Former Senate leaders join forces on health system reform

Washington -- There is no shortage of national health reform plans this year, but only one will come from four former Senate majority leaders.

Tennessee Republican Howard Baker, South Dakota Democrat Tom Daschle, Kansas Republican Bob Dole and Maine Democrat George Mitchell joined in 2007 to form the Bipartisan Policy Center. It is designed to forge consensus policy plans on five issues: national security, energy, agriculture, transportation and health care.

The first stage of the health project consists of four public forums -- one conducted by each former senator. They will use their findings to create a reform proposal they all agree upon and then advocate for it in Congress and at the White House. Daschle held his forum on April 24 in Washington, D.C. The others will hold their events in their home states in coming months. Daschle said he expects the center to offer a health reform proposal by the end of this year.

"Our hope is to solicit the views of as broad of an array of participants as we can make contact with," said Daschle, who along with Dole was interviewed by AMNews. Dole agreed that the recommendations will be driven by input from outside the policy center. "What we're not talking about is having a staff put together something and we sign off on it."

Still, day-to-day project guidance will be provided by Chris Jennings, a senior health care policy adviser to President Clinton, and Mark B. McClellan, MD, PhD, a senior health care policy adviser to President George W. Bush. Dr. McClellan also was Centers for Medicare & Medicaid Services administrator and Food and Drug Administration commissioner.

Four tenets will guide the effort:

• Preserving and improving quality and value.
• Increasing availability and accessibility of affordable coverage options in a reformed insurance market.
• Promoting the individual's role in health care coverage and cost.
• Securing a workable financing mechanism for the nation's health care system.

Ready for reform?

The proliferation of news outlets on cable TV and the Internet have allowed partisanship to flourish, Daschle said. But comprehensive health care reform could be easier for Congress to adopt today than in the early 1990s when President Clinton's effort failed, he added, because problems in our system have worsened.

For example, per-person spending was $3,300 in 1993 but eclipsed $7,000 in 2006, CMS said. Also, about 47 million people lack insurance today, an increase of 7 million since 1993, according to Census Bureau estimates.

"My view is that people who may be totally against any change have come around to the view that something is going to happen, and we better get ready," Daschle said.

Although there's more partisan rhetoric from lawmakers today than in the past, Dole said he doesn't think Congress itself is more partisan.

New members are less shy about speaking their minds than in 1960 when he was first elected. "It just wasn't appropriate to have some whippersnapper like Bob Dole from Kansas in his first term in Congress say anything," he said.

Partisanship doesn't extend into the policy center's leadership, Dole and Daschle said. "We start with a good chemistry and a good working relationship, and we hope we can build on that," Daschle explained.

Dole said he can discuss anything with the others. "That's why we have a chance [to succeed]. ... There are no bomb throwers in this group."

Still, the former lawmakers will have to forge agreement from very different perspectives.

Daschle views the U.S. health system as facing three major interrelated problems: affordability, quality and access. But the country also needs to come to terms with myths about our health system, he said.

"We don't have anywhere near the best health care system in the world, and we should acknowledge that. We have islands of excellence, but those islands are in a sea of mediocrity," Daschle said. "But I also think we've got 21st-century operating rooms and 19th-century administrative rooms. We've got serious problems with regard to transparency."

Access, cost issues

Dole doesn't share this critical view but agrees that access and cost are major issues.

"Overall, we have a good system. How do you make a good system better and make it more available to the little kid down the block who's 5 years old and has never seen a doctor?"

Dole prefers reforms that limit government responsibility for health care. Daschle, meanwhile, authored a book, Critical: What We Can Do About the Health Care Crisis, that calls for a national board to oversee the U.S. health system the way the Federal Reserve board regulates the financial sector.

But Dole isn't worried that Daschle is closed to all other options. "Tom's got some ideas, but he's not going to try to sell us that book."

Dole said he doesn't have a preconceived plan for the project. "If you ask me today which way we're going, I would have no idea. We don't want to have any ideas at this point. We're trying to gather information."

He acknowledged that it's possible both presidential candidates, who have their own health reform plans, could ignore the policy center's recommendations. "What if they say, 'This is my plan, and why should we change?' I don't have a good answer. ... We may fall on our face."

But it's also possible the senators' recommendations will bridge the gap between the McCain and Obama plans, Dole said.