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First and Ten



Commentary on Health Care Opinion Leaders' Views on Health Reform, Implementation, and Post-Reform Priorities by former Senate Majority Leader Tom Daschle 


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At long last, it is now official policy that all Americans have access to health care, regardless of circumstances. In doing so, we have put this country on a path to controlling costs and improving the quality of health care.

Congratulations to President Barack Obama and his team for their extraordinary leadership and persistence in achieving something that his predecessors did not. In addition, House Speaker Nancy Pelosi, Senate Majority Leader Harry Reid, and the courageous members of the House and Senate who supported this bill demonstrated remarkable leadership while withstanding immense political pressure

However, after 15 months of historic legislative effort that included countless meetings, innumerable congressional hearings, many difficult votes, and thousands of speeches, this is only the beginning. If this were a football field, we would only be first and 10 on the 30 yard line with 70 yards to go. This landmark legislation now gives us the opportunity to move the ball toward the goal line of universal access, reduced cost through meaningful payment reform, and dramatically improved health quality and outcomes.

After the incredibly arduous and unprecedented lift of legislating, the challenging and time-consuming task of implementation must now commence. It includes substantial reform of our insurance market, embryonic efforts to reform the way we pay for health care, and initial policy investments to improve health care delivery. It is critically important to apply these new policy tools to address our current circumstances and to give priority to the problems we must solve.

As a result of the close cooperation and coordination among leaders in Congress with key officials in the White House and Department of Health and Human Services, this challenge is well understood. They know we must use the full authority of this legislation to aggressively begin comprehensive and expeditious implementation.

My hope is that the administration and Congress will work closely with all health care stakeholders to maximize the positive impact of health reform and minimize disruption. As they do, they must make a concerted effort to use their newfound legislative authority to ensure the following five enacted goals are given high priority:

First, following the economic stimulus legislation last year, this is the second critical legislative achievement in this Congress that advances the implementation of health information technology (HIT). In many ways, HIT represents the very heart of transformational health practices. Currently, we have the benefits of a 21st century operating room but are saddled with a 19th century administrative system. Only by moving into the 21st century both administratively and medically can the rest of reform be accomplished.

Second, the new law calls for far greater transparency in our health care market. Health care is the most opaque of all sectors in our economy. It is virtually the only sector where at the time of purchase we do not know who will pay or what it will cost. Sadly, we have more statistical information on every sports figure in America than we do on providers, institutions, or local health care markets. Beginning now, if implemented aggressively, providing pricing, performance, and consumer health information can be the new reality.

Third, the new law provides tools to eliminate unnecessary medical care at all levels. Much of the unnecessary and duplicative care in our health care system results from fee-for-service reimbursement policies. We must cease rewarding the volume of care and instead provide incentives for value. In addition, we must remove incentives from the practice of proprietary medicine and market-driven care. We also need a health care delivery environment that addresses defensive medicine by allowing providers to be advocates, rather than adversaries, when medical mistakes are made while also adopting innovative ways to compensate patients. This legislation puts us on a path to do that. Finally, once greater transparency is achieved, far more work needs to be done to eradicate pervasive fraud and abuse in both the public and private sectors of our health care marketplace.

Fourth, health care is like a pyramid. Preventive care and wellness promotion occupy the base. As one ascends, health care becomes more sophisticated and technological with heart transplants and magnetic resonance imaging (MRI) at the top. While most other countries starts at the base and works up until resources run out, we start at the top and work down until resources run out.

By reallocating resources through the elimination of unnecessary care, the law provides an opportunity to cover our health care pyramid from top to bottom. It would be nearly impossible to invert it and relinquish our worldwide leadership in research and technology. But by addressing the priorities above, we should have ample resources to cover all our health care needs from top to bottom. Wellness, however, cannot simply be the responsibility of our health care marketplace. It is also an individual and community responsibility. We must also strive to make good nutrition cool.

Fifth and finally, this country must encourage best practices. We must destroy the myth that we have the best health care system in the world. Americans deserve better outcomes. Readmission rates must come down. Infection rates are unacceptable. The number of injuries and deaths from medical mistakes are an embarrassment to this country. Coordinated care for chronic illness, evidence-based medicine (beginning with universal utilization of simple checklists), and comparative research and best practices work. Look no further than some of our finest health institutions for proof. The new law helps the rest of health care in America to follow suit.

First and 10 on the 30-yard line is an unprecedented and historic achievement. It will take leadership, teamwork, and an emphasis on the aforementioned priorities—along with a lot of luck and great effort—to reach the goal line. But, at long last, we are now on the field.

Publication Details



T. Daschle, First and Ten, Modern Healthcare and The Commonwealth Fund, April 2010.