Family-values champion Ensign is still wrestling with revelations that he was tangled in a sex and influence-pedaling scandal with two former staffers. As head of the state GOP, Lowden drew criticism as the scandal broke for rejecting calls for Ensign’s resignation. She reportedly told a local newspaper this week she “hopes to see Ensign campaigning for Republicans in Nevada.”

Talking Points Memo:

The Democratic Senatorial Campaign Committee plans to ask the other candidates if they agree with her, and to note national Republicans have distanced themselves from Ensign since he admitted having an affair with a staffer.

“Sue Lowden’s support of John Ensign may have fundraising value to her, but it is a reflection of her own character and fitness for office. She has shown more fidelity to him, than he has shown to his own wife,” DSCC spokesman Eric Schultz will say in a press release today.

Lowden, a former state party chairwoman and state senator, announced her candidacy last week and will be one of 9 Republicans hoping to pull a “Daschle” on Reid next fall.

On the stump, Lowden paints Reid as a government-can-solve-anything Democrat and says he’s “in lock step” with President Obama and Speaker Nancy Pelosi, according to the Elko Daily.

Wadhams made his name early as captain of the campaign that defeated Minority Leader Tom Daschle in 2004 in South Dakota.

But Wadhams has been considerably less successful since then. He has had a rocky ride in Colorado, where he has been the party’s engineer of defeat since he climbed aboard two years ago. He was also the strategist steering Virginia Sen. George F. Allen’s failed 2006 run against Democrat challenger Jim Webb. Analysts agree Allen lost the contest as a result of the “macaca moment,” when the senator slurred a member of Webb’s team at a public function and the incident was posted on YouTube, going viral almost immediately, the tape replayed on network news. Allen’s response failed to satisfy both supporters and detractors.

Wadham’s handling of the campaign was later set out as an example of how not to succeed by the National Republican Senatorial Committee.

Got a tip? Freelance story pitch? Send us an e-mail. Follow The Colorado Independent on Twitter.

The Anchorage Daily News reports the governor is staying mum on how much Palin might owe the Internal Revenue Service after billing the state for meals and incidental expenses while living in her own home.

The governor’s office wouldn’t say this week how much she owes in back taxes for meal money, or whether she intends to continue to receive the per diem allowance. As of December, she was still charging the state for meals and incidentals.

“The amount of taxes owed is a private matter,” Sharon Leighow, Palin’s spokeswoman, said in an e-mail. “If the governor collects future per diem, those documents would be a matter of public record.”

Palin’s record of nickel-and-diming the state of Alaska isn’t exactly in Tom Daschle limousine territory, but that’s what makes it all the more dicey that the Republican governor could have to amend her taxes.

The payments became a touchy issue for Palin last fall when she was running for vice president and campaigned as a budget watchdog.

The Washington Post published a story in mid-September that said she had charged the state almost $17,000 for meals and incidentals while staying in her own home.

The state considers Juneau, where she lives in the Governor’s Mansion, to be Palin’s official duty station.

Palin billed the state for 312 nights spent in her Wasilla home during her first 19 months in office, according to the Washington Post.

Our colleagues at The Washington Independent note that Palin’s tax troubles have been on public view for months, and not only for her unreported per-diem collections.

One big issue that tax attorneys are pointing to is the fact that the Palins did not report as income the $43,490 that the state gave the family to cover travel expenses for Mr. Palin and the Palin children. Had the Palins reported these payments as income, the couple would have had to pay taxes on it.

Experts also raised questions about $9,000 that First Hubby Todd Palin deducted for snowmobile racing expenses — allowable if his racing counts as a business, but not if it’s a hobby.

Weighed down by tax return problems and charges of DC influence peddling, former Senate Majority Leader Tom Daschle pulled out as President Obama’s candidate for Secretary of Health and Human Services — just as the President was trying to accelerate momentum for Senate passage of his economic stimulus plan, and the Republicans were equally trying to slam on the brakes.

Daschle’s withdrawal, coupled with the same day, tax-inflicted stepping down of Nancy Killefer, who was to be the White House’s chief performance officer, forced President Obama to use a lightning round of network interviews he’d intended as stimulus promotion to defend himself against charges that his oratorical hopes of cleaning up government and solving all its problems had hit a speed bump.

The resulting “I screwed up” mea culpas were refreshing in a town where shifting blame to the other guy is the standard modus operandi. But whether contrition for the cameras, combined with President Obama’s continued high popularity, can translate into forward-moving action remains unknown. By week’s end, President Obama had dropped his conciliatory tone of bipartisanship and gone on the attack to try to rescue the stimulus package.

