Daschle out at HHS – Sharfstein in at FDA?

Oie_090203_daschle_634The early stages of the Obama administration are beginning to
resemble the Clinton years, which I 
observed from afar (I was a foreign
correspondent in Tokyo at the time). Take Zoe Baird and substitute Tom
Daschle, who dropped out of the running for Secretary of Health and
Human Services today because of tax and conflict-of-interest problems.
Take gays in the military and substitute putting in charge of the bank
bailout a man (Tim Geithner) who knows all the bankers from his years
at the New York Fed, seems overly solicitous to their needs, and has
his own tax problems.

Once again, a new Democratic president appears to have a semi-automatic weapon semi-permanently aimed at his foot.

No doubt the New York Times editorial this morning, which
came down on hard on Daschle's financial ties to health-related trade
groups and firms, weighed
heavily on the nominee's mind. In my view, this was not a tax issue, no
matter how the press reports it. He had a structural conflict of
interest that would have made it very difficult for him to do his job,
at least in the first year, and he must have realized that any effort
to pursue serious health care reform this year would run into
allegations that his financial relationships influenced the
administration's decisions.

Daschle and Geither are both fine public servants and would have (in
Daschle's case) and will do (in Geithner's case) a decent job. But it's
hard not to think that President Obama's infatuation with insiders and
high-tone resumes is leading him to eschew what voters really were
looking for last November — a breath of fresh air in Washington.

He has a chance to rectify that situation in his search for a new
Food and Drug Administration commissioner. Dr. Joshua Sharfstein, it is
now rumored, is the frontrunner for the post. He's young; he's smart
(from Harvard Med); he knows the agency from his years working for Rep.
Henry Waxman on Capitol Hill and serving as director of the FDA
transition team; and, most significantly, he left Washington two years
ago to take on a big city health department in one of the nation's most
troubled cities — Baltimore. Unlike so many of the academics
frequently mentioned as frontrunners for the post, he at least has a
taste of major administrative experience.

Finally, unlike several other top candidates, he has never done any
work for the pharmaceutical industry. One of the big debates in recent
years as consumer advocates pushed to eliminate conflicts of interest
on FDA advisory committees was whether the agency could find top-notch
talent to fill those rosters if they eliminated everyone who worked for
Big Pharma. The consumer groups argued that the agency would have to
look a little harder, but the independent experts were out there.

Now that the salmonella-tainted peanut crisis has gotten the
president's attention and made it more likely the new FDA pick will
come sooner rather than later, Obama is lucky that he doesn't have to
look far to find a top talent without ties to the industry. He's just
45 miles up the road in Baltimore.

(It's interesting how the Daschle situation is shining a
"conflict-of-interest" spotlight on the FDA decision; read this
interesting post by Dan Carlat,
where he disqualifies all the prominently mentioned candidates except
Sharfstein and Susan Wood of George Washington Univresity because of
the others' ties to industry.)

Meanwhile, who will get the nod for HHS? My guess is one of the two
Harvard health care economists who ran Obama's health care advisory
board during the campaign: David Cutler or David Blumenthal. Both have
their strengths and weaknesses: Cutler knows economics, but, in my
view, has been overly solicitous to the idea that most new technologies
are a good buy for the health care system. Blumenthal understands
health care delivery systems better, and began his career conducting
research and raising questions about conflicts of interest in medicine.
But he's farther removed from the inside-the-Beltway savvy needed to
push the health care reform agenda.

A dark horse? Ken Thorpe of Emory University. He has emerged as the
leading advocate of bringing a prevention focus to health care reform
and understands the need for better managing of chronic disease, which
is concentrated among 20 percent of the population but accounts for 75
percent of all health care costs.

He's not like Donna Shalala, though, who also left academia to
become HHS secretary. She ran the University of Wisconsin for a decade
before spending a year in Washington at the Children's Defense fund;
she remained as head of HHS during both Clinton terms — the only
cabinet official to do so.

Thorpe has been instrumental in pushing health care delivery system
reform efforts around the country. He has strong, progressive views on
the ways that income inequality, the built environment, food policy and
public health interventions influence the overall health of the
population. He would truly be a breath of fresh air in Washington. But
he has virtually no administative experience, which matters when it
comes to managing the sprawling HHS bureaucracy. Appointing Thorpe
would be a risk, but given the way Obama has so far expended zero
politlcal capital in that direction, it would be one worth taking after
the Daschle fiasco.

Merrill Goozner has been writing about economics and health care for many years. The former
chief economics correspondent for the Chicago Tribune, Merrill has
written for a long list of publications including the New York Times,
The American Prospect and The Washington Post. His most recent book,
"The $800 Million Dollar Pill – The Truth Behind the Cost of New Drugs
" (University of California Press, 2004) has won acclaim from critics
for its treatment of the issues facing the health care system and the
pharmaceutical industry in particular. You can read more pieces by Merrill at  Gooznews.com, where this post first appeared.

