Kathleen Sebelius, Healthcare Reform and the Budget

Today, according to the Associated Press and Washington Post, President
Obama will announce 
Kathleen Sebelius as his nominee for Secretary of
Health and Human Services. She has a once in a lifetime opportunity to
execute healthcare reform – a popular President, a sense of urgency,
and enough resources to get the job done. What are these resources?

You'll find the Office of Management and Budget FY2010 Budget Overview Document online The full FY2010 Budget is expected to be released this Spring.

Highlights from the Healthcare portion of the overview document include:

A reserve fund of more than $630 billion over 10 years to finance
fundamental reform of our health care system, funded half by new
revenue and half by savings proposals that promote efficiency and
accountability, align incentives for quality, and encourage shared
responsibility. Examples of new revenue include a proposal that
individuals earning more than $85,000 pay higher premiums for their
Medicare drug coverage starting in 2011. Examples of savings include a
revision of payments to insurers that provide Medicare Advantage plans.
Those payments have been on average 14% higher than what the government
typically spends per beneficiary. Under the budget proposal, insurers
would be required to competitively bid to offer plans beginning in
2012, which the administration believes would lower per-patient outlays.

The Budget expands research comparing the effectiveness of medical
treatments. Building on the unprecedented $1.1 billion included in the
Recovery Act for comparative effectiveness research, the Administration
will continue efforts to produce state-of-the-science information on
what medical treatments work best for a given condition.

* The
Budget includes language to "Strengthen Program Integrity," noting that
reducing fraud, waste, and abuse is an important part of restraining
spending growth and providing health care quality service delivery to
beneficiaries. The Budget proposes to dedicate additional resources
that will initially be targeted to improving oversight and program
integrity activities for the Medicare Prescription Drug Program (Part
D), Medicare Advantage, and the Medicaid Program.

* The Budget
includes over $6 billion within the National Institutes of Health (NIH)
to support cancer research. This funding is central to the President's
sustained, multi-year plan to double cancer research. These resources
will be committed strategically to have the greatest impact on
developing innovative diagnostics, treatments and cures for cancer.
This initiative will build upon the unprecedented $10 billion provided
in the Recovery Act, which will support new NIH research in 2009 and

* The Budget includes $330 million to address the shortage
of health care providers in certain areas. The Budget's new resources
will sustain the expansion of the health care workforce funded in the
Recovery Act.

*The Budget includes continued efforts to
accelerate the adoption of Health Information Technology, building on
funding provided in the Recovery Act.

The combination of a
reserve fund to accelerate transformation/additional coverage,
comparative effectiveness data, enhanced operations, a strong NIH, and
appropriate numbers of primary care physicians is a powerful array of

As with any change process, she'll encounter
resistance from some stakeholders and will be distracted by the tyranny
of the urgent (naming a new head of the FDA to help address the recent
peanut butter salmonella contamination problem, a perceived failure of
our food safety systems). However, I am confident that government,
payers, providers, and patients all recognize that our current
healthcare system provides low quality/high cost (poor value) care
which reduces our ability to compete in world markets. The FY2010
budget summary reflects a serious amount of resources and a commitment
to change that is likely to move us forward.

Best of luck Kathleen and welcome to Washington!

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Fred JKeith GroetheHealth Care Management DegreePeterJBCollins Recent comment authors
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Fred J
Fred J

Before selling ourselves on the Canadian system, we probably ought to learn some lessons from them. Interesting prespective from a Canadian Ortho surgeon on how it affects patient care: “Without a private system, Canadian patients have nowhere to turn, which is why so many seek care in the United States. In fact, the United States is the private arm of the Canadian healthcare system.” “In his film “SiCKO,” Michael Moore contends that Canadian health care is free: This is absolutely not the case. Canadians pay out of their own pockets for about 30 percent of their health care for items—–such… Read more »

Keith Groethe
Keith Groethe

Dear Kathleen Sebelius, Having lived with the NHS in England for 25 years, I couldn’t find fault with the way I was treated. I was in a NHS hospital twice. It was fine but no private rooms. And I even liked the food. People in England take for granted that when they are young that they will have to help pay–and not unhappily–for health care for those who are in need, as long as when they’re older and are in need that the younger workers will do the same. The public health of a nation should be a shared responsibility–moneywise.… Read more »

