Health in an Obama world — what we know so far

We know the name of the 44th President of the United States: Barack Obama. As the next President’s supporter Oprah Winfrey is known to ask, "What do you know for sure?" When it comes to health, there are a few things we know about a President Obama.

First and foremost, addressing challenges in U.S. health care will require a multi-pronged strategy which brings stakeholders together. The key health-aches to address will be:

  • Covering the uninsured
  • Stemming rising health care costs
  • Wiring the health information infrastructure and getting electronic health records into medical practice
  • Funding what works, and de-funding what doesn’t
  • Ensuring an innovative health discovery and commercialization environment.

This is not a one-man job, and Senator Obama knows that. He has surrounded himself with a cadre of experts who understand these Big Hairy Health Issues and are on the forefront of solutions. He has, thus far, made smart choices in his campaign staff and advisers. This is the concept known as "judgement."

Some of the names mentioned to head up health cabinet and key office posts are very sound. To head the Centers for Medicare and Medicaid Services, Peter Orszag of the Congressional Budget Office has been talking passionately about health care and the Medicare Trust Fund for several years. Read his approach to health care costs here in Health Populi as the CBO dissected health care costs.

In addition, the Obama team has worked with David Cutler of Harvard, a health economist who writes papers with Dr. Mark McClellan, and author of the 2003 seminal paper, "Why Have Americans Become More Obese?" which tied together health with the food industry, calorie consumption, and time required to prepare meals; and, Dan Mendelson of Avalere Health, a well-respected beltway consulting firm deep into health care.

There are several interesting contenders to lead the Department of Health and Human Services, including Howard Dean, the head of the Democratic National Committee, former governor of Vermont, and a physician; Tom Daschle, the former Senate Majority leader wrote Critical: What We Can Do About the Health Care Crisis, and a supporter of universal health plans; Kansas Gov. Kathleen Sebelius, who has actively reformed insurance in her state; and, Massachusetts Gov. Deval Patrick, who understands the life science industry and universal health coverage.

Health and safety are key issues for the next President to address, and the FDA needs to get smarter about its role in ensuring safe Food and Drugs. Some of the names mentioned for FDA Commissioner are more controversial than those rumored for the other senior health posts. One is Steve Nissen of the Cleveland Clinic, who has been involved with clinical trials and very visible recently with drug safety and recalls and one of TIME Magazine’s most influential people in 2007.

In addition, several advisers to Obama on FDA issues have been Harvard professor David Blumenthal who has helped shape Obama’s health plans and is part of the Kennedy health camp; Robert Califf of Duke Medicine, who has worked on FDA reorganization plans; Dora Hughes, an MD/MPH and advisor to both Kennedy and Obama on health issues; Bruce Psaty of the University of Washington, who is health safety guru; and, Susan Wood from George Washington University, who left the FDA when the Agency failed to move the morning-after pill to over-the-counter status and now researches environmental and occupational health.

Jane’s Hot Points: While the economy may preclude accomplishing major reforms for the first two years of an Obama presidency, some major issues can be tackled and planned-for. We’ve missed sound longer-term planning in these agencies, and in the larger health reform discussion. In particular, wrestling with Medicare’s financial sustainability will be crucial as we lurch toward the expected implosion of the Medicare Trust Fund in 2017. Peter Orszag’s visibility in health cost speech-making have placed him in a central expert role for dealing with this.

The health economists have a big role to play in sorting out how to pay for performance and migrate the U.S. toward evidence-based medicine and payment. Getting primary care into its rightful place at the nexus of the citizen and the health system will be part of a larger move toward managing costs and optimizing health outcomes.

In this statement in the October 9, 2008, issue of the New England Journal of Medicine, Modern Health Care for All Americans, Obama sets out his health priorities. He says:

"My health care plan has three central tenets. First, all Americans should have access to the benefits of modern medicine. Once and for all, we must ensure that this great country lives up to its ideals and ensures all Americans access to high-quality, affordable health care. Second, we must eliminate the waste that plagues our medical system — layers of bureaucracy that serve no purpose, duplicative tests and procedures that are performed because the right information is not readily available, and doctors providing unnecessary care for fear of being sued. Third, we need a public health infrastructure that works with our medical system to prevent disease and improve health."

