Previewing the Senate’s confirmation hearing for President-elect Barack Obama secretary of Health and Human Services appointee Tom Daschle, the New York Times predicts: “Daschle to Face Tough Questions on Competition in Health Insurance.” And we certainly do hope that Senators press Daschle hard on his vision for a government run health plan that will ‘compete’ with private health care options. As we have argued before, just as the Boston Red Sox would not trust George Steinbrenner to write the rules and hire the umpires for Major League baseball, Americans should not trust Congress to both set the rules for health care competition and then also ‘compete’. If you think a government entrant into the marketplace will not inevitably turn into a monopolistic financial disaster, then we’ve got two failed mortgage financing giants we’d like to sell you.

But the creation of a government run health plan is just one of many troublesome view held by Daschle. His book, Critical: What We Can Do About the Health-Care Crisis is an excellent source for possible questions and issues to be raised at this hearing. These key questions include:

The Future of the Doctor-Patient Relationship: On page 199 of his book, in discussing the powers of the proposed Federal Health Board, Daschle writes, “Doctors and patients might resent any encroachment on their ability to choose certain treatments, even if they are expensive or ineffective compared to the alternatives. Some insurers might object to new rules that restrict their coverage decisions.” Daschle ought to explain why his vision for reform of America’s health care system will deny doctors the right to prescribe, and patients the right to choose, medical treatments or procedures that they deem best for their particular medical condition when a appointed government panel deems them to be too “expensive”.

Recourse for Patients Denied Care: On page 200 of his book, once again discussing the powers of the proposed Federal Health Board and its appointees, Daschle writes, “When the Federal Reserve Board sets interest rates, it affects people’s money. But when the Federal Health Board makes coverage decisions, it will affect people’s lives.” Then, on page 201, discussing the power of the board members, Daschle adds, “They will be political appointees, chosen by the president and confirmed by the Senate. The board will derive its authority from Congress, and Congress can dismantle it whenever it wants. Congress will have the power to overturn a board decision or remove a board member for good cause, although I hope it will use this power sparingly, if ever.” If an individual patient were denied a medical treatment, procedure or drug as a result of a decision of the board, what would be their recourse short of an act of Congress? Would there be an appeals process, like Medicare, or access to the federal courts, or both?

The Government Run Plan: On page 171 of his book, Daschle writes, “The Federal Health Board would also work with Medicare to develop a public insurance option for the (national) pool, designing it to compete with the private health insurance plans on the FEHBP menu.” Based on the robust findings in the professional literature, the creation or expansion of public health programs invariably “crowds out” private health insurance coverage, particularly as employers drop health coverage and enroll their employees in government programs. How can Daschle guarantee Obama’s promise to Americans that if they are enrolled in private health plans, nothing would change for them?

The British NICE Precedent: On page 127 of his book, Daschle writes, “In other countries, national health boards have helped to ensure quality and rein in costs in the face of these challenges. In Great Britain, for example, the National Institute for Health and Clinical Excellence (NICE), which is part of the National Health Service (NHS), is the single entity responsible for providing guidance on the use of new and existing drugs, treatments, and procedures.” If that British agency determines that a treatment is cost effective, it must then be available within the NHS, but it also denies reimbursement for treatments, making them practically unavailable for patients. Based on NICE’s record, does Daschle really want to see similar results for doctors and patients in the United States?

Tax Policy: Senator Max Baucus (D-MT), chairman of the Senate Finance Committee, has said that Congress should re-examine the federal tax treatment of health insurance, noting that there is a strong, bipartisan consensus among economists and policymakers that the existing tax policy governing health insurance is both unfair and economically efficient. Does Daschle believe that this growing consensus is sound and that persons who do not or cannot get health insurance at work should be penalized by the tax code if they buy it on their own?

There is a clear consensus in the country that America’s current health care system, under which the government already purchases 46% of all medical care, must be changed. Where there is sharp disagreement is over what direction that change should take. Those means should not deny Americans the ability to maintain private health insurance that they want; the benefits, medical treatments, and procedures that they want; or the relationship with the physician that they value. The answer is less socialized medicine, not more.

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