Since Barack Obama’s election as the 44th President there are early signs of what direction the new administration and Congress will pursue in reforming the American health care system. The early signs come from the people that Team Obama has tapped for leadership posts and actions in Congress that will push the new administration toward health care reform.

There are two major developments on the personnel level in transition to the Obama Administration. First, the rumored appointment of former Sen. Tom Daschle as Secretary of Health and Human Services signals both the high visibility of health care in the new administration and the recognition that any reform will require a skilled political negotiator.  Daschle’s experience as the Senate’s Democratic Leader and his new book on health care reform, “Critical: What Can We Do About the Health-Care Crisis” provide a rare combination of political and policy acumen.

Should he be confirmed, Daschle is likely to pursue a philosophy he outlined in his book. A major recommendation of the book is the creation of a health care board, similar in structure and function to the Federal Reserve Board, which would offer a public framework within which a private health-care system can operate more effectively and efficiently – insulated from political pressure yet accountable to elected officials and the American people. Other recommendations include:

  • Establish an autonomous oversight body for health care.
  • Invest in information technology. Negotiate drug pricing.
  • Promote disease prevention and wellness.
  • Use data to identify best practices that would unify clinical practice throughout the country and have a significant impact on quality and cost. Promote transparency in the health care debate.
  • Provide some degree of protection for physicians from medical malpractice and allow them more practice flexibility.
  • Improve patient-provider interactions through the use of technology.
  • Promote universal health coverage.

Second, and perhaps more significant substantively, is the appointment of John Podesta as co chair of the transition team. Podesta is the head of the Center for American Progress (CAP), which has produced most of the policy briefing papers that President-elect Obama and his staff are using as guides to forming the new administration. In health care, CAP documents call for both short term and long term changes.

Short term recommendations are aimed at addressing the economic and racial inequalities that exist in America’s health care system. The first short term step is passage of the 2007 Children’s Health and Medicare Protection Act (CHAMP), which expanded children’s access to health insurance and provided for greater emphasis on primary and preventive services in Medicaid and Medicare. Another step is reauthorization of the Workforce Investment Act. This act should include employment, retention and training services for health care workers, especially allied health professionals, long term care workers and nurses. Investment in the National Health Service Corps should also be increased and target to underserved areas.

Long term recommendations from CAP documents are aimed at reducing complexity in the current system. For example, eligibility standards, payment policies and benefits for Medicare, Medicaid, and The Veteran’s Administration health programs are set by law and administrative rules, which makes them inconsistent inflexible and unable to adopt current best practices for access, quality and value purchasing. Building a framework that can simplify and outline key operating parameters for all federal health programs will provide long term change in American’s health care.

Recent actions in the House of Representatives and the Senate make it clear that congress intends to push the Obama administration on health care reform. Sen. Ted Kennedy’s publicized return to work is a signal of his desire to produce health reform legislation quickly. Senate Finance Committee Chair Max Baucus has also drafted a proposal for national health care that follows many of the elements in the Obama Campaign documents. The Baucus proposal goes beyond the Obama health plan by mandating health insurance coverage. Both of these senators want to produce legislation when Congress reconvenes in January.

In the House of Representatives, the decision to make Henry Waxman chair of the Energy and Commerce Committee (where health care legislation will be considered) is a sign of increase power for the Democratic party’s liberal wing, which has made health care reform a high priority.  Chairman Waxman can be expected to push very hard for significant health care reform. The increased Democratic majority in both the Senate and the House of Representatives makes health care reform more likely.

If you have questions or comments on this article please contact Dr. James Chesney, Primary Care Resource Center and Health Policy consultant, by email at  Jchesney@policyinitiativesconsultinggroup.com.