Secretary of Health
and Human Services
Tom Daschle, foi escolhido pelo presidente eleito, Barack Obama, para ocupar o cargo de secretário (ministro) da saúde. link
Perdida a hipótese da Saúde, o casal Clinton parece negociar em desespero de causa um lugar na equipa do próximo governo de Obama. link
Perdida a hipótese da Saúde, o casal Clinton parece negociar em desespero de causa um lugar na equipa do próximo governo de Obama. link
Etiquetas: USA health
3 Comments:
O Senador Tom Daschle, aparentemente,
preparou-se para o novo cargo.
Em Março deste ano escreveu um livro sobre política de Saúde: Critical. What We Can Do About the Health-Care Crisis , que se pode entroncar na campanha de Barack Obama.
Equacionou aí diversos problemas e preconizou soluções organizativas. Na questão organizativa e administrativa defendeu a criação de um "Federal Health Board", orgão de cordenação federal das políticas de Saúde (do tipo do Fed).
Salienta a existência no "sistema americano" a persistência e o agravamento progressivo de 3 problemas fundamentais:
1. um galopante aumento de custos;
2. problemas na acessibilidade aos serviços;
3. uma grande disparidade de qualidade entre os diferentes serviços.
Não li o livro...
Somente encontrei esparsas referências genéricas e sectoriais sobre o seu conteúdo. Impressionou-me a denúncia da ocorrência, nos EUA, de 98.000 mortes anuais por erros médicos e tecnológicos.
Todavia, penso que o mesmo poderá ser a chave da compreensão de uma nova política de saúde americana.
Alguém leu "Critical. What We Can Do About the Health-Care Crisis "?
Under the headline in today's Washington Post, "Kennedy Announces Plan to Submit Bill For Universal Care" was this:
"Some Democrats, including members of President-elect Barack Obama's circle, have begun to view expanded [health care] coverage as a longer-term goal."
Is the new administration trying to send a message to its health care eager constituencies that given the economy and all of the challenges we face it would be best to settle expectations down a bit?
If it is, I would suggest, that would be a smart thing for the incoming administration to do.
As I have recently posted, it is not apparent to me that we have either the consensus on what a mega health plan would look like, the solid voter support for real health care change, or the money to do it.
Many longtime health care reform advocates are calling for the Obama administration to move quickly on comprehensive health care reform while their political capital is strong--do it now or lose the opportunity goes the argument.
Actually, I would argue that if Democrats do go for the whole deal they are likely to run into a political buzz saw and possibly squander the ability to do a more modest bipartisan list of health reform accomplishments that could be the first important steps in a longer-term strategy.
Do you know how many pages were in the 1993 Clinton Health Plan?
1,462.
That number will be with me forever!
An Obama campaign-like comprehensive health care reform proposal converted to legislative language would easily exceed 1,000 pages. You think we have a consensus on what health care reform would look like? Put 1,000 pages of health care policy minutia on the table and watch the vultures attack.
Without a strong consensus going in, I've always said that a 1,000 + page health care bill will afford the opportunity for every man, woman, and child in America to find at least 300 pages each they disagree with--and they won't be the same 300 pages!
There is a heck of a lot more work for President-Elect Obama and health care reform advocates to build the kind of consensus necessary to lift something so big as health care reform across the line.
What can be done is to look to the places we do have bipartisan agreement and take some very important steps that begin the ultimate health care reform structure we will need. Maybe we can build the foundation over the next couple of years and we should try.
In these problematic fiscal times, it will be just as important to pick some steps that either cost little or can be funded under PayGo rules that require upfront money.
That foundation of bipartisan steps might include:
Expansion of the State Children's Health Insurance Plan from 6 to 10 million kids and paying for it with a cigarette tax.
A Medicare bill. We desperately need physician payment reform. Something we are nowhere near getting agreement over. But everyone does agree we need to try. It is also generally agreed that primary care physicians need to be better paid. It is also agreed that there is $62 billion in five-year private Medicare HMO payments that can be used to grease the skids toward a Medicare provider payment system that is more sustainable.
Cost and quality initiatives. A cost and quality board to arbitrate and set the standards for a whole host of items to improve cost and quality outcomes that were in both the Obama and McCain health plans--health information technology standards and requirements, transparency in provider pricing, and health outcomes research, and many others.
Assistance for small businesses and individuals in getting health insurance. Conservatives and liberals alike think insurance exchanges make a great deal of sense as a means to help individuals and small business be able to access coverage. If there is money to be found, there is also bipartisan support for modest premium assistance, likely in the form of tax credits to help small businesses--the place our employer-based system is in the most distress--to be able to pay for coverage for their workers.
Federal budget assistance for state Medicaid programs as part of a stimulus bill. The Congress is likely to do this one anyway and it might as well be part of a package the Democrats and Republicans can take credit for.
When the year is done, the new President, Democrats, and the Republicans could point to bipartisan progress in covering more people (SCHIP), getting Medicare's house in order, and beginning to build the structure (an insurance exchange and cost and quality board) that will be important to the next stage reforms.
No doubt that even these things will be controversial. But I do expect they are the kind of things that could be passed with strong bipartisan support.
Or, Democrats could go for the 1,000-page bill and risk starting a food fight that would set health care reform back once again.
What will they do?
My guess is that no one is going to tell Ted Kennedy he can't try. Presuming Senator Kennedy can't get traction with the big bill, I look for Plan B. In the meantime, look for President Obama to call for comprehensive health reform but be cautious waiting to see how things develop.
Bers
Daschle for HHS?
Word around town is that Tom Daschle, the former Democratic Senate Majority Leader, is going to be named HHS Secretary.
That would mean that President-Elect Obama is going with a political and health care policy heavyweight.
With word yesterday that Senator Kennedy has appointed Hillary Clinton (presuming she stays in the Senate) to take the lead on the health insurance reform portion of his health bill, it is clear that the playing field is filling up with Democratic heavyweights.
A Daschle appointment would make clear that President-Elect Obama does not intend to cede this process entirely to the Congress. It would also indicate that it will be HHS that will take the health care policy lead on behalf of the administration--not White House staff. That would be different from prior efforts.
It also tells me that Obama would have a very smart politician on hand to keep the Congress within the bounds of what can get the votes, what will get broad stakeholder support, and at the same time what will fly on main street.
If it pans out, Daschle would be a superb pick for the new President.
February 2008 post regarding Daschle's book on health care reform and Obama's comments on it: A "Health Care Fed" and Obama
R. Laszewki
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