Tuesday, February 3, 2009

The road to health reform gets bumpier and bumpier ...

A few minutes ago, the White House announced that Tom Daschle withdrew his name from nomination for Secretary of the Department of Health and Human Services. Faced with increasing Senate opposition over his failure to pay over $100,000 in back taxes, Daschle apparently concluded that he had no choice but to pull his name.

Daschle's withdrawal puts a big bump in the road to health reform.

With no obvious runner up, there likely will be weeks of delay in identifying, vetting, nominating, and confirming the next Secretary of HHS. In the meantime, HHS will be rudderless.

Rudderless at a time when HHS may soon have to figure out how to distribute tens of billions of dollars for health care and information technology included in the economic stimulus bill.

Rudderless at a time when the agency is required to conduct a policy review of regulations inherited from the Bush administration.

Appointments to other key agencies that fall under HHS, including the Administrator of the Centers for Medicare and Medicaid Services, will remain unfilled as long as the secretary position is vacant.

President Obama also loses his right hand man on health care reform. Daschle had been hand-picked by the president to spearhead the administration's health reform initiative, to the point of being given an office in the White House. But this role too is now gone. "I will not be the architect of America's health-care reform, but I remain one of its most fervent supporters," Daschle said in announcing his withdrawal.

Daschle's views on health care reform - in particular his support for primary care - provided a window into President Obama's health reform priorities. Now, this window is closed.

Daschle's withdrawal is hardly fatal to the President's efforts to reform health care. After all, we are only two weeks into the Obama administration, and there is time to get things right and get health care reform back on track.

But there also can be no denying that Daschle's departure is a setback for the new President and for his hopes to reform health care.

Today's questions: What kind of person do you think President Obama should be looking for to run HHS and carry out his vision for health care reform?


Steve Lucas said...

Sadly, the best person to run health care reform does not exist. There is a need for a person with a grasp of the big picture, the experience running a large organization, but without the political baggage that comes with that experience.

We can see from this experience, the revolving door in Washington, makes it very difficult to find someone without a personal agenda or has been influenced by outside sources. Add to that the need to cut medical spending in the US in half and you will find it difficult to fill this position. My wife dealt with some great people in the Bush administration, as well as the Clinton administration, the problem was the political pressure they felt was intolerable and often did nothing to enhance the program they were trying to run.

Steve Lucas

Hal Dall, MD said...

John Kitzhaber, who led the development of the Oregon Health Plan later derailed by HHS. OHP used an open, consensus-based and public process to implement explicit rationing so as to control costs while expanding the population covered. No national health plan will be viable without limits, we must choose if those limits will be determined openly or if we expand covert rationing by bureaucrats and insurance companies. Unfortunately, the need for this politically prohibits Dr. Kitzhaber's selection.

AliMT,MD said...

On a related topic, the White House Office for Health Care Reform is also rudderless. I would suggest one of these three luminaries from the non-profit world, each of whom has helped steward health care reform during an era of complacency:

1. Karen Davis, PhD. President of the Commonwealth Fund.
2. Drew Altman, PhD. President & CEO of the Kaiser Family Foundation.
3. Risa Lavizzo-Mourey, MD, MBA. President & CEO of the Robert Wood Johnson Foundation.

Ali Thomas, MD