The biggest task Tom Daschle will likely tackle in his new job as health-policy "czar" will be to create a goverment insurance program to compete with private plans.
If his recent book is any guide, Daschle will try to do this by expanding the Federal Employee Health Benefits Program, which offers private health plans to eight million federal employees and members of Congress.
In his vision, Americans would continue to get their insurance as they do now - through their jobs, individual plans, or through Medicaid or Medicare - as well as through this new expanded government program.
Many conservatives oppose this, seeing it more as an expansion of big government than an expansion of options for the consumer.
"Many crucial health care decisions would be made in Washington," wrote Robert E. Moffit, director of the Center for Health Policy Studies at the Heritage Foundation.
Another key component of Daschle's challenge will be to expand coverage to the nation's estimated 46 million uninsured. He hopes to achieve this by offering subsidies to millions who cannot afford health insurance and do not have it available through their workplace. They could then purchase insurance from the new government program or from existing private plans. Daschle would not allow insurers to exclude people from coverage because of preexisting conditions.
But this raises a big concern among insurance companies. A trade group, America's Health Insurance Plans, last week came out for universal coverage and eliminating preexisting-condition clauses, but only if all Americans are required to buy insurance.
The insurance industry says the only way to offer afforable insurance to the sickest people is by requiring healthy people to buy insurance, creating a larger pool.
Daschle has supported this mandate, but President-elect Barack Obama, who yesterday nominated Daschle to run Health and Human Services, has backed mandates just for children.
Daschle has strongly advocated the creation of a federal health board, which would have great power over policy.
In a book Daschle cowrote this year,
Critical: What We Can Do About the Health-Care Crisis
, he wrote: "We won't be able to make a significant dent in health care spending without getting into the nitty gritty of which treatments are the most clincially valuable and cost effective. That means taking a harder look at the real costs and benefits of new drugs and procedures."
The cost of insuring all Americans has long stopped an overhaul, but many experts think not any longer.
"Our frame of reference has changed," said Robert Field, head of health policy at the University of the Sciences. "We just got a report about the progress of a $700 billion bailout. Solutions for the problem of the uninsured tend to have price tags in the $100-to-$200billion-a-year range, and that's beginning to look like pocket change."
Many experts said Daschle has learned from the mistakes of the Clintons in 1993.
"He basically prepared himself for this intellectually for two years," said Uwe Rheinhart, a health economist at Princeton University. "He wrote this book. He traveled to Taiwan, which has a pioneering health-care system.. . . My view is he's the ideal man for this job at this time."
"One really big difference from the early '90s - there's a whole lot more humility going around," said Len Nichols, director of the Health Policy Program at the New America Foundation, a centrist group in Washington. "What's amazing is how aligned the stars seem to be in making health reform a top priority in the new Congress."