Demissão
Tom Daschle, Secretário da Saúde e Recursos Humanos da Administração Obama, pediu a demissão na sequência da divulgação do seu caso de fuga ao fisco e da pressão política causada por inúmeros editoriais sobre as suas antigas ligações a grupos de interesses na área da saúde. link
Um pesado contratempo para a prometida mudança na Saúde.Etiquetas: USA health
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Daschel Withdrawal Sets Back Health Care Reform
In many ways picking Tom Daschle to be HHS Secretary was the perfect choice. The former Senate majority leader knew Congress like the back of his hand, he wrote a book outlining not only what would be the Obama health plan but laid out the process to get there. He is an effective communicator on behalf of the administration on an issue that can easily become buried in controversial policy minutia. In short, a health care wonk that speaks English and was as good a legislator as they come.
Now what?
First, the administration has lost crucial health care reform momentum. In effect, Daschle has derailed one of his first priorities—moving quickly on health care reform before the opposition can get organized and while the administration still has big political capital.
There was no second choice for HHS Secretary in Obama’s mind—Daschle had this nailed well before the election. There is no obvious second choice period.
It is also possible that Obama's biggest health care reform challenge may not come from Republicans but from those on the far left of his own party. Their pushing on things like a public health plan to compete with the private sector could be a big hurdle. While Daschle supported some of these things, like the public plan and a cost board, in his book he was also a skilled and pragmatic legislator and could well have done a good job managing the President's left flank.
This will set the health care debate back months not weeks. It appears the economic crisis is deepening and there is talk of President Obama planning to come up with another giant bailout bill. That would take a lot of time and political capital.
Add the two together and we could be looking at the fall before this administration gets its health care effort back on track.
Posted by ROBERT LASZEWSKI
Why Tom Daschle Had to Withdraw and Who Will Replace Him?
Howard Dean? Kansas Gov. Kathleen Sebelius? Former NIH director Harold Varmus (now at Memorial Sloan-Kettering Cancer Center)? Dr. Atul Gawande? Former Oregon Governor John Kitzhaber? John Podesta, founder and president of the Center for American Progress, formerly chief of staff to President Bill Clinton? These are a few of the names being floated in the mainstream press and the blogosphere as possible replacements for Tom Daschle as Secretary of Health and Human Services and/or healthcare czar.
But before replacing Daschle, let’s consider why he is stepping out of the game, and what this means for healthcare reform. In announcing his withdrawal, Daschle put his finger on why he must leave: “If 30 years of exposure to the challenges inherent in our system has taught me anything, it has taught me that this work will require a leader who can operate with the full faith of Congress and the American people.”
Daschle was not, as some claim, undone by the Republican nomination. Nor should Obama be blamed for “conceding defeat.”
As Daschle himself acknowledges, he did himself in by undermining the full faith and trust that anyone who hopes to guide health care reform must have.
When explaining his departure, most pundits emphasize the fact that he failed to pay about $128,000 in back taxes mainly for the use of a limo and driver over three years. No question, anything that gives headline writers a chance to pair the word “liberals” and “limos” is truly unfortunate. But Daschle is not the only government official who has ever had to explain an “oversight” regarding his taxes. (Though the fact he was the second cabinet appointee who found himself in that position posed a serious problem for the administration.)
Still, what is more troubling is the recent disclosure that Daschle had taken more than $200,000 in the past two years speaking to members of the health care industry that he was assigned to reform.
The speaking fees were just a portion of the more than $5.2 million the former senator earned over the past two years as he advised health insurers and hospitals and worked in other industries such as energy and telecommunications, according to a financial statement filed with the Office of Government Ethics.
Among the health care interest groups paying Daschle for speeches were America's Health Insurance Plans, $40,000 for two speeches; CSL Behring, $30,000; the National Association of Boards of Pharmacy, $16,000; and the Principal Life Insurance Co., $15,000.
Daschle knew that he wanted to become a leader of healthcare reform. What was he thinking? Perhaps he had spent too many years in Washington. Here, I must quote Bob Laszewski, editor of the Health Care Policy and Marketplace Review:“ I have a friend who says that when you first come to Washington you see it as this ugly political swamp but after you are here awhile it begins to seem like this wonderful hot tub. He says that's when it's time to get out of town and go back home.”
Many would argue that it is difficult to find a senior federal official who has not moved in and out of the industry he oversees. Perhaps. And perhaps we need laws to block—or at least slow—the revolving door.
In any case, it is essential to remember that healthcare is not just another industry. It is an industry charged with protecting our health. Any suspicion of graft within Health and Human Services would be like a hint of corruption with the Federal Aviation Administration: lives are at stake.
How would you feel if you heard that the new head of the FAA had taken large speaking fees from various airlines—and now he was being appointed to an oversight position where he would be responsible for overhauling the industry and making sure that airlines did not continue to cover-up the causes of major airline catastrophes?
Fortunately, our airline industry has not shown a penchant for scandal. By and large, it is quite forthcoming when it comes to co-operating with accident investigations. The same, unfortunately, cannot be said about our healthcare industry.
