By choosing former Senate Majority Leader Tom Daschle to head his healthcare reform effort, President-elect Barack Obama got more than an old congressional hand with a policy book on his resume.
Obama has also picked up a hardheaded political strategy for his push to overhaul the nation’s healthcare system.
Guided by lessons from President Clinton’s healthcare debacle 15 years ago, Daschle has put a premium on cooperation between the White House, Congress and major healthcare interest groups, many of whom agree that major action on healthcare is vital.
Daschle, who will lead both the Department of Health and Human Services and a new White House Office of Health Reform, favors moving decisively to seize political momentum and, if necessary, cut off opposition, something he said Clinton failed to do in 1993.
He thinks delays by the Clinton administration and soft support from the left in the early 1990s allowed Republicans and industry groups such as insurers to kill the Clinton plan with a well-organized political campaign that made voters afraid of reform.
Daschle is urging a far more aggressive push by those advocating systemic change.
“This means going on the offensive,” he wrote in “Critical,” his recent book about healthcare, in which he singled out drug makers and insurers as potential obstacles to a successful overhaul.
“We cannot assume that the public recognizes the distortions and fallacies peddled by the reform opponents; we have to educate people on the emptiness of the anti-reform rhetoric,” he said.
Daschle has even suggested using the Senate’s rules to prevent opponents from filibustering healthcare legislation, a move that one senior Republican staff member warned would make it “extremely difficult” to get any GOP support for major reform.
Daschle, who declined to be interviewed, has specific -- and potentially controversial -- ideas about how to reshape the healthcare system.
Among other things, he envisions a new federal agency, which he calls a Federal Health Board, with the authority to set guidelines for what treatments and procedures are most cost-effective.
Daschle argues that the board, which would have authority over federally funded healthcare programs such as Medicare, would insulate medical decisions from political meddling by Congress and could help design a system for achieving universal coverage.
He also has called for a mandate to require all Americans to get health insurance and for the creation of a public insurance program to cover people who don’t get private insurance.
But more importantly, Daschle has provided a virtual road map for the kind of campaign the Obama White House and its allies will probably pursue in their effort to avoid the pitfalls that doomed Clinton’s effort.
“Most of the compelling lessons from 1993 and 1994 are political lessons,” said John McDonough, a senior health advisor to Sen. Edward M. Kennedy (D-Mass.) who helped develop Massachusetts’ groundbreaking overhaul and is drafting healthcare legislation that Kennedy plans to introduce next year.
Obama absorbed one of those lessons during the presidential campaign, carefully emphasizing that any reform effort would allow voters to keep their health coverage if they were satisfied with it.
Many in Washington, including Daschle, think Clinton made a crucial error by allowing his opponents to portray his plan as a threat to the healthcare Americans had.
The insurance industry famously exploited that perception with its “Harry and Louise” ads, featuring a couple fretting that the federal government would take away their ability to choose coverage.
Since election day, Daschle has been working hard to avoid another misstep he and others think helped sink Clinton.
In 1993, the White House wrote a massive healthcare bill after then-First Lady Hillary Rodham Clinton led a months-long task force that was widely perceived as shutting out key players in the debate, including congressional leaders.
“Relying so heavily on the task force certainly contributed to the eventual defeat of the president’s plan,” Daschle wrote in his book, noting that the process “only bred resentment among the people who weren’t invited to participate, and produced a ‘compromise’ without the input of key stakeholders.”
Today, Daschle talks frequently with interest groups and senior lawmakers, who in turn have taken pains to reciprocate with supportive comments about the new administration’s early moves.
“There clearly is an openness to listen,” American Medical Assn. President Nancy Nielsen said Friday. “Fifteen years ago, physicians felt excluded.”
On Capitol Hill, Kennedy and Senate Finance Committee Chairman Max Baucus (D-Mont.) have received the new administration’s explicit blessing to develop healthcare legislation.
And Baucus, who had a rocky relationship with Daschle when the two were in the Senate together, recently praised the South Dakota Democrat for recognizing the need for congressional involvement.
For his part, Obama has signaled his intent to tackle healthcare reform soon after he takes office -- another difference from 1993, when Clinton waited nearly a year before his healthcare legislation was introduced in Congress.
By then, the administration had expended significant political capital balancing the federal budget and trying to pass the controversial North American Free Trade Agreement, a move that alienated many Democrats and liberal interest groups.
On Thursday, Obama said he wanted swift action. “It’s hard to overstate the urgency of this work,” he said.
Taking another page from Daschle’s political playbook, the president-elect carefully framed a healthcare overhaul as an economic necessity and a moral imperative.
“Day after day,” he said, “we witness the disgrace of parents unable to take a sick child to the doctor, seniors unable to afford their medicines, people who wind up in emergency rooms because they have nowhere else to turn.”