Why Not Howard Dean for HHS Secretary?

Whenever you hear about Howard Dean's prospects to replace Tom Daschle as the White House's pick as HHS Secretary, he's always labeled the "dark horse," with most stories overly dismissive of his chances.  He's on bad terms with Rahm Emmanuel, we hear, or he and Obama were never close.  Although I buy into these political considerations when it comes to managing the White House Office of Health Reform, it's just not compelling to also keep Dean from being considered more seriously for HHS Secretary.

I will concede that I just don't see Dean taking over for Daschle as Obama's health care reform wingman.  On that front, Daschle's political acumen was as important as his policy background - indeed, probably more important.  He had the relationships in the Senate and knew all the parliamentary ins and outs of getting legislation passed.  He was an affable and compelling salesman to the public, but also unquestionably Obama's man.  He had strong relationship with all the players in the health care debate (including the insurance companies) and was the consummate inside-the-Beltway professional - ironically, the very reason why his nomination got torpedoed.  Absolutely none of this describes Dean.  He's clearly more comfortable playing the outsider game than the insider game, his relationships with Congress are questionable, and we'd be in for a gazillion "can these guys get along" process stories about whether Dean was pushing Obama's health care agenda or his own.

Plus, Dean's presidential campaign was discouraging on the topic of universal health care.  If you're a single-payer advocate, perhaps you remember his bald statement from 2003, "I do not believe in free health care or free anything.  If you want to totally reform the health care system, I'm not your guy. Just expand the system we already have to include everybody. I'm not interested in having an argument about what the best health care system is."  What Dean proposed during the campaign was an incremental approach to improve access, based largely on tax credit subsidies and public programs, but he did not sell it well during the debates, particularly when confronted with the bolder plans offered by Dennis Kucinich and Dick Gephardt.

But running the agency that is responsible for Medicare, Medicaid, the FDA, the Center for Disease Control, the National Institute of Health and others plays remarkably well into Dean's strengths.  As many have observed, Dean's track management track record is as good as his record avoiding conflict with the power players in Washington is bad.  His years managing Vermont's budget were both excellent and marked with surprising fiscal conservatism - 11 balanced budgets while also paying down much of Vermont's debt.  His tenure at the DNC and institution of the 50 State Initiative, although controversial, proved to be a wise strategy to turn the DNC into as prodigious an organizing institution as it was a fundraising institution which helped enable the successful campaign of 2008 on all levels.  Even more relevant is how Dean was able to lower the percentage of uninsured in Vermont from 12.7% to 9.6% (during the campaign, Dean cited another assessment that 96.4% of Vermonters had coverage) -- by leveraging the power of existing programs, primarily Medicaid, to cover nearly all children and pregnant mothers, and doing so without busting the budget.  He proved adept at promoting public health not with a bureaucrat's eye but a physician's eye, focusing on primary and preventative care.  Is that not exactly the perspective we'd like to see in the man in charge of Medicare and Medicaid?

Ironically, I didn't like Dean as a presidential candidate.  And I'm not in a position to say Dean is automatically the best candidate (Kansas Governor Kathleen Sebelius also has excellent credentials and perhaps warrants her own post), but he is more deserving of a look as Tennessee Governor and former insurance CEO Phil Breseden.  HHS Secretary might not be as glamorous a job as Obama's Health Care Reform Quarterback, but Medicare has a big role to play in reforming our health care system to make it cheaper and more efficient.  Dean's experience should trump the politics.  After all, could he possibly be more disruptive to Cabinet meetings than Judd Gregg would have been?

(Photo credit:  drummajorinstitute on Flickr.)