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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21 replies »

  1. 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 whole health care system devolves into the bureaucratic nightmares of the VA or indian health services systems of care.

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

  3. 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.

  4. 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 interests in health care. He would certainly bring a charge to the effort for universal coverage.

  5. 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.

  6. 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. initiatives. An HHS Secretary really should take lives into consideration when a president is thinkng of launching an attack. This one would have done so.
    I don’t know whether she has made an effort to put her name forward. Because I care about my own health along with the nation’s, I consider this a draft.
    Her is a bio, lifted from the web:
    CSP Senior Advisor for Health and Medicine
    Former U.S. Assistant Surgeon General
    Former Deputy Assistant Secretary for Women’s Health, U.S. Department of Health and Human Services
    Rear Admiral Susan J. Blumenthal, M.D., M.P.A. (ret) is the Senior Advisor for Health and Medicine at the Center for the Study of the Presidency, where she is leading the Center’s Agenda 2008 health care initiative. As a top government health leader with over 20 years of Federal service, Dr. Blumenthal was recently decorated with the Distinguished Service Medal of the U.S. Public Health Service, its highest honor, “for distinguished and pioneering leadership, groundbreaking contributions, and dedicated public service that has improved the health of women, our Nation, and the world.” Dr. Blumenthal served as Assistant Surgeon General of the United States, as the first ever Deputy Assistant Secretary of Women’s Health and as Senior Global Health Advisor in the U.S. Department of Health and Human Services. Dr. Blumenthal has also been a White House advisor on health issues, the top medical advisor to the U.S. Secretary of Agriculture and a research branch chief at the National Institutes of Health.
    Dr. Blumenthal has done pioneering work on women’s health, establishing many innovative initiatives including the National Centers of Excellence on Women’s Health, the National Women’s Health Information Center, and the “Missiles to Mammograms” program that transferred imaging technology used for space exploration and intelligence purposes to improve the early detection of breast cancer. Additionally, she has been an international leader in global health, the response to terrorism, emergency preparedness including pandemic flu, obesity, mental illness, AIDS, suicide, violence and disease prevention. She also fostered numerous international collaborations on health issues including establishing a Middle East Health Initiative and was the U.S. representative to the World Health Organization’s Global Commission on Women’s Health. Dr. Blumenthal has been at the forefront of applying technology to improve health, providing national leadership in digital medicine and telehealth as one of the first in the government to use the internet for health education, envisioning and establishing several award-winning health websites including 4woman.gov, safeyouth.org, nutrition.gov, globalhealth.gov, and 4collegewomen.org.
    Dr. Blumenthal serves as a Clinical Professor at Georgetown and Tufts Schools of Medicine, and as Distinguished Visiting Professor of Women’s Studies at Brandeis University. She has served as the Bundy Visiting Professor at the Mayo Clinic, as a Visiting Professor at Stanford University in Washington, and as a Fellow at Harvard University School of Government. Dr. Blumenthal began her career in the Federal government, serving for 12 years as a Branch Chief of major national research programs at the National Institutes of Health and was Chair of the NIH Health and Behavior Coordinating Committee. She has chaired numerous Federal committees as well as national and international conferences and commissions.
    As a leading advocate, policymaker, and national spokesperson on health, Dr. Blumenthal has briefed Heads of State and Health Ministers, testified before Congress, and often appeared as a medical expert on national television and radio news programs. Admiral Blumenthal has authored many scientific articles, edited books, and been the health columnist for U.S. News and World Report and several women’s magazines. She is currently the Chief Medical Advisor to a PBS Health Initiative and the Medical Director of a Discovery Channel/American Film Institute Global Health Film Series. She has served as Host and the Medical Director for an award-winning television series on health. Admiral Blumenthal serves on the Board of Directors of several philanthropic and educational institutions including Save the Children, the Academy of Achievement, Stanford University in Washington and the Meridian International Center. Dr. Blumenthal is the recipient of numerous awards, honorary doctorates, and the highest medals of the United States Public Health Service for her global leadership and landmark contributions to improving health.