But one thing the Daschle affair and the problems with other Obama appointments makes clear is that while new administrations come and go, what hasn’t changed — yet — is the phenomenon of the revolving door, the back-and-forth fandango of lobbyists moving into government jobs at the same time that officials out of power parlay their resumes into suites on K Street. Republicans and Democrats, liberals and conservatives — all are guilty.

A recent report from the non-partisan organization CREW, Citizens for Responsibility and Ethics in Washington, found that of 24 men and women who served as cabinet members during the Bush Administration, seventeen of them left office and raced to private sector jobs with some 119 companies. Sixty-five of those businesses spend money lobbying the United States government — and 40 are directly hitting up government agencies the former cabinet secretary was in charge of.

Former Attorney General John Ashcroft started his own lobbying firm. Energy Secretary Spencer Abraham joined the board of Occidental Petroleum. Tom Ridge, the first Secretary of Homeland Security, is well-known for his involvement with companies profiting from the fear of terrorist attack or natural disaster, including Lucent Technologies and Home Depot, where duct tape is king.

But the poster boy seems to be former Health and Human Services Secretary Tommy Thompson, who CREW says has worked for 42 different companies since he left the Bush cabinet in 2005. They include Centene Corporation, which runs Medicaid plans in seven states; the pharmaceutical company Novartis; and even an operation called Whey Cool Health Foods. Logistics Health, a medical readiness company of which Thompson is president, saw its federal contracts go from $19.9 million in 2003 to $104.8 million in 2007. The company claims Thompson never contacted folks at Health and Human Services on its behalf, but Logistics’ founder and chairman told a Wisconsin newspaper, “Tommy really is able to get us in to see the right people.”

Maybe you thought the in-and-out revolving door would shudder to a halt with a new President who vowed to clean up Dodge and campaigned on the promise that no lobbyist would find job security in the White House. The day after his swearing-in, President Obama signed an executive order barring former lobbyists in government positions from overseeing anything related to their past business interests.

Apparently, that presidential executive order comes with an asterisk: no lobbyists in charge — except when they are. Take Deputy Secretary of Defense designate William J. Lynn III, former executive and lobbyist with Raytheon, world’s largest manufacturer of guided missiles, including the Patriot missile. Raytheon received more than ten billion dollars in defense contracts last year. Lynn says he lobbied for “only a handful” — missiles, destroyers, warheads, a radar system, a spy satellite. Some handful. But because both the President and Defense Secretary Robert Gates insist he’s the only man for the job, Lynn’s been given a waiver.

Also please give a big welcome to anti-tobacco lobbyist William Corr, the newly designated number two at Health and Human Services. He insists he’ll stay out of any HHS business that has to do with tobacco, won’t even yell at anyone smoking in the elevator. We’ll see.

According to The Washington Times, nearly two dozen of President Obama’s executive level appointments have worked as registered lobbyists. “Even the toughest rules require reasonable exceptions.” That was the explanation of White House Press Secretary Robert Gibbs. True, there’s an argument to be made for bringing in people with expertise and experience in maneuvering the mazelike intricacies of big government. But with so much money at stake, so much power too easily corrupted, the perpetual revolving door remains a big problem.

Ah, sigh the jaded cynics and opportunists who spawn along the shores of the Potomac, the more things stay the same, so what can you do? What you can do is speak up, and, as the late Molly Ivins would say, keep raising hell. Otherwise, that breeze you’ll feel blowing out of Washington will never be the winds of change; just a fetid gust generated by Beltway blusters of hot air and the endless spin of those damned revolving doors.

Michael Winship is senior writer of the weekly public affairs program Bill Moyers Journal, which airs Friday night on PBS.

One of Obama’s first acts in office was to sign an executive order tightening restrictions on lobbyists joining the executive branch. Daschle was a lobbyist in all but name, he even worked for the lobbying firm Alston & Bird. Daschle’s back taxes were a big problem, but Tim Geithner was confirmed as Treasury Secretary despite having owed tens of thousands of dollars in back taxes. What made Daschle’s position untenable was the fact that he’d accrued his undeclared income as a crypto-lobbyist for interests he hoped to regulate. That’s exactly the revolving door Obama pledged to block.

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“I accept his decision with sadness and regret. Tom made a mistake, which he has openly acknowledged. He has not excused it, nor do I. But that mistake, and this decision, cannot diminish the many contributions Tom has made to this country from his years in the military to his decades of public service.”

Matthew Cooper at TPM DC parses the fallout:

After Daschle, a few big questions:

1. How many more officials are going to run into the tax buzzsaw. Just spoke to someone who is applying for a senior job in the administration. “If you haven’t been preparing for public service your whole life, you’re really kind of screwed,” said the person. That may be a bit much, but it does raise the question of what tax indiscretion/error is now enough to derail your career in the Obama administration.

