Daschle's withdrawal raises doubts about healthcare reform

Tom Daschle’s withdrawal of his nomination for Secretary of Health and Human Services (HHS) has some speculating whether or not healthcare reform will be derailed.

Daschle withdrew after saying that his failure to pay more than $120,000 in taxes could be a “distraction.”

“Conventional wisdom, Obama popularity, and inside-the-Beltway decision-making are not always in full sync,” said F. Randy Vogenberg, RPh, PhD, senior scholar, Thomas Jefferson University, Jefferson Medical College, and principal, Institute for Integrated Healthcare. “Clearly, the political constituency losses and reputation damage-to himself, Obama, and the Democratic party-were too great to overcome and successfully spearhead any significant health reform through Congress this year. It appears that everyone cut their losses quickly so a second-choice secretary could be made rapidly and be able to continue the healthcare change agenda on a fast track, most likely now primarily led by Ted Kennedy [D–Mass].”

The Obama administration has a mix of prospective nominees for HHS secretary, according to Kip Piper, senior counselor at Fleishman-Hillard and president of Health Results Group, a Washington, DC, consultancy firm. “One group are the healthcare-savvy politicos, such as Kansas Governor Kathleen Sebelius or Senator Tom Harkin [D–Iowa],” he said. “Another group of prospects are healthcare wonks, such as Harvard economist David Cutler, Georgetown’s [University professor] Judy Feder, and Jeanne Lambrew, deputy director of the White House Office of Health Reform. Given the Daschle experience, the administration may need to focus on sitting officials or high-profile academics.”

Reportedly, other contenders for the HHS secretary post may also include former Oregon Governor John Kitzhaber, ex-Democratic National Committee Chairman Howard Dean, and Obama’s transition chief, John Podesta.

Meanwhile, Daschle’s withdrawal could delay selection of the new FDA commissioner. For that post, the administration will need new blood to rebuild the agency’s internal morale and external reputation, according to Piper. “Ideally, it’ll need to be a research-savvy physician with a visible profile and strong leadership and management skills. That’s a rare combination.”

Robert M. Califf, MD, vice chancellor for clinical research at Duke University, professor of medicine in the Division of Cardiology at Duke, and longtime advisor to FDA and the Institute of Medicine, is an obvious choice, said Piper, “with strong reputation and mix of experience. Baltimore’s Health Commissioner Joshua Sharfstein is on many short lists. His experience is relatively limited but he would bring high energy to the job.”

In other appointment news, Robert Kolodner, MD, the national coordinator for health information technology (HIT), has stated that he is not confirming a published report that he will remain in the position under the Obama administration.

The White House would be wise to retain Kolodner as head of Office of the National Coordinator, according to Piper. “He has an excellent record of HIT reform at the VA [Veterans Affairs]. The administration’s HIT agenda is a cornerstone of health reform, and the HIT provisions of the stimulus bill are very ambitious,” he said. “They need to hit the ground running.”

Kolodner became the interim head of the Office of National Coordinator in mid-2006, replacing David Brailer.