President-elect Barack Obama’s HHS secretary nominee — former Senate Majority Leader Tom Daschle (D-S.D.), who Obama also named as director of a new White House Office of Health Reform — “has put a premium on cooperation between the White House, Congress and major health care interest groups” in the overhaul of the U.S. health care system, the Los Angeles Times reports. The Times examines Daschle’s book on health care called “Critical,” and his specific and “potentially controversial” plans for health care reform…  Click title to read more…

Daschle has proposed to establish a Federal Health Board modeled after the Federal Reserve to determine the medications, medical devices and other treatments that federal health care programs should cover based on cost-effectiveness. According to the Times, Daschle also has proposed a requirement that all U.S. residents obtain health insurance and the establishment of a public health plan to provide coverage for those who do not obtain private coverage. The Times also looks at Daschle’s “virtual road map for the kind of campaign the Obama White House and its allies will probably pursue in their effort to avoid the pitfalls that doomed” health care reform efforts by former President Bill Clinton in the 1990s (Levey, Los Angeles Times, 12/15).

Health Care ‘Czar’
According to the Wall Street Journal, as director of the White House Office of Health Reform, Daschle will serve as a “health czar of sorts” — one of a number of czars whom Obama has appointed to address various issues. Obama seeks to “have someone in the White House with the president’s ear to coordinate policy and give the topic the weight it deserves,” and the appointment of a czar “gives an issue prominence, allows for coordination among agencies and streamlines decision making,” the Journal reports (Meckler, Wall Street Journal, 12/15).

Daschle will have a role on health care reform that “truly does represent a czar role,” Phil Blando of the health care consulting group AB+M Partners said, adding, “He’s the go-to guy across the board. People will try to end run around him, and they’re going to have nowhere to go” (Frates, The Politico, 12/13).

Next NIH Director Faces Budgetary Issues
The next NIH director will face a number of budgetary issues, among other concerns, the Washington Post reports. According to the Post, over the past five years, the NIH budget has “risen only slightly,” and “when adjusted for inflation, has declined.” Obama during his campaign promised to “double the research budgets of key science agencies,” such as NIH, over 10 years. However, whether “that is still the plan, given the nation’s current economic straits, is unknown,” according to the Post.

In addition to budgetary issues, the NIH director will face “pressure to strengthen conflict-of-interest rules governing scientists at universities and medical schools who get money from the agency” and will have to address a “flood of requests for grants” in the event that Obama overturns current restrictions on federal funding for embryonic stem cell research, the Post reports.

An additional “major question facing the new administration is what role, if any, the NIH will play in the huge number of cost-effectiveness, comparative-effectiveness, quality-improvement and patient-safety studies that many health care policy experts say must be done to get the full value of the products of medical research,” according to the Post. Experts maintain that many such studies “are going to have to be done by someone … if the Obama administration is serious about health care reform,” the Post reports.

No leading candidate for the next NIH director has emerged, according to observers (Brown, Washington Post, 12/13).

VA Funding Proposal Faces Obstacles
A campaign promise by Obama to provide more stable and transparent funding for the Department of Veterans Affairs health care system “faces a number of obstacles in the 111th Congress, even among Democrats,” CQ Today reports. Days before the election, Obama promised to ask lawmakers in 2009 to pass appropriations bills for VA for fiscal years 2010 and 2011. Veteran advocacy groups have said that VA cannot “run a health care system without knowing how much money will be available in the future,” according to CQ Today.

Obama likely will receive support for the problems from several important lawmakers and some congressional institutions. However, the implementation of a proposal that would “provide one agency’s spending farther into the future and subject the rest to the regular order” would “be unusual and perhaps logistically difficult,” according to CQ Today (Johnson, CQ Today, 12/12).

