With Daschle Out, Should Obama De-Couple HHS from Health Care Reform?

Published February 03, 2009 @ 11:00AM PT

Yesterday, I wrote, "Or is this all the usual sturm and drang from Washington, where Daschle will be roughed up before being eventually confirmed as planned, again following the Geithner script? I tend to think it will ultimately be the last of these."

Boy, did I blow that one. In breaking news, Tom Daschle is withdrawing his nomination for HHS Secretary. Unknown at this point is whether he will also withdraw as Executive Director of the White House Office of Health Reform - a post which does not require Senate confirmation. But it's difficult to see how the political climate would be favorable to that unless the president were willing to soft-pedal health care for a few months before bringing Daschle back - something he's shown no indication of doing.

There's no question this is bad news. In his dual role, Daschle would have had an office in the West Wing, making him not only the first HHS Secretary with such an honor but giving the push for universal health care an office within walking distance of the Oval Office was a visual cue of how central health care was to this presidency. But it could be an opportunity. Normally, the HHS secretary is not the quarterback for health care reform - certainly Donna Shalala wasn't during the Clinton years. Tom Daschle may have been uniquely positioned to wear both hats, but if he's not an option, the two jobs shouldn't remain joined out of nostalgia.

After all, there are big tasks ahead for HHS independent of any push for health care reform. Daschle had talked at length about comprehensive analysis of cost-effectiveness for the treatments being reimbursed by Medicare and Medicaid - but that's going to be a fight requiring a strong leader at the top of the agency. We've discussed the possibility of Medicare experimenting with "episodes of care" reimbursement instead of traditional fee-for-service. The incoming HHS Secretary will also need to find a way to stop the bleeding on Medicare Part C (aka Medicare Advantage) and Medicare Part D's prescription drug program, with the "overpayments" and waste in those programs. Finally, if the Economic Recovery Act goes through as planned, we'll see a spike in the number of people on Medicaid through temporary eligibility extended to the unemployed. Over the coming months and years, this will be a tall order for any cabinet secretary, let alone one who is also trying to stage-manage what will doubtlessly be the biggest legislative fight of a generation.

There's also a question of timing. The selection, vetting, and pageantry of a new HHS Secretary pick is going to take a very long time - at least a month and a half, likely more. By then, the push for health care reform will already have begun in Congress. If there's one thing we don't want, it's an Executive Director of the White House Office of Health Reform playing catch-up with a process that's already underway. President Obama needs to appoint someone as his quarterback as soon as possible - even if it means de-coupling that role from HHS - if he wants to keep the White House as a player in the reform to follow.

But what do you think? One role or two? And who should President Obama tap to lead the charge on universal health care?

(Photo credit: shij13 on Flickr.)

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Comments (11)

With Daschle Out, Should Obama De-Couple HHS from Health Care Reform?

NO, you need to make this a proirity for the American people.

Posted by Michael Brabender on 02/03/2009 @ 11:15AM PT
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Our lost.

Posted by Sandra Battle on 02/03/2009 @ 11:40AM PT
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With Tom Daschle out, now is the time to name Howard Dean for HHS Secretary. He was great as the DNC chairman and the fifty state strategy and also as governor of Vermont, he was very progressive concerning healthcare. He would be more an advocate of universal healthcare than Daschle would have been. Universal healthcare is ultimate goal in my opinion.

Posted by pauly vachal on 02/03/2009 @ 11:56AM PT
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hmmm...now that you mention it, Dean would be a better choice.

Posted by Chris * on 02/03/2009 @ 12:29PM PT
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Katz Rule!

Posted by Chris * on 02/03/2009 @ 12:31PM PT
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Howard Dean. Yes, yes.

Posted by MIldred Templeton on 02/03/2009 @ 02:11PM PT
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My first thought to head Health and Human Services is Dennis Kucinich. Dean hadn't come to mind, but he'd be good too.

Posted by suzanne sparks on 02/03/2009 @ 03:36PM PT
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I want Dean for HHS Secretary and Daschle to quarterback universal health care. There is more than enough work for them both, they ought to be able to work together, and two high profile people working on the same task could be formidable.

Posted by Peter Reese on 02/03/2009 @ 06:52PM PT
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I thought Dennis Kucinich would be my dream too... I'm now glad I didn't finish Daschle's book. He wasn't on the same page as single payer supporters anyway.
Maybe this is the real chance to have a national health insurance.
Go HR676! I'm sick of hearing terrible stories about private health insurance companies.

Posted by Yuriko Lee on 02/03/2009 @ 08:05PM PT
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Yes to Howard Dean and Yes there can still be room for Tom..

We are looking at the best chance of using the best working formulas from all health care programs. Drawing them into medicare a little at a time might be the right way to go as us older folks are the biggest drain on medicare and we pay close to $100.00 per month. We can trim enough wasted money to insure children.

I feel terrible that Tom Daschel had to give in but if government employees don't pay their proper taxes it makes everything look upside
down and improper. He was and is a wonderful man and we needed him, hopefully the government can give him a great work from home for the health agency!

Once again the republicans show their dirty side, the uncaring for dying children, dying adults, it doesn't matter to them as long as there is a chance people will think all this humanity is coming from democrats.

- People Helping People -
http://www.kiva.org/app.php

Posted by sammyo41 Olson on 02/03/2009 @ 09:53PM PT
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I'm also a Howard Dean supporter for HHS and to drive the universal healthcare agenda. Aside from his being a physician, as governor he fought for and got healthcare for all children in Vermont. Also, as DNC chair he developed and successfully pursued the 50-state strategy which has led to majorities in both houses of congress. He's shown himself to be an effective administrator and a fighter who would be an awsome leader for what is likely to be a viscious battle to institute universal healthcare in the US.

Posted by Dan Fishman on 02/04/2009 @ 01:30PM PT
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Tim has been an online organizer and blogger on health care policy for the Obama for America campaign (during the primaries) and currently for the Committee of Interns and Residents/SEIU Healthcare, a labor union for intern and resident doctors. Views expressed here are Tim's, and don't represent the positions of CIR or SEIU.