Embarrassingly, I avoided learning about the politics of the mid-East for a long, long time. Too complex and insoluble. Then 9/11 and, well… I picked up “The Mid-East for Dummies” at Barnes and Noble. “It’s a start,” I told myself, and not a bad one as it turns out.
As a supposedly responsible political actor, I’ve found myself similarly ignorant and avoidant when it comes to the droning debate on health care. And, God knows, listening to the candidates for President is no help. For all the noise in the channel about health care this election season, I’ll be damned if I can find the signal.
To my aid now comes Tom Daschle and his co-authors, whose “Critical: What Can We Do About the Health Care Crisis” could have just as well been sub-titled “U.S. Health Care Policy for Dummies.” Unlike the “Dummies” books, this one is prescriptive. Senator Daschle et al basically argue that the U.S. Congress is in over its head on health care and that–as it did on monetary policy with the creation of the Federal Reserve in 1913–it should outsource much of its decision making on the immensely complex topic to a Presidentially appointed panel of experts. This is an interesting proposition, coming as it does from the former Senate Majority leader who hails from a state with deep populist roots. But while the case he makes is too much of an outline to be compelling, neither is it easily dismissed.
Daschle calmly traces how health care reform has crashed repeatedly upon the same special interest shoals. The shape of the barely submerged obstacle may change (doctors, unions, insurance companies), but its sheer, hulking mass only increaseth. Congress, he argues, has neither the collective knowledge nor institutional will to make good and far-sighted decisions on behalf of its constituents.
The book is worthwhile if for nothing other than its mid-section, wich recounts the history of attempted reform, especially since Truman. The Clinton/Magaziner effort of the early 90s gets special attention, as it should. Daschle–ever the statesman–manages to scoff at how silly was the C-M approach to health care reform, while not laying a glove on the former first lady. In fact, his account is practically tantamount to hagiography compared to the version delivered by Carl Bernstein in his biography of Mrs. Clinton.
Again, this is a very helpful book for the lay reader (e.g., yours truly). But its brevity and accessibility require that many good questions are left open. Is the obsession over absolutely universal coverage necessary? If the fault of the Clinton plan was primarily that it was too detailed, what details could have been eliminated with eviscerating its substance? If Congress can’t handle health care, what else is it not up to? Energy policy? The more delicate pieces of foreign policy oversight?
And finally, the elephant which has taken up tenancy in Daschle’s rather modestly sized room: “gee, isn’t all this good health pretty pricey?” By book’s end, I found myself with the mental image of one dial spinning clockwise, tallying the cost of the incremental (and undoubtedly worthwhile) programs Daschle proposes. Another opposing dial spun the opposite direction, counting the result of the cost savings the book proposes. You can guess which one spun faster.
Three things become especially clear in reading “Critical.” The first is that tackling the challenge of universal health care coverage will requre monuumental Presidential leadership, and an almost reckless risk of political capital which no event other than a fresh election will generate. Clinton promised a proposal in the first 100 days of his presidency. And while that turned out to be a hyperbolic mistake of ambition, it nonetheless reminds us that in order for health care reform to succeed, it likely must be a new President’s top priority.
Second, although Daschle’s proposal of a National Health Board is not new, its timing may be apt. Health care has bubbled to the top of the list of main street issues, and Congress has perhaps never in the modern era been less trusted to cleave the Gordian knot.
And finally, you can bet that if the nation chooses Barack Obama as its 44th President, this is not the last we’ve heard from Tom Daschle on health care.
Probably not the worst thing.