With Daschle Out, Should Obama De-Couple HHS from Health Care Reform?

Yesterday, I wrote, "Or is this all the usual sturm and drang from Washington, where Daschle will be roughed up before being eventually confirmed as planned, again following the Geithner script?  I tend to think it will ultimately be the last of these."

Boy, did I blow that one.  In breaking news, Tom Daschle is withdrawing his nomination for HHS Secretary.  Unknown at this point is whether he will also withdraw as Executive Director of the White House Office of Health Reform - a post which does not require Senate confirmation.  But it's difficult to see how the political climate would be favorable to that unless the president were willing to soft-pedal health care for a few months before bringing Daschle back - something he's shown no indication of doing.

There's no question this is bad news.  In his dual role, Daschle would have had an office in the West Wing, making him not only the first HHS Secretary with such an honor but giving the push for universal health care an office within walking distance of the Oval Office was a visual cue of how central health care was to this presidency.  But it could be an opportunity.  Normally, the HHS secretary is not the quarterback for health care reform - certainly Donna Shalala wasn't during the Clinton years.  Tom Daschle may have been uniquely positioned to wear both hats, but if he's not an option, the two jobs shouldn't remain joined out of nostalgia.

After all, there are big tasks ahead for HHS independent of any push for health care reform.  Daschle had talked at length about comprehensive analysis of cost-effectiveness for the treatments being reimbursed by Medicare and Medicaid - but that's going to be a fight requiring a strong leader at the top of the agency.  We've discussed the possibility of Medicare experimenting with "episodes of care" reimbursement instead of traditional fee-for-service.  The incoming HHS Secretary will also need to find a way to stop the bleeding on Medicare Part C (aka Medicare Advantage) and Medicare Part D's prescription drug program, with the "overpayments" and waste in those programs.  Finally, if the Economic Recovery Act goes through as planned, we'll see a spike in the number of people on Medicaid through temporary eligibility extended to the unemployed.  Over the coming months and years, this will be a tall order for any cabinet secretary, let alone one who is also trying to stage-manage what will doubtlessly be the biggest legislative fight of a generation.

There's also a question of timing.  The selection, vetting, and pageantry of a new HHS Secretary pick is going to take a very long time - at least a month and a half, likely more.  By then, the push for health care reform will already have begun in Congress.  If there's one thing we don't want, it's an Executive Director of the White House Office of Health Reform playing catch-up with a process that's already underway.  President Obama needs to appoint someone as his quarterback as soon as possible - even if it means de-coupling that role from HHS - if he wants to keep the White House as a player in the reform to follow.

But what do you think?  One role or two?  And who should President Obama tap to lead the charge on universal health care?

(Photo credit:  shij13 on Flickr.)