The long road to healthcare reform

A new column for the FT on Tom Daschle's chances of reforming the health system:

He is a good choice. He combines years of experience in Washington with longstanding expertise in health policy. He watched at close hand as the last big effort to reform US healthcare - the project led by Hillary Clinton in 1993 - came to nothing. He thinks he knows why that project failed and how to do better next time. And he has just published a book on the subject: Critical: What We can Do About the Healthcare Crisis.

Reforming US healthcare is a heroic undertaking, crucial to long-term economic prospects. Now, on top of all the difficulties that sank the Clinton plan, healthcare reform must bid for financial and political resources against the vast outlays that the recession will pre-empt. What are Mr Daschle's chances?

Consider first the errors of Hillarycare. A lot went wrong, says Mr Daschle, but the overall design was not the mistake. The plan was one of many similar schemes to build on (rather than replace) the current mostly private, employer-based system. The plan sketched by Mr Obama during the campaign has much in common with it - so does Mr Daschle's variant; the system already operating in Massachusetts is similar. In each case, the idea is to use subsidies and mandates to fill gaps in coverage, while adding a layer of control to press down on costs.

What killed Hillarycare, Mr Daschle argues, was the process. Behind closed doors, her team devised a 1,342-page law that nailed down every last detail of the new system. Little effort was made to get sceptics invested. The administration then gave its critics an almost infinite number of technical issues around which to organise resistance. Mr Daschle's book suggests a different approach...