Should Obama Close the White House Office of Health Reform?

There’s a report in Politico today suggests that the White House “is considering dumping its newly created Office of Health Reform.”  Originally, Tom Daschle was slated to both be the Secretary of Health and Human Services and the Executive Director of this new White House bureaucracy, complete with an office in the “real estate at a premium” West Wing.  With the collapse and withdrawal of Daschle’s nomination, speculation has been that his role would be split in two – one Secretary of HHS and one quarterback for the health care reform effort.  But since they’re obviously having trouble replacing Daschle for either one of his roles, it begs the question whether they should even try to retain the new office that was created with him in mind.

Here are my five reasons why it makes sense to switch gears on how the administration tackles health care reform and close the doors.

1.)    It’s the quarterback, not the bureaucracy

Ezra Klein makes this point better than I will, but the Office of Health Reform was, from all accounts, Daschle’s idea.  Having lived through the Clinton reform efforts, when it wasn’t clear if you should be talking to HHS Secretary Donna Shalala, consultant-in-chief for the health care task force Ira Magaziner, Hillary Clinton or the president if you wanted the final word, Daschle wanted to make it obvious he was The Guy.  If he could show the White House’s full commitment to reform by being a corridor away from the Oval Office, even better.  It’s easy to see why.  As a former Majority and Minority Leader in the Senate, Daschle is used to the power structure and support of an office.  It’s his most comfortable working style.

But whoever the point man or woman on health care reform will be, he or she won’t be Daschle.  Unless it’s someone who’s also used to that working style, like John Podesta (which is unlikely), it doesn’t make sense to give an office so clearly designed for one man’s vision to someone else.  It's likely the new point person won’t even need it to do the job.

2.)    It’s not even the quarterback -- it’s the team

A new bureaucracy created a strong power center for Daschle. The trappings of a new office sent a clear signal that when it was crunch time, Daschle would still be running the show even then, not Rahm Emmanuel, Larry Summers or anyone else.  But that’s likely no longer the case.  Minus an all-star, the heavy lifting on health care reform is now likely to translate to an “all hands on deck” approach.  Indeed, that probably will increase the likelihood of success.

Put another way, there was no Executive Director of the Office of Economic Stimulus needed to get that bill passed.  There were a few point persons in the early going, but then the full resources of the White House stepped up when it mattered.  Health care reform should be the same.

3.)    A symbol of commitment is less important than the commitment

A West Wing office for the Office of Health Reform was a wonderful symbol.  But you know what’s even better than that?  A budget. Vice President Biden is fond of quoting his dad saying, “Don’t tell me what your values are.  Show me your budget, and I’ll tell you what your values are.”

The good news is that by all accounts, tackling health care reform this year has been written into the president's first budget in an unmistakable way.  The Washington Post quotes an anonymous official saying, "The budget will kick off or facilitate a focus on getting health care done this year."  I’ll take that over a bureaucracy in the White House.

4.)    The division of labor never quite made sense

As fancy as a White House Office of Health Reform sounds, it didn’t quite seem to add anything to the mix.  From the moment Daschle was unofficially leaked as HHS Secretary, he became the face of health care reform on Change.gov, the transition’s Web site.  Great, I thought, health care reform will be run through HHS.  That makes sense, since reforming Medicare and Medicaid particularly on compensation and Medicare Part D will be huge components of a system-wide reform.

When Daschle was formally announced as both the pick for HHS and the Executive Director of a new office, it sounded exciting but no one was quite sure what it meant.  Jeanne Lambrew, Daschle’s co-author on his health care policy book, and Mark Childress were named Deputy Directors. But Mark Childress was also slated to be Chief of Staff at HHS.  And Jeanne Lambrew is now also working at HHS on the health care provisions of the stimulus.  So it was feeling a little redundant already.

5.)    With Daschle out, others are stepping up

Big players make big plays if they have a chance to get in the game.  Here's just one example: OMB Director Peter Orszag has shown himself over the past month and past years to be a big player.  For the past two years as Director of the Congressional Budget Office, he has been a one-man evangelist of the need to address health care costs head-on to prevent a future budget catastrophe.  It’s expected that the first budget will demonstrate Orszag’s vast knowledge on health care costs as much as Obama’s values.

More recently, and more surprisingly, Orszag emerged as the negotiator who got the stimulus over the last few hurdles, after both Rahm and Larry Summers had left the room.  Sen. Harry Reid sings his praises.  We need more of his input on health care reform, which means health care will need to be dealt more and more at at a Cabinet level.  But can that happen if a new quarterback, late to the administrations plans on health care, is given the territory of a new bureaucracy to defend?  Or will that just incite infighting and turf fights?

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The prospects of a White House full court press on health care reform this year are as strong as they ever were.  Daschle dropping out slowed but did not stop that momentum.  So long as the president has a clear point person in the early stages, a whole dedicated office shouldn’t be necessary.  It’s time to close the doors.  I’m sure they can find someone else who needs the office space.

(Photo credit:  zen on Flickr.)