Health Care Reform 2009 Part 2: The White House

Obama has made health care reform his top priority, which is why everyone’s talking (yelling) about it.  When Clinton tried to pass health care reform in 1993, he was criticized for developing a huge, complicated bill without Congress’s input.  This time around, Obama’s approach has been more hands off-  in interviews, speeches, and townhall meetings he’s stressed the importance of reform, while letting Congress work out the many details.  However, this approach has had its own drawbacks.

Here are some of the key figures in the White House working on health care reform:

Peter Orszag
Title: Director of the Office of Management and Budget (OMB)

The Office of What? The OMB (Office of Management and Budget )is the cabinet office that writes and oversees the federal budget.  If you’ve never heard of it before, don’t worry.  Director of the OMB is usually not a high profile position (for example, without looking at wikipedia, try to name any of the four OMB directors under George W), but this year it’s a big deal.  Health care reform will mean a massive new item in the federal budget, and Orszag has been influential in developing the White House’s health reform policies.

Experience: Before joining the Obama administration, was head of the Congressional Budget Office (CBO), a nonpartisan agency that estimates how much new legislation will cost (or how much money it will bring in)– so he knows the complex federal budget process inside and out.

Approach: Orszag is extremely interested in studies that show some regions of the country spending way more on health care than others, but not getting any better results.  According to a profile of Orszag in the New York Times:

“In recent years, many say, he has helped popularize the idea that reducing health care costs is essential to the country’s economic future and the sustainability of the federal budget.”

To address the problem, he wants to do no less than change the way medicine is practiced, eliminating unnecessary tests and unproven treatments in favor of what he calls a higher-value approach that he says will actually improve health. But no one quite knows how much money such measures would save, and Republicans already accuse him of trying to limit care.”

Kathleen Sebelius
Title: Secretary of Health and Human Services (HSS)

Experience: Governor of Kansas since 2002.  As democratic governor of one of the reddest states Sebelius, gained a reputation for bipartisanship.  Before becoming governor she was the state’s Insurance Commissioner (when she was elected she was the first Democrat to hold the office in over 100 years), and while she held that position, Governing Magazine named her one of its 2001 Public Officials of the Year.  According to the article:

In her two terms, Sebelius has managed to walk a careful line. She has revamped her department’s technological capabilities, making it far more efficient. She has slashed regulations that were duplicative, irrelevant or particularly quirky [translation: duplicated, not relating to the problem or just plain weird]. And she has worked with the legislature to deregulate commercial insurance lines and to boost tax credits for businesses that buy health insurance for their employees.

At the same time, Sebelius has raised the department’s profile as a source of reliable consumer information on companies and their products, and promoted a raft of consumer-oriented bills in the legislature: a patients’ bill of rights; mandated maternity coverage; a requirement that companies pay their bills promptly; an initiative to protect consumers’ privacy. She has created “market conduct” and anti-fraud units aimed at monitoring companies’ and agents’ behavior.

Role: Sebelius was a late pick after Tom Daschle’s nomination fell through.  Even though she has a lot of experience taking on insurance companies back home, she’s umm… not in Kansas anymore (sorry).  So in terms of pushing health care reform, it looks like the strategy is to have Sebelius taking the case to the American people, in media appearances and op-eds like this one.  Meanwhile Nancy Ann DeParle, who has a ton of experience in Washington, will focus on making sure a health reform bill gets through Congress.

Nancy-Ann DeParle
Title: Director of the recently created White House Office of Health Reform

Huh?: also called Obama’s Health Reform Czar

Role: Orszag and Sebelius are both heavily involved in health care reform, but each has a ton of other responsibilities, so the White House created a position to have another high level figure working on health care reform full time.  You probably haven’t seen much of her in the media- the others are the ones you see on in the news all the time- deParle’s job mainly involves working behind the scenes.

