Obama health policy team takes shape

WASHINGTON, D.C. - The delay in confirming a secretary of Health and Human Services (HHS) has not diminished White House predictions that health reform is on track for this year.

While Congress readies action on Kansas Governor Kathleen Sebelius to head HHS, Nancy Ann DeParle is settling in as White House health reform czar. DeParle has a wealth of knowledge about government health programs as well as health plan operations. She was in charge of Medicare and Medicaid during the Clinton administration following a stint as Tennessee's health commissioner.

However, she would have faced difficulty gaining Senate confirmation to a top HHS job because of her recent ties to healthcare and medical product companies as an investment advisor and member of several corporate boards.

Orszag, who beefed up CBO's health policy assessment capabilities as head of that office, has played a lead role in explaining the administration's 2010 budget plan and efforts to implement provisions in the economic stimulus plan. Elmendorf has had to field complaints about CBO's reluctance to "score" budget savings from future healthcare improvements, such as those potentially gained from preventive programs and comparative-effectiveness research. Congressional leaders fear that it will be difficult to enact major reform measures without more "dynamic" scoring of reform policies.

FIXING FDA

A key challenge for the Obama administration and new HHS secretary is to revitalize the Food and Drug Administration. A sign of FDA's critical state is that Obama decided not to wait until Sebelius was confirmed by the Senate to announce his pick to head the troubled agency. In a broader talk on improving government food safety operations, Obama identified Margaret Hamburg, MD, as FDA's next commissioner, with Joshua Sharfstein, MD, as principal deputy commissioner.

Dr. Hamburg has experience turning around a low morale, underfunded public health agency as New York City's public health commissioner in the 1990s. Before that, she did AIDS research at the National Institutes of Health and headed up the HHS policy office during the Clinton administration.

Recently she has led the Nuclear Threat Initiative's effort to reduce the threat of biological warfare. Both industry and consumers applauded Dr. Hamburg as capable and experienced and not so inclined to toot her own horn.

As Baltimore's health commissioner, pediatrician Sharfstein attracted national attention by launching a successful campaign in 2007 to halt prescribing of cough and cold medicines for very young children. A former aide to Rep. Henry Waxman (D-Calif.), chairman of the House Energy & Commerce Committee, Dr. Sharfstein faced tougher confirmation prospects in the Senate because of industry concerns. He has opposed pharma marketing to doctors and medical students, promoted access to prescription drugs and backed FDA regulation of tobacco.

The administration's emphasis on restoring FDA's food oversight capabilities, yet making it more distinct from drug regulation, walks a middle line between those who want to pull food out of FDA and into a new federal food safety agency, and those who prefer to keep FDA intact. But it remains to be seen if appointing two high-profile officials to share FDA leadership will really work.