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The “Dark Horse” Of HHS: Place Your Bets

Merrill Goozner has been speculating about who will be nominated as the new Secretary of HHS. He reviewed his most likely candidates (David Cutler or David Blumenthal), and threw in a “dark horse” potential nominee: Ken Thorpe (whom I’ve interviewed several times on this blog and spent time with during Obama’s inauguration ceremony).

Tommy Thompson told me that the nominee is likely to be a current or former democratic governor (such as Kathleen Sebelius or Howard Dean).

But I’ve been pondering the “long shot” question and think that Goozner may have missed a more obvious choice – someone who works with Ken Thorpe at the Partnership to Fight Chronic Disease: former Surgeon General Dr. Richard Carmona.

Here are the 10 reasons why Richard Carmona would be a smart choice for Secretary of HHS (in random order):

1.    He was confirmed by the senate as Surgeon General in 2002 and lived under their scrutiny during his term of service, meaning he has no hidden secrets, tax or nanny problems likely to embarrass Obama and could be confirmed rapidly – perhaps in under a week.
2.    He has forged extensive good relationships with both parties over the course of his tenure as Surgeon General and is known internationally.
3.    He has been the CEO of a large, public health system (including hospitals, Medicare and Medicaid clinics, nursing homes, and emergency medical systems in Arizona).
4.    He has been a paramedic, nurse, and physician and understands the healthcare system from the inside out.
5.    He has a track record of leadership in prevention, preparedness, health disparities, health literacy, global health and health diplomacy. He has worked on both sides of the aisle, including assisting Senator Kennedy with issues of disability and socio-economic determinants of health.
6.    He is Hispanic, which adds additional diversity to the Obama leadership team.
7.    He has experience managing local, state and federal health programs, including significant experience in immigration and border health issues.
8.    He demonstrated competency and leadership as manager of the US Public Health Service of over 6000 uniformed public health officers both nationally and internationally.
9.    He has extensive military experience, and is a combat-decorated Vietnam veteran. He maintains a strong relationship with military surgeons general and the department of defense.
10.    The fact that he is a political independent might actually provide a middle ground for parties with differing agendas in health reform.

Is point number 10 a deal breaker? It may be, but Obama could look farther and do much worse. And while the clock is ticking and credibility is paramount (as Maggie Mahar wrote, “Reform needs to be overseen by someone who is perceived as being above suspicion—purer than Caesar’s wife”) I think the Obama/Biden team needs to take a closer look at Dr. Carmona. He’s actually the most experienced, low risk candidate under discussion – and could truly hit the ground running at HHS. And wouldn’t it be nice to have a physician who is also a health policy expert with advanced managerial experience at the head of the healthcare reform table?

Former HHS Secretary Tommy Thompson On Tom Daschle’s Withdrawal

Many Americans have been surprised and disappointed by Senator Tom Daschle’s withdrawal as HSS Secretary nominee. I asked Tommy Thompson, former Governor of Wisconsin and the 7th U.S. Secretary of Health and Human Services, what he made of this. You may listen to our full conversation by clicking on the podcast arrow, or read a shortened summary below. Enjoy.

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Dr. Val: Tom Daschle’s withdrawal as HHS Secretary nominee has been a real shock for most people. Some are saying that without Daschle’s influence, healthcare reform will take a back seat to other economic priorities this year. What do you think?

Thompson: I don’t think that will happen because we’re in such dire need of reform that even without Tom Daschle there’s going to be a tremendous transformation of the healthcare system this year. Two healthcare bills are already undergoing the legislative process, and one is ready to be signed into law – the expansion of SCHIP, the insurance plan to cover poor children. The second bill involves the expansion of COBRA, which allows unemployed individuals to buy in to their previous employer’s health insurance plan.

But beyond this, the new stimulus package has 20 billion dollars set aside for health IT infrastructure – to create an electronic medical record for all Americans and beef up broadband access. There will also be a lot of money set aside for preventive health initiatives – to help Americans become healthier so they won’t need as many medical services.

Of course, Senator Kennedy is pushing for a “play or pay” plan modeled after Massachusetts’ law. There will be a lot of pressure to get this done quickly due to his ailing health. So you can bet your bottom dollar that the healthcare system that we know today is going to be changed so considerably that I doubt if you’ll recognize it a year from now.

Dr. Val: Do you have any idea who might replace Tom Daschle as HHS Secretary nominee?

Thompson:  I’ve been hearing a lot of names. Governor Kathleen Sebelius from Kansas is very much in the running. Howard Dean’s name has also come up. Overall I do think it will be a governor or former governor who gets the position.

Dr. Val: What sort of person would have the skills for the job?

Thompson:  I think a governor is the ideal person for the job because they already have experience running both state and federal programs – both initiating and managing them.

Dr. Val: Do you think that being a physician could be an advantage as well?

:  There are so many physicians in the department that I don’t believe that being a physician adds or detracts from the position. Being the Secretary of HHS is an administrative position and although doctors have many skills, I’m not sure that running a large agency of over 67,000 employees with a budget of over 600 billion dollars is something that most doctors have the experience to do well.

Dr. Val: Do you think Daschle made the right choice to withdraw?

: Tom Daschle is a friend of mine. I think he’s an honorable person and I think he would have made an outstanding Secretary of HHS. I’m sorry he’s withdrawn, but the debate about his taxes was splashy enough to be affecting the stimulus bill and diverting attention from it. So I think overall it was probably the right thing to do.

Dr. Val: What’s the most important thing for the American people to know about the Daschle case?

Thompson: They should know that there is no double standard between people in power and those not in power. All of us are equal in the eyes of the law, and we’re a country of laws, not of men. We’re all responsible for our own personal decisions, and that includes paying our taxes.


See KevinMD’s excellent round up of further thoughts about Tom Daschle.

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