2. What’s Plan B for HHS and the health care campaign? Remember Daschle was not only supposed to run the largest cabinet agency but also to quarterback health care reform. Will the jobs now be bifurcated?

3. What’re the recriminations for Leo Hindery, the New York financier for whom Daschle worked? Did he do anything untoward or was this all Daschle’s failure to keep his accounting straight?

4. How badly is Obama tarnished by this both in terms of his competence — two cabinet nominees choke before they reach their confirmation hearings — and his promise of reform.

Pay special attention to No. 2.

When Daschle unveiled a multipronged attack on health care woes at a seminar put on by former Colorado Sen. Ken Salazar — who has since left the Senate to helm the Department of the Interior — he did so as Obama’s Health Policy Team leader because his HHS nomination hadn’t been officially announced yet. By all accounts, the two positions were inextricably linked, and Daschle — perhaps Obama’s key mentor when the young Illinois senator was first elected — was pegged as the public servant best equipped to pull off the job. (Perhaps, as Salon’s Glenn Greenwald pointed out to a fault, Daschle was too well equipped.)

While health care reform has taken a back seat to saving the economy, at least in the first couple of weeks of the administration, Daschle and Obama made no bones about the links between the two: “Providing quality affordable health care for all Americans is one of my top priorities for this country because our long-term fiscal prospects will have a hard time improving as long as sky-rocketing health care costs are holding us all down,” Obama said the same day Daschle spoke in Denver.

While he didn’t set a time line for the massive undertaking, Daschle made clear the administration intended to finish the job sooner rather than later. “Once we get started, it would be a big mistake to put it aside,” he said in Denver. “Once we get started, let’s finish it. Let’s get it done, let’s get it signed, let’s get it implemented.”

Any of those steps, at least for the moment, have been pushed back until Obama picks a replacement for his health reform czar.

From Obama’s prepared remarks introducing Daschle and Jeanne Lambrew, who will be deputy director of the newly created White House Office of Health Reform, via DemConWatch:

Today, I am pleased to announce two leading members of my health care team whose work will be critical to those efforts: Senator Tom Daschle and Dr. Jeanne Lambrew. I haveasked Tom to servenot just as my Secretary of Health and Human Services –- but also as Director of my White House Office of Health Reform. As such, he will be responsible not just for implementing our health care plan –- he will also be the lead architect of that plan. Jeanne will serve as Deputy Director of this office, working closely with Tom on these efforts.

It is hard to overstate the urgency of their work. Over the past eight years, premiums have nearly doubled — and more families are facing more medical debt than ever before. 45 million of our fellow citizens have no health insurance at all –- and day after day, we witness the disgrace of parents unable to take a sick child to the doctor, seniors unable to afford their medicines, people who wind up in the emergency room because they have nowhere else to turn. Year after year, our leaders offer up detailed health care plans with great fanfare and promise, only to see them fail, derailed by Washington politics and influence peddling.

This simply cannot continue. The runaway cost of health care is punishing families and businesses across our country. We are on an unsustainable course, and it has to change. The time has come –- this year, in this new Administration –- to modernize our health care system for the twenty-first century; to reduce costs for families and businesses; and to finally provide affordable, accessible health care for every American.

Now, some may ask how, at this moment of economic challenge, we can afford to invest in reforming our health care system. Well, I ask a different question –- I ask how we can afford not to.

Right now, small businesses across America are laying people off or shutting their doors for good because of rising health care costs. And some of the largest corporations in America –- including major American car makers –- are struggling to compete with foreign companies unburdened by these costs. Instead of investing in research and development, instead of expanding and creating new jobs, our companies are pouring more and more money into a health care system that is failing too many families.

So let’s be clear: if we want to overcome our economic challenges, we must also finally address our health care challenge.

The president of the Planned Parenthood Federation of America immediately seconded the nomination of Daschle and applauded the choice of Lambrew. From a statement issued by Cecile Richards, via the National Journal’s Hotline blog:

Tom Daschle is an excellent choice to lead the Department of Health and Human Services. Former Sen. Daschleis a strong advocate for health care reform and understands the need to improve access to quality, affordable health care. We are delighted by his nomination and look forward to working closely with Sen. Daschle on promoting and protecting the full range of women’s health care, including family planning and prevention services.

We’ve worked closely with Sen. Daschle during his time in the U.S. Senate. Former Sen. Daschle has a strong record of standing up for women’s health and women’s rights and supporting commonsense policies that improve health outcomes for women.

We also applaud the appointment of Jeanne Lambrew as deputy director of the White House Office of Health Reform. She is one of the leading health policy experts in the country, and someone who is an advocate for women’s health issues and prevention measures.