  7. 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 tough to peal off any Republican Senators votes to a piece of major healthcare legislation. Any Republicans that do vote for it will likely play a large toll and frankly their just aren’t that many moderate Republican Senators left anymore.
    Still feel that the whole wildcard in this is Kennedy over the next 2 years. If he really does take a turn for the worse, I could see him making the passage of a universal health care coverage bill his last major hurrah (and arguably the last major act of the Kennedy political clan).

  8. 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!).

  9. 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 be a politician with a long and deep Washington resume. No matter how talented or personable, a Governor is going to struggle with the relationship part, the hard part of health reform. It is going to be one gigantic, messy deal making process, if it is to happen at all.

  10. 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.

  11. 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 as the Medical Director of Anthem and WellPoint. During his campaign against an incumbent Congressman this past spring, he ran on a platform of moving this nation to electronic health records. He has practiced in the emergency room of a major trauma center and he received his education at Stanford and Harvard Universities.

  12. 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.

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

  14. 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).

  15. To replace Daschle I would suggest a combination of Bill Frist who is an experienced MD and knows the legislative process and also New York City Health Commissioner Tom Frieden, MD who along with New York City Mayor Mike Bloomberg has done a terrific job 1) implementing an electronic health record system that for city docs that focuses on prevention 2) got the teen smoking rate down to 8.5% from 21% nationwide and helped 200,000 smoking adults or 20% of those smoking adults to quit smoking and has done other things to help with preventative care. Commissioner Frieden knows this article well:
    We Can Do Better — Improving the Health of the American People

  16. As a member of the Emory community, I know Ken Thorpe as a mover and a shaker in the area of public health with strong ties to the CDC (his office is literally next door to the CDC). He has Washington experience as Deputy Assistant Secretary for Health Policy during the early years of the Clinton administration, and has testified before Congress a number of times on public health issues. There is no stronger advocate for public health and preventative care than Thorpe.

  17. I have to admit, I’m glad to see some of these events transpire. This should be a wake up call for everyone. For 8 years, Republicans were portrayed as these evil creatures by a large portion of the media, as well as some lefties here. At the same time, Democrats were supposed to be the Answer. As we’re starting to see again, the Dems really are no more pure or free from hidden agendas or corruption than those on the other side of the aisle. In the end, they are all politicians.
    If we’re going to fix healthcare, it’s going to need to be a joint effort between the public and private sectors. Both bring important perspectives and authorities to the table. To suggest that either should do it alone is dangerous.

  18. Where I come from, we have a saying – if you go high enough to see everyones yard – they all have the same story. Sen Dachle is no different than what we have seen here and in the news – doctors, ceos, politicians all are violating the ethics and sometime rules.
    The very culture that creates innovation in America also creates these problems. Innovation requires risk taking and then people do the same in ethical/legal areas to push the envelop. I am not sure if he was the best candidate but I hope we find the right candidate.
    And that also leads to the next comment. I am not sure why should doctors be only qualified. We all know that healthcare system is the worst managed system and I also bet majority of them are doctors.
    This is not to say that doctors can not be great managers but it is equally silly to push for medical professional and expect against the statistical result that the result will be any different. Here is a story…last year, I saw all the stat from a hospital about quality-both clinical and process. I approached the cmo and asked if he would mind spending sometime to discuss and see what we might be able to do to achieve his objective. He said “We have no problem” :-).
    We need external to medicine people look into healthcare issues – mostly the consumer side should lead
    ravi the healthcare consultant

  19. Tom Daschle is neither competent nor honest, and I think he would have failed as a health insurance policy maker and as an administrator.
    That he wrote a book that has been panned by people who know health insurance and took the HHS and WH jobs knowing that his tax troubles would make his confirmation problematic testifies to his integrity.
    He just wanted a tax-free limo and driver.
    So I question the intellectual integrity and judgment of all the politicians, including President Obama, who have sung Daschle’s praises in recent days. Bet they wish they could do a redo.