Managed Healthcare Executive - April 2009 - (Page 5) NEWS ANALYSIS Obama health policy team takes shape Old hands in powerful positions raise prospects for upcoming healthcare reform efforts JILL WECHSLER | WASHINGTON BURE AU CHIEF WASHINGTON, D.C. — The delay in con rming a secretary of Health and Human Services (HHS) has not diminished White House predictions that health reform is on track for this year. While Congress readies action on Kansas Governor Kathleen Sebelius to head HHS, Nancy Ann DeParle is settling in as White House health reform czar. DeParle has a wealth of knowledge about government health programs as well as health plan operations. She was in charge of Medicare and Medicaid during the Clinton administration following a stint as Tennessee’s health commissioner. However, she would have faced di culty gaining Senate con rmation to a top HHS job because of her recent ties to healthcare and medical product companies as an investment advisor and member of several corporate boards. While the top HHS jobs have been empty, O ce of Management and Budget Director Peter Orszag has been making the administration’s case for health reform on Capitol Hill, along with Congressional Budget O ce (CBO) chief Douglas Elmendorf. Ezekiel “Zeke” Emanuel, head of the National Institutes of Health bioethics o ce and brother of White House chief of sta Rahm Emanuel, rounds out the team as Orszag’s right-hand man in Jodie Coston/Photodisc/Getty Images crafting reform options. Orszag, who beefed up CBO’s health policy assessment capabilities as head of that o ce, has played a lead role in explaining the administration’s 2010 budget plan and e orts to implement provisions in the economic stimulus plan. Elmendorf has had to eld complaints about CBO’s reluctance to “score” budget savings from future healthcare A key challenge for the new HHS secretary is to revitalize the FDA improvements, such as those potentially gained from preventive programs and comparative-e ectiveness research. Congressional leaders fear that it will be di cult to enact major reform measures without more “dynamic” scoring of reform policies. FIXING FDA A key challenge for the Obama administration and new HHS secretary is to revitalize the Food and Drug Administration. A sign of FDA’s critical state is that Obama decided not to wait until Sebelius was con rmed by the Sen- ate to announce his pick to head the troubled agency. In a broader talk on improving government food safety operations, Obama identi ed Margaret Hamburg, MD, as FDA’s next commissioner, with Joshua Sharfstein, MD, as principal deputy commissioner. Dr. Hamburg has experience turning around a low morale, underfunded public health agency as New York City’s public health commissioner in the 1990s. Before that, she did AIDS research at the National Institutes of Health and headed up the HHS policy o ce during the Clinton administration. Recently she has led the Nuclear Threat Initiative’s e ort to reduce the threat of biological warfare. Both industry and consumers applauded Dr. Hamburg as capable and experienced and not so inclined to toot her own horn. As Baltimore’s health commissioner, pediatrician Sharfstein attracted national attention by launching a successful campaign in 2007 to halt prescribing of cough and cold medicines for very young children. A former aide to Rep. Henry Waxman (DCalif.), chairman of the House Energy & Commerce Committee, Dr. Sharfstein faced tougher con rmation prospects in the Senate because of industry concerns. He has opposed pharma marketing to doctors and medical students, promoted access to prescription drugs and backed FDA regulation of tobacco. The administration’s emphasis on restoring FDA’s food oversight capabilities, yet making it more distinct from drug regulation, walks a middle line between those who want to pull food out of FDA and into a new federal food safety agency, and those who prefer to keep FDA intact. But it remains to be seen if appointing two high-pro le o cials to share FDA leadership will really work. MHE APRIL 2009 5
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