We are confident that President-elect Barack Obama, incoming HHS Secretary Daschle, and Jeanne Lambrew will represent an administration committed to ensuring women’s access to affordable, high-quality health care, family planning and prevention services, and to protecting a women’s right to choose. Planned Parenthood is excited about the opportunity of having true partners in the White House and HHS committed to promoting and protecting women’s health.

“The cost of health care is going to destroy many of our manufacturing industries unless we fix the system,” Daschle told a crowd of about 500 gathered at the 2008 Colorado Health Care Summit on Friday, as the Colorado Independent reported.

“Health care costs are skyrocketing, outpacing economic growth and that of wages,” he said. “Rising health care costs are recognized as the nation’s No. 1 long-term economic and budget challenge.” If nothing changes, he said, health care costs could double over the next six years. “Status quo could be the most costly option of all.”

This is policy stuff, to be sure, and it’s always helpful to compare such wonk with the words uttered during the heat of the campaign.

From a September 2006 Washington Monthly article, headlined “Rove 2.0: Dick Wadhams is the next Republican maestro of cutthroat campaigning: Can Democrats figure out how to stop him?”

In 2004, when Wadhams was helping Republican John Thune to unseat South Dakota Democrat and Senate Minority Leader Tom Daschle, every weapon in the arsenal was unfurled. There were damaging storylines: Daschle was a “pathological liar,” a farm-boy turned effete Michael Moore groupie who had reliably “emboldened Saddam Hussein.”

There was base-filing: At many of the state’s churches, packages arrived filled with bumper stickers carrying the slogan “Vote Daschle, Vote for Sodomy.” (Wadhams was careful to distance himself personally from those deliveries but happy to discuss them.) And there was Wadhams as a one-man campaign wrecking ball: When Daschle communications director Dan Pfeiffer tried to squeeze in a media hit after an election-related courthouse faceoff, Wadhams stood just off-camera bellowing “Bullshit! Bullshit!” like an outraged baseball fan cat-calling a major-league ump.

After Daschle, of course, Wadhams moved on to Brian Schweitzer, now the governor of Montana who ran unsuccessfully for the U.S. Senate against Conrad Burns. From The Washington Monthly: “Wadhams told an [Associated Press] scribe that Schweitzer had performed like a ‘smart-ass thug.’”

And six years ago, “when Sen. Wayne Allard of Colorado faced a challenge from Democrat Tom Strickland, Wadhams described Strickland as an untrustworthy ‘lawyer-lobbyist,’ and ‘the dirtiest candidate in America.’”

Wadhams doesn’t appear responsible for the Macaca moment of his former boss George Allen of two years ago. But fresh off this year’s unsuccessful Bob Schaffer campaign against Mark Udall, a little reminder of his latest grabby claims is in order: namely, that he and his candidate are “going to shove a bunch of 30-second ads up [Udall’s] ass.”

Could it be — to address The Washington Monthly’s question, “Can Democrats figure out how to stop him?” — that they have? Can eloquence, and the need to get serious at last, be triumphing over the politics of thuggery?

Remarks of Transition Health Policy Team Leader Tom Daschle
Colorado Health Summit – hosted by Senator Ken Salazar
Friday, December 5, 2008

Denver, Colorado

Thank you very much, Ken, for that wonderful introduction and thank you all for your warm reception. It is such a pleasure to be here. In politics you get introduced in so many wonderful ways and sometimes hyperbolic. I remember that time when I was introduced as a model United States Senator, and a model South Dakotan, and a model leader and a model person overall, my wife Linda was with me and later showed me the word model as its defined in the dictionary as a small replica of the real thing. Ken chose not to use that word and I appreciate it very much. I don’t know about you, but I get moved every time I hear stories like we’ve just seen this morning. Compelling personal stories. You can read statistics until your eyes glaze over and I’ll be throwing out statistics in my remarks this morning. But what really matters is that, what really matters is the impact that those numbers have on real people. And I’m sure that all of us as diverse as we may be in this room this morning have our own stories, either family stories, stories relating to friends, maybe personal, but we can all relate to stories like that. And so we’re gathered here because I would like to believe that a few years from now we won’t have to hear stories like that from people. A few years from now I would like to hear stories that are much more optimistic and much more persuasive that we can do a better job as Americans in providing basic healthcare for every single American regardless of circumstance.

And so, first and foremost let me thank my very special friend. I know you know this, but I think it takes someone from outside of Colorado to tell you, you have one of the finest United States Senators any state has every sent to Washington in Ken Salazar and I am very grateful that you have. He and I have become very close personal friends, we get together for dinner from time to time and talk over all kinds of things. He was one of the first people with who I shared my book before it was printed. We’ve had many good conversations. He cares deeply about prevention and wellness. He’s talked to me about it very passionately about it very passionately and articulately. We’ve talked about the problems of chronic shortages in doctors and nurses and other providers. He and I share a common commitment to rural healthcare in particular. So many parts of our two states are underserved as a result of the lack of providers today. So we have a lot in common.

