Senator Tom Daschle of South Dakota is an important figure in U.S. legislative and regulatory policy, with 25 years of combined service in the U.S. House of Representatives and U.S. Senate. Daschle stands out as the only senator to serve twice as both the majority and minority leader. Daschle has participated in the development and debate of almost every major issue in the last three decades.
With his extensive experience and unique perspective, Tom Daschle discusses the future of U.S. healthcare with American Healthcare Journal staff writer, Caroline Miller.
Q: Ten years on, how would you grade the Affordable Care Act?
A: I’d say the Affordable Care Act is a major contribution to the advancement of better health in the United States. It improved access, and it improved, to a certain extent, the quality of care that our people are now getting. I believe it elevated our overall efforts to achieve a better system in the country.
It fell short in a number of ways, in part because of vehement opposition by Republicans and by this administration in particular. It fell short of many of our goals 10 years ago, but I still think it was a major and very critical contribution.
Q: Looking towards the 2020 election, what would you say is at stake for healthcare?
A: I would say there’s an enormous amount at stake for healthcare.
I’ll start with the COVID-19 pandemic. The coronavirus will be of major consequence as the campaign unfolds and the election is decided. I think there will be a number of issues involving the capacity of our country to deal with pandemics: our capacity to test, to trace, to treat and our ability to create a vaccine. And in large measure, our ability to provide the public health necessities that have been far below the standards we should have as a modern country.
In addition to COVID, I think we still have three fundamental challenges to healthcare in our country that must be addressed in the coming years:
The first is access. We have close to 40 million people who have no health insurance. We have estimated that at least 60 million more Americans have limited health insurance or insurance that is not adequate. We have a major problem around access that has not yet been addressed.
While the Affordable Care Act helped address it, many states chose not to expand Medicaid. And as a result of Supreme Court decisions, as well as decisions at the state level, the Medicaid program is not fully functional in terms of its capacity to serve a lot of uninsured individuals. We will have major access problems so long as that number of Americans remain uninsured.
The second challenge we have in health is cost. We spend almost $14,000 per capita, and our healthcare costs are far greater than that of any other country. We still have not addressed cost effectively for many reasons — primarily because medications and healthcare services are overpriced in the United States and far more costly than in almost any other country.
The third problem we have is quality. We don’t even register in the top 20 when it comes to the basic quality measures around a healthcare system. And so, we have to do far more to address quality than we have in the past.
Q: How would you grade Trump on healthcare policy, as well as Biden on healthcare policy?
A: I would give the Trump administration poor marks with regard to healthcare. They have vehemently opposed the Affordable Care Act. They have badly bungled the national effort to address the coronavirus. All of the criteria around access, cost and quality have gone in the wrong direction over the last four years.
I think it’s a little difficult at this point to pass judgment on Joe Biden’s record on healthcare. I will say that his positions are ones that I wholeheartedly endorse across the board. He is one who believes that the $3 trillion public-private partnership that we have in America around healthcare is one that should be improved. He has talked effectively and persuasively on the importance of improving access, reducing costs and doing more to address quality. I have high expectations for a Biden presidency and what he would do on healthcare, were he to become the next president.
Q: What are the benefits and drawbacks of each party’s approach to healthcare policy?
A: I will say this: Both parties share the same aspirations. I don’t think you get any disagreement among Republicans about the importance of addressing cost, access and quality. I think the big difference lies in what is the role of government. I would argue, and I think without fear of contradiction, that most people would describe our healthcare system today as a public-private partnership. It’s about 50 percent government and 50 percent private sector today.
I have long argued that we don’t have a single healthcare system in the United States. We have a collage of subsystems, both public and private. The Republican party generally tends to favor more of a private role. Democrats tend to favor more of a public role. There are advantages to having this public-private partnership, and it’s one that I have long supported.
I think Democrats recognize the importance of public health. We have a very fragile and fragmented public health system today, unfortunately. It’s eroded over the years. We need to do a much better job creating a more expansive, better funded and better supported public health system than in the past.
I would give both parties high marks for their recognition of the importance of telemedicine today. Telemedicine has become a vital tool in this coronavirus pandemic, and I think it will become a transformational tool as we look to address physical and mental health going forward.
I think there is also broad bipartisan recognition of the need to address drug prices more effectively. There are different approaches to how that is done. But I don’t think there’s any question that it is a bipartisan issue that will continue to dominate healthcare policy debate going forward.
Q: What do you think the U.S healthcare system will look like in 2030?
A: Well, I think it’ll still be the public-private partnership that I have described. I hope that it will be one that has solved the problem of access, where we have absolute universal coverage.
I hope that we can find a way to ensure that it’s also less costly. We’ve got to bend the cost curve, and there’s absolutely no doubt that we can do that, but it’s going to take more forceful options than we’ve seen thus far. I certainly hope that we have addressed the need for higher quality and addressed some of the great deficiencies we have in quality containment and overall quality effectiveness.
I think you’ll see a lot more technological application. Telemedicine is a good example, but my guess is you’re going to continue to see new and innovative approaches to how we look at healthcare. The technological advancements, I think, will be incorporated over the next 10 years.
I certainly hope and believe that we will have put the coronavirus pandemic behind us, but I hope we’re better prepared for the next one.
Finally, I hope that we can build the public health infrastructure that I have previously mentioned. That is critical. Those are my aspirations for the next decade.