Critical: What We Can Do About the Health Care Crisis

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A much-needed and hard-hitting plan, from one of the great Democratic minds of our time, to reform America's broken health-care system.

Undoubtedly, the biggest domestic policy issue in the coming years will be America's health-care system. Millions of Americans go without medical care because they can't afford it, and many others are mired in debt because they can't pay their medical bills. It's hard to think of another public policy problem that has lingered unaddressed for so long. Why have we failed to solve a problem that is such a high priority for so many citizens?

Former Senate Majority Leader Tom Daschle believes the problem is rooted in the complexity of the health-care issue and the power of the interest groups--doctors, hospitals, insurers, drug companies, researchers, patient advocates--that have a direct stake in it. Rather than simply pointing out the major flaws and placing blame, Daschle offers key solutions and creates a blueprint for solving the crisis.

Daschle's solution lies in the Federal Reserve Board, which has overseen the equally complicated financial system with great success. A Fed-like health board 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. Daschle argues that this independent board would create a single standard of care and exert tremendous influence on every other provider and payer, even those in the private sector.

After decades of failed incremental measures, the American health-care system remains fundamentally broken and requires a comprehensive fix. With his bold and forward-looking plan, Daschle points us to the solution.

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Editorial Reviews

From Barnes & Noble
Everybody seems to agree that the American health care system is broken. Achieving a consensus on how to fix it, however, is not so easy. In this straightforward policy guide, former U.S. Senate majority leader Tom Daschle offers specific measures that can address the economic and political complexity of the health care issue as well as the power of the interest groups involved. Clear exposition, on the table for discussion.
Senator Barack Obama (IL)

The American health-care system is in crisis, and workable solutions have been blocked for years by deeply entrenched ideological divisions. Sen. Daschle brings fresh thinking to this problem, and his Federal Reserve for Health concept holds great promise for bridging this intellectual chasm and, at long last, giving this nation the health care it deserves.
Senate majority leader Senator Harry Reid (NV)

This book provides real solutions for America's broken health care system.
From the Publisher

“I may not agree with some of the political statements but Senator Daschle is right on target on the need to start a serious dialogue on health care for Americans. His thoughtful health-care proposals will move the process forward. Senator Daschle and I agree on the need for nonpartisanship in coming to grips with this number one domestic problem.” —Bob Dole, former Senate majority leader

“The American health-care system is in crisis, and workable solutions have been blocked for years by deeply entrenched ideological divisions. Sen. Daschle brings fresh thinking to this problem, and his Federal Reserve for Health concept holds great promise for bridging this intellectual chasm and, at long last, giving this nation the health care it deserves.” —Senator Barack Obama (IL)

“This book provides real solutions for America’s broken health care system.” —Senator Harry Reid (NV), Senate majority leader

Critical provides answers to one of the most vexing challenges of our time.” —John Podesta, president and CEO of the Center for American Progress and a former White House chief of staff

“It is a must-read.” —Jerome H. Grossman M.D., senior fellow and director of the Health Care Delivery Project at Harvard University’s Kennedy School of Government

“Senator Daschle adds to his reputation as a clear thinker and leader. Critical shows us not only why we must solve our health care crisis but that—with political will—we can.” —Judy Feder, professor and dean at Georgetown Public Policy Institute

Publishers Weekly

The U.S. is "the only industrialized nation that does not guarantee necessary health care to all of its citizens," and as former senator Daschle observes, "Skeptics say we can't afford to cover everyone; the truth is that we can't afford not to" because U.S. economic competitiveness is being impeded by the large uninsured population and fast-rising health costs. Daschle's book delineates the weaknesses of previous attempts at national health coverage, outlines the complex economic factors and medical issues affecting coverage and sets forth plans for change. Daschle proposes creating a Federal Health Board, similar to the Federal Reserve System, whose structure, functions and enforcement capability would be "largely insulated from the politics and passion of the moment," in addition to a merging of employers' plans, Medicaid and Medicare with an expanded FEHBP (Federal Employee Health Benefits Program) that would cover everyone. "There is no more important issue facing our country," Daschle asserts, "than reform of our health-care system," and the book's "health-care horror stories" bring this immediacy home. (Feb. 19)