Experience: A veteran from the failed attempt at health care reform in the early 90’s, she represented the OMB as associate director for health and personnel at the Office of Management and Budget.  She went on to run the agency that manages Medicare and Medicaid later in the Clinton administration.  When she was first appointed, here’s how Jonathan Cohn described her in his blog, The Treatment:

DeParle is smart–rocket scientist, brain surgeon, 1600 SAT smart. And she knows as much about health policy as anybody you’ll encounter in Washington…  Despite her career-long identification with Democrats, DeParle has credibility with Republicans. And, no less important for Obama, she’s popular with centrist Democrats who could–if they wanted–make health care reform difficult.

But, she has business ties to companies with a direct stake in the health care debate- since leaving public office, she made over $6 million serving on the boards of various health care companies- which have some questioning her willingness to challenge the industry.  Others see her business ties as an asset. According to the New York Times:

Allies of Ms. DeParle described her work in the private sector as a plus, because her familiarity with the industry would enable her to lean on companies to make tradeoffs essential in expanding access to the uninsured.

“She can call their bluff far more credibly and say, ‘Come on, guys, I’ve seen the books, I know you can do this with lower margins and higher market share, and you’ll do quite well,’ ” said Chris Jennings, who was President Bill Clinton’s top health policy adviser. “To me that’s very, very helpful.”

The general belief is best summed up by Craig Holman of Public Citizen, a liberal-leaning advocacy group.  “There are significant conflicts, but they’re not overwhelming.  You can’t set up a reverse revolving door to exclude everyone who’s ever worked in the health care industry.”

Tom Daschle
Title: Not technically part of the administration anymore.  He was on the White House transition team and was Obama’s original pick for both Secretary of Health and Human Services (HSS) and Health Care Reform Czar, but had to withdraw his nomination because of tax problems.  However, Daschle remains influential and many of his senior advisers are still working for the White House.

These days he’s an adviser for the law firm Alston and Bird (more on them in a second) and a fellow at the Center for American Progress, a liberal policy think tank.

Experience: Senator from South Dakota for 1986 to 2004, and Senate majority leader from 2002 to 2004.

In 2007, founded the Bipartisan Policy Center, with other former Senate Majority Leaders Howard Baker(R), Bob Dole(R) and George Mitchell(R).

In 2008 he published a book with Jeanne Lambrew (who’s now heading the Health and Human Services Office of Health Reform, under HHS Secretary Kathleen Sebelius) called Critical: What We Can Do About the Health Care Crisis.  In it they propose:

• people who want to keep their health insurance can, but people should also be able to purchase insurance from the pool covering federal employees or a similar pool
• all Americans should be required to have health insurance
• a federal health board modeled on the federal reserve.  Staffed with experts, it wouldn’t regulate private insurance but would regulate federal programs like medicare and medicaid.  It would assess the effectiveness and costs of various treatments.

Controversy: Here’s a partial list of controversies Daschle has been involved in since Obama was elected:

• Forced to withdraw his nomination for HSS Secretary when it was revealed that he owed $140,000 in back taxes.
• At the time of his nomination Daschle worked for Alston and Bird, a law firm that represents (and lobbies for) many major health care clients (for example Aetna, Abbott Laboratories, Alliance for Quality Nursing Home Care, American Orthotic and Prosthetic Association– those are just some of the A’s).  The administration stated however that since Daschle was a “policy adviser” and not a registered lobbyist, it wouldn’t violate Obama’s policy of not appointing lobbyists.  Matt Taibbi, a political reporter with Rolling Stone magazine had this (and other less charitable things) to say:

  “But in picking Daschle — who as an adviser to the K Street law firm Alston and Bird has spent the last four years burning up the sheets with the nation’s fattest insurance and pharmaceutical interests — Obama is essentially announcing that he has no intention of seriously reforming the health care industry.”

• In June, Daschle’s Bipartisan Policy Center released a health care reform proposal that appeared to fold on the public option.  He later clarified (some might say backpedaled) that he supports a public plan, but it was something he was willing to compromise on.

[PS: For way more information on these and other government officials, check out whorunsgov.com.]