRs and long-time advocate of them, I agree with Peter Orszag that EHRs are a tool and not a solution. It is how we use that tool that matters and until we require that EHRs build in fraud management protections and provide incentives to physicians to use the decision support capabilities of EHRs, they will increase costs, not decrease them.

    (Originally posted on World Congress World Health Care Blog)

  20. rsgrady says:

    I would be curious to know where the ideas of “health” and “responsibility” fall within Tom Daschle’s book and within the new administration’s thinking on healthcare. I am also interested in what, if any, healthcare “quick wins” have been identified and how those can be leveraged to build momentum for solving these issues. I am also curious as to Mr. Daschle’s positions on HDHPs/HSAs a year after writing his book given employer adoption of them this enrollment season along with evidence that people with them are indeed becoming more engaged with their own health and healthcare.

    (Originally posted on World Congress World Health Care Blog)

  21. Chris Ewin, MD says:

    John Leppard’s piece…
    True leaders stay out of the way of people who know what they are doing. In health care, it’s the physician.

  22. Diane Vlassis says:

    Daschle is not a good candidate for Health and Human Services Secretary, and I question whether his background has been thoroughly investigated.

    In 1994 and 1995 the Senator and his wife, who was second in command of the FAA, came under scrutiny for their possible role in protecting B& L Aviation of Rapid City, South Dakota (B&L) from sanctions due to safety violations found by the U.S. Forest Service. In February 24, 1994, 3 Indian Health Service physicians were killed when their chartered B&L plane crashed in Minot, N.D. The pilot was cited for gross negligence. Please refer to the New York Times’s article published on October 16, 1994 and subsequent articles. The issues regarding this crash were also presented on 60 Minutes in February 1995.

    Prior to the 1994 crash, The U.S. Forest Service had found numerous life-threatening safety violations (mechanical and pilot) of B&L Aviation over a period of approximately ten years and wanted B&L to be eliminated from flying federal charter flights. One Forest Service inspector even went so far as to report that he would not allow his family members to fly with B&L due to what he had found! Daschle, rather than initiating further investigation, attempted to protect his good friend, Merl Bellew, the owner of B& L Aviation, who greatly profited from the federal government contracts. Daschle chalked up the concerns of the U.S. Forest Service to its “dictatorial” attitude toward Merl Bellew. Daschle shielded B&L from any repercussions following the Forest Service inspections at the expense of the public.

    Senator Daschle is the very last person, who should be the leader of health reform, as he has demonstrated a reckless disregard for the safety of his constituents, and a failure to recognize that the delivery of health services to remote areas, at a minimum requires safe travel for the providers.

  23. Dennis Cotter says:

    The creation of a Federal Health Board sounds somewhat reminiscent of DHHS’ National Center for Health Care Technology (1979-82) whose charge was to assess the value of established and new technologies. Although its tenure was short-lived, one should learn from the reasons for its demise.

  24. Betty Schleimer says:

    I do not approve of the health care plan as it is now. I think that any plan suggested should first be tried by congress. Now you have your own individual insurance coverage by insurance companies for the rest of your life, paid for by people like me. I think that is the type of coverage we should all and not some government plan, also paid for by people like me, that won’t even cover me. The country is in debt and shouldn’t take on more!!!!!