Sebelius, DeParle will have their work cut out for them
posted 3-2-2008 7:46 p.m.

 br>The Obama Administration today announced the nominations of its top two health care officials. In appointing two different people for those positions, the administration wisely reversed itself. Each of the nominees will have more than enough to do, once they are approved.

Earlier today, Kansas Gov. Kathleen Sebelius(D) accepted the nomination for Secretary of Health and Human Services, replacing former senator Thomas A. Daschle, who withdrew from consideration last month after his tax problems and position as a lobbyist complicated matters for the Obama Administration. Also, Nancy-Ann DeParle was named director of the White House Office for Health Reform. DeParle headed the Health Care Financing Administration, which oversaw Medicare and Medicaid, during the Clinton Administration. She was also a Clinton era health care adviser at HHS and at the White House Office of Management and Budget.

Previously, Mr. Daschle had successfully negotiated to hold both positions, a concept some thought a bad idea because of the sheer amount of work that would be involved. I objected for other reasons. First, the position of HHS Secretary is essentially administrative: someone has to make sure the agencies and departments run well. Second, being the point person for health care reform is in itself a full-time job. It helps to know how HHS runs, but HHS itself won't be the primary focus of the health reform czar (or in this case, czarina): fixing the financing and delivery systems will. Third, health care reform will take a long time -- perhaps as long as 10 to 15 years -- but once the direction has been set firmly in motion and both the financing and delivery systems begin to show significant results, the health care reform director's position isn't really a permanent one. It's not like being the chairman of the Council of Economic Advisors: a president will always need the latter. If the director of health care reform does her job well, she will eventually eliminate her own position.

I was, perhaps, one of the very few progressive analysts who was relieved by Tom Daschle's withdrawal mainly for health policy reasons. I admire much of what Mr. Daschle has accomplished over the years, and he certainly does understand how much of the system works, but I cringed at his notion of creating yet more federal bureaucracy to accomplish ongoing health care reform. That's unnecessary. Much can be accomplished by delegating work to existing agencies within HHS and creating a committee or commission or two within HHS to accomplish the rest. While Mr. Daschle was still the HHS nominee, there was every indication that his own ideas would hold sway and that President Obama would likely defer to many of them. This no longer appears to be the case, thank heavens. Of course, now I worry that the president will defer too much to Sen. Ted Kennedy, but that's a different conversation.

Gov. Sebelius's previous position as state insurance commissioner will serve her well. She certainly knows the problems consumers have with health insurers and while commissioner opposed the financial rationing of care by health plans and premature hospital discharges. However, during her two terms as governor, Sebelius was unsuccessful in pushing for significant improvements in health coverage or costs. In this, she is not unique among governors. Still, she's reportedly a wonk on health policy, not unlike Secretary of State Hillary Clinton, and at least has a realistic idea of what she's up against on health policy issues.

DeParle, meanwhile, has been out of government for a while. She was Tennessee commissioner of human services during the late 1980s. After her stint in the Clinton Administration, DeParle went private. Currently, she is a managing partner with the private equity firm CCMP Capital Advisors LLC and is on the boards of Cerner, Medco Health Solutions and Boston Scientific, two of which are medical technology companies and one of which manages pharmacy programs. On one hand, this is less of an obstacle because DeParle isn't being nominated to the cabinet; on the other hand, she'll still have to resign all those positions and is expected to recuse herself from matters that would directly affect any of these firms in a significant way.

Nevertheless, having been head of HCFA, DeParle should certainly understand the problems facing Medicare and Medicaid in detail. Her experience at OMB will have given her perspective on how health care costs play out in the federal budget, which means she should be able to anticipate and work around, if not refute, some of the objections others will no doubt raise about attempting costly reform mechanisms.

I haven't seen anything yet regarding what reform position, if any, DeParle has favored in the past -- employer mandate, individual mandate, some combination of the two, or some version of national health insurance, with or without single payor -- but I wish I knew. There are some in Congress, including Sen. Kennedy, Sen. Max Baucus, Rep. Henry Waxman, and others, who have their own ideas about what health care reform should include, and no doubt they're already pushing behind the scenes to influence which way the president leans. It would certainly help to know which way DeParle leans -- and whether or not she can push back gently but firmly against both Congressional forces and people like Rahm Emanuel and his recently nearly as visible brother, Ezekiel Emanuel (yet another newbie theorist who's written his own manifesto on health care reform; trust me, it's a yawn, though I'm sure his brothers don't think so).

It also remains to be seen how much public support the president will give DeParle as his point person on this issue. Let's hope it's enough to keep her independent and open minded, looking for mechanisms that actually work rather than following anyone's party line. That would be refreshing.

It's also refreshing to see two smart, powerful women named to these positions. It signals the president's continuing effort to get good people who also reflect the nation as a whole. About time.