And the eloquence and the passion that you heard as he made his remarks this morning are the same passionate expressions of concerns that I hear from the heart every time he and I talk about healthcare. He also, as you probably have recognized is going to be one of the key Senators as a member of the Senate Finance committee working on healthcare. The Senate Finance Committee is that committee designated with the primary responsibility along with the health education and labor committee to move this legislative agenda through the Senate. So he will be right in the room when a lot of these decisions are made. So your presence here this morning is making history. This is the beginning of a process, hopefully a successful process that will ultimately bring us to a conclusive and successful effort in the not too distant future to bring meaningful health reform to people all over this country. So I am grateful to each of you for participating and I’m grateful to our sponsors, those who helped make this possible for bringing us all here today. And I’m so proud and pleased to be a part of it.

President-Elect Obama has made health reform one of his top priorities. He did it in the campaign and I am here to tell you that his commitment to changing the health care system remains strong and focused. The potential for healthcare in our country is enormous. The disease that once threatened so many lives in America in many cases are now curable, conditions that were once devastating are now treatable, and we have the knowledge to extend and improve lives in ways we never felt possible just a few decades ago.

But the system as the stories again remind us today is flawed and failing. Healthcare costs are skyrocketing, outpacing economic growth and that of wages. One half of all bankruptcies, one half of all home foreclosures are related to medical costs. Business are caught between a rock and a hard place as they balance the need to provide healthcare with the need to stay competitive. And rising healthcare costs are now recognized as the nation’s number one long term economic and budget challenge.

There’s no question that the economy is going to be directly related to our capacity and our ability to reform the healthcare system in the months ahead. So our goal I think can be clearly stated. The goal must be to build to a high performance health care system providing every American with higher quality, greater access, and lower costs. One that in the words in one American who recently participated in our online discussion transition website –“shifts the paradigm from a focus on sickness to focus on wellness.”

But before we define the solution, I think it’s important that we define the problem. It’s important that we’re all on the same page, that we agree what the problem really is. Before we define the problem we have to destroy the myth. And the myth in our country has long been that we have the best healthcare system in the world. Why else would kings and leaders all around the world, people of prominence come to the United States?

Well to a certain extent that is true. But for every king who may come to the United States, there are thousands of people who leave the US to get medical care elsewhere. They call it now medical tourism. Thousands of people leave the United States because the quality and the cost is better in other countries. So how do we explain, well we explain by simply stating that we have islands of excellence in a sea of mediocrity.

We are 29th in the world when it comes to infant mortality. 29th. We are 24th in overall women’s health. We rank 31st in life expectancy. On Pine Ridge Indian reservation the life expectancy of an Indian male is 47 years. The same as what it is in Botswana. We rank 37th overall in outcomes. 37th. Below Costa Rica and just above Slovenia. And I would ask how long would this country stand for being 37th in the Olympics? We wouldn’t stand for it long.

So we recognize just those numbers that we have a long, long way to go to be the best health care system in the world. Well if we’re going to be that best healthcare system, it seems to me we have three very distinct categories of problems we have to solve. I notice the charts on the side of the room over there that outline them well.

The first is cost. To a large extent cost is driving many of the problems we are facing today. We pay for out healthcare in one of three ways, but all of us pay in all three ways. We pay through taxes, we pay through premiums, and we pay an out of pocket expense.

The aggregate of taxes, premiums, and out of pocket expenses exceeded for the first time $7,500 for every man, woman and child in the country. 16% of our GDP. Over 40% more than the second most expensive country in the world. General motors spends more on healthcare than they do on steel. Starbucks spends more on healthcare than they do on coffee. Business more on healthcare now than they make in aggregate profit. Costs are a huge problem. And if we do nothing, all the analysts tell us that over the course of the next ten years those costs are going to be exacerbated. That’s $7500 is expected to double by the year 2015 if we do nothing.

So let us recognize that the status quo could be the most costly option of all.

The second category is access. We saw some examples of the problems with coverage and access with these powerful stories. 47 million people have no health insurance. If we go to 7.5% unemployment, we’re going to pick up 2 and a half million additional uninsured in the country and that’s just with 7.5% unemployment. But as these stories so compellingly articulate that’s just the beginning of the problem. The problem is far more consequential than that because over 40% of the people in this country are under insured. According to common wealth and so many other studies over 40% of the people who think they have insurance when they need it find out that when it comes to getting the treatments required, they fall short. And so access becomes a problem not just to those who have no insurance, but those who have insurance as well and that doesn’t even tell the story, because we still don’t have mental health parity in this country. Those who don’t have the ability to access their needs for mental healthcare are totally under insured and have very little access. Long term care and dental care are also significant problems and if you live in certain rural parts or an Indian reservation the problem is more exacerbated than you find in some third world countries today. So we have a horrific problem that has to be addressed.