Copyright 2007 Reed Business Information
Library Journal

Several recent books-e.g., Arnold Relman's A Second Opinionand Laurence Kotlikoff's The Healthcare Fix-have proposed various ways to reform America's ailing health-care system. This easy-to-read, straightforward book by former U.S. senator Daschle ranks as one of the best. With decades of experience on Capitol Hill, Daschle clearly knows the politics of health care-he crafted numerous pieces of health-care legislation and worked with President Clinton to develop a national health-care program. Here, Daschle describes the various problems of the present system, before going on to discuss the many failed attempts by different presidents to reform the system. He proposes the creation of a Federal Health Board, modeled loosely on the Federal Reserve System, which would develop standards of care and evaluate the efficacy and overall benefits of new drugs and medical technologies compared to those in current use. The board would also regulate all health-care organizations and providers receiving federal funds. Daschle believes such a board would make complex medical decisions and resist political pressure from special-interest groups. His proposal appears to be realistic and politically feasible. Highly recommended for all academic and public libraries.
—Ross Mullner

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Product Details

  • ISBN-13: 9780312561642
  • Publisher: St. Martin's Press
  • Publication date: 8/18/2009
  • Edition description: First Edition
  • Pages: 240
  • Product dimensions: 5.52 (w) x 8.26 (h) x 0.69 (d)

Meet the Author

Tom Daschle is a former U.S. Senator and Senate majority leader from South Dakota. He is currently a special policy advisor at the law firm Alston & Bird LLP, a visiting professor at the Georgetown Public Policy Institute, and a Distinguished Senior Fellow at the Center for American Progress.

Jeanne M. Lambrew is an associate professor at the Lyndon B. Johnson School of Public Affairs at the University of Texas. Dr. Lambrew is also a senior fellow at the Center for American Progress. Previously, she worked on health policy at the White House as the program associate director for health at the Office of Management and Budget (OMB) and as the senior health analyst at the National Economic Council.

Scott S. Greenberger, a former staff reporter at The Boston Globe, is a writer and consultant at Ricchetti, Inc., in Washington, D.C.

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Read an Excerpt


Before exploring my idea in detail, it’s worthwhile to review the current state of affairs. By almost any measure, the situation is grim. We like to boast that we have the highest standard of living in the world, and yet at the dawn of the twenty-first century, we are the only industrialized nation that does not guarantee necessary health care to all of its citizens. It is stunning and shameful. There are about 47 million Americans without health insurance, and researchers have estimated that about four-fifths of them are either employed or members of a family with an employed adult.1 An additional 16 million people are “underinsured,” or have coverage that would not protect them from catastrophic medical expenses.2 Simply put, an increasing number of Americans lack health insurance because they—and their employers—just can’t afford it.

Only 65 percent of people earning less than $10 an hour are offered health insurance at work. Furthermore, as health-care costs have exploded, many employers who offer coverage have reduced the portion of the premiums they cover. As a result, many working people can’t afford coverage even when it is made available to them. Other firms are eliminating coverage for prescription drugs, dental care, vision care, and care of dependents.3 And it isn’t just low-wage workers or the unemployed who are in danger: Statistics show that more middle-class people—families with annual incomes of $50,000 or more—are joining the ranks of the uninsured. Today, 18 million of the roughly 47 million people without insurance have family incomes that exceed $50,000.4

Vicki H. Readling, a fifty-year-old real estate agent and breast cancer survivor from Salisbury, North Carolina, knows this all too well. Real estate agents are independent contractors, so Readling doesn’t have medical coverage through an employer. She earned about $60,000 in 2006, a solidly middle-class salary in the Piedmont region of her state. But because of her medical history, the only policy Readling could find on the individual insurance market would have cost her more than $27,000 a year, far more than she could afford. She delays visits to the doctor and makes her $300-a-month cancer medication last longer by taking it only three or four times a week instead of every day. “I really try to stay away from the doctor because I am so scared of what everything will cost,” Readling said in an interview with The New York Times. “Why am I being punished? I just don’t understand how I could have fallen through this horrible, horrible crack.”5

More than 16 percent of our economy, or $2 trillion, is spent on health care. On a per person basis, Americans spent more than $6,100 on medical care in 2004, more than twice the industrial world’s average and about 50 percent more than the next most expensive country, Switzerland.6 This disparity is even more striking when one considers that in every other industrialized country, every citizen is covered. Between 2000 and 2007, U.S. health premiums have risen 98 percent, while wages have increased by only 23 percent. The average family health insurance policy now costs more than the earnings of a full-time, minimum-wage worker.7 No wonder medical bills are the leading cause of bankruptcy in the United States, accounting for about half of them. Incredibly, one fifth of working-age Americans—both insured and uninsured—have medical debt they are paying off over time. More than two-fifths of these people owe $2,000 or more.8

Representing South Dakota, where incomes are lower than in most other states, I encountered many families who were struggling to pay their medical bills. One woman who made an especially vivid impression on me was Donna S. Smith, one of the thousands of Americans who literally have been driven to bankruptcy by our health-care system. Smith isn’t a deadbeat or a slacker—far from it. During the early years of her marriage, she stayed at home to care for her six children while her husband Larry worked as a machinist. When their youngest child was two, Donna decided to go back to work.

