What does the appointment of Tom Daschle as HHS Secretary mean to us and health care? Well, first recognize that Daschle sits on the board of Mayo Clinic, and has participated in the development of their principles for reform, which are very similar to ACC’s Blue Ribbon Panel (BRP) recommendations, with the addition of his proposing a national health board that might function similarly to the Federal Reserve Board. One might suggest that the Federal Reserve has stumbled a bit of late? But, I believe there is merit to having an intermediary between health care delivery and Congress for oversight of benefits, quality oversight and standards, health IT standards, privacy policy, payment systems, comparative effectiveness, and so on. His (and Mayo’s) basic idea is to create an institution to oversee Medicare and government programs, run by experts, that answers to the government but is “largely insulated from the politics and passions of the moment,” Daschle writes in his book, Critical: What We Can Do About the Health Care Crisis. Of course, some of the leaders of Congress (think Pete Stark) will still want to oversee these things themselves, and will worry that such a board would be as politically charged as Congress could reasonably be accused of being.

Daschle also believes that Medicare should pay more for care that leads to good outcomes, and should stop paying for unnecessary or harmful treatments. He will be an advocate of quality measurement like we promote with the National Cardiovascular Data Registry (NCDR); and as you may recall, I presented our Quality First concept to him 6 months ago at the Bipartisan Policy Center, which he has been co-chairing. Like Obama, he says Americans who want to keep their employer-based insurance should be allowed to do so, but people should also be able to buy insurance from the pool that covers federal employees (FEHBP), or from a new pool based on a similar model in order to expand choice and portability and promote affordable premiums.

He also argues that all Americans should be required to buy health insurance (or face tax consequences) — a key difference from Obama, who argues that only children should be required to have health insurance. (Plenty of powerful Dems, Ted Kennedy, Max Baucus and Hillary Clinton, have also called for mandates).

He stops short of saying the U.S. should have a U.K.-style, hard-and-fast rule on cost-effectiveness (as in NICE—their Nat’l Institute for Comparative Effectiveness). But he does say the U.S. “won’t be able to make a significant dent in health-care spending without getting into the nitty-gritty of which treatments are the most clinically valuable and cost effective.”

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