Opinion Pieces

• Oliver Fein, Atlanta Journal-Constitution: Recent job losses “spell disaster for our health,” as millions of U.S. residents have lost their employer-sponsored health insurance, and millions more “are finding it harder to pay their copays and deductibles and are scrimping on their medications and doctor visits” because of the current economic recession, Fein, associate dean and professor of clinical medicine and public health at Weill Cornell Medical College and president of Physicians for a National Health Program, writes in a Journal-Constitution opinion piece. Fein writes, “In short, affordable health care has never been more urgently needed. Yet most of the health reform proposals coming out of Washington these days won’t get us there.” According to Fein, current proposals by Obama, Senate Finance Committee Chair Max Baucus (D-Mont.) and Senate Health, Education, Labor and Pensions Committee Chair Edward Kennedy (D-Mass.) “share a fatal flaw: they preserve a central role for the private health insurance industry.” He writes, “As long as we rely on private health insurers, universal coverage will be unaffordable.” In place of private health insurers, Fein recommends an expansion of Medicare to all residents (Fein, Atlanta Journal-Constitution, 12/14).
• Mike King, Atlanta Journal-Constitution: “The depth of the nation’s financial crisis seems to argue that major reform efforts on a host of long-delayed critical issues should be put off yet again,” but “getting started on fixing the nation’s health care financing system is more important than ever,” King, a member of the Journal-Constitution editorial board, writes. According to King, “this country’s expensive and inefficient health care delivery system is linked to many of the financial problems facing U.S. manufacturers, most notably American automakers.” He adds, “The long-term survival of the industry — and much of the nation’s manufacturing sector — depends on finding a solution that takes some of the burden of health care costs off not just employers but their workers and the people who buy American goods and services.” He concludes, “Such an approach may take longer to carry out, but it would in time answer questions that so many politicians have avoided for so long: Do Americans have a right to health care, and if so, how much are we willing to pay for it?” (King, Atlanta Journal-Constitution, 12/14).
• Kevin Sack, New York Times: Obama “placed a heavy bet last week that the recession-wracked country he is about to inherit has finally reached its tipping point on health care,” New York Times reporter Sack writes. “It might seem counterintuitive to gamble that political and economic forces would converge at such a low point after more than half a century of failure,” but Obama remains committed to efforts to provide U.S. residents with affordable health care, Sack writes. According to Sack, “Obama, like others, sees political opportunity in the country’s economic distress, and he threw in last week with those who argue that the financial crisis has only made it more imperative to remake the health delivery system — that, in fact, economic recovery depends on it.” With the Daschle nomination, “Obama made explicit that the reeling economy had not softened his commitment” to health care reform, according to Sack (Sack, New York Times, 12/14).
• Ann McFeatters, Seattle Post-Intelligencer: Obama has announced a number of health care proposals, but he “is still not able to answer the most important question about improving health care in America: how to pay for it,” Scripps Howard columnist McFeatters writes in a Post-Intelligencer opinion piece. She adds, “Obama recognizes the challenge: Year after year, our leaders offer up detailed health care plans with great fanfare and promise, only to see them fail, derailed by Washington politics and influence peddling.” McFeatters writes, “Forcing employers to pick up more of the health insurance burden is not an option. It is often a leading factor in the failure of small businesses. Some large firms are unable to compete with global companies that don’t have to pay employee health benefits. Solving the economic crisis means solving the health care crisis.” She concludes, “On top of his other challenges, Obama must do something concrete in 2009 about health care besides talk about it. Choosing Daschle was a start, but the clock is ticking” (McFeatters, Seattle Post-Intelligencer, 12/12).
• David Broder, Seattle Times: Comprehensive health care reform “has a much better chance of passage in the next Congress than when Bill and Hillary Clinton tried back in 1993-94,” syndicated columnist Broder writes in a Seattle Times opinion piece. He adds, “Today, that status quo has become unendurable for almost everyone. The budgets of families, businesses and government at all levels are being wrecked by the rising cost of health care.” According to Broder, “Daschle is a shrewd choice to lead the Obama effort,” as he “knows the politics of Capitol Hill intimately.” Broder concludes, “It will really test the whole political system to determine if the fragile emerging consensus on the need for major reform can overcome the thousand particular issue battles that are certain to erupt” (Broder, Seattle Times, 12/12).

Broadcast Coverage
NPR’s “Weekend Edition Saturday” on Saturday reported on the Daschle nomination. The segment includes comments from NPR’s Juan Williams about how Daschle and the Obama administration will address health care reform (Simon, “Weekend Edition Saturday,” NPR, 12/13).