In the keynote speech at today’s 2009 Legislative Conference, grassroots advocacy expert Mike Dunn spoke to ACC members about the importance of grassroots lobbying and political action committees in influencing policy. He made very clear how much of an effect the two can have in influencing policy. If you want to do what you do (treating patients), you have to get involved in politics, he said. It doesn’t matter whether you like politics, he noted -- politics likes you. According to Mike, he who determines the rules, determines the care patients receive. Cardiovascular professionals have to be part of the equation of who determines the rules.

Mike also discussed a brief history of political donations. With the outlaw of soft donations, organizations like the ACC have a limited ability to influence lawmakers and form relationships. Because PACs and grassroots are the only two ways for us to influence policymakers legally, cardiovascular professionals must see themselves not just as medical professionals, but also as government relations professionals. Our strength is in our relationships with lawmakers, which we must bolster through our visits and through our donations.

He closed his presentation with some pointers for our Hill visits tomorrow:

• Don’t tell the history of cardiology or your own income concerns – your time is too short
  
  
• Emphasize the effects of the CMS cuts on quality of care and the viability of your practice
  
  
• Put in a word for tort reform. Health care reform should have tort reform – we won’t get Republican support without it
  
  
• Don’t ignore the staffer in the room

Mike started his presentation by saying, "Your house is on fire." Sadly, this is true. We got to use our advocacy efforts – even if you don’t like to get involved, even if you hate politics – to make sure we can put the fire out. Visit's ACC PAC's Web site here.

Dr. Peggy Hamberg’s appointment at FDA has been well received in town (we had better ideas); no word yet on the all-important CMS job, given Medicare’s status as the means for much of the reform process; and hearings for Governor Sebelius have yet to be set up.

I still hope our own Past President Tim Garson is in the mix for Surgeon General or Assistant Secretary for Health after Gupta pulled out. Tim may not agree with me on promoting this, given his dedication to his wonderful current position as Health Provost at U of VA, but he’d be great there.

Also, last week HHS (Department of Health and Human Services) established an Office of Recovery Act Coordination, which will coordinate all ARRA (Stimulus) implementation efforts and serve as the primary liaison to the Office of Management and Budget. Dennis Williams, former Deputy Administrator of the Health Resources and Services Administration has been selected to oversee the new office as Deputy Assistant Secretary. Dennis is due to have lots of new friends, us included!

Kathleen Sebelius has gotten the nod today to be HHS Secretary. She was insurance commissioner before being Governor; worked in an insurance world for a while. Don’t know how good that is for us. She was one of the first Obama Governors though. Seems to have done a good job with their state Medicaid program. I hear good things about her. Must have her taxes in order. So, then -- let’s get moving!

Still no real word on the Secretary of HHS. Governor Sebelius of Kansas is being background vetted, so may be #1 choice. Ted Kennedy has come out for her.  But no word really. The FDA job seems down to Margaret Hamburg, M.D., former NYC Commissioner of Health, and Baltimore Health Commissioner Scharfstein (Kennedy’s favorite), and former Henry Waxman (D-Calif.) staff person. Hamburg is a very effective person. Everything else seems on hold still.

*** Kathleen Sebelius. Image from Wikimedia Commons (Dayton Mitchell) ***

Who will be the new Secretary for HHS? No word on whether Governor Sibelius is interested. Even if so, she might need a couple of years to get the hang of Congress. Dr. Dean has a lot of naysayers. John Podesta, the Obama Transition Chief of Staff is seen as ready to move on the issue, but I’m not hearing much more on his name a week later.

Personally, my choice of a surprise candidate would be Ahnold! Seriously. Governor Schwarzenegger is a moderate Republican, married to Ted Kennedy’s niece, whose recent health system plan was patterned very much like Massachusetts, the Obama principles, and the Baucus plan. With Senator Gregg’s resignation, the President needs another R member of the Cabinet. Arnold’s smart. And who could better strong arm the Congress, grab the public’s attention, and have some real-world experience with how tough this is than Arnold? Start the rumor campaign.

The unexpected withdrawal of former Senate Majority Leader Tom Daschle (D-S.D.) from his nomination for secretary of HHS and White House health czar shook things up badly. His acknowledgment of responsibility for $140,000 in unpaid taxes would perhaps not been so serious had it not been related to three years of chauffeured limo service, compliments of a company that itself is now mired in tax fraud allegations.

The loss of Mr. Daschle is very concerning regarding the prospects of health system reform. The ACC supported many of the ideas Daschle articulated in his book on health care reform, and reform principles he crafted as part of the Mayo Clinic’s board. He was steering away from a single payer system and toward a middle of the road approach, combining government action with market based reforms. I expected this good man to be confirmed — I think everyone did — but, the tax issues he faced clearly weren’t in line with the new administration’s pledge to promote higher ethics.