At thirty-one, discouraged by a series of minimum-wage jobs, she enrolled in college courses while still working full-time as a bank teller. Eventually she earned a bachelor’s degree from Colorado College in Colorado Springs—graduating cum laude and Phi Beta Kappa. I met her when she was working as a journalist for one of our South Dakota newspapers.

Donna and Larry always had health insurance for themselves and their children—they even carried disability insurance—but that didn’t shield them from financial ruin once they encountered serious health problems. After Larry developed coronary artery disease in the early 1990s, he could no longer work as a machinist. Instead, he did light maintenance work, delivered pizza, and toiled as a cashier, earning far less than he had before.

The financial pressure mounted after Donna was diagnosed with uterine cancer in 1999. Just weeks after undergoing surgery, she returned to her job caring for disabled children in a group home because she desperately needed the income, and she feared that if she stayed away too long she’d lose the job and the health coverage that went with it. She wore an abdominal brace and a back belt to protect her incision site, but those precautions didn’t prevent her from developing an abdominal hernia, and she had to have surgery again in the summer of 2000.

Donna recovered, but the family’s premium payments, drug costs, and co-payments went through the roof. By 2003, their monthly medical expenses were more than $1,000, and Larry’s continuing health problems frequently forced him to miss work. The Smiths did what they could to stay afloat. They bought food and other household goods on credit, and borrowed money against their cars. When things got truly desperate, they visited a local food pantry and tapped family and friends for help.

They sold their house, but the sale netted them a paltry $8,000. In the spring of 2004, Larry lost his job at a casino because he could no longer do any heavy lifting. With bill collectors practically beating down their door, the Smiths declared bankruptcy. Two years later, the couple was forced to move in with their grown daughter and her family in Denver. “The life we worked so hard to build and the life we fought to save was lost. We had failed. The health-care system had crushed us,” Donna Smith told House members during a hearing held in July 2007. After telling her story, Smith chastised the lawmakers for failing to do something about our broken health-care system.

I am so angry with you. I lived the American dream as my father taught me and as his father taught him. I worked, I educated myself, I voted, I bought a home and then moved up into a better home, I raised my children responsibly and I served in my community—and you left me broken and battered because you failed to act on health-care reform. Just as I have come out of the shadows of economic ruin and shame, so too will others come forward to hold you accountable. Remember the hardworking people who elected you. Their bankruptcy shame due to medical crisis really is your shame.9

I have heard similar stories from other people in South Dakota and across the country. Donna’s testimony was notable for its eloquence, but her story is far from uncommon.

Americans with solid, employer-based insurance may believe they are secure, but in our health-care system everyone is just a pink slip, a divorce, or a major illness away from financial disaster. A 2005 study on the link between medical costs and bankruptcy found that “even brief lapses in insurance coverage may be ruinous and should not be viewed as benign,” and that even people with insurance can be forced into bankruptcy by high medical bills, because “many health insurance policies prove to be too skimpy in the face of serious illness.” Medical debt affects health, families’ economic security, and even their jobs. The same study recounted a story that illustrates this:

For instance, one debtor underwent lung surgery and suffered a heart attack. Both hospitalizations were covered by his employer-based insurance, but he was unable to return to his physically demanding job. He found new employment but was denied coverage because of his preexisting conditions, which required costly ongoing care. Similarly, a teacher who suffered a heart attack was unable to return to work for many months, and hence her coverage lapsed. A hospital wrote off her $20,000 debt, but she was nonetheless bankrupted by doctors’ bills and the cost of medications.10

Copyright © 2008 by Tom Daschle. All rights reserved.

