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Daschle's Initial Health-Care Reform Philosophy: Listen

HealthDay News -- There's little doubt where former Sen. Tom Daschle, Barack Obama's choice for Health and Human Services Secretary, is going to concentrate his energies after he's confirmed by the U.S. Senate: His second title -- director of the White House Office of Health Reform -- points to his highest priority.

After being introduced by Obama as Health and Human Services Secretary-designate Dec. 11, Daschle emphasized his desire to bring affordable health care to all Americans. "I accept this role in fixing the largest domestic policy challenge," Daschle said, "and not just to implement the change, but also to help create it."

A week earlier, in his first public speech as the transition team's lead health adviser, the South Dakota Democrat announced plans to hold community meetings across the country to mobilize support for a health reform plan that addresses access, cost and quality. In addition, the campaign recently launched a web site created to foster public debate on health reform. He repeated that promise Dec. 11, saying that two-way communication between the public and the health reform office would be highlighted well into January, 2009.

Such efforts speak to the would-be cabinet secretary's leadership style and that of the president-elect.

"They both appear to reach out to different viewpoints and take a lot of factors into consideration before reaching their own conclusions and judgments," said lobbyist Martha Kendrick, a partner at the Washington, D.C.-based law firm Patton Boggs LLC.

Having served 26 years in the House and Senate, including 10 years as Democratic leader in the Senate, Daschle has significant legislative and leadership experience -- a plus for the task of getting health reform passed.

"His style was thoughtful, provocative, a real whip, so it wasn't just about the policy; it wasn't just about the votes. He was a good mixture of the two," said Peggy Tighe, a partner in Washington, D.C., office of Strategic Health Care, a health lobbying firm.

He also has a record as a "passionate leader on initiatives related to medically underserved areas and rural health needs," having represented a largely rural state with a significant Native American population, Kendrick observed.

"I think it's clear that he is a serious player" and his presumed appointment "reflects the seriousness with which President-elect Obama views health reform," offered David Merritt, project director at the Washington, D.C.-based Center for Health Transformation, a project founded by former House Speaker Newt Gingrich.

In recent years, Daschle has remained an active thought leader on health care. His book, "Critical: What We Can Do About the Health-Care Crisis," lays out a strategy for reform that envisions the creation of a Federal Reserve-like "Health Board" to oversee public health programs.

On the whole, Daschle's priorities align with those of his boss. One is to build upon the current public-private health system to expand access to care.

By virtue of timing, many observers expect the Obama administration to begin by expanding coverage to children and perhaps low-income adults. The State Children's Health Insurance Program comes up for reauthorization in March 2009.

Plus, with Medicare physician fees facing a 21 percent cut in 2010, pressure to fix the flawed formula is mounting. The ensuing debate presents "a ripe opportunity" for dealing with quality-of-care issues, Merritt said.

In exchange for enhanced payments, there may be a push for the use of "comparative effectiveness" information, for example, or the adoption of information technology. "They'll avert the cut, but there will be many strings attached to averting those cuts," he explained.

Daschle has already signaled his interest in revamping reimbursement. "We've got to get away from payment based on volume to payment based on value," he told health advocates at a Denver forum.

To remedy the medical workforce shortage, he supports the adoption of policies that encourage primary care -- no matter who provides it. "We need physician's assistants, nurse practitioners, primary care doctors. We need them all," he said.

December 15, 2008
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