Finally we have a quality problem. The quality problem is related in part to cost. It’s related in part to access, but it’s also related to the system itself. The congressional budget office has estimated that of the more than 2 trillion dollars we spend on healthcare, 700 billion could be unnecessary. That’s about a third may be unnecessary. Part of the reason could be because we have a 21st century operating room with all of the sophistication we can envision in those incredibly complicated rooms but we have a 19th century administrative room. We are still driving this huge part of our economy by paper. And that paperwork is costing our country a bundle. Anywhere from 15-25% of all healthcare costs are now attributed to the administration of our system. We also don’t have the transparency we need. My best illustration of that would come in the following little story.

God forbid a plane crash occurs in some airport involving a 747. What happens? Well in this country, the 747 crashes the national transportation safety board is on site within hours and within weeks or months we have a full report as to why it was that these 450 people on that plane were killed. We know because there was extraordinary record keeping. We know because there is extraordinary transparency. We know because there is a framework in place to examine these mistakes and fix them. A combination of the FAA and the NTSB and the transparency that comes with the laws involving aviation and we fix the problem. It’s why we have one of the safest aviation systems in the world.

I am getting healthcare myself these days with a little cold. But what happens in our health care system. Well the equivalent of a 747 about 450 people die every day and a half because of medical mistakes. And we don’t have any way to fix it. We don’t have any transparency. We don’t have any mechanism by which to adjust to deal with that reality. And we’ve got fix it. We’ve got to come to some realization. And until we fix it, we will never have the best healthcare system in the world. All healthcares in this country is a little bit like a pyramid, where at the base of the pyramid you have primary care.

The base of the pyramid you have primary care and you work your way up until you get to the most sophisticated type of care at the top: heart transplants, MRIs all of the most sophisticated technology we can apply to healthcare today. Every country starts at the base of the pyramid and they work their way up until the money runs out. And the money does run out. This country starts at the top of the pyramid and works our way down

And so what happens today is millions of Americans go without high-value preventive services, from cancer screening to immunizations. And we’re facing an epidemic of chronic disease today.

Increasing the number of Americans who die needlessly because of diseases such as obesity, diabetes, heart problems, cancer HIV/AIDS. One in 3 Americans—about 133 million Americans today suffer from a chronic disease. But what is all the more compelling to me is that one out of every three children today in America will acquire diabetes sometime in their lifetime. One out of three. The obesity epidemic that is now affecting children in this country will cause them to have a lower life expectancy than ours. If that isn’t the most compelling argument to make for prevention and wellness, I don’t know what is.

So what do we do? So what do we do? First I think we have to agree that we need to build a system that will address all three categories—the problems I have outlined. The cost problems, the access problems, the quality problems. Second and this is where President-elect Obama feels very strongly, we need to use the public-private framework that is already in place. If you like what you have, you ought to be able to keep it. But if not we ought to pool the resources of those who aren’t in a system they like and offer them the same plan of options that members of congress have. And I believe that in a sense it’s really like our federal aviation system. Our job in government is to get everybody from here to there safely. You can fly coach, business or first class, but we want to make sure however you fly you get there safely. The same can be said for healthcare. We want to get you from the beginning of life to the end of life in as healthy a condition as you possibly can be. And in order to do that we need to build a framework within which that can be done. And in part that will require protecting and strengthening the public programs like Medicare and Medicaid and the state children’s health insurance program. Third, we have to make the system affordable. I already talked about the paperwork. We can do so much by incorporating a new information technology system,. System wide we’ve already seen what the Veteran’s administration has been able to do by incorporating their information technology system so effectively and we can apply that across the country and we will.

Secondly, we’ve got to recognize the importance of chronic care management. When 75% of the health care dollars are spent managing and dealing with chronic care today we know we can do a better job. Third we need payment reform. We’ve got to get away from payment based on volume to payment based on value.

And finally, we need to ensure that we provide the kind of financial assistance to those who simply have no capacity to pay for themselves.

Fourth we need to shift the paradigm. We need to shift it away from sickness and on to wellness. We need to recognize that there are cost and quality implications with all of this. But we also need to recognize that this can’t just happen within the healthcare system. And that is why we need to coordinate across our whole society. I think it’s time we teach nutrition in schools, that we have the kind of physical education in schools that is so critical to good health. That we deal with the meals that children receive and the junk food that is available to them and make sure that we make schools places of good nutrition and good health from the very beginning.

We also need to [inaudible] the workplace making sure that employers have opportunities to do what they need to do at the workplace to stay healthy as so many good businesses are doing already.

