WASHINGTON - President-elect Barack Obama and his aides are determined not to repeat the mistakes the Clinton administration made 15 years ago in trying to revamp the nation's health care system. That means applying some of the lessons learned -- moving fast, seizing momentum and not letting it go.
Tom Daschle, Obama's point man on the issue, discussed the early strategy, although details of Obama's proposals won't be finalized for a while. Already, however, the political and public relations parts are coming into place.
The strategy begins with giving people the chance to highlight their concerns and experiences. Daschle invited people around the nation to hold what amounts to house parties from Dec. 15-31. Obama's transition team will gather the information from those meetings and post the material on its Web site, http://change.gov.
By asking anybody and everybody to share their health care experiences, Daschle is confronting one of the major criticisms of 15 years ago: that the effort to craft former President Bill Clinton's plan for universal coverage was too secretive.
"We have to make this as inclusive a process as possible," Daschle, the former Senate majority leader from South Dakota, said in a speech in Denver. It was his first since Democratic officials confirmed last month he was offered the job as health and human services secretary and that he had accepted.
"They are clearly trying to do it differently and help the American public see the case for reform in human terms," said John Rother, public policy director for the advocacy group AARP.
Daschle maintains the efforts to bring about universal health coverage in the first two years of the Clinton presidency took too long. In a book published this year, he urged the next president to act immediately to capitalize on the good will that greets any incoming administration. His speech and recent behind-the-scenes meetings with lawmakers and consumer groups address that point.
"We need to be on the offense," Daschle said.
He cited other lessons, too. This time around, lawmakers cannot try to address every detail when it comes to legislation.
"Details kill," Daschle said. "If we get too far into the weeds, if we produce a 1,500- or 1,600-page bill, we're going to get hung up on all the details and we're never going to get to the principles."
Once Congress does take up a health plan, it also can't divert attention to other subjects, he said.
"Let's not put it down, let it lie there for months and months and figure out a time when we can get back to it later," Daschle said at a Colorado Health Care Summit organized by Sen. Ken Salazar, D-Colo.
Nevertheless, any overhaul will cost a lot. During the campaign, Obama said he planned to pay for expanding health coverage in part by increasing taxes on the wealthy and requiring larger businesses to provide health coverage or contribute a portion of their payroll to a new public insurance plan. The current recession provides a significant obstacle to both options.
Daschle did not provide any details about how the incoming administration would pay for expanding coverage. Instead, he made the case that not dealing with health care would worsen the economic problems because companies such as General Motors spend more on health care than steel and Starbucks spent more on health care than on coffee.
"Health care is going to destroy many of our manufacturing industries unless we fix the system," he said.
He outlined an array of problems with the current system: high costs, lack of access and mediocre quality. He said the myth has long been that the U.S. had the best health-care system in the world, but statistics and an increase in medical tourism show that is not the case.
Health insurers put out their own plan this past week and it mirrored some of Obama's proposals, including expanding programs such as Medicaid to help out the poor. But the insurers want to require that people buy insurance, while Obama only supports a coverage mandate for children. They also oppose requiring companies to provide insurance or pay into a pool, referred to as the "play or pay" mandate.
