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"?
Well, they may feel that way about taxes, they may feel that way about other citizen responsibilities. But people ask me all the time whether healthcare is a right. And my answer is that it's a moral right. It's not a legal one. But if it is a moral right, I also think there is a fundamental personal responsibility that comes with that right. Just like there is a responsibility for citizenship in so many other ways—the responsibility to vote; the responsibility to pay your taxes; if you have a car, the responsibility to have car insurance. We've mandated car insurance if you drive a car. No one's challenged that. So it seems to me that there are certain requirements for personal responsibility that come with American citizenship. And this is one of them.
You talk about that in your book, not just the responsibility to purchase healthcare insurance but the responsibility to be more involved in the decisions, to be more skeptical of new procedures. You feel that that's something that's really important to making sure that this initiative works.
Absolutely. We have to become better consumers. And we have to become better advocates for our own well-being. We can't just wait until we get sick to be concerned about health. We have to be concerned about health in a very pro-active way, putting greater emphasis on prevention, greater emphasis on wellness, greater emphasis on our own physical well-being.
As someone who was both majority leader and minority leader of the Senate, what is your feeling on the filibuster?
I think it's grossly overused. We were averaging one filibuster a year all through the 20th century, until the 1960s. In the 1960s, we went to three a year, and then in the 1990s we went to about 10 a year. And now we're averaging two filibusters a week in the Senate in 2010. There's just been an explosion of use of the filibuster, and it has created a dysfunctionality that is very troubling to me. I think, at the very least, we should test going back to the old process of round-the-clock, 24/7 requirements, physically, to be on the floor when these filibusters occur. And not dual and triple, and run multiple tracks of legislation, that is commonly done today. That is, stay focused on one thing, as long as it takes, to get the bill done. That's harder to do, but I think it's something that we ought to take a hard look at.
How regretful are you that the issues that came up during confirmation, the financial and tax issues, prevented you from being more involved in the healthcare process?
Well, you have to deal with life's setbacks philosophically, and understand that sometimes things occur that are major disappointments. I've had two major disappointments in the last five years—my re-election effort in 2004, and then this. But I have an adage that I live by, that the windshield is much bigger than the rearview mirror. So I prefer not to look through the rearview mirror and keep looking forward. The good fortune that I've had to work with my former colleagues and the White House in an informal capacity gave me tremendous opportunities to stay involved—and writing this book, and speaking as I have around the country. I was just in Chicago yesterday, and today I'm in Missouri speaking about health, and so I'm very fortunate to have that opportunity, to continue to be involved, even though it's not a role that I had originally anticipated.
- Read more about healthcare reform.
- See which members of Congress get the most from health professionals.
- Check out our editorial cartoons on healthcare.