Fifth, we need to cover everyone. We need to end pre-existing conditions and the adverse selection that goes on today. Everybody needs to be part of the system. That would go a long way to end the cost shifting that costs so much for those of us who pay today. Cover everyone.

Sixth, we need to improve quality. And there are a lot of things we need to do to do that. Evidence based medicine and best practices especially. Continuity of care. Recognizing we can coordinate our care so much better with medical homes. Using m ore transparency and recognizing the role that nurses can play in so many ways that they aren’t playing today. We need to do that and we’ll improve quality across the board.

Seventh, we need to address the medical workforce shortage. WE have a huge problem with regard to providers today. We’ve seen a precipitous drop in primary care students and we have a shortage of nurses almost country wide. We need to [inaudible] people to come back into medical care. WE need physicians assistants, nurse practitioners, primary care doctors. We need them all. And we need schools to recognize the important role that they can play. No one should every have to apologize for wanting to graduate as a primary care provider in the United States of America. And we need to encourage and incent that across the board.

Finally we need to create a more efficient decision making infrastructure. There are many ways in which to do that but I think the decision making and the need to make our private-public system more compatible is so critical. And we’ll get into ways with which to do that as we go into the meaningful health reform discussions we’ll have.

So as we prepare for this historic undertaking the goal of our transition team is to gather information on a bi-partisan basis across the capital, across the country with consumers in the corporate world and to reach out in as many ways as we possibly can. One of the most important ways to reach out is at the grass roots level. With full transparency as you can see with the many cameras that are here today. President-elect Obama says he wants CSPAN to cover this and I as understand it they are. We want an open process which was the hallmark of the Obama campaign and our transition effort which is why this conference is so critical as we now begin. I’m proud to report that the transition team is reaching out aggressively already. Over the last two weeks we have done a numbers of things to begin that outreach including working with the media team to kick off a new feature on our transition website which some of you may know is called change.gov.

And the title of our new program is called join the discussion. The day before Thanksgiving two of our valuable team members did a video for this website where they encouraged people to give us their own view as to what they considered to be the biggest problem facing our healthcare system today. We really didn’t expect too much given the fact that it was the Thanksgiving day weekend, but incredibly more than 3,500 people commented in the first weekend alone.

We followed up with another review providing some report on the degree to which people had already commented using what we call word cloud using the phrases and concerns that came together the most often and asked people to further comment on that.

And now just in the last week, we’ve had 10,000 comments, including more than 100 from people in Colorado alone. So what’s next? We want to take this whole process to the next level. And what’s next is you are. What we want to do now is to move to a discussion across the country. And I’m proud to announce that next week the transition team will hold healthcare community discussions all across this country for two weeks in December, beginning the 15th through the 31st. We want your views on what we need to do to build a better system. We want your exact ideas. What do you think we need to emphasize. What specifically should we be incorporating in this new reform effort. And we want to take as many of those discussions as possible into the living rooms.

We’re going to model these health care discussions after the successful platform meetings that we used during the campaign. So if you’re interested we encourage you, and I hope many of you will actually do this, go to change.gov, sign up for a discussion in your home, sometime between the 15th and the 31st. We’re going to providing hosts with moderator kits. We will have tools for discussion that will enable anybody that wants to participate in one of these discussions to take place.

The healthcare policy team then will assemble all of the information that you provided and do two things with it. First of course we’ll present it to the President elect, but secondly we will post all of this detailed information in summary form on our website for everyone to see as part of this transparent process. And I am currently planning to attend one from the list of people who sign up online. And so I’m looking forward to that as well.

But whether this succeeds or not depends in part on you and whether you’re willing to take it to the next level. And I certainly hope that some of you will take us up on the invitation to join us for some of those important discussions during that two week period.

I have many heroes in my life. Some of them are very quotable. Two of them are especially quotable and relevant today. One is Winston Churchill. If you’re like me you’ve admired his extraordinary leadership in times of adversity. Churchill once said, he thought Americans would always do the right thing after they’ve exhausted every other possibility.

Nelson Mandela also said something of extraordinary import. He’s my hero too and if you’ve never read his book “Long Walk to Freedom” it is one of the single best auto biographies I could ever recommend. Nelson Mandela once said, “many things seem impossible until they are done.” We’ve exhausted virtually every other possibility, and for a long time this seemed impossible. But with your help, with the leadership of a Ken Salazar, with our President elect I believe for the first time in American history, healthcare reform will be done. Thank you all very much.

(Photo/S.C. Axman, Flickr)

Daschle, the presumptive Health and Human Services secretary, struck a combative tone as he outlined plans to repair a “failed” health care system. “Those who don’t want change will have to explain why change is not better than what we have now,” he said.

