Critical: What We Can Do About the
Health-Care Crisis by Tom Daschle
Realistic About The Problem, Dystopian About The Solution
A much-needed and hard-hitting plan, from one of the great Democratic
minds of our time, to reform America’s broken health-care system.
Undoubtedly, the biggest domestic policy issue in the coming years will be
America’s health-care system. Millions of Americans go without medical
care because they can’t afford it, and many others are mired in debt
because they can’t pay their medical bills. It’s hard to think of another
public policy problem that has lingered unaddressed for so long. Why have
we failed to solve a problem that is such a high priority for so many
citizens?
Former Senate Majority Leader Tom Daschle believes the problem is
rooted in the complexity of the health-care issue and the power of the
interest groups—doctors, hospitals, insurers, drug companies,
researchers, patient advocates—that have a direct stake in it. Rather than

simply pointing out the major flaws and placing blame, Daschle offers key
solutions and creates a blueprint for solving the crisis.
Daschle’s solution lies in the Federal Reserve Board, which has
overseen the equally complicated financial system with great success. A
Fed-like health board would offer a public framework within which a private
health-care system can operate more effectively and efficiently—insulated
from political pressure yet accountable to elected officials and the
American people. Daschle argues that this independent board would
create a single standard of care and exert tremendous influence on every
other provider and payer, even those in the private sector.
After decades of failed incremental measures, the American health-
care system remains fundamentally broken and requires a comprehensive
fix. With his bold and forward-looking plan, Daschle points us to the
solution.
Personal Review: Critical: What We Can Do About the Health-
Care Crisis by Tom Daschle
With the Obama administration now bringing healthcare to the forefront of
political agenda, Critical is a must-read for anyone wishing to understand
the issues being debated on Capitol Hill. Senator Daschle tackles the long-
lingering problems of our national healthcare system, beginning with the
roots of insurance a little over a century ago. In part one, Daschle
describes the evolution of healthcare in the United States and how over
time growing complexity has overloaded the payment protocols and
systems established decades ago. Importantly, he describes which
initiatives have worked, and why certain plans such as the failed Clinton-
era reforms of the 1990s led to political disaster.
Daschle does an excellent job pointing out the deficiencies in our current
system, such as the misaligned incentives of an employer-based
healthcare system. As is, employer-provided healthcare is a problem for
the morbidly ill - the sick are unable to find work, which deprives them of
the treatment necessary to return to health, leading to a vicious cycle. This
is not only a financial burden on individuals, but a toll on the greater
economy. Start-up companies with smaller pools of workers become
challenged with the undue burden of exorbitantly rising costs.
Entrepreneurs have less freedom to start new businesses due to the risks
of not carrying health insurance. Another unintended consequence arises
from our current managed care-based system - patients without insurance
are charged much greater fees for service because they do not have the
benefit of the negotiated discounts granted by a PPO or HMO.
In addition to ideas such as the expansion of coverage using federal
dollars, the crux of Daschle's cost-containment solution lies in a Health
Board. This proposed Board will be a Federal regulatory agency capable

of setting rules and standards for healthcare providers. It will set criteria
for treatment, and break down the much-too-cozy relationships between
industry suppliers and the physicians that deliver their supplies. The
Federal Health Board will be a cross-functional agency, designed to cover
a more encompassing jurisdiction than the FDA or NIH alone.
While I applaud the Senator for effectively addressing America's
healthcare problem and presenting a well-thought plan, however I
personally do not believe a Federal Health Board is a panacea. A number
of conflicts could still exist with a Health Board, especially if given
unchecked power as suggested in Daschle's plan. With the federal
government deciding the best practices for treatment, would this
necessarily lead to better care for all individuals? Or would the Federal
Health Board deny individuals better, but unproven treatments in exchange
for more statistically econometric treatments to the payors? America is
now caught in a bind between cost containment, and its thirst for more
costly but more experimental sets of treatments.
Whether you agree or disagree with Daschle's solution, this book is an
excellent starting point to open a healthcare debate. It is a must-read to
stay informed about today's healthcare crisis and the ideas influencing
public policy. Many of Daschle's lines of thinking are evident in political
discussion and are likely to appear within upcoming legislation, in some
form or another.
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