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Why Tom Daschle’s “answer” was the wrong answer.

Posted Feb 10 2009 11:04am

Now that Tom Daschle is not going to be Secretary of HHS, I can write something that would have been…impolitic for someone like me who wants to help heal healthcare rather than just write about what the problems.

Tom Daschle had precisely the wrong answer.

When Daschle’s name was put forward, I carefully read his book (pictured above). It is another example of how well intentioned people can go far astray when trying to solve healthcare.

Daschle’s answer is his FHB (Federal Health Board) “fashioned after the Federal Reserve Board.” The FHB would have the “knowledge to make complicated medical decisions and the independence to resist political pressures.” It would “emulate some of the regulatory functions of the Securities Exchange Commission.”

Translation of the above: let’s create a new powerful governmental agency with undefined but sweeping powers. That will “cure” healthcare. His answer was a central control agency. No diagnosis. No plan. No simplification, but a further expansion of an already insupportable bureaucracy.

If you do not know what is wrong with a patient, how can you cure him or her? You need a diagnosis before effective treatment. Also, the patient must understand and agree with the diagnosis or the patient will not cooperate with the treatment plan.

Without a consensus on the causes of the symptoms of healthcare dysfunction – millions without insurance; personnel shortages; error rate; out-of-control costs – how can anyone or any agency cure anything?

Daschle’s FHB would be staffed by “highly independent experts.” We all know how successful these self-styled experts have been in healing healthcare so far. Speaking of experts, think about the Nobel laureate “experts” whose brilliant, complex econometric models helped create the financial meltdown we are now all experiencing.

Possibly the most frightening part of Mr. Daschle’s answer was this seemingly innocuous statement, “we should build on what we have.” He thinks that to fix our healthcare system, we should modify it. With respect (and I mean that), WRONG! When the bottom was torn out of the Titanic, they had to transfer to a ship that wasn’t going down. Bailing water or trying to plug the hole wasn’t going to save them. Healthcare is heading toward the bottom. We need to abandon ship.

The problem IS the current system. To fix the “problem,” we need to create a new system.

A functional and sustainable new system will answer these Five Questions and sing the Chant. (C/B stands for cost/benefit analysis.)
1.    Are they reconnecting me with my money?
2.    Do they measure what we want?

3.    Are the incentives right (or are they perverse)?
4.    Will our care get better and better (and better)?

5.    Are they thinking in lines or in loops?
Chant: Show Me the C/B! Show Me the C/B!


Healthcare is (as Daschle wrote) “Critical,” but his answer – central control – is no answer. First establish a consensus causal diagnosis. Then treat causes not symptoms. Hopefully, the new Secretary of HHS will understand.

System MD

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