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Critical: What We Can Do About the Health-Care Crisis Hardcover – February 19, 2008

by Tom Daschle (Author), Jeanne M. Lambrew (Narrator), Scott S. Greenberger (Narrator)

4.0 61 ratings

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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.

Print length

240 pages
Language

English
Publisher

Thomas Dunne Books
Publication date

February 19, 2008
Dimensions

5.8 x 1.23 x 8.55 inches
ISBN-10

0312383010
ISBN-13

978-0312383015
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Editorial Reviews

From 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 © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved.

Review

ADVANCE PRAISE FOR CRITICAL
“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

About 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.

Excerpt. © Reprinted by permission. All rights reserved.

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.

Product details

Publisher ‏ : ‎ Thomas Dunne Books; 1st edition (February 19, 2008)
Language ‏ : ‎ English
Hardcover ‏ : ‎ 240 pages
ISBN-10 ‏ : ‎ 0312383010
ISBN-13 ‏ : ‎ 978-0312383015
Item Weight ‏ : ‎ 1 pounds
Dimensions ‏ : ‎ 5.8 x 1.23 x 8.55 inches

Best Sellers Rank: #3,093,479 in Books (See Top 100 in Books)
- #1,397 in Health Policy (Books)
- #2,300 in Government Social Policy
- #304,680 in Health, Fitness & Dieting (Books)

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4.0 61 ratings

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Scott S. Greenberger
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Scott Greenberger was a newspaper reporter for twelve years, first at the Austin American-Statesman and then at the Boston Globe. He's also written for the New York Times, the Washington Post, Politico, and GQ. Greenberger has a bachelor’s degree in history from Yale University and a master’s degree in international relations from George Washington University. He lives in Takoma Park, Maryland.
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Thomas Daschle
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Tom Daschle is a former U.S. Senator and Senate Majority Leader from South Dakota. He is currently a Senior Policy Advisor to the law firm of DLA Piper and a member of DLA Piper's Global Board. Daschle is a Distinguished Senior Fellow at the Center for American Progress, a co-founder of the Bipartisan Policy Center in Washington DC, and the author of Critical: What We Can Do About the Health-Care Crisis. He is married to Linda Hall Daschle and has three children and four grandchildren.
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Customers find the book excellent, concise, and fair. They also say it provides a good overview of the state of American healthcare and the issues that plague it. Readers mention the history of US healthcare is well-told, informing them how we arrived in the conundrum.

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"...It is, however, excellent reading for those who want to learn about the roots of our system, its many current problems, and at least one idea for..." Read more

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Customers find the story quality good. They mention it provides a good overview of the state of American healthcare and issues that plague it. Readers also appreciate the well-told history of US healthcare, informing them how we arrived in the conundrum.

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Winston Kotzan

Realistic about the problem, dystopian about the solution

Reviewed in the United States on May 15, 2009

Verified Purchase

With the Obama administration now bringing healthcare to the forefront of political agenda, Critical is a must-read for anyone wishing to understand the issues being debated on Capitol Hill. Senator Daschle tackles the long-lingering problems of our national healthcare system, beginning with the roots of insurance a little over a century ago. In part one, Daschle describes the evolution of healthcare in the United States and how over time growing complexity has overloaded the payment protocols and systems established decades ago. Importantly, he describes which initiatives have worked, and why certain plans such as the failed Clinton-era reforms of the 1990s led to political disaster.

Daschle does an excellent job pointing out the deficiencies in our current system, such as the misaligned incentives of an employer-based healthcare system. As is, employer-provided healthcare is a problem for the morbidly ill - the sick are unable to find work, which deprives them of the treatment necessary to return to health, leading to a vicious cycle. This is not only a financial burden on individuals, but a toll on the greater economy. Start-up companies with smaller pools of workers become challenged with the undue burden of exorbitantly rising costs. Entrepreneurs have less freedom to start new businesses due to the risks of not carrying health insurance. Another unintended consequence arises from our current managed care-based system - patients without insurance are charged much greater fees for service because they do not have the benefit of the negotiated discounts granted by a PPO or HMO.

In addition to ideas such as the expansion of coverage using federal dollars, the crux of Daschle's cost-containment solution lies in a Health Board. This proposed Board will be a Federal regulatory agency capable of setting rules and standards for healthcare providers. It will set criteria for treatment, and break down the much-too-cozy relationships between industry suppliers and the physicians that deliver their supplies. The Federal Health Board will be a cross-functional agency, designed to cover a more encompassing jurisdiction than the FDA or NIH alone.