“Our goal can be clearly stated,” said Daschle, speaking as the Obama transition team’s Health Policy team leader because his nomination to head the Health and Human Services Department hasn’t been announced. “The goal must be to build a high-performance health care system providing every American with greater quality, greater access and lower cost.”

Exploding health care costs threaten to derail any effort at economic recovery, Daschle said. This makes broad health care reform both frugal and urgent. “If we don’t control costs, whatever bailout we provide the automobile manufacturers will be almost meaningless,” he told a crowd of about 500 at the 2008 Colorado Health Care Summit, which was organized by Colorado’s Sen. Ken Salazar. “The cost of health care is going to destroy many of our manufacturing industries unless we fix the system.”

The former senate majority leader from South Dakota also pointed to problems in the health care system as root causes of the current economic meltdown. “Health care costs are skyrocketing, outpacing economic growth and that of wages,” he said. “One half of all bankruptcies, one half of all home foreclosures are related to medical costs.” Businesses face the same challenges as individuals, and must “balance the need to provide care with the need to stay competitive. Rising health care costs are recognized as nation’s No. 1 long-term economic and budget challenge.” If nothing changes, he said, health care costs could double over the next six years. “Status quo could be the most costly option of all.”

Obama’s health care plan, outlined during his presidential campaign, would build on existing employer-based insurance plans and allow uninsured or under-insured Americans to “pool resources to offer the same options members of Congress have,” Daschle said. But expanded coverage is only part of the solution, he said, outlining a series of goals that included mental-health coverage parity, better treatment of chronic diseases and information technology advances that have lowered costs in some hospital systems, including the VA health system.

Daschle compared the government’s role in a reformed health care system with the FAA’s role in ensuring the safety of airline passengers whether they fly coach or first-class. “However you fly, you get there safely,” he said. “We want to get you from the beginning of life to the end of life in as healthy condition as you can possibly be.”

The task ahead is enormous, he admitted. “We have a long, long way to go to be the best health care system in the world,” he said, after listing poor rankings for Americans in categories including infant mortality and life expectancy.

Pointing to earlier efforts to reform health care — including the Clinton administration’s failed 1993 plan — Daschle said he intended to “apply the lessons learned.” Primarily, he said, reformers would “make this as inclusive a process as possible.”

After describing the system’s problems and sketching out goals, Daschle threw the solution, in part, to the audience. “So what’s next? ” he asked. “We want to take this whole process to the next level. And what’s next is you are. What we want to do now is to move to a discussion across the country.”

Toward that end, Daschle announced a series of community discussions devoted to health care. The discussions will be organized through the Obama transition team’s Web site, change.gov. The house parties, which take place during the last two weeks of December, will allow Americans to generate ideas and make recommendations for health care reform. Daschle said he would attend one meeting scheduled through the Web site.

The meetings mimic the Obama campaign’s platform committee meetings held during the summer, the transition team said in a release, and are designed to “help the Health Team flesh out key issues around health policy and give the Team fresh ideas about the best ways to promote the President-Elect and Vice President-Elect’s vision of quality affordable health care for all Americans.”

“Providing quality affordable health care for all Americans is one of my top priorities for this country because our long-term fiscal prospects will have a hard time improving as long as sky-rocketing health care costs are holding us all down,” Obama said in a statement. “Yet in order for us to reform our health care system, we must first begin reforming how government communicates with the American people.” Obama promised the discussions would give Americans “a direct say in our health care reform efforts.”

In addition, Daschle said he would apply another lesson learned from the Clinton-era health-reform endeavor: Avoid getting bogged down in details. The legislative process can be deadly if bills get too ornate, said the former Senate majority leader: “If we produce a 1,500-page bill, [we'll] get hung up in all the details.”

While he didn’t set a timeline for the massive undertaking, Daschle made clear he intends to finish the job sooner rather than later. “Once we get started, it would be a big mistake to put it aside. Once we get started, let’s finish it. Let’s get it done, let’s get it signed, let’s get it implemented.”

Former Sen. Tom Daschle delivers the incoming Obama Administration's first major health policy speech at the Colorado Health Summit, Dec. 5, 2008.

Former Sen. Tom Daschle, expected to be tapped to head Health and Human Services, will make the incoming administration’s first major health policy speech in Denver this morning as the keynote speaker at the Colorado Health Summit sponsored by Sen. Ken Salazar.

In prepared remarks, previewed by the Wall Street Journal, Daschle will confirm that charge: “The president-elect made health-care reform one of his top priorities of his campaign, and I am here to tell you that his commitment to changing the health-care system remains strong and focused.”

C-SPAN has the video replay of Daschle’s remarks.

The Colorado Independent has reprinted the text of Daschle’s speech at the Colorado Health Summit.