GETTING IT DONE

There are two things you don’t want to see being made: sausage and laws. Here’s a close-up look at the grinder that produced health-care reform a year ago.

Daschle (co-author: Critical: What We Can Do About the Health-Care Crisis, 2008, etc.), formerly a U.S. senator from South Dakota, was in line to become Secretary of Health and Human Services under the incoming Obama administration. He withdrew from consideration, he writes, in part because his brother was undergoing a medical crisis—an irony, he writes, that “was almost too much to believe.” Whatever the case, Daschle, with the assistance of former Congressional Quarterly reporter Nather, writes from an insider’s perspective. The author clears up several misconceptions about the health-care reform package, not least of them the fact that the system is a hybrid of the public and private sectors. “What we are really arguing about,” he writes, “is what the proper mix should be.” Given that many Americans mistrust the government and believe it to be overstepping its bounds—although so many of those mistrusting Americans are glad to receive Medicare benefits—the temptation is to privatize a system that would seem instead to cry out for more public intervention. Yet it is from the private sector, writes the author, that imbalanced priorities have come, particularly with an emphasis on medical technology and pharmaceutical and surgical treatments rather than prevention and affordable basic coverage. The sausage-making occurs deep into Daschle’s comprehensive account, and includes such incidents as the backroom deal whereby Nebraska got a no-cost extension of Medicare benefits in exchange for its senator’s vote. However, such machinations pale in comparison to those of the opposition, which misrepresented and impeded the bill from the start and continue to do so.

A useful view of how laws are made and a good explanation of what health-care reform entails, including a year-by-year breakdown of future benefits.