With some regularity, drug companies are accused of repressing evidence that their favorite blockbusters are causing heart attack and strokes or device-makers forget to inform the FDA about heart devices that implode inside a living heart. Over the past 15 years, for-profit hospitals have found themselves the target of FBI raids that revealed they had been lying to Medicare, lying to insurers, lying to shareholders—or, in the worst cases, performing unnecessary surgeries on perfectly healthy patients, leaving some dead, others maimed.
As I have documented in Money-Driven Medicine: The Real Reason Health Care Costs So Much, this is an industry fraught with conflict of interest. This is why reform needs to be overseen by someone who is perceived as being above suspicion—purer than Caesar’s wife.
When it comes to his dealings with the industry, Daschle may well be pure of heart—but, as he acknowledges, the way that the public will perceive him has been muddied. An experienced politician, Daschle knows, all too well, how the opponents of reform would use this. Moreover, it is time for the Obama administration to make it very clear to all that it means what it has said about change in Washington.
This is why Daschle had to step down.
This is a loss because he seemed uniquely positioned to serve as the Obama administration’s liaison to Congress. Among his Congressional colleagues he is reported to be well-liked on both sides of the aisle. Arguably, this is because he is not the strongest leader Democrats have ever had. When it came to controversial issues such as standing up to President Bush on the war in Iraq, or the tax cut for the very wealthy, Daschle was timid.
The recent vote on what should have been a slam-dunk for the Democrats—expanding healthcare for poor children—turned into a sometimes bitter battle, an indication that the ideological opposition to reform remains fierce. Perhaps the administration will need a liaison made of stronger stuff—here John Podesta comes to mind.
Nevertheless, Daschle seemed sincerely dedicated to the cause of providing health care for all Americans. And, without question, his departure will slow the process—though I expect Senate Finance Chairman Max Baucus will continue to push ahead in Congress. And Baucus’ white paper is not very different from the President’s, so in that sense, the administration will still be well-represented within Congress.
But it will take time to find a replacement for Daschle, more than a week or two, I would wager. Here are a few of the names being bandied about, and the reasons why they might, or might not, be viable candidates:
Howard Dean: The fact that Dean is an M.D. makes him an attractive candidate. We need a healthcare reform leader who understands that medicine is not a business, but a profession---which means that it must put patients first. Dean might be able to rally doctors; their support is, I believe, crucial because patients will listen to their doctors. As Governor of Vermont, Dean expanded health insurance to children, and faced the challenges of health care reform. (He also paid off the state's public debt, signed civil unions into law, and delivered a balanced budget every year.) To cap off his resume, as Chairman of the DNC he implemented the 50-state strategy that many say gave Obama the foundation for victory. On the other han, Rahm Emmanuel, opposed the 50-state strategy; rumor has it this is why Daschle’s name was never on the short list for Secretary of HHS. There is also the fact that many media pundits simply don’t like Dean. Whether that should be counted as a point in his favor or a point against him is open to question.
Dr. Atul Gawande: The American Prospect’s Ezra Klein threw Gawande’s name into the ring. But in a private interview at the Families’ USA conference last week, Gawande said twice “I know nothing about politics.” He said it cheerfully, smiling, a man happy that he knows nothing about politics. He also has a job that he clearly loves as a surgeon and brilliant writer. It is hard to believe he would give that up.
Former Oregon Governor John Kitzhaber: Kitzhaber is dedicated to health care reform. An M.D., he is extremely intelligent, honest, articulate and charismatic. In many ways he would be the ideal candidate. But Kitzhaber hates Washington. Many years ago, when the Democrats tried to draft him to run for the Senate, he told me that after visiting the city, he had determined that he would never work there. Too many lobbyists, too much intrigue, too much graft--- impossible to get anything done. Perhaps he would view Obama’s D.C. differently, but I’ve been following Kitzhaber’s career, and I doubt it.
Kansas Governor Kathleen Sebelius: Former insurance commissioner in Kansas, she knows the issues, and has a good relationship with Obama. Sebelius is a well-respected politician, but since she is coming from outside the beltway, she wouldn’t make as much sense as Obama’s liaison to Congress. Still, she might well be an excellent choice as Secretary of HHS. It’s quite likely Obama will replace Daschle with two people. But I have no idea as to whether she wants the job.
Former NIH Director Howard Varmus: The Wall Street Journal’s Healthblog mentioned Varmus (along with Dean and Daschle) as one of three candidates for the post when the short list was first being prepared, and mentioned him again today. Clearly the Nobel Laureate has the ability, but does he have the temperament—and again, would he want the position?
CAP president John Podesta: As a politician he is more than Daschle’s equal—and a stronger figure. Moreover, Podesta understands both the policy issues and the politics involved in healthcare reform. The most liberal reformers might object that Podesta is too much of a centrist. On the other hand, when it comes to healthcare reform that may be what is needed, not just to achieve consensus, but to avoid disaster. See my recent post on Dr. Atul Gawande’s prescription for what I call reality-based reform: Gawande stresses that when it comes to universal coverage we need to proceed in a way that allows for continuous learning from mistakes, constant tinkering with reform.
