THE TREATMENT FEBRUARY 3, 2009
Can health care reform go ahead, this year, even without Tom Daschle? Yes.
Does this episode--and Daschle's absence--make the task of enacting health care reform harder? Yes, although how much harder is difficult to say right now.
Daschle had a combination of talents not easy to find in one person--poiltical savvy, connections in Washington, and a thorough knowledge of health care policy. But that doesn't mean you can't replace those skills, particularly if you're willing to find several people instead of one.
Remember that Daschle was actually up for two posts. He was going to run the White House office of health care reform. And he was going to lead the Department of Health and Human Services.
The latter has more enduring institutional power; it means running a vast cabinet agency. But when it comes to crafting, then selling, a health care reform plan, there's no reason it has to have such a prominent role.
Plenty of prominent Democrats would have the requisite experience to handle HHS: Netroots favorite Howard Dean, former Oregon Governor John Kitzhaber, or perhaps a non-physician, sitting governor like Kathleen Sebelius of Kansas or Jennifer Granholm of Michigan.
Filling the job of health reform czar is a bit more difficult. You need somebody with a command of health policy that runs both broad and deep, ideally somebody with the chops to deal--on a roughly equal plain--with the likes of Peter Orszag and Larry Summers, who have already asserted themselves strongly in the health care policy debate.
Jeanne Lambrew, a top health policy scholar who's already serving as the office's deputy, could do the job. In fact, based on things I've heard, she's been doing much of it for a while.
It's that second part--selling the plan politically--where Daschle's loss could make a bigger difference. His ties to Congress, particularly the Senate, made him an ideal ambassador to Capitol Hill. His soft-spoken, unthreatening demeanor also made him a terrific spokesman--just the type to put the voters at ease whenever the next round of Harry and Louise ads go up.
If George Mitchell weren't already on his way to the Middle East, you could imagine him doing this job as well. (He happens to know a lot about health policy.) Absent him, I'm just not certain who plays the role of White House emissary.
Then again, maybe that position doens't need filling. The rest of the administration certainly has political talent to spare. Rahm Emanuel is in the room, as is Phil Schiliro, the legislative liason Obama inherited from Henry Waxman's staff and about whom I've heard nothing but raves. I assume Neera Tanden, the longtime Clinton aide who'd signed on to be a Daschle deputy at HHS, isn't going anywhere. And Lambrew, for what it's worth, has a political sense of her own.
Less certain is how Daschle's loss affects health care's place in the Obama agenda. Daschle had a direct line to Obama, a result of the relatively long relationship the two men had. That gave the health team clout. And clout matters at a time when, inevitably, budget resources are going to be scarce--and legislative priorities are still not definitive.
At the very least, a planning process that was not only well underway but starting to near completion will now have to go on hold, at least for a little while, as the administration cleans up the damage of this mess. One possible effect: Health care may not end up in the new budget, which doesn't necessarily preclude comprehensive reform this year but could make it more difficult. That's far from certain, however (or so I'm told).
Daschle says he left so that the health care reform fight can go on, as planned. I understand that's how at least some of the decision-makers in the administration were thinking, too.
It'd be foolish to think this development doesn't set things back. But, as one senior administration official just told me, "the most passionate advocate for health reform in the administration is staying put--right in the Oval Office."
P.S. I got to know Daschle and his work pretty well in the last year. And I remain convinced of what I wrote yesterday: He always struck me as genuinely offended by the damage our health care system does to countless Americans--and genuinely committed to solving that problem, as quickly and comprehensively as possible. His book actually did a lot to spread the word about health reform. Whatever his missteps, I hope he'll remain a voice for improving health care, even if it's a voice he raises from the private sector.
Update: Ezra has heard some names for Daschle replacement in the White House (as opposed to HHS). With the possible exception of John Podesta, whose political connections are unrivalled, I continue to think none of them represents over an upgrade over the very capable Lambrew, who could then bring in a new deputy. (If not somebody from the existing staff, then a wonk like Peter Harbage, who worked with John Edwards on his health plan, comes to mind.)