Anyone who doubted whether Barack Obama would keep health care reform front and center on his legislative agenda due to his understandable preoccupation with our broader economic crisis was likely proven wrong today, as the president-elect introduced the former Senate majority leader, Tom Daschle, not only as his secretary of health and human services, but also as director of a new White House Office of Health Reform, where he will be the lead architect in crafting ways to expand coverage and control costs.

Details remain sketchy, especially about how Mr. Obama will finance an expansion of health care coverage for those 45-to-50 million now uninsured. In response to a reporter's question, he emphasized the need to cut costs first–for example, by allowing Medicare to negotiate with drug companies for better prescription prices, as well as eliminating subsidies for Medicare HMOs, and bringing the paper-intensive medical industry into the computer age.

But when Mr. Daschle spoke, there were far more controversial issues raised.

As reported in The New York Times, “Mr. Daschle wants to establish a Federal Health Board–an independent entity like the Federal Reserve,” which would “make coverage decisions for federal health programs.” He said the board would reduce or deny payment for new drugs and procedures that arent as effective as current ones. (For the full Times article, click here.)

That's political land mine number one, as the powerful makers of drugs and medical devices battle to protect their turf. You also have to wonder about the negative impact this might have on medical care innovation, if manufacturers decide it's not worth spending hundreds of millions of dollars to develop new drugs or devices if a federal board will decide it's not worth paying for.

Political land mine number two is the question of whether Uncle Sam should launch a federal health insurance plan to compete with private carriers. Backers say private insurers will hold down premiums if faced with such non-profit competition, but the Times noted that critics contend “a government plan would have unfair advantages and could drive private insurers from the market.” Might that be the long-term intent of the Obama administration?

Political land mind number three is Mr. Daschle's stated intent to break the myth that this is the best health care system in the world,” instead describing it as islands of excellence in a sea of mediocrity,” with care determined by how much money you have, and your eligibility for coverage determined by your prior medical history, leaving many out in the cold.

When people complain about the Canadian system, this is the focus of their critique–that critical procedures are either denied or delayed, while in the U.S. people (at least the insured) get quicker and more comprehensive care. Even Michael Moore, in his “Sicko” documentary, conceded that we might all have to wait longer for care if everyone is insured, since one way to ration care is simply to exclude a huge segment of the population–not exactly fair, especially if it's your life or health on the line.

Political land mine number four, of course, is expected opposition from the powerful health insurance lobby. Mr. Daschle made it clear he is under no illusions about what he is up against, expecting an all-out war to defeat reform by the healthcare industry, including insurers.

Mr. Daschle blasted insurers specifically in the Times article for underwriting strategies that exclude or charge the highest rates to people who need the coverage the most–citing those with preexisting conditions.

Of course, the Times article concluded, “insurers recently offered to accept all applicants, regardless of any pre-existing medical conditions–if the government required everyone to have coverage.”

Will the Obama administration call the industry's bluff and do just that?

Fasten your seat belts, folks, because it's going to be a bumpy ride after Jan. 20, 2009!

Special Reports /

Health Care Reform Back On The Front Burner

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