Posted by Maggie Mahar
A importância de Tom Daschle
Health Reform: In his prepared statement, link
Daschle said reform “cannot be dictated from the White House and Washington,” but instead must come from the grassroots and must be an open and transparent process. He pledged close collaboration with Congress.
The top Republican on the committee, Wyoming’s Mike Enzi, made clear that members of his party want a voice at the table too. “It’s the only way we’re going to get something done,” he said, according to the AP.
Food and Drug Administration: We’ll let this quote from his transcript speak for itself.
Unfortunately, there is growing concern that the FDA may have lost the confidence of the public and Congress — much to our detriment. When Americans are nervous about eating spinach or tomatoes or cantaloupes, that’s not good for our health and it is terrible for our farmers. When nearly two-thirds of Americans do not trust the FDA’s ability to ensure the safety and effectiveness of pharmaceuticals, the result is Americans may hesitate to take important medications that protect their health. This is unacceptable.
National Institutes of Health: The NIH’s funding has been flat in recent years, reducing the NIH’s “buying power,” Daschle said. There’s been a sharp drop in success rates for research grant applicants, with the figure at 10% for many of the institutes, he added. The NIH has also “suffered from some instances of people putting politics before science.” He said he’ll work to “strengthen NIH.”
Now that the Daschle era at HHS is over before it began, who should 'take over'?
Bob Laszewski recommends President Obama consider Oregon Senator Ron Wyden (D) for the post.
I agree.
Bob points out that Sen Wyden is respected on both sides of the aisle, has demonstrated an ability to subordinate his own ego when needed, and thoroughly understands health care. I met with the Senator in his offices early last year, and came away quite impressed with his deep understanding of the payer community, their motivations and limitations. Sen Wyden has taught gerontology and has been a nursing home regulator. He understands the new media (Wyden introduced his Healthy Americans Act to health care bloggers very early in the process) and communicates quite well.
The Healthy Americans Act remains my personal choice as the best solution on the table. It has:
- broad bipartisan support,
- is revenue neutral,
- eliminates most of the problems in the current system, and
- requires universal coverage.
There's one other factor that may be just as important to the President in the selection process. Wyden is quite the basketball player; he was a scholarship athlete at UC-Santa Barbara.
Este discurso de Tom Daschle link fez-me lembrar CC.
Correia de Campos, no entanto, leva vantagem: conseguiu liderar o MS cerca de dois anos e meio. Justificadamente. Pois, ao que se sabe, cumpriu zelosamente todas as suas obrigações fiscais.
A DOR "NECESSÁRIA"...
Os "lapsos" fiscais de Tom Daschle, indigitado Secretário da Saúde não me impressionam por aí além...
Se verificar-mos bem, eles atingem, como o é caso de Nancy Killefer insignificantes pagamentos por prestação de serviços domésticos, que facilmente (e inconscientemente) passamos ao lado...
Mas, agora, aparecem à luz do dia porque são a consequência do severo escrutínio a que são sujeitos os novos membros da Administração americana, mas também podem ser fruto de desorganização pessoal, desleixo manter os papéis (e as obrigações) em ordem...
Todavia, a ética de Obama tem de acabar os "gloriosos" tempos de Dick Cheney, de Donald Rumsfeld e, de outros do inner circle de G.W.Bush, onde política e negócios se misturavam num infame e explosivo coktail.
Em meu entender, o problema de Tom Daschle é mais grave.
Diz respeito á não declaração de interesses.
De facto, Daschle não podia "esquecer-se" que tinha cobrado elevadas quantias (> 200.000 dólares) pelo exercício de serviços de consultoria a empresas especializadas em Serviços de Saúde.
Teve, com certeza, de trabalhar, largas horas nesse campo.
Um campo sempre muito próximo do lobby, que sendo legal nos EUA, consome muito tempo, energias e "marca" a vivência pessoal.
Ora, aqui, os "esquecimentos" são pouco plausíveis.
Ao fim e ao cabo, tratavam-se de Empresas que teria de controlar e exercer uma acção reguladora se, acaso, tivesse mantido e ocupado o cargo lhe estava destinado na área da Saúde.
Significa isto que a área da Saúde é um grande negócio. Engª. Isabel Vaz, dixit.
E são cada vez menos os experts, políticos ou meros técnicos, que se mantêm imaculados dos gigantescos e dos contraditórios (para o exercício de funções públicas...) conflitos de interesses.
Penso que foi doloroso para Obama, mas tinha de ser feito.
Recordo, neste transe, Fernando Pessoa:
O que me dói...
"O que me dói não é
O que há no coração
Mas essas coisas lindas
Que nunca existirão...
São as formas sem forma
Que passam sem que a dor
As possa conhecer
Ou as sonhar o amor.
São como se a tristeza
Fosse árvore e, uma a uma,
Caíssem suas folhas
Entre o vestígio e a bruma."
in "Cancioneiro"
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