The U.S. Senate Committee on Health, Education, Labor, and Pensions held this hearing for Secretary of Health and Human Services-Designate Tom Daschle, former Senate Majority Leader, on January 8, 2009. His statement follows below. For a transcript of the question and answer portion, click here.
Chairman Kennedy, Senator Enzi, members of the Committee, thank you for inviting me
here today to discuss my nomination to be Secretary of Health and Human Services.
I’m grateful to President-elect Obama for putting his trust in me. And I look forward to
returning to public service at such a pivotal moment in American history.
The Department of Health and Human Services touches the lives of all Americans in
crucial and fundamental ways. It is called upon to protect our citizens as well as offer them
assistance in fulfilling essential tasks for their well being. It is called upon to ensure the safety of
food and the effectiveness of drugs a mother gives her child; to help find the cure to the disease
afflicting a parent and to educate a community on preventing disease; to help the struggling
family afford child care so parents can work; to ensure children are receiving the social and
developmental care they need as they enter school and prepare to learn; to help the family
struggling with caring for an aging parent; and of course, to help our seniors and most vulnerable families by providing health care, which many would otherwise go without.
This Department also will be central to tackling one of the greatest challenges of our
time: reforming the U.S. health care system. The flaws in our health system are pervasive and
corrosive. They threaten our health and economic security that is why the President-Elect has
crafted the new White House Office of Health Reform and I am honored to be chosen to serve in
this role as well. If confirmed, I will use these dual roles to marshal the talent and energy
necessary to at last succeed in making health care affordable and accessible for all Americans.
In short, the mission of HHS is to assist Americans by performing some of the most
fundamental responsibilities of our government. In this time of great economic challenge, that
mission is more important than ever.
As I know it is with many of you, health care is personal to me.
I ran for Congress 30 years ago to help places like rural South Dakota, where people
sometimes went without proper health care because the nearest doctor’s office was too far away.
When I came to the Senate, I had the privilege of serving with many of you and working
together on significant health care legislation – covering millions of children through the
Children’s Health Insurance Program, improving the ability of workers to keep their health
insurance if they lost or changed a job, and ensuring, that advances in genetics do not lead to
health and employment discrimination.
When I left the Senate, I was able to travel around the country talking to businesses,
community groups, and people I met about what was broken in our health care system. I wrote a book called Critical about how I thought we could fix it.
Ensuring all Americans have health care is integral to the mission of HHS and the wellbeing
of our families – but to achieve this goal, we will have to work together to tackle tough
While our investments in research and pioneering work by our scientists lead innovation,
too often, patients don’t actually get our best.
In 1994, we had 37 million uninsured. Today, we have nearly 46 million. In 1987, one
dollar out of fifteen went toward health care for the average family. Today, it’s one out of six.
And even though the U.S. spends more on health care than any other country, we rank low on
life expectancy and infant mortality.
President-elect Obama recognizes that many of you have been working for many years
on these issues, and that any effort at reform will require close collaboration with Congress.
He also realizes that change cannot be dictated from the White House and Washington
out – but must come from the grassroots of this country and involve as many Americans as
possible in the process of reform. In addition, to being a collaborative process, it also needs to
be an open, transparent process where people know their voices are being heard.
We have already begun to listen. During the Transition, we reached millions of
Americans via our website, Change.gov, to get their input on how best to change our health care
system. Tens of thousands of Americans shared their greatest concerns about health reform, and
thousands more opened up their homes to host Health Care Community Discussions.
We are currently compiling their reports to share, but one thing was crystal clear:
America cannot afford more of the same when it comes to health care in this country. On this, I
think we all can agree.
It is unacceptable that in a nation of approximately 300 million people, nearly one in six
Americans don’t have health insurance. As we face a harsh and deep recession, the problem of
the uninsured is likely to grow.
But the number of uninsured only describes part of the problem. Even Americans who
do have health insurance don’t always get the care they need, especially high-value preventative
care. In some cases, this is due to a shortage of providers – especially primary care providers in
rural areas that we must work to address.
In other cases, it is simply because our health care system is not oriented toward
prevention, and therefore, fails to incentivize the screenings and lifestyle changes that can do so
much to improve health. Any health care reform plan must make sure every American has
preventative care that prevents disease and disability. Coverage after you get sick should be a
second line of defense. Today, it’s often the first line of defense.
In addition to being sound medicine, this is sound fiscal policy. Studies have shown that
for every $1 spent on prevention we could net a return of $5.60 in health care costs – totaling
upwards of $16 billion annually within five years.
But it’s not enough to give every American care. It needs to be high-quality care.
By some measures, nearly one third of the care Americans receive is at best inadequate,
and at worst harmful. While we have pockets of excellent care, too often recommended care is
This quality gap contributes to racial and ethnic disparities in outcomes. On the Pine
Ridge reservation in South Dakota, half the people over 40 have diabetes, and the life expectancy is just 47 years, or what life expectancy was for the rest of the country… in 1900. This, too, is unacceptable.