It’s critically important who they nominate in his place, and the speculation is about seeking now a Governor who has managed a state Medicaid program well, such as Kathleen Sibelius (KS) or former governor John Kitzhaber (OR). Many hope it’s not the polarizing ex-Governor of Vermont, Howard Dean. Ex-Congressman Dick Gephardt is also a possibility — he’s fluent in health policy matters, and respected on the Hill. Ahnold of California has been mentioned also, and who wouldn’t want to get away from a $40 Billion deficit?

But none of those names could necessarily bring Ds and Rs together to achieve a consensus around divisive issues and constituencies -- and, the appointees Daschle has already hired to work with him already might not be the people with whom the next Secretary designee wants to work. Complicated. The Senate HELP (Kennedy et al) and Finance (Baucus et al) Committees are still planning to move the reform agenda, but we need somebody on the Administration side to help bring things together.

The FDA appointment was not announced as promised this week. The Daschle events eclipsed this. I am hearing Dr. Califf’s name more frequently whispered of late (Mr. Waxman is supporting his former staffer instead). For the CMS job, academics Don Berwick, M.D. (pediatrician and IHI founder), Ken Thorpe, Ph.D. (Emory University for former Clinton policy appointee in HHS), and Bob Berenson, M.D. (Urban Institute researcher and former CMS senior staff) are names in the rumor mills (among others). There’s nothing more about Sanjay Gupta for SG. C’mon, Tim Garson.   

Bill Corr is an interesting choice for deputy secretary at HHS under Daschle. Usually this person is an administrative type without any health policy expertise. Corr was in fact chief of staff under Donna Shalala when she was secretary, but he spent the last four years as an executive at the Campaign for Tobacco Free Kids and is passionate about the issue — along with prevention in general. Looks like another interesting and wise appointment.

Beginning Tuesday, FDA Chief Scientist and Principal Deputy Commissioner Frank Torti became acting commissioner. There’s already an "acting" at NIH. Health and Human Services (HHS) announced the decision earlier this month, along with transition plans for the other key positions. Assistant HHS Secretary Charlie Johnson will take over when Michael Leavitt this week steps down. Johnson will serve as acting secretary until Secretary-designate Daschle takes office. CMS COO Charlene Frizzera will take over from Kerry Weems when he steps down this week.

In each case here, a civil servant is taking over as the acting director in place of the former Senate-confirmed appointee—because the appointees have been asked to resign by Bush, the Obama Transition, or both. Julie Gerberding at CDC wanted to stay, but was asked to go. Only one HHS key appointee did not get the resignation request: Carolyn Clancy, Director of AHRQ (Agency for Health Research and Quality). Why? Well, first, she’s one of few Dems appointed by the Bush Administration. But second, she’s great, and we work closely with her on many issues. Obama wants her to stay. This is good.

Douglas Elmendorf, Ph.D., was appointed (just before the Big Apple descended) to be the new CBO (Congressional Budget Office) director, replacing Peter Orzag, who is now the White House Budget Director. Like Orzag, Elmendorf was an economist at the centrist Brookings Institution in D.C., after having previously been a key staffer at CBO, Justice, the Federal Reserve, and Clinton’s Council of Economic Advisors. Pretty good credentials. He was appointed by Ms. Pelosi and the House Dems. His expertise seems to be mainly in financial markets, housing, and tax policy (how will that helpful?).

My friends at Brookings really like this guy. I’ve met him at a few recent events there, and he is impressive. He will need to be.

The Obama administration has asked that interested parties set up neighborhood town-hall kinds of meetings to discuss health system reform priorities and needs to be collated and shared with Secretary-designee Daschle and President-Elect Obama. We at ACC will offer assistance of information to any of you out there who might be willing to hold one of these meetings. ACC may hold one at Heart House and at a private home in Washington. Mr. Daschle has promised to try to attend a few of these personally, and to send some of their team out to others. I encourage you to sign up to host your own meeting -- but don't forget to let us know if you do! E-mail qualityfirst@acc.org. 

After the fall of Chairman Dingell (D-Mich.) of the House Energy and Commerce Committee to Rep. Henry Waxman (D-Calif.) several weeks back, it now appears increasingly certain that Chairman Rangel (D-N.Y.) of House Ways and Means, arguably the most powerful Chairman of the most powerful committee in the House, may go down as well.  WAM Health Subcommittee Chair Pete Stark (D-Calif.) has the greatest seniority to replace Rangel, although he is known as a somewhat uncontrollable firebrand.  ACC has a remarkably good relationship with Stark, even if we don’t like some of what he proposes. 

Rep. Xavier Becerra (D-Calif.) has emerged as a more interesting and perhaps bipartisan choice.  Becerra is a moderate Democrat, and he is a man of reason, and, in my opinion, one of the most intelligent members of the House. He is also a good friend. It could be positive for health care if he became Chair of WAM. However, he is also a highly regarded candidate to move into the Obama administration, which is considered likely (as chair of the Federal Trade Commission). Either way, we would be in good position to talk with the new Chairman if it happens.

Other big news of late last