WASHINGTON - Drawing on lessons from past debates, President-elect Barack Obama handed Tom Daschle two prime jobs yesterday and one gigantic assignment: overhauling the health-care system so more people are covered by insurance.
Daschle, the former Senate majority leader, is Obama's choice as Health and Human Services secretary and director of a new White House office on health reform.
In previous administrations, the White House and not the cabinet agency has led attempts to expand coverage, potentially at the expense of the health secretary's decision-making power.
Daschle's joint appointment "ensures that there is one primary voice speaking on behalf of the president when it comes to health-care reform," said Chris Jennings, who was President Bill Clinton's senior health-care adviser. "Both in the Bush and in the Clinton administrations, there was a question about who was talking for the president and what level of authority they have. This resolves it from Day One."
But would spending time at the White House undermine Daschle's ability to manage an agency responsible for food and drug safety, medical research, and health-insurance programs covering nearly 100 million elderly, disabled and poor people?
Jennings said the appointment of an experienced administrator, Jeanne Lambrew, as deputy chief of the new office makes clear that Daschle does not always have to be at the White House. Lambrew has worked at HHS and the White House budget office.
The department will need strong hands at the Food and Drug Administration and the Centers for Medicare and Medicaid Services, and Daschle must find a capable deputy and chief of staff. "Those posts and their ability to manage well will be placed at a premium," Jennings said.
Introducing Daschle at a Chicago news conference, Obama stressed the link between reviving the economy and making health coverage more affordable and accessible to more people.
"If we want to overcome our economic challenges, we must also finally address our health-care challenge. I can think of no one better-suited to lead this effort," Obama said of the former senator from South Dakota.
Daschle, 61, said that he believed fixing health care - expanding coverage, improving quality, and slowing costs - was the nation's biggest domestic-policy challenge.
"We have the most expensive health-care system in the world, but are not the healthiest nation in the world," Daschle said. "Our growing costs are unsustainable, and the plight of the uninsured is unconscionable."
Ron Pollock, who backed Clinton's health-overhaul attempts in 1993, said the new office for Daschle was a practical move, not a symbolic one. Pollock said that HHS played a supportive role but that the White House called the shots.
"Now, you've got that integrated in one person who has the full confidence of the president-elect, and is well-liked and respected in Congress, where the reform debate is taking place," said Pollack, executive director of Families USA, which advocates for universal health coverage.
Thomas Miller, a resident fellow at the American Enterprise Institute, said he could not recall another cabinet secretary taking on such twin roles. He said titles come and go, but at the end of the day, it's people working 15 hours a day in the West Wing of the White House where most of the decisions are made.
"It's structurally difficult," Miller said. "But he's trying to make sure he's not cut out of the action."
Of course, crafting policy from the White House is no assurance of success.
As first lady, Hillary Rodham Clinton discovered that in 1993-94 - after insurers and business groups revolted against the Clinton health plan and persuaded Congress not to go along.
Vice President Cheney had more mixed results with his energy task force. But many important recommendations, such as opening a wildlife refuge in Alaska to oil drilling, building more nuclear power plants, and updating and expanding the electrical power grid, never were realized.
61; born Dec. 9, 1947, in Aberdeen, S.D.
Distinguished senior fellow, Center for American Progress; special public policy adviser, Alston & Bird; Senate minority leader, 2003-05; Senate, 1987-2005; U.S. House of Representatives, 1979-86; aide to Sen. James Abourezk, 1972-77; intelligence officer, U.S. Air Force, 1969-72.
B.A. in political science,