We need to make sure every American gets high-quality care. If you see fit to support
my nomination to be Secretary of Health and Human Services, I’ll make sure this goal includes
the Indian Health Service. I will also make sure the health disparities affecting all other minority
and underserved populations are acknowledged and addressed.
But even if every American had good insurance and great care, we have an
overwhelming problem related to health costs. Over the past nine years, health insurance
premiums rose three times faster than inflation.
The fact that health care premiums have doubled since 2000 leaves some families to
make the awful choice between health insurance and rent, or heat, or food. And these cost
increases are as unsustainable for our national budget as they are for families’ budgets. By 2025, the Congressional Budget Office projects that health care will account for 25 percent of our
GDP. By comparison, the entire federal budget today is about 20 percent of GDP.
Any health care reform plan must achieve the three goals of increasing access and
quality, while containing cost. But helping to develop a successful plan is only a piece of what
the next Secretary of Health and Human Services must do. Here, I highlight a few of the
agencies and their challenges and opportunities.
Centers for Medicare and Medicaid Services
Medicare, Medicaid, and the State Children’s Health Insurance Programs are pillars of
health care coverage in our country. As the organization under which they each operate, the
Center for Medicare and Medicaid Services will have a vital role to play in promoting health care
reform and its goals of affordability, accessibility, and quality. CMS should ensure that all those
eligible for Medicare, Medicaid, and SCHIP are enrolled and have access to high-quality, costefficient health care. It should improve its protections for Americans with the highest costs and lowest incomes. HHS has a historic role in serving underserved communities as well. As we
embark on the mission of expanding coverage to all Americans, we must maintain that
CMS can also drive higher quality and greater efficiency in the delivery system,
enhancing value for beneficiaries and taxpayers and becoming a catalyst for health reform. CMS
can be a gateway to reforming the way providers are paid to better align incentives with the
provision of high-quality care and make it more affordable. For example, CMS can support
disease management, “medical homes,” and other approaches to improve care and reduce costs
for patients with chronic conditions. In addition, by using its demonstration authority, CMS can
identify the cutting-edge practices that will become the bedrock for a high-performing health
At the same time, CMS must focus on prevention and primary care, steering its resources
toward wellness rather than sickness. To do so, it will need to work side-by-side with the Public
Health Service and the human services agencies at HHS.
Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention can contribute to a 21st-century health
system by making prevention more than just a part of its name. I believe that moving our system
toward health care and away from sick care is critical to solving our long-term health challenges.
The CDC is critical to that goal.
Too often, too many Americans go without high-value preventive services, such as
cancer screening and immunizations to protect against flu or pneumonia. Similarly, communitybased prevention efforts, which have helped to drive down rates of smoking and lead poisoning, for example, are underutilized despite their effectiveness. The nation also faces epidemics of obesity and chronic diseases as well as new threats of pandemic flu and bioterrorism. Despite all of this, fewer than four cents of every health care dollar gets spent on prevention and public health. This needs to change.
At the core of CDC’s mission is collaborating to create the expertise, information, and
tools that people and communities need to protect their health through health promotion and
prevention of disease. CDC’s efforts to reduce unhealthful behaviors through public awareness
campaigns have paid real dividends. Today heart disease rates have declined by half, in no small
measure because of the role of community-based prevention. If confirmed, I will work with the
Director of the CDC to promote these proven strategies for success.
I will work to revitalize CDC and strengthen its ability to detect and investigate health
problems; conduct research to enhance prevention; develop and advocate sound public health
policies; implement prevention strategies; promote health behaviors; and foster safe and
healthful environments. We should provide greater support to the public health and primary care
CDC can focus on ensuring effective coordination between public and private resources
at the national, state, and community levels to promote wellness throughout the lifespan, and
ensure healthy communities. And we can reduce the impact that diseases over the lifespan (such
as childhood diseases, chronic diseases, and the aging population) have on public health, the
health care system, and our economy. I believe CDC can be a leading agency in promoting the
goal of prevention in our health care system.
Food and Drug Administration
As Americans focus more on prevention through healthier living, HHS must live up to its
responsibility to protect the American people through its regulation of food and drugs. Ensuring
the food we eat and the medications we take are safe is a core protection that the American
people deserve and a core responsibility of government.
The FDA is responsible for the safety of thousands of items Americans depend upon
from the toothpaste we use in the morning to the fruits and vegetables we eat all day from the
medications we take for the occasional headache to the extraordinary drugs, vaccines, and
medical devices that save our lives. Unfortunately, there is growing concern that the FDA may
have lost the confidence of the public and Congress – much to our detriment.
