WASHINGTON (By David S. Broder, Washington Post) November 23, 2008 — Things are looking up for substantive reform of America's troubled health-care system.

No one who knows the history of such efforts, from Harry Truman's administration through Bill Clinton's, needs to be reminded of the difficulties that inevitably confront any plan to overhaul one-seventh of the U.S. economy and bring high-quality medicine to millions of the uninsured.

But developments at both ends of Pennsylvania Avenue last week ― and across the country ― pointed up both the urgency of the problem and the prospects for seeing significant action.

When Barack Obama's transition team let out word that former Senate majority leader Tom Daschle would be his choice to run the Department of Health and Human Services and to quarterback his work on health reform, it signaled that Obama is serious about his campaign promise to make that issue a first-term priority.

Daschle would not leave a lucrative job at a law firm to twiddle his thumbs. Only with a clear understanding that the new president will put his own political capital at risk in this cause would the South Dakotan sign up for the job.

Daschle can be of great help to Obama in achieving the goal. He has made his own in-depth study of health-care issues and brings a genuine passion to the subject. And he knows the Senate, where past efforts have foundered.

Senate Leaders Hold Closed-Door Meeting To Discuss Health Care Overhaul Legislation

There are positive signs within the Senate as well. Max Baucus of Montana, the chairman of the Finance Committee, one of the two main centers of Senate action, moved first by releasing a detailed outline of his preferred piece of legislation. Edward M. Kennedy of Massachusetts, the chairman of the other committee of jurisdiction ― Health, Education, Labor and Pensions ― quickly asserted his right to be at the center of action. He organized three task forces within his committee and reached out to Baucus to suggest that their staffs start exchanging ideas as well.

Senate Health, Education, Labor and Pensions Committee Chair Edward Kennedy (D-Mass.) and Senate Finance Committee Chair Max Baucus (D-Mont.) in a Wednesday meeting that included other Senate leaders discussed plans for health care overhaul legislation to be proposed next year, CongressDaily reports (CongressDaily, 11/19). Baucus after the meeting said, "All are dedicated toward getting meaningful health care reform enacted in this next year."

Baucus said, "We all agreed that there has not been a better time in modern American health care to" overhaul the nation's health system. He added, "I think we have to move very quickly to seize the opportunity and build momentum because it's difficult to anticipate what else is going to come up next year that will involve the Congress." Baucus last week announced details of his universal health care proposal. Kennedy, who announced plans this week for drafting health care legislation, did not speak with reporters. Also present at the meeting were Senate Banking Committee Chair and second-ranking Democrat on the HELP Committee Chris Dodd (D-Conn.), HELP Committee ranking member Mike Enzi (R-Wyo.), Sen. Orrin Hatch (R-Utah), Sen. John Rockefeller (D-W.Va.); and Finance Committee ranking member Chuck Grassley (R-Iowa).

Kennedy and Baucus both have said that a health care overhaul bill likely would not include offsets for its full cost. Grassley on Wednesday said, "I think that for a lot of us, [pay-go] is a big issue," referring to rules that all measures passed include funding offsets. Baucus said, "You have to invest in order to reap long-term savings," adding, "That's understood by senators; that's understood by outside groups. I talked to [Congressional Budget Office Director] Peter Orszag ... [and] that's understood clearly by him" (Armstrong, CQ Today, 11/19).

House Majority Leader Steny Hoyer (D-Md.) on Tuesday said that while a health care system overhaul could increase the national deficit in the short-term, in the long-term it would stop adding to the deficit, according to The Hill. "Hoyer's comments are notable because he is considered the chief advocate of the [Blue Dog Coalition] and the pay-go policy in the House Democratic leadership," The Hill reports. Hoyer said, "Our objective is going to be (to) have a pay-go compliant policy over the longer term," but that "may not be possible in the short term, given where we are." He noted that addressing health care problems and inefficiencies could reduce costs and limit the impact of an overhaul on the deficit. In addition, Hoyer said, "When it comes to health care, we can no longer think of entitlement reform and expanded access as two separate issues."

At a Finance Committee hearing on Wednesday, Baucus said a health care system overhaul "must be part of any successful economic recovery plan." He said, "Health care costs and the economy are linked: The key challenges of our health care system are high costs, low quality and insufficient access," factors that affect family budgets, competitiveness of U.S. businesses abroad and government spending.

One issue that could have clouded House prospects was resolved when the Democratic caucus voted to make Henry Waxman of California chairman of the Energy and Commerce Committee, replacing John Dingell of Michigan. Both are skilled legislators; Waxman is closer to Speaker Nancy Pelosi.

A fast start is important because it takes untold hours to work through all the complex issues involved in comprehensive health care. When Bill Clinton delayed in getting Hillary Clinton's legislative proposal up to Capitol Hill until the end of 1993, his first year in office, he made it much easier for opponents to throw up roadblocks.

The architects of the Clintons' defeat were Newt Gingrich and Bob Dole, then the leaders of GOP forces in the House and Senate. Gingrich has now become an advocate for systemic change in the way health care is financed and delivered. His approach differs from Obama's, but it starts from the same premise: The current system is too wasteful and unproductive to be sustained.

And Dole, who in 1994 moved belatedly to opposing the Clinton effort as his own presidential ambitions rose, told me last week that today's circumstances make a repetition of those scorched-earth Republican tactics inappropriate. Instead, he is reminding Republicans of his own contributions to bipartisan successes ― the 1983 Social Security rescue and the passage of the Americans With Disabilities Act in 1990.

Dole and Daschle have both worked for the firm of Alston and Bird for the past few years, and it would not surprise me if Dole finds ways to be helpful to Daschle and Obama in the coming fight.

Some have argued that Obama will be forced to delay his promised effort at health-care reform, either because of the urgency of the economic problems facing the country or because there will be no money in the budget to pay for such an enterprise.

But every indication is that he will not wait. Indeed, he could well argue that the current plight of the Big Three automakers stems in part from the burden that Ford, General Motors and Chrysler are carrying for the failures of our employer-based health-care system. One of their basic competitive disadvantages stems from the fact that Japanese and other foreign carmakers are operating in countries where government and society as a whole ― not individual companies ― pay the costs of health care.

No question, it will be a tough fight. But you can see the possibility of success.