Leading Healthcare Change: No Room for Politics as Usual

The decision by Tom Daschle to withdraw his nomination for Secretary of Health and Human Services (HHS) amidst partisan discord and objections is very concerning. The work of the HHS is too important to be politicized. Too often politics has played a decisive role in who fills this important position. The President should find a strong alternative candidate and that is not limited or undermined by politics.

The HHS oversees a budget that encompasses nearly a quarter of all federal spending and is responsible for the current and future health of our nation. The HHS supports important research conducted by the NIH, supervises disease surveillance and prevention through the CDC, safeguards medical treatments through the FDA, and supports programs for the uninsured, pregnant women and infants. Most notably however, HHS is responsible for the Centers for Medicare and Medicaid Services. With a budget of nearly $2 billion per day, Medicare and Medicaid cover roughly 100 million lives and lead other healthcare institutions by setting reimbursement rates and policies that most private insurers adopt as well.

An ideal leader must work well with congress, but more importantly, such a person would be an effective manager with clear understanding of the issues and the strategic vision to lead us to a program that will provide quality healthcare to all Americans. Unfortunately, the past three Secretaries have had limited experience in health systems or delivery prior to taking office and real reform remained elusive.

Several potential replacement candidates have been mentioned by pundits, but most are governors or politicians, rather than the people with the most relevant experience. I would look at leaders within medicine who have experience in running healthcare organizations, understand the science, politics, and the operations of healthcare organizations.

One such candidate (whom I have neither met nor audited his tax records) would be George Halvorson, Chairman and CEO of Kaiser Foundation Health Plan & Hospitals. Kaiser is a non-profit organization that is somewhat unique in that they not only provide medical insurance, but also operate hospitals and pharmacies for their members. Since they eliminate the conflict between hospitals wanting to bill insurers for more procedures and insurers wanting to deny necessary care, the focus is where it should be on what is needed for the patient. They also focus on preventing illness and keeping patients healthy rather than waiting until they present to the emergency room, too sick to ignore.

Under Halvorson's guidance, the Kaiser system introduced one of the most effective IT systems. When a patient sees a Kaiser doctor, the computer system runs a check to make sure they are up to date with their preventive care. The goal is to find disease before it causes problems, keeping people healthy and controlling preventable healthcare costs. A patient may see a doctor for a foot pain, and leave not only with treatment for their foot but also with appointments for overdue mammograms, a colonoscopy, or screening blood test.

Halvorson recognizes the challenges and opportunities that currently exist, stating that our present system is inefficient, wasteful and at times, dangerous. We currently spend a greater percent of our GDP (17%) on healthcare than any other country, but lag in key indicators like life expectancy and infant mortality rate. As costs steadily rise and baby boomers approach Medicare eligibility, projections for health spending are frightening:

The non-partisan Congressional Budget Office calculated that if healthcare costs continue at their same rate of increase as they have since 1975, we will be spending 30% of our GDP on healthcare within twenty years and 50% by 2050. We can promote health and care for the sick. We can reduce the burdens of disease and aging, for your family and for mine. We can and must slow the rate of growth in healthcare spending.

But to do so will require a complex understanding of the strengths, weaknesses, tensions and leverage points in the current system. We are facing incredibly difficult decisions, but policies implemented today will help us to live healthier, longer lives, while also saving billions of dollars. The next Secretary of Health and Human Services cannot be considered not on the basis of his political affiliations, but rather on a deep understanding of the challenges (and opportunities) for healthcare reform and enhancement.

President Obama nominated a uniquely qualified person for Secretary of Energy, who can lead us in developing new sources of clean energy. The HHS deserves a similar leader who can lead a program that will provide quality and cost effective healthcare to all Americans.

It does not matter whether the next Secretary designate is Democrat or Republican. What is important is that he or she has the vision and ability to. Our families, our children, and our future economy are too important for partisan games or politics as usual.

Comments

[Robin Cohen]

Very interesting insights...I agree with many of them. As important as HHS is, if the Obama administration wants to create real credibility with Congressional Republicans and more importantly the American people, Daschle had to step down (or have been properly vetted as promised by the administration in the first place). Yes Obama must act swiftly, but he also must make sure the new nominee is not only credible for the position but has paid his taxes. The Democrats cannot continue to be tarnished by the inability of some of its richest members in this year of great hope and change.

[SHY710]

This is an incredibly insightful and thought provoking piece that guided me to take a different look at such an important issue. Interested in reading more of your work once a new secretary of HHS is appointed.

[NWGuy]

Concur that the health care (really, illness care) system is at a critical point and must be revised. Ideally, there should not be partisan politicking, but, there is no doubt there will be. The repubs will fight any form of nationalized health care in favor of the status quo. The next HHS secretary, in addition to the characteristics described above, must also have an understanding of public health concepts.

The vision of what health/illness care will look like in the near future is still not clear. Do we keep or discard the "insurance" paradigm? Will rationing of certain services be necessary, if so, to whom, based on what? What type and level of responsibilities should be put on the public to promote their own well being? How do we get more primary care physicians? How will the workers and professionals be reimbursed for their work? Will tort reform be necessary?

Not only is it necessary that the next secretary of HHS be a strong leader, but since health care affects every American, we too, need to be active in guiding the vision and implementation of health care reform. We, the people, need to make it clear to our elected representatives that politics as usual will not be tolerated. We need to make it clear that health care reform is to benefit the American population, not special interest groups.