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Mar 09, 2009
 |  BioCentury  |  Politics, Policy & Law

Healthcare landscape takes shape

Key White House appointments announced last week, along with statements by President Barack Obama, members of Congress and influential stakeholders at a White House summit, provide a clearer view of the topography of the healthcare reform debate and reveal several fault lines.

Obama's nomination of Kansas Gov. Kathleen Sebelius to be secretary of Health and Human Services and his appointment of Nancy-Ann DeParle as counselor to the president and director of the White House Office for Health Reform make it clear the administration's healthcare policy will be directed from the White House rather than from HHS.

Sebelius lacks the connections to members of Congress and in-depth healthcare experience that would be required for her to play a leading role in formulating or negotiating reforms. Her administrative experience suggests she is destined to focus on running HHS.

By contrast, DeParle has deeper front-line experience, and bruises, gained from being inside the battles over healthcare reform in the Clinton administration.

She has strong personal links to influential members of Congress. More importantly, as a former administrator of the Healthcare Financing Administration, which later became the Centers for Medicare and Medicaid Services (CMS), and as a partner in a private equity firm that invested in healthcare companies, DeParle has a great deal of both public and private sector experience.

Thus, unlike the academics and political operatives who fill most of the top slots in Obama's White House, she'll bring real world experience with business in general, and specifically with healthcare products and services.

DeParle's job will be to coordinate administration healthcare policy, to help communicate that policy to Capitol Hill, and to help negotiate the many compromises that will be needed to keep reform on track.

But unlike Tom Daschle, Obama's first choice for the job, DeParle will be operating from outside the inner circle of advisers with access to the president inside the West Wing of the White House and who have strong views about healthcare, including National Economic Council Director Lawrence Summers and Office of Management and Budget (OMB) Director Peter Orszag.

DeParle, who will be in an office across the street, will be depending on her experience as part of the Clinton team that failed to force through healthcare reform in the early 1990s.

DeParle made her debut as healthcare czar at last week's healthcare summit, an event that brought together about 50 members of Congress and 80 representatives of interests ranging from insurance companies to labor unions, hospitals, physicians, large and small employers, and the pharmaceutical industry.

The kick-off for healthcare reform was staged as a deliberate contrast to the closed door sessions conducted by the Clinton healthcare inner circle in 1993, with last week's event notable for pledges of collaboration from adversaries who had clashed in the last attempt to revamp the U.S. healthcare system.

Nevertheless, Republicans drew a line in the sand in opposition to the creation of a government-run program that would compete against private health insurance companies, while Democratic activists were equally adamant in supporting the concept.

But contention was not restricted to disputes between the parties. Sen. Max Baucus (D-Mont.), chair of the Finance Committee, politely but firmly rejected a proposal in the Obama budget summary to limit itemized tax deductions for wealthy Americans and apply the funds to healthcare.

Finally, the week revealed who was on the White House's "A list" of stakeholders in healthcare reform, as the close confines of the White House East Room relegated both the biotech and generics industries to the sidelines, at least for the time being.

Conducting HHS symphony

The Sebelius nomination did not come as a surprise as she has been on pundit lists of candidates for vice president and several cabinet positions since she endorsed Obama during the presidential primary campaign.

In addition to loyalty to Obama, Sebelius brings executive experience and a...

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