While I applaud the Senator for effectively addressing America's healthcare problem and presenting a well-thought plan, however I personally do not believe a Federal Health Board is a panacea. A number of conflicts could still exist with a Health Board, especially if given unchecked power as suggested in Daschle's plan. With the federal government deciding the best practices for treatment, would this necessarily lead to better care for all individuals? Or would the Federal Health Board deny individuals better, but unproven treatments in exchange for more statistically econometric treatments to the payors? America is now caught in a bind between cost containment, and its thirst for more costly but more experimental sets of treatments.

Whether you agree or disagree with Daschle's solution, this book is an excellent starting point to open a healthcare debate. It is a must-read to stay informed about today's healthcare crisis and the ideas influencing public policy. Many of Daschle's lines of thinking are evident in political discussion and are likely to appear within upcoming legislation, in some form or another.

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David

Important Story

Reviewed in the United States on April 24, 2012

Verified Purchase

This very short book is a great synopsis of our current health care situation. The first section, which describes how the United States arrived at it's current health care state, the raw numbers, the comparisons to other country's systems is worth the read alone. So many have tried to tackle this problem from so many points of view, and Daschle presents his ideas for a solution plainly and with the perspective of years of working on the problem. While his clearly progressive solution will not suit some tastes, it presents one case that at the very least offers a rational plan to control runaway costs while at the same time maintaining the incentives for all rational actors involved, providers and recipients. One thing is certain, anyone who reads this book will have a much better grasp of the problem, and in an easy quick read.

Reviewed in the United States on January 22, 2009

Verified Purchase

Senator Daschle's book is surprisingly good. I award it 4 stars. The focus of the book is on several areas: (1) recounting of the politics of passing healthcare reform legislation in general (2) the reasons for the failure of the last federal government attempt at reform while Senator Daschle was in Congress in the Clinton Administration in 1994 (3) Senator Daschle's proposal for a Federal Health Board modeled on the Federal Reserve System.

Senator Daschle and his co-authors do a good job in all three areas. The style is what I call journalistesque. That is the writing style is somewhat simplistic in that it mimics speech rather than good writing. Nonetheless the style permits easy and quick reading.

Senator Daschle writes from his competency as a politician and as a long-term, influential member of Congress. Appropriately so, given that he is not a scholar or physician. The physician perspective is well represented by several books, such as Dr. Arnold Relman's book A Second Opinion, among several other good to excellent books on healthcare policy. The "journalistic" perspective is well-represented by Jonathan Cohn's book Sick and Maggie Mahar's book Money-Driven Medicine, both excellent.

Needless to say, political - as opposed to knowledge-based or science-based - considerations will predominate in regard to any fundamental reform in the overall healthcare system, both in its financing and its delivery. As a consequence it is worth noting Senator Daschle's perspective. That encompasses a continuation of a "private/public" entities. Presumably, employer-funded private insurance will continue. The federal government would create the Federal Health Board - a concept which I agree with - whose functions would be (1) to insulate decision-making from the Congress to Congress "meddling" in minutiae by Congressmen and -women, a good attribute in my opinion, and (2) to act as a neutral decider/researcher on any number of reform initiatives from public financing proposals to changes in the methods of payment to healthcare providers to changes in medical service delivery to medical infrastructure investment to further development and implementation of electronic medical records. All good tasks in my opinion that need to be at least one step removed from day-to-day political considerations.

Senator Daschle explicitly notes on page 144 "If passage of a single-payer system isn't realistic...", so presumably the desire of many physicians, patients and citizens to have such a system is thwarted. Senator Daschle further states on page 145: "So instead of creating a 'pure model', I believe we should build on the one that we have."

Senator goes on to discuss many aspects of reform including expansion of the Federal Employee Health Benefits Program that covers federal workers and Congress to individuals not covered by a plan offered by their employer.

He cites the need to pay medical service providers on the basis of "outcomes", a commonly recommended characteristic that has become a popular buzzword among politicians, who always seek to echo concepts that sound good, but which may in fact mean little. In this case, the efficacious measuring of outcomes of medical service intervention is a crucial aspect of improvement to the "system", but the reality of trying to create an accurate measure of outcomes is quite difficult, noticeably due to the inevitable lag time and indirect linkage between intervention and results.

Overall, my opinion is that the USA is lucky to have someone with Senator Daschle's intimate knowledge of Congress and personal acquaintance with currently serving members of Congress. He also clearly is someone who has thought about healthcare reform in other than a superficial way, evidenced by this good book on the topic.

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