President-elect Barack Obama tapped former Senate Majority Leader Tom Daschle for his Health and Human Services Secretary today, and Daschle is reported to have accepted. If his appointment is confirmed, Daschle will be at the center of the healthcare reform that Obama has vowed to pursue. Daschle has his own ideas about how to change the system, as he outlined in a Zócalo lecture in March. Below is a summary of and a link to a recording of his talk.

Former Senate Majority Leader Tom Daschle, accustomed to being introduced as a model politician and a model South Dakotan, appreciated the absence of the word “model” from his introduction at a Zócalo lecture at the Los Angeles Central Library. “My wife Linda showed me the word ‘model’ as defined in the dictionary,” he said, “and it’s defined as a small replica of the real thing.”

Thus Daschle eased into an engaging, informative and at times dismaying discussion of a pressing domestic policy issue: how to reform the American healthcare system. Following in the footsteps of Al Gore’s environmental work, Daschle put together a book and a road show (though he treated the Zócalo crowd to a unique speech). “I fully expect the nomination for an Oscar and a Nobel,” Daschle joked.

The last time we tried . . .

Daschle had a ringside seat for the last major attempt at national healthcare reform, during President Clinton’s first term, and he highlighted the lessons Americans should learn. This time, leaders need to build a more effective coalition and keep an eye on the big picture rather than becoming “engrossed in the weeds of policy.” The 1,300 page bill proffered than “should have been 13 pages,” he said.

Since then, Daschle noted, the country has tried to address healthcare at four levels, sometimes succeeding and sometimes failing. At the legislative level, congress managed to pass a children’s health insurance program and a prescription drug program for Medicare (though it was, in Daschle’s words, “almost a disaster”). At the state level, Massachusetts managed a broad healthcare reform (which Daschle praised despite its troubles since passing). California failed to do the same. At the executive level, all the presidential candidates addressed healthcare, particularly Hillary Clinton and Barack Obama. And at the private sector level, businesses and organizations are testing new models and pushing for change.

Cost, access, quality

But the country’s circumstances have changed dramatically in the same time frame, Daschle noted. Healthcare costs in the U.S. have risen 100% in the last six years, to about $7,500 per capita each year. That per-capita figure is set to double by 2015. And, as audience members noted in Q&A, high costs means high profits for some in the healthcare system, who have a greater incentive to treat sickness than to pursue wellness.

Cost isn’t the only problem. Daschle noted that 47 million people lack health insurance, and one in three who do have it can’t get the care they need. Emergency rooms are far from able to fill the gap: about 500,000 ambulances are turned away each year. And, in states like Daschle’s South Dakota, doctors are often hundreds of miles away.

The final and most unexpected problem is a lack of quality. As Daschle put it, “A 747 crashes in our healthcare system every two and a half days.” That is, an equivalent number of people die because of medical mistakes every few days. The U.S. ranks about 35th in quality, Daschle said, despite being first by far in dollars spent.

And some things haven’t changed since the 1990s. Our healthcare system remains complex and opaque, Daschle said, and a series of deeply-held myths about healthcare continue to confound reform.

Healthcare myth-busting

“We have islands of excellence in a sea of mediocrity,” Daschle said, addressing head on the first healthcare myth he sought to undermine: that the U.S. has the best healthcare system in the world, which attracts the wealthy worldwide. But Americans travel for care too, often because they can’t pay for the same procedure at home. Nearly 200,000 American “medical tourists” spent $2 billion last year, and that figure is expected to rise exponentially.

Those who would allow that the system may need reform still cling to a couple of assumptions, Daschle noted: that a solution would require rationing, and that we can’t afford a solution anyway. Daschle insisted that the status quo is far more costly than any reform, and that our healthcare system is already 45% public, and operates without cost effectiveness, like “two financial systems working side by side with no interrelationship.” Daschle also noted already ration our healthcare. “We ration today on the worst possible criteria,” he said, “and that is one’s ability to pay or one’s health condition.” That is, if you can’t pay, you don’t get care. And sometimes, if you’re sick, you don’t get care.

A federal reserve for healthcare

How do you change a system so big and so flawed? By crisis, leadership, or both, Daschle said, citing the world wars as inciting factors, along with the leadership of Franklin Roosevelt and later, Lyndon Johnson, who passed Medicare in 1965. This time around, it will be a combination of both, Daschle predicted before offering his recommendations for a better system. The priority of any reform, he said, must be to cover all Americans, and to unite all types of care, physical and mental. Then, the reform should also improve the practice of medicine by focusing on wellness rather than sickness, establishing a set of best practices that would protect patients and doctors, increase nurses’ responsibilities; pool resources and equipment; modernize administrative technology (right now, Daschle said, medical administration offices are “lucky to have a push-button phone”); and make healthcare more transparent. Finally, Daschle suggested we follow the example of the Veterans Administration and negotiate drug prices.

The ideal way to implement these changes is what Daschle called a “federal health board,” possessed of the same decision-making authority as the Federal Reserve. He suggested the audience pursue a thought experiment: imagine that Congress was in charge of setting interest rates, and had to make the tough and unpopular decision of when to raise them. “I can guarantee you, from 26 years of experience, it would never happen,” Daschle said. But, “that’s what we’re being asked to do with healthcare today.”

Listen to the lecture here (stick with it for a few seconds and you’ll hear the talk starting).
See more photos here.

*Photos by Aaron Salcido.