The 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
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.