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Health Care Leadership: Knowledgeable and Pragmatic

Author: William J. Sonnenstuhl

When we look at the history of healthcare in the US, it is obvious that the failure has been one of leadership.  Not necessarily leadership at the top, but leadership at the second level.  The Clinton administration’s failure of healthcare was not a failure of vision, but one of execution.  The same could be said of the Nixon administration, and every one since.  By appointing Tom Daschle, Obama is sending a message that his concern is with execution.  He wants people in place who can deal with the daily practical reality of what needs to be done in order to move an agenda.  He wants people in place who can put ideas on the table and sustain momentum.  Daschle, while sharing many ideas with the president-elect, has the nuts-and-bolts skills of getting people on his side and moving the agenda along.

President-elect Obama’s nominations are a welcome return to the era of expertise in Washington, and Senator Tom Daschle’s nomination as Secretary of Health and Human Services is a noteworthy example. Senator Daschle will bring to his role formidable expertise. As a former Speaker of the House, he knows how to move legislation through Congress. He has also written one of the most thoughtful books on health care reform in the United States to come off the presses this year and been an advisor to Obama on health reform during the presidential campaign.

Senator Daschle knows this and understands that getting coverage for all Americans is the most pressing issue in health reform and the key to improving Americans’ health. While Americans overwhelming support universal health care, coalitions of medical practitioners, insurance and pharmaceutical companies, employers, and unions have blocked it from becoming a reality since it was first proposed almost 100 years ago. Senator Daschle knows how such coalitions work their magic upon Congress and is well suited to lead Obama’s efforts to create support for his health care agenda

Obama and Daschle both understand some horrible truths about US health care. The US does not have the best health care system in the world. The WHO ranks the US 37th out of 190 countries in health care. More damning still, a recent study of 19 industrial countries ranked the US dead last in amenable mortality – death from treatable conditions. Obama and Daschle also understand that the US has such a terrible record on health care because we have turned health care over to the market. By contrast, other industrial countries have either turned health care over to the government (e.g., United Kingdom and Canada) or rely on a combination of government and market forces (e.g., Switzerland, France, Germany, and Italy). WHO ranks the health care systems of France and Italy as numbers 1 and 2, respectively. Obama’s plan and Daschle’s reform proposals both draw inspiration from the mixed market – government systems. Obama’s plan has been severely criticized by Republicans for not giving markets an even freer hand and by Progressives for not creating a single-payer, government-sponsored system based on Medicare. It is a pragmatic plan. It is not revolutionary and builds on the success of other nations while recognizing that the government already pays for the majority of health care in the US. Obama thus needs a pragmatist in charge, not a revolutionary.  Daschle is exactly that.

Obama speaks about giving every American a plan as good as his or her Congressman and Senator. But for that plan to become a reality, he needs someone at Health and Human Services who can make it happen. That means someone who understands how Congress works, is likewise committed to his vision of universal health care, and can create a winning coalition for his health care agenda. In short, Obama needs Daschle’s expertise to get his agenda enacted in Congress. The appointment of Daschle sends a strong signal that Obama understands that leaders need a staff that shares their vision, and most importantly are capable at executing and delivering.



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