When Americans are nervous about eating spinach or tomatoes or cantaloupes, that’s not
good for our health and it is terrible for our farmers. When nearly two-thirds of Americans do
not trust the FDA’s ability to ensure the safety and effectiveness of pharmaceuticals, the result is
Americans may hesitate to take important medications that protect their health. This is
As Secretary, I will work to ensure that trust in FDA is restored as the leading sciencebased
regulatory agency in the world. I will support strengthening the FDA to meet the pressing
scientific and global challenges of the 21st century. And I will send a clear message from the top
that the President and I expect key decisions at the FDA to be made on the basis of science –
Today, there is a broad understanding that the FDA’s public health mission is as critical
as ever. Consumers want pure and healthy foods. Patients understand that their lives depend on speedy access to safe and effective medical products. Industries need the FDA’s seal of approval to inspire confidence. There are also thousands of talented and committed professionals at the agency ready to serve. We can work together to restore the credibility of FDA and advance the health of the American people. The Committee led the way through its bipartisan work last year in reauthorizing the user fee programs and strengthening safety.
National Institutes of Health
Equally critical to protecting people by regulating drugs is discovering new drugs and
treatments that can prevent, treat, and cure disease. The tremendous discoveries funded by the
National Institutes of Health have often enabled us to live longer, better, more healthful lives.
These are exciting times at NIH. We are on the cusp of numerous scientific discoveries. What
we are learning from the human genome project is truly breathtaking.
NIH is the steward of medical and behavioral research for the nation. Its mission is
science in pursuit of fundamental knowledge about the nature and behavior of living systems,
and the application of that knowledge to extend healthy life and reduce the burdens of illness and disability. It is well documented that investment at NIH pays real dividends, not only for the
health of our citizens but for the strength of our economy. NIH is a unique and prominent
agency, the major source of research intended to protect the nation’s health, stimulate the
economy with high-tech job creation across the country, make discoveries that fuel the biotech
and pharmaceutical industries, and train biomedical scientists for the future.
However, NIH has been flat-funded in recent years, which has produced a 17 percent loss
of “buying power” since 2003. There has been a sharp fall in the success rates for grant
applicants, now as low as 10 percent for many NIH Institutes. Alternative sources of research
support from industry, universities, and philanthropy are also under severe stress because of the
current economic downturn. It has also suffered from some instances of people putting politics
America has been an innovation leader, and part of its edge in the areas of biotech is
attributed to NIH. Countries around the world are trying to cut into that edge. I will work to
strengthen NIH, with leadership that focuses on the dual objectives of addressing the health care challenges of our people and maintaining America’s economic edge through innovation.
Administration on Aging and Administration for Children and Families
As we address these fundamental science questions, we cannot lose sight of the struggles
families are facing to make ends meet. A growing challenge for many families is long-term care.
The group most likely to need long-term care, those 85 and older, will increase from 5 million in
2006 to 21 million by 2050, creating a generation of Americans who are caring for both their
parents and their children. The average out-of-pocket costs facing family caregivers are $5,500
per year. Addressing the long-term care needs of our rapidly aging population will not be a simple undertaking, but it is doable.
The Administration on Aging plays a lead role in promoting home- and community-based
long-term care, including initiatives related to state systems of care, targeting services to those at risk for institutional placement, and much, much more. The growing challenge of long-term care
needs calls upon all of us to strengthen the institutions in our communities that support family
The Administration for Children and Families will also play a role in improving the
health and economic security of Americans. As we face a recession, its impact on the most
vulnerable amongst us – our children and low-income families – will be acute. I am reminded
that it was a very difficult New Year’s for too many of our fellow Americans. That is why as the
country moves through this recession, I am committed to ensuring ACF is working arm in arm
with states and localities to address the needs of our families. It can help with child care, foster
care, and supporting those struggling to simply pay the bills for their energy costs through the
In addition, many of the core services provided at ACF offer direct economic relief to
struggling families and communities. ACF helps low-income workers enter and move up in the
job market, promotes fatherhood and strengthens child support enforcement, strengthens
communities, and assists in reducing poverty.
HHS plays a vital role in early learning and development through the child care block
grant and Head Start as well as Early Head Start. We must recognize that in these tough
economic times, those programs will see an increase in demand as well. We know how
important investments are in this area; some studies show way dollar invested in high quality
care at these ages yields $7 dollars in reduced government spending down the road. Ensuring
our children’s proper emotional, social and cognitive development is one of the greatest
responsibilities of the Department, and I look forward to strengthening the important initiatives
that are critical to our future as a nation.
The challenges facing our country and the priorities of the Department are great --
beginning with the need to reform the system.
When health care reform collapsed in 1994, I remember all the criticisms people had after
the fact. They said it took too long, they said the process was too opaque, they said the plan was too hard to understand, and they said the changes felt too dramatic.
These are good arguments for undertaking reform in a way that is aggressive, open, and
responsive to Americans’ concerns. They are not good arguments for ignoring the problem.
One of my favorite quotes is from Nelson Mandela. Referring to apartheid, he once said,
"Some things seem impossible, until they are done." He could have been talking about health
reform because, for generations now, it has seemed an impossible goal. But this time the cost of
failure is simply too high. This time, working together, Democrats and Republicans it no longer
has to be impossible. This time, it can be done.