Fragile health-care-reform consensus will test nation's leaders

WASHINGTON — On the same morning that President-elect Barack Obama introduced Tom Daschle, the former Senate majority leader, as his prospective secretary of health and human services and his point man on health-care reform, a panel of key constituency group leaders met to assess the prospects for success.

Taking the microphone, in turn, at a Washington hotel were the head of the Business Roundtable, speaking for leading corporations; the CEO of Pfizer, the giant pharmaceutical company; the president of America's Health Insurance Plans, the trade association for that industry; and spokesmen for the National Federation of Independent Business, the small-business lobby, and AARP, the senior-citizens organization.

All of them agreed that major health legislation has a much better chance of passage in the next Congress than when Bill and Hillary Clinton tried back in 1993-94. And so did John Harwood of CNBC and myself, the two journalists invited to be on the panel.

The comments of the corporate representatives were particularly important because the small-business, insurance and pharmaceutical lobbies were instrumental in killing the Clinton reforms. As John Castellani, president of the Business Roundtable, said, "This is not 1994," when his constituents were willing just to thwart the Clintons and live with the status quo.

Today, that status quo has become unendurable for almost everyone. The budgets of families, businesses and government at all levels are being wrecked by the rising cost of health care.

What Obama said on Thursday was the simple truth. "Some may ask how, at this moment of economic challenge, we can afford to invest in reforming our health-care system. ... I ask how can we afford not to."

The president-elect went on to say, while introducing Daschle, that "right now, small businesses across America are laying off (workers) or shutting their doors for good because of rising health-care costs. Some of the largest corporations in America, including major American carmakers, are struggling to compete with foreign companies unburdened by these costs."

Daschle is a shrewd choice to lead the Obama effort. The former South Dakota senator knows the politics of Capitol Hill intimately. He recently wrote a book on health reform with Dr. Jeanne Lambrew, who will be his deputy. By designating Daschle also as head of a newly created White House Office of Health Reform, Obama has circumvented one of the problems that plagued the Clintons.

Hillary Clinton formulated her proposal through a secretive White House task force, which hid its work from Congress and from the Department of Health and Human Services and from Treasury. The heads of those departments let Congress know they were skeptical of her scheme — and damaged its chances of passing. Obama and Daschle should be able to avoid that snare.

As auspicious as the start has been, enacting a major health-care bill will still be a daunting task. When you talk about reorganizing one-sixth of the U.S. economy and changing the way a vital service is delivered, every single decision, from the most trivial to the monumental, will be controversial.

But Obama has the good fortune that the four committee chairmen who will handle his legislation have strong motives to make it succeed. For one Senate chairman, Montana's Max Baucus, this is an opportunity to report out the largest bill of his two-year tenure. For the other, Ted Kennedy, now battling brain cancer, it is the chance to achieve the main goal of his long Senate tenure — while he still has time.

In the House, one chairman, California's Henry Waxman, is brand new in the position, so this is a test of his legislative skill. The other, New York's Charles Rangel, is a veteran now under scrutiny by the House Ethics Committee for possible conflicts of interest. If he survives the investigation, this bill more than any other offers him a chance for vindication. If he falls, his successor, like Waxman, will find it his first and most crucial assignment.

It will really test the whole political system to determine if the fragile emerging consensus on the need for major reform can overcome the thousand particular issue battles that are certain to erupt.

Can representative government work?

David S. Broder's column appears Sunday on editorial pages of The Times. His e-mail address is davidbroder@washpost.com