But these days it often seems as if Mr. Daschle never left the picture. With unrivaled ties on both ends of Pennsylvania Avenue, he talks constantly with top White House advisers, many of whom previously worked for him.
He still speaks frequently to the president, who met with him as recently as Friday morning in the Oval Office. And he remains a highly paid policy adviser to hospital, drug, pharmaceutical and other health care industry clients of Alston & Bird, the law and lobbying firm.
Now the White House and Senate Democratic leaders appear to be moving toward a blueprint for overhauling the health system, centered on nonprofit insurance cooperatives, that Mr. Daschle began promoting two months ago as a politically feasible alternative to a more muscular government-run insurance plan.
It is an idea that happens to dovetail with the interests of many Alston & Bird clients, like the insurance giant UnitedHealth and the Tennessee Hospital Association. And it is drawing angry cries of accommodation from more liberal House Democrats bent on including a public insurance plan.
Friends and associates of Mr. Daschle say the interests of Alston & Bird’s clients have no influence on his views. They say he sees no conflict in advising private clients on the one hand and advising the White House on the other, because he offers the same assessment to everyone: Though he has often said that he favors a government-run insurance option, the Senate will not pass it.
“The message I deliver to labor unions and business leaders is the same one I share with doctors, hospitals and insurance companies,” Mr. Daschle wrote in a brief e-mailed statement. “I do not tailor my views to any specific group or client.”
Mr. Daschle is not registered as a lobbyist and recently told U.S. News and World Report that he preferred to describe himself as a “resource” to those in government and industry.
“I’d like to be a resource to my former colleagues, to the extent that I can, to the administration, to the stakeholders and to people interested in just kind of knowing how this is all going to play out,” he said. “I am most comfortable with the word resource.”
White House officials say they appreciate his help. “He is one of a number of people that provides outside advice to the White House, and the president greatly appreciates that advice and Tom’s friendship,” said Dan Pfeiffer, a spokesman for the White House who previously worked for Mr. Daschle. Mr. Pfeiffer added that the former senator was “a recognized expert on health reform who knows more about the legislative process than just about anyone.”
Critics, though, say his ex officio role gives Alston & Bird’s health care clients privileged insights into the policy process. They say Mr. Daschle’s multiple advisory roles illustrate the kind of coziness with the lobbying world that Mr. Obama vowed to end. If he had been confirmed as health secretary, Mr. Daschle would have been subject to strict transparency and ethics rules.
His position, some liberals say, raises at least an appearance of a conflict of interest. “I hope the president can make a decision based on what the country wants, not what a handful of Daschle’s clients want,” said Representative Lynn Woolsey of California, a leader of the progressive caucus.
Clients of Alston & Bird say Mr. Daschle advises them, sometimes indirectly through the firm’s registered lobbyists, about the personalities of his former colleagues, as well as strategies to achieve their policy goals.
“He would tell us, ‘Make sure you present the value proposition of home care with as great detail as you can, so Congress understands that home care is part of the solution rather than a cost to be cut,’ ” said William A. Dombi, a lawyer at the National Association for Home Care and Hospice.
Some of the health overhaul bills would make deep cuts in Medicare payments for home health services, but Mr. Daschle has instead argued for an increase. And though he does not lobby, he took that message to Capitol Hill last month, giving a paid speech at a meeting for Congressional staff convened by a group of home health care equipment concerns.
“My mother’s quality of life is a hundred times better given the fact that she can live at home rather than be institutionalized at 86,” Mr. Daschle told the audience, according to industry newsletters.
Representative Jason Altmire, a Pennsylvania Democrat who spoke alongside Mr. Daschle, praised the former senator but said it was inevitable that his dual roles would draw criticism, especially “given the high profile this president has given to trying to show some distance from the lobbying business.”
Mr. Altmire added, “That makes it even more difficult for him to be involved.”
Mr. Daschle does not shrink from his leading role in the debate. Speaking at a hospital industry conference last week, for example, he accepted billing as “the architect of President Obama’s health care plan.”
Before such industry groups, Mr. Daschle can sometimes cheer on their lobbying efforts, as he did at a meeting on Aug. 8 of chain drugstore executives when he urged them to push lawmakers to raise certain Medicaid reimbursements.
“This is a message that I hope each and every one of you will take to your member of Congress,” he said. “There is no more critical time to do that.”
He both recommends and predicts an incremental approach.
“We are not going to see this happen overnight,” Mr. Daschle told a biotechnology trade group in May. “It can’t. It is too big a shift in the economy.” If the legislation can begin to “ramp up” coverage for all, health information technology and some cost controls, he said, “we will have succeeded.”
He often enumerates what he considers areas of political momentum as well as points of disagreement, including the government insurance plan. “There is no consensus on whether there ought to be a public option,” he told the drugstore executives.
Last week he told the hospital executives, “There is virtually no support among Republican members for a public option, and that remains an unresolved element of this debate.”
Senate Democratic leaders have recently said they concur it is unlikely to pass.
Mr. Daschle’s friendship with the president goes back to Mr. Obama’s first days in the Senate. An early and important backer of Mr. Obama’s presidential campaign, Mr. Daschle also sent a steady stream of former aides to Mr. Obama’s Senate office and White House staff. Mr. Obama’s senior adviser Pete Rouse was Mr. Daschle’s chief of staff. Jeanne Lambrew, a top White House adviser on health care reform, was a co-author of Mr. Daschle’s 2008 book, “Critical: What We Can Do About the Healthcare Crisis.”
Mr. Daschle’s cabinet nomination was done in by the disclosure that he had failed to pay taxes on the use of a friend’s car and driver while making millions advising Alston & Bird’s clients. After he withdrew his nomination, he threw himself into preparing a bipartisan proposal for health care overhaul with two former Republican Senate leaders: Bob Dole, a colleague at Alston & Bird, and Howard H. Baker Jr., now at another law and lobbying firm. Their proposal, released in June, was among the first to spell out the idea of helping states establish health insurance “co-op plans with consumer boards.”
Senator Kent Conrad, Democrat of North Dakota and one of Mr. Daschle’s closest friends, began pitching the idea at about the same time and has become its champion. Mr. Conrad is among six members of the Senate Finance Committee working on their own compromise proposal that aides say looks increasingly like the Daschle-Dole-Baker report.
As a backstop, their plan provided that if state co-ops or other programs failed to meet certain cost and coverage goals in five years, the president could create a public plan on a fast track without threat of a Senate filibuster.
That feature, known as a trigger, was briefly acknowledged as another possible compromise by the White House chief of staff, Rahm Emanuel. Though it was little discussed, Senator Olympia J. Snowe, Republican of Maine and one of the Finance Committee’s group of six, has recently expressed support for the concept, and committee aides say the idea is under consideration.
To address doctors’ fears of lawsuits, Mr. Daschle and his collaborators proposed a “safe harbor” from legal liability for doctors who follow certain rules. Mr. Obama took up the idea in a mid-June speech to the American Medical Association.
After Mr. Daschle left the Oval Office on Friday, a White House spokesman described their meeting as a “quick check-in” on the overhaul process. The spokesman said the two “agreed to stay in touch over the coming weeks and months.”
