In choosing former Senator Tom Daschle to head the Health and Human Services department, President-elect Barack Obama sent a clear signal that he is serious about pursuing health care reform legislation in the new year. Whether it will be comprehensive reform or piecemeal improvements remains to be seen.

Daschle knows Capitol Hill and knows health care. He just wrote a book on the subject that called for federalization of the system under what amounts to a Federal Reserve Board for health. Clearly, he's not afraid of bold reforms.

But, just as importantly, he has the knowledge that will allow him to make his mark in the short run by instituting bold administrative changes at the agencies under his new command, especially the Center for Medicare and Medicaid Services. Changes in the government's two big health care programs, which account for half of all health care spending, can pave the way for changes throughout the system.

For instance, look for him to reinstitute programs like Medicare Health Support, which offered individualized chronic care management to beneficiaries with heart disease and diabetes, but was abruptly canceled by the Bush administration earlier this year. He may experiment with broader pay-for-performance rules for physicians, or tinker with the relative compensation system that pays radiologists and surgeons three times the salary of primary care physicians. Look for an exponential increase in pilot programs at HHS that could set the stage for broad-based reform.

Also look for him to bring University of Texas professor Jeanne Lambrew into his subcabinet. She was his co-author on "Critical;" served in the Clinton White House on health policy issues; and issued a far-reaching report last year for the Brookings Institution's Hamilton Project on how to reconfigure the nation's prevention programs. Dubbed the Wellness Trust, her idea was immediately translated into legislation and introduced by Sen. Hillary Clinton (see this GoozNews post).

On the campaign trail, Obama made prevention a cornerstone of his pledge to moderate the long-term growth in health care spending. The Daschle and Lambrew team have the knowledge and skills to put meat on those bones, even without an immediate push for comprehensive health care reform.

Earlier this week, Sen. Max Baucus of Montana released a comprehensive health care reform white paper, signaling that the chairman of the powerful Senate Finance wants to be a player in the health care reform debate. Ditto for Sen. Edward Kennedy, who, despite his illness, put in an appearance on the Hill this week to show that the Health Education Labor and Pensions committee won't be left behind.

That's also good news for Daschle and the rest of the Obama team. A vigorous debate on the Hill over comprehensive reform could put a damper on individual legislators' penchant for micro-managing changes in Medicare policies, which are almost always at the behest of one special interest or another (the oncologists; the durable equipment makers; Amgen; whatever). I've been watching these changes for over a decade now, and all they do is needlessly run up health care costs since they almost always involve paying for pills, technologies or procedures for which there is little or no medical evidence.

Daschle knows that game as well as anyone. As head of the agency that can deploy lobbyists on Capitol Hill, he will finally be in a position to put a stop to it -- if he wants to.