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Table of Contents

Acknowledgments     vii
Introduction     xi
The Crisis     1
The History of Health Reform     43
What Went Wrong and Models for Making It Right     105
The Federal Health Board     139
Prospects for Health Reform     181
Conclusion     203
Notes     207
Index     219
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Sort by: Showing all of 17 Customer Reviews
  • Posted December 21, 2008

    Federal Reserve Created the current Meltdown by Loose Money Supply

    Federal Reserve has done great before Sen.Dashcle wrote this book.But it is apparent NOW that Federal Reserve created too much money and FED the HOUSING BUBBLE.Greenspan has admitted his mistake and CNN listed him among top 10 culprits.<BR/> Are we going to create another Bubble some day--by Creating another Federal Reserve of HEALTH?<BR/> We had a good system--Doctor-Patient handling their affairs--like Dentists.Then came the middlemen--Insurance co./HMO's--they became rich--while doctors/patients got squeezed.Finally Tort Lawyers joined the party and the result is Unnecessary Tests/Scans/Procedures--to help the CookBook doctors.<BR/> Doctors are unhappy,Patients are unhappy with their premiums--some one is definitely happy.CEO's making millions.<BR/> Why not adopt Health Insurance available to Senators/congresspersons?True way to CREATE A BUBBLE.<BR/> Solution: Limit Malpractice compensation<BR/> Give option to patients to pay like they do to a dentist.They can bargain with doctors and pay direct.Save on admin.costs.<BR/> Let insurance take care of Hospital bills.

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  • Posted December 7, 2008

    National Healthcare Reform

    Tom Daschle goes into great lenghts in explaining a new and refreshing idea on how to fix the healthcare industry. Even if we dont create a National Health Care Plan, We need to establish a new set of guide lines for the Insurance Companies, Doctors, Employers when it comes to funding the Healthcare System. What Tom Daschle does, is goes into great lenghs in explaining what and how the Health Board would do and how it should regulate the industry. maybe this cant fix the problem, but it cant get any worse. <BR/><BR/>What Tom Daschle is saying is to open up the Government supported Insurance Plans to the american people and make it affordable for the American People who cannot get Insurance, but yet want to purchase insurance. You will still have the people with no jobs with no insurance, but that is what the Free Clinics are for which wont change under this plan. What Daschle's plan does is strengthen the Privatized Health Plans and make them more competative.<BR/><BR/>I highly recommend anyone interested in Obama's Health Plan to read this book if you want to learn more about what Obama wants to do. Obama definately supports Daschles plan, and it shows by naming him his Secretary of Health and Human Servics.<BR/><BR/>MZ<BR/>Sioux Falls, SD

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  • Anonymous

    Posted February 10, 2009

    Entertaining read, not a lot of substance

    Critical does a nice job describing the issues and giving a historical perspective of how we've gotten where we are today with double digit inflation. However, if you're looking for detailed answers on fixing the problem they aren't in here. He spends 80% of the book describing the problem and 20% giving a high level overview of the solution. Why? is a complicated issue that is extremely complicated and however you fix the healthcare system will cost major money. I found it ironic that Daschle pointed blame to the drug companies, high cost of technology and lack of electronincally managed health data (all rightfully so), but never mentioned the cost of frivolous lawsuits that lead to defensive medicine. Of course he wouldn't do anything to upset all of his liberal attorney friends in congress. He also fails to hold Americans accountable for our lifestyle decisions which account for well over half the cost of medical attention in our country...another welfare point of view. Anyhow, overall a well written book but not a lot of substance or sustainable solutions.

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  • Posted February 10, 2009

    It would have been helpful to learn more about the Federal Medical Board.

    How will we pay for health care for all? Is not answered in this book. The synergy afforded by one payer, whatever form, will only account for 4.2 % of the 550 Billion needed to insure the 45 Million uninsured and 16 Million under insured.

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  • Posted January 23, 2009

    How will health reform be shaped within the coming years?

    In Daschle¿s book we get a review of the past failed efforts at health reform, incremental efforts of past moves from fee-for-service care to managed care and a historical framework of understanding for where we are today. An excellent book for someone interested in healthcare policy and the larger perspective of the US healthcare system. He presents in an easy to understand and intellectually thought stimulating presentation the urgency of non-action with our current situation. One receives a glimpse into how our secretary of health and services thinks of the issues and his bold new idea for a Federal Health Board, an idea modeled after that of the Federal Reserve Board; however, with the responsibilities to promote competition, curb administration costs, and stand in the best interests of the consumer. A good read, but one which may provoke discussion amongst healthcare practicing professionals. I give him credit for his creative solution. As Americans, we shout in disatisfaction of our increasing costs and decrease in quality care. Daschle is not a doctor, nor does he claim he can diagnose what is most clinically efficacious for individual patient¿s treatments, he is simply offering a bold new suggestion. Proper alignment of incentives to increase primary care physicians in the work force for preventive care, improvement for a healthy competition within the market, and effectively shaping healthcare system¿s infrastucture are `Critical¿ to ensure the health of our nation.<BR/>TiffanyW.Kuo, MPH

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