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lexrexRobert Carl ParisienA. SpolarichCharles Pollack, M.D.Ali Thomas, MD Recent comment authors
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you all are horribly mistaken if you think an answer to the problem is going to come out of washington, dc and the hhs secretary. the government should be a part of the solution, only because it is currently a part of the problem. but more government intervention is not what we ought to be seeking. let’s hope that, at worst, the hhs sec and the federal government do absolutely nothing on health care reform. and at best, let’s hope that the government slowly backs away from it’s current interventions and allows the private sector to handle it, lest our… Read more »

Robert Carl Parisien
Robert Carl Parisien

Dr Robert Carl Parisien says: How can Dashle not know the impact of filing his taxes? Personally I like Howard Dean for the post.

A. Spolarich
A. Spolarich

Rumor has it that Margaret Hamburg, MD, may be in the running to become the nominee as FDA Commissioner. She, in my opinion, could be the DHHS Secretary with her credentials. Having said that, I would be proud and pleased to see her as the new FDA Commissioner. She could have an amazing impact in turning that place around. On another note, there is some discussion about John Podesta being the DHHS nominee for Secretary.

Charles Pollack, M.D.
Charles Pollack, M.D.

Why isn’t Howard Dean more talked about as a candidate for HHS Secretary? He’s been a practicing physician – his wife still is – and a governor who improved health care in his state. He has also spent many months as DNC chairman working with important officials in every state. Is he too difficult to work with? He doesn’t come across these days as the almost-hysterical partisan of 2004. Does he have tax or other problems? He can still galvanize an audience and he has the energy, intelligence and sense of humor to go head to head with the vested… Read more »

Ali Thomas, MD
Ali Thomas, MD

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 our collective understanding of 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.

Cynthia Erville
Cynthia Erville

Rear Admiral Susan Blumenthal for HHS Secretary Whether healthcare reform actually bring about more health is dependent on much more than access to care. We need an enlightened individual who cares not only about early detection of disease, but who will also make an effort to acknowledge and block environmental factors which promote disease. Admiral Susan Blumental is our best shot. It is of vast importance whom she would name to head the FDA, the CDC, and the NIH. Her experience in Global Health would be an asset when working with others on the Cabinet, such as on State Dept.… Read more »


Plenty of good alternative candidates mentioned but you have to figure that if there was going to be a major healthcare bill that gets passed to Congress in the next 2 years, the major hurdle is going to be the Senate for the simple fact that the Democrats don’t have the 60 votes needed to override plenty of procedural rules that McConnell could use to bury any legislation. Daschle obviously has a pretty good familiarity with the players in the Senate and that would have likely counted for something. My bet is that McConnell is going to make it really… Read more »

Matthew Holt

I guess my odds went back under 50/50. And that’s no bad thing as the minimalist Mass type plan daschle/baucus et al were pushing will not fix the uninsured problem which is the precursor for fixing the whole thing. (I know tcoyote, bklepper and others disagree, but not enough space here to tell them whey they’re wrong!).


The tragedy here is that Daschle had the political gravitas and relationship capital to manage the politics of health reform. And unlike virtually anyone who rose as far as Daschle had in Congress, he had invested the time to acquire both domain knowledge and a point of view on key health reform issues. It was the leaching away of Daschle’s gravitas and credibility that rendered his appointment nonviable. It isn’t domain knowledge that is critical to managing the reform process, but the political judgment that was so poignantly lacking in the Clinton effort. The new HHS Secretary almost has to… Read more »


Another knowledgeable person for HHS is Janet Corrigan, President of the National Quality Forum. She knows the issues, has the vision, and knows her way around Washington.


There are several excellent candidates for whom Obama can choose to replace Daschle. I would suggest another candidate, Woodrow Myers, Jr., M.D., M.B.A. to add to the short list already suggested. His resume includes tenure as the New York City Health Commissioner as well as the Indiana State Health Commissioner. He has testified before Congress on public health issues as a leading educator and advocate for children/people with AIDS. He has been responsible for the healthcare of workers in more than 11 countries as the Medical Director for the Ford Motor Corporation. He has profound knowledge of the insurance industry… Read more »


Cutler, Blumenthal, and Thorpe all seem like the wrong direction. The genius of Daschle was that he could navigate and negotiate health care reform in the treacherous Beltway waters where so many have perished before. Putting an outsider or a wonk (or both) in charge of moving health care reform creates a much higher liklihood of repeating the mistakes of the past.


I am glad Daschle backed out of his nomination. He should of been fired for not paying his taxes, and gone to prison.


My bet is that with Daschle’s name being removed from the HHS nod, any chance of a significant healthcare bill getting real daylight in Congress this year is near 0%. Just too many issues that take greater precedent right now on the domestic front (e.g., a wholesale change in regulation/oversight of the finance system over the next 12-18 months) and on the foreign policy side (e.g, situation in Afghanistan that is likely to escalate further with more incursions into Pakistan and become further strained once the Taliban begins offensive operations with the end of winter in 2 months).

Dr. Rick Lippin

Howard Dean for HHS
Rick Lippin