Godspeed, Mr. President.

8 replies »

  1. It is important that the person who runs CMS has operational knowledge about the Medicare and Medicaid programs, and how they pay for care. It is bewilderingly complex, not to mention political, and simply having a macroeconomic understanding of the need for entitlement reform does not equip someone to manage this agency.

  2. I hope many think can change now…
    Very good post. Same sheryl say :
    A good compromise might be to work on enrolling those that are eligible for public programs but haven’t already done so.

  3. It will be interesting to see what proposed solution Obama’s team will implement. I believe that the major issues stem from the fragmented health care system, growing U.S. population, and inflated health care prices that arise from the demand for new technologies and HMO’s private interests.
    What needs to be funded is primary/preventative care so to reduce future health expenses. From an individual’s perspective, everyone physically able should establish good long-term health habits (diet and exercise) so reduce the likeliness of chronic conditions (http://publichealthbugle.com/?p=38).
    Also, the private stakeholders in the health care field (insurance companies) are not going out of business anytime soon. So to implement an immediate national health reform will be difficult if these private companies are not involved. So, my suggestion is to mandate states to develop their own health reform initiatives. The advantage: 1) state governments are working with smaller populations vs. the entire US population 2) each region/state has its own health disparities that might not be a major concern in other states; thus funding can be efficiently spent towards major health concerns.

  4. I see all this group mostly as a bunch of co-opted centrists who’ll do little on health care–and I still cannot get over Cutler’s influence in the campaign on this topic. I sincerely hope that I’m proved wrong, but I think that Obama’s modest proposal will be whittled down to very little in the next Congress.
    The only exception is Orszag–who’d be a great choice to run CMS. But even he is overly concerned about the costs of Medicare & Medicaid — although for the right reasons — and doesn’t seem to believe in expanding them, which in the end is the key to cost control (Universal coverage is a necessary pre-condition for reasons of economics 101–as I’ve said many times–because it removes the ability of the industry to trade increased cost for a slightly reduced customer base).

  5. So far, I read only summaries of Obama’s plans. I did not dig any deeper because I did not want to get excited about a presidential contender who may not get elected or who may desert his election agenda.
    Having said that, I think that (team) Obama’s statement is excellent. He does seem to have a realistic understanding of our health care mess – I am particularly delighted about his intent to strengthen primary care and to consider tort reform, the latter – despite being on most doctor’s minds – still is a stepchild of health economics/public health.
    I encourage everyone to read the short NEJM article and very much hope that Pres. Obama will be able to act accordingly, despite resistance from Congress and interest groups which is to be expected as soon as the status quo is touched. Despite the dire economic situation, there is a lot of waste and wasteful reimbursement in medicare that can be used for Obama’s goals.

  6. Good post, but please, not Howard Dean!! Both HHS and FDA have been beaten up badly during the Bush administration – particularly the FDA, whom an employee friend of mine says has been more politicized than this employee has seen in his/her 20+ year employment. These agencies need people like Obama himself – measured, cerebral and of sound judgement. Being a physician does not automatically confer these qualities, I’m afraid, and Dr. Dean is one example.

  7. I don’t think we can overemphasize the importance of carrying things out in the right order. Insuring all citizens simply cannot be the first priority because we don’t have the primary care infrastructure to support it. A good compromise might be to work on enrolling those that are eligible for public programs but haven’t already done so.
    We can jumpstart the primary care rebuild by integrating more nurse practitioners in the primary care physician group model. Maybe the government could offer practices 0% financing to fund the start up costs that go along with bringing on a new provider.

  8. One name I would add is John Podesta as he is heading up Obama’s transition team. Not only was he Clinton’s former White House chief of staff but he is also the head of the Center for American Progress. He formed CAP five years ago with some other former top aides to President Clinton to counter some of the other think tanks in Washington. (Podesta confirmed today that he will return to CAP once Obama is in office.)
    A year ago CAP along with IOM contracted with 60 author’s for their newly released book “The Healthcare Delivery System – Blueprint for Reform” that focuses on how to fix the delivery system and lays out some of the agenda in its 125 pages.
    Sherry Reynolds