Former Senate Majority Leader Tom Daschle (D-SD)’s new book Getting It Done: How Obama and Congress Finally Broke the Stalemate To Make Way for Health Care Reform comes out next week, but this morning he spoke to me about some of the concessions the administration made to pass reform and the shortcomings in the Affordable Care Act.
In his book, Daschle reveals that after the Senate Finance Committee and the White House convinced hospitals to to accept $155 billion in payment reductions over ten years on July 8, the hospitals and Democrats operated under two “working assumptions.” “One was that the Senate would aim for health coverage of at least 94 percent of Americans,” Daschle writes. “The other was that it would contain no public health plan,” which would have reimbursed hospitals at a lower rate than private insurers.
I asked Daschle if the White House had taken the option off the table in July 2009 and if all future efforts to resuscitate the provision were destined to fail:
DASCHLE: I don’t think it was taken off the table completely. It was taken off the table as a result of the understanding that people had with the hospital association, with the insurance (AHIP), and others. I mean I think that part of the whole effort was based on a premise. That premise was, you had to have the stakeholders in the room and at the table. Lessons learned in past efforts is that without the stakeholders’ active support rather than active opposition, it’s almost impossible to get this job done. They wanted to keep those stakeholders in the room and this was the price some thought they had to pay. Now, it’s debatable about whether all of these assertions and promises are accurate, but that was the calculation. I think there is probably a good deal of truth to it. You look at past efforts and the doctors and the hospitals, and the insurance companies all opposed health care reform. This time, in various degrees of enthusiasm, they supported it. And if I had to point out some of the key differences between then and now, it would be the most important examples of the difference.
Despite being “taken off the table” as a result of the “understanding,” the White House continued to publicly deny claims that it was backing away from the provision even as it tried to focus on other aspects of the bill. “Nothing has changed,” said Linda Douglass, then communications director for the White House Office of Health Reform in August of 2009 and many times thereafter. “The president has always said that what is essential is that health insurance reform must lower costs, ensure that there are affordable options for all Americans and it must increase choice and competition in the health insurance market. He believes the public option is the best way to achieve those goals.”
Daschle also said that he was disappointed that the law did not include greater specificity about ways to control health care spending and reform the delivery system. “I’m concerned that we are going to do potentially not achieve all that we might have achieved had we been more specific,” he said. “We lay out a very clear 10-year schedule, with great specificity about how insurance reform is going to work…[but] we don’t do that nearly as much with cost-containment and with delivery reforms.” “I think we could have put into the legislation specific targets and actions that would be required have to do with unnecessary care, in terms of primary care, transparency and even a more ambitious and delineated schedule for HIT, moving away from fee-for-service.”
Asked about the future of health reform, Daschle said he was “reasonably confident” that the government would prevail in the state legal challenges to the individual mandate, although admitted that “given the unpredictability of the Supreme Court as well as other appeals courts, it’s not as much of a closed case as I think as it should be.” He also expressed concern that newly elected Republican governors would refuse to implement the law, but said he had “two sources of general confidence building” about the GOP promise to defund the law, should they regain control of the House.
“A lot of what we did in health care reform has more of an entitlement than a discretionary funding base. So as an entitlement, they would really have to change the law rather than simply not fund in order for it to be effected. The entitlement sections of the legislation are going to be fairly immune from defunding,” Daschle predicted. He also added that approval will likely increase as different benefits become available.
Daschle’s book, published by St. Martin’s Press, comes out next Tuesday, October 12th. To read more of my interview with Daschle, including his response to whether or not Obama advocated for progressive ideas, click here. Whether Congress over-learned the lessons of Bill Clinton’s failure and relied too heavily on Congress to write the health care bill:
DASCHLE: I think so, it would have been better if we moved more quickly. Although, I have to say, this legislation [moved] more quickly than Social Security or Medicare and so it’s almost surprising in that regard.
On the absence of malpractice reform:
DASCHLE: I’m actually not surprised, I’m disappointed that we’ve failed to go further on some of these issues. I think the President is a realist, he’s a pragmatist, he needed to ensure that we could bring a bill, maybe not with everything he/we wanted across the line. I think he felt it would be hard to hold Democratic caucuses together moving a bill that went further. Ultimately, I’m confident that it’s going to happen….it was probably a bridge too far in this legislative effort.
During the transition, Daschle hosted a series of videos asking Americans to submit their own solutions and stories to the health care crisis. I asked him why the administration abandoned its grassroots outreach efforts as reform progressed:
DASCHLE: I don’t think it stopped….I don’t know if we were successful as many would have hoped in sustaining a visibility level and engaging people as much as we did initially…But your point is well taken. Visibility dropped off and in part it’s because we were overwhelmed by the degree of grassroots opposition on the other side.
On President Obama not strongly advocating on behalf of progressive priorities like the public option. Could Obama have done more to fight for these ideas?
DASCHLE: I think so. I think that there were times when we let the ball drop some. But I think the President from the very beginning wanted to take as much of a realistic approach as possible….At the end of the day, he got what he wanted the first comprehensive piece of health legislation ever to be passed, and under very very difficult circumstances….So it’s hard to argue with his logic even though many of us wish we could have seen more.
Sen. Daschle sent over this statement clarifying his remarks:
“In describing some of the challenges to passage of the public option in the health reform bill, I did not mean to suggest in any way that the President was not committed to it. The President fought for the public option just as he did for affordable health care for all Americans. The public option was dropped only when it was no longer viable in Congress, not as a result of any deal cut by the White House. While I was disappointed that the public option was not included in the final legislation, the Affordable Care Act remains a tremendous achievement for the President and the nation.”