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Daschle gives his take on healthcare reform legislation

on May 13, 2011

Former U.S. Senator Tom Daschle was an ardent supporter of healthcare reform during his tenure in Congress and he came to the SAS Health Care & Life Sciences Executive Conference on Thursday to address the topic.

But Daschle, who has since spent his time away from elected office as an adviser and speaker on policy issues, kicked off his keynote with a personal anecdote. Daschle said that as he went through the metal detector sans shoes and metal at an airport recently, he caught the eye of a fellow traveler who felt the urge to strike up a conversation.

Passenger: Anybody ever tell you that you look like Tom Daschle?

Daschle: Yeah, I’ve heard that.

Passenger: Doesn’t that make you mad?

The story drew a laugh from roughly 800 who attended the conference that was held on the campus of Cary, North Carolina software company SAS Institute. But the anecdote also illustrates that not everyone is a fan of the policies and positions advocated by the former Democratic Senate majority leader.

Although the federal Affordable Care Act passed last year, the debate is far from settled. By one count, the law is the subject of at least 31 lawsuits. This week, the 4th U.S. Circuit of Appeals in Virginia became the first appellate court to hear arguments on the constitutionality of the federal law. While that panel of judges is perceived as supportive of the law, most agree the matter is headed for the U.S. Supreme Court. Meanwhile, competing state legislative proposals abound that would alter, defund or even block the federal law. Some states are refusing to create the health insurance exchanges called for by the law. Others trying to do so can’t agree on what those exchanges should look like. Daschle acknowledged the challenges. Yet he said they can be overcome and change must happen. Daschle said that when he was born in 1947, healthcare spending was 4 percent of gross domestic product. He said that if he has great-grandchildren, by then healthcare spending is projected to be 32 percent of GDP. “That is not sustainable,” he said.

Daschle took a few minutes away from the conference to talk one-on-one with MedCity News. An edited Q&A follows:

Q: We’re on the campus of SAS, one of the largest software companies in the world. What are your thoughts on technology and the role of technology in healthcare reform?

A: There’s little doubt that with the advent of [health IT] and the extraordinary opportunities it presents, it will continue to drive meaningful transformation of healthcare quality, delivery and access as we go forward. Unfortunately, today the healthcare marketplace is still too paper reliant. We have a long way to go. I like to say [we have a] 21st century operating room and 19th century administrator. We have to bring that administrative room to the 21st century.

Q: Technology costs money. Healthcare gets more expensive as we find new ways to do things. How does the expense of technology play into the effort to contain costs?

A: I don’t think technology costs money. I think the over-utilization of technology costs money. It can save money as a guide to treatment as well as administrative costs. In the VA for example, technology has brought administrative costs down well over 30 percent, some might argue 50 percent. It can continue to reduce medical errors. If we had greater reliance on technology, I’m absolutely confident the error rate, the medical mistake rate would go down.

Q: I want to ask about the federal health reform that passed last year. You spent more than a quarter of a century in Congress. What was it like watching reform pass from the outside?

A: I’m very gratified and I’m especially pleased that after all of these efforts, seven notable efforts to pass health reform, that we have done so. Even though health reform has passed, there are a lot of obstacles. Even if you remove most of the obstacles, we’re still only on the 30-yard line with 70 yards to go with regard to achieving the potential of meaningful transformational change of healthcare delivery. This puts us on the field, it puts us in position, but we still have a lot of work to do.

Q: If we’re still on the 30-yard line, what are those obstacles?

A: The first are the legal obstacles. We just saw the 4th Circuit appeal of the constitutionality, primarily of the individual mandate, this week. The second would be the policy and the legislative approaches that are being offered largely by opponents: repeal, defunding, amending, dealing with some of the funding mechanisms of Medicare. All of those issues revolve largely around the question of “What is the appropriate role of government in healthcare delivery?” We have created a compromise with about 50 percent public, 50 percent private. The question is should it be more or less of one or the other.

The third level is probably the most complex: the administrative and regulatory level — insurance reform, also the exchanges. The second part of that will be payment reform, moving off of fee-for-service, disincenting volume and putting greater emphasis on value. Coming up with a new paradigm for the way we finance healthcare in this country.

The final [obstacle] is all the activity happening in the states, the creation of the exchanges, the new marketplaces, how healthcare will be accessed. There’s going to be tremendous change in the architecture of healthcare.

Q: There are challenges at the state level. Georgia, for example, passed a healthcare compact law that would allow the state to create its own health policy. How big of an obstacle are these state challenges to getting the law implemented?

A: The drafters of the legislation, they anticipated opposition and reluctance and inaction in some instances. Where that inaction takes place, they gave the Secretary [of Health and Human Services] the authority to come in and on behalf of the people of a particular state, set up an exchange or take the action if the state government refuses to implement. That doesn’t mean there won’t be a lot of litigious circumstances where many of these things continue to be challenged in court. As they’re challenged, obviously there may be delay, there will be uncertainty. I think that uncertainty is something that business is going to be concerned about. Business likes greater clarity. That lack of certainty is a problem for a lot of people in the healthcare field. They don’t know what will the Congress do? How will the judicial and regulatory and administrative factors all play themselves out? What will the states do? That uncertainty I think is why you find interest in conferences like this to better understand what can we expect and where will all this take us.

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