Christopher George
Christopher George

As a practical matter, we can never afford to give every citizen every medical procedure. Plenty of European countries has state mandated healthcare, but it is radically different than ours. No legal liability. That alone would end a lot of over testing and overtreatment. No dialysis for people over 60 or so. Here, we have a Federal program which pays for all chronic renal failure treatment. No treatment at all for “hopeless cases”. No modern treatments or drugs for the unconnected. If they don’t think you are sick, they kick you out of the ER and tell you to see… Read more »

Health Care Management Degree

It sound like now is a great time for individuals who are interested in the healthcare management profession. Are you passionate about healthcare issues? Do you see yourself making a difference in a healthcare environment? As healthcare management careers and services diversify, demand for business professionals with an enhanced knowledge of healthcare management is expected to continue to grow. Many college student are electing to earn their Bachelor of Arts in Business Administration with a specialization in Healthcare Management. This curriculum is designed to give you a broad-based business perspective along with a concentration of knowledge in healthcare management. Whether… Read more »


Peter, how does Canada or any other state, province, sector etc account for income and population imbalances among different geographical areas? I see this as similar to school funding where within a state one can find big differences between different economic areas. I would not object to each state raising the level of coverage and services if desired, if they want to make their state pay for it and abide my a certain minimum standard of coverage. Tis is one of the problems I seem ot be reading about with NICED in Britain where there can be pretty vast differences… Read more »


“What I have NEVER understood is why health care is a state expense instead of a Federal expense.” PKinSFLA, I agree with your comments but want to add that I would rather have the states administer Federal healthcare goals and regulations AND have a state portion of funding. This seems to work well in Canada where the Feds fund the lions share through fed taxes, but the provinces administer the federal program with certain provincial considerations and also fund a much smaller portion. The federal government uses it’s health funding power to make sure the provinces are, in general, abiding… Read more »


I just want to clarify some of my comments so Republicans understad that I am not using a blanked indictment of them for health care problems. I differentiate the different levels of representation and how elected leaders and their respective parties address the issue. I happen to live in Florida where Gov Crist takes heatlh coverage for the uninsured far more seriously then many other Republicans I have seen. The economic slowdown seriously effects state budgets and eventually places the financial cost of their care on the state as private coverage is lost with job loss. Several Republican friends I… Read more »


“She was first elected to the Kansas House of Representatives in 1986. In 1994 she left the House to run for state insurance commissioner and stunned political forecasters by winning – the first time a Democrat had won in more than 10 years. She is credited with bringing the agency out from under the influence of the insurance industry.[citation needed] She refused to take campaign contributions from insurers and blocked the proposed merger of Blue Cross Blue Shield of Kansas, the state’s largest health insurer, with an Indiana-based company. The decision by Sebelius marked the first time the corporation had… Read more »


I hope Governor Sebelius will fight the insurance and drug lobbies and work for the rest of us! Martin Luther King said, “Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane.” Only a single-payer approach will end the inhumanity of our failed healthcare insurance system, where profits are more important than patients’ health. Only a single-payer approach will end the current disgraceful practice of insurance companies refusing to pay for medical treatment, denying claims, and engaging in rampant price gouging that discourages patients from going to the doctor and has resulted in 50 million… Read more »


Governor Sebelius is a great choice for HHS Secretary. She’s knowledgeable, respected, experienced, and about as bi-partisan as it gets. As the Democratic Governor of a deeply red state, Sebelius knows how to work with Republicans, and is respected by most from that party.


I am very hopefull over her nomination. In reading about her backround in Kansas she has experience in being both for cost containment and expanding health coverage. Health care has been one of the fiercest disagreements with my conservative friends in recent history. I view myself as a conservative and am appaled at the lack of health coverage for many Americans. It may have something to do with both being employed in health care and being a patient and consumer of products and services. Most of the time I feel like I am debating a table top AM radio instead… Read more »

Christopher George
Christopher George

A trial lawyer as head of HHS. Just what our health care system needs.