Tuesday, November 04, 2008

The Next Administration: Obama’s Top Health Positions

Earlier, we put out the short lists of possible McCain health people. Now, again, the lists are by no means scientific. These are names that have been circulated, brought up in discussions with sources, or individuals we think could end up being candidates based on their experience. Remember, this is just for fun. Here we go:

Obama Administration

HHS Secretary:

Former Senator Tom Daschle: The former Senate Majority leader is a favorite for Obama’s chief of staff along with Rep. Rahm Emanuel. If Obama goes with Emanuel, HHS Secretary would be an obvious spot for Daschle. He wrote a book on health care and he was a supporter of President Clinton’s health care proposal, and universal health care is Daschle’s pet issue.

Kansas Governor Kathleen Sebelius: The Kansas Governor made a name for herself in Kansas as an insurance reformer (she wouldn’t accept campaign contributions from insurance companies) and stopped Blue Cross Blue Shield from merging with another out of state firm. She is very close to the Obama campaign as a key surrogate and was supposedly in the top 3 for VP. Sebelius makes a lot of sense here.

Former Vermont Governor Howard Dean: The DNC chairman is an obvious possibility here with his MD, plus he oversaw expansion of health care in Vermont. But Dean is such a lightning rod for the Republican party, we just don’t know that he would be the right choice here considering how fragile a coalition it will take to advance Obama’s health plan.

Massachusetts Governor Deval Patrick: No governor, it seems, has been more active in the health care discussion as Patrick. Whether its universal health care, the state’s $1 billion life sciences/biotech plan to bring more companies into the state, or the Mass. law on pharma marketing restrictions, Patrick has been in the middle. We think Patrick is perfect for the position, but we think he’s more likely to get a nod for the next Supreme Court opening. Otherwise, it could be Patrick.

FDA Commissioner:

Bruce Psaty (U of Washington): We think Psaty’s drug safety work probably make him a possibility but also may take him out of serious consideration. His focus on drug safety issues may be too extreme to appease both reformers and more moderate FDA stakeholders. Still, he warrants mention.

Steve Nissen (Cleveland Clinic): Avandia. Need we say more? However, Nissen also works closely with drug manufacturers on large, important clinical trials (Pfizer’s HDL-raising drug torcetrapib, for example). He’s recently changed his messaging somewhat from one focusing on drug safety to one more rooted in pro-innovation themes (witness his endorsement of Lilly’s anticlotting drug prasugrel). If Obama goes with a real reformer in the mold of David Kessler, Nissen has to be at the top of the list. He’s also an official adviser to campaign now, an important development.

Robert Califf (Duke): The Duke researcher has close ties to FDA through the Critical Path Initiative, and advisory committee process and has both Republican and Democratic supporters. In September 2006, Duke entered into an agreement with FDA to serve as a warehouse for electrocardiograms to serve as tools for drug safety research. If Obama goes with a big name, but one less associated with major reforms, Califf could easily be the pick. One thing that may serve as roadblock is his close ties to drug manufacturers (a Kennedy pet peeve).

Mary Pendergast (consultant): The former associate commissioner under Kessler and independent consultant is a dark horse candidate for the job. It’s understood she was previously vetted by Kennedy for commissioner (and did well) after Kessler left. She’s not an MD but that may not matter if Obama chooses an MD to head up HHS (Howard Dean, for example).

David Blumenthal (Harvard): A Harvard professor and director of Massachusetts General Hospital’s Institute for Health Policy, Blumenthal is a major contributor to the Obama health plan. He will be a strong candidate for a number of important positions either in the White House as a special assistant to the President or as head of one the key health agencies. Blumenthal, a physician, got his start in politics as a professional staff member on Senator Ted Kennedy’s Subcommittee on Health and Scientific Research during the 1970s.

Susan Wood (GWU): The former head of women’s health at FDA resigned in protest from the agency due to the delay in switching the morning-after pill over-the-counter. She now represents the Union of Concerned Scientists in a public capacity and is a research professor at the George Washington University for Public Policy. Wood campaigned vigorously for Hillary Clinton during the primary, and if Clinton takes over the Senate HELP Committee in the case that Kennedy becomes less involved, the former FDAer would have an outside shot. Still, the odds are against her.

Dora Hughes (Obama Senate FDA advisor): Hughes, an internal medicine physician, is Obama’s Senate health advisor. If Obama picked her, she would be the first African-American woman commissioner. It’s more likely she will be highly involved in making the pick. She previously served as deputy director for health for Senator Ted Kennedy on the HELP Committee.

CMS Administrator

CBO director Peter Orszag: The head of the Congressional Budget Office has been everywhere making public speeches on skyrocketing healthcare costs, regional disparities in how care is paid for, the Medicare program, and strategies on how to find costs savings without compromising quality of care.

Harvard Economist David Cutler: The health economist and Institute of Medicine member is a top health adviser to Obama and is considered a major architect of Obama’s health care reform plan. Cutler has co-authored health economics papers with McClellan and shares some of McClellan’s views on finding significant cost savings by correcting and reforming the inefficiencies in the system. Cutler could end up in any number of positions, probably at the White House council of economic advisors, but we think this isn’t such a bad one, is it? Blumenthal could also be a candidate here.

Avalere Health founder Dan Mendelson: Before starting Avalere, Mendelson served as associate director for health under the Clinton Administration from 1998-2000 at the Office of Management and Budget. Mendelson’s ties to people involved in the campaign make him an intriguing candidate for a position at CMS or possibly another health role in the next administration.

Harvard’s Steven Pearson: The comparative effectiveness guru is a senior fellow at the insurer’s trade association the America’s Health Insurance Plans and runs Harvard’s Institute for Clinical and Economic Review. Pearson has published research on how to use a standardized scoring system when it comes to comparative effectiveness research. Interesting. If not CMS, Pearson would be at the top of any list to head up a national center on comparative research.

This list is just a start and we'll be adding to it and subtracting from it after the election depending on who wins. We'll give you our picks next, but what do you think? Show us your picks and we'll post them.


Anonymous said...

Oh my. If Obama selects Steve Nissen, I will demand to rescind my vote for him. Nissen would be a true disaster.

Anonymous said...

Cool, thx for the list. Looking forward to seeing how it evolves.