Critical by Tom Daschle

It's difficult for me to be objective about this issue.

It is not difficult for me to be pessimistic about this issue.

I truly get the feeling that the people who realize just how complicated this issue is are exceedingly rare. And this is what leads to my pessimism.

And yet, I don't question in the least that the system is broken. In fact, I often can be heard telling people just that.

And perhaps it'll take someone or some ones willfully ignoring the depth of the complexity of the situation to fashion a workable solution. Because, god knows, it certainly seems an insurmountable problem to most who pay attention to the details.

With his thin book, Daschle can't be accused of getting mired down in details. It is a superficial look at the problem. The anecdotes he trots out to illustrate his points are compelling on the surface but frustrating in their omissions. Omissions which are not obvious to most but will strike those who work in the industry.

Daschle's basic idea is that a board akin to the Federal Reserve Board should be set up to manage health care decisions, just as the Fed manages interest rate decisions. Given the current financial crisis, the suggestion that anything should be modeled after the Fed is a bit unfortunate. And yet, the reasoning behind his approach seems sound. A board of qualified individuals in position to make difficult and painful decisions, insulated from political pressures but with transparency so there is trust and buy-in.

It does seem utopian. I don't much trust utopian . . .

It's a scary time to be in the industry and to be trying to make decisions with long-term repercussions when the premises upon which those decisions must be based have their foundations in shifting sand.

I'm just going to hang on tight for a wild ride.