Tom Daschle: Biggest Healthcare Challenges Are Cost, Quality

Obama adviser discusses the healthcare reform law.

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Like many other longtime Democratic senators, South Dakota's Tom Daschle dreamed of one day being involved in legislation that finally put into place a system of universal healthcare in the United States. But after a close election in 2004 cost the minority leader his Senate seat—and personal income tax issues derailed his nomination to be President Obama's health and human services secretary—he wasn't officially involved in passage of the Affordable Care Act. But as he recounts in his new book Getting It Done, as a friend and informal adviser to Obama, Daschle had a close view of the legislative wrangling and the emotional, partisan debates that ultimately lead to enactment of perhaps the most substantial legislation in a generation and what could become the most important law Congress has ever passed on healthcare. Daschle spoke recently with U.S. News about his role in the bill's passage and how he hopes the country will progress on the healthcare issue. Excerpts:

Many of the interests in the debate, such as insurance companies and the pharmaceutical industry, started reaching out to Barack Obama even before he was elected, regarding what the final bill would be. Why?

I think they did it for two reasons. One, they felt that we had to address the challenges we face in health—cost, access, and quality—and we couldn't avoid this problem any longer. And that if they began developing lines of communication and cooperation early on, it would enhance their leverage as we worked through these very difficult problems, and I think that's exactly what happened.

From Obama's point of view, did it improve the final product to work with the industry so early?

Well, I think that all along, the president understood that it was important to try to be pragmatic. And he certainly is a student of history, and remembers quite clearly that through seven efforts in the past, it was the stakeholders almost more than anyone else who were responsible for defeating healthcare. So bringing the stakeholders to the table, and making sure that they were engaged and invested, was I think one of the critical reasons why healthcare was successful this time.

When you look at what was finally passed, and all of the legislative maneuvering that it took, what would you say is its strongest point, and its weakest point?

I think the strongest point, by far, is the infrastructure that has now been created, or, I should say, the infrastructure that will be created over the course of the next several years. To provide far greater access, through insurance, to healthcare for the vast majority of the American people. Providing both access as well as new confidence in their financial security, as they address their health problems and challenges. That's the strength. I would say that the big concern I have is whether or not the other two challenges we face in healthcare, cost and quality, will be adequately addressed. I think we're off to a strong start in those categories as well.

This law has moving parts, to be enacted at different times. And who knows what the political climate is going to be in four years or in 10 years? Are you worried that a different administration or a different Congress might not implement this in the way that its authors are hoping it will be?

That is a concern. I think that it's harder for opponents of health reform to do so as the years unfold, because with each year, additional infrastructure is built, and additional cost support for many of the provisions in this law will continue to grow. But I think that it is a very significant concern as we start out. And I think that in the early years, especially, whether it's legal challenges as we've seen now with two court cases, or legislative challenges that could come if Republicans are to take control, [these] are concerns that are going to continue to have to be part of the landscape.

What do you say to someone who says, "Look, this is a free country. The government has no business telling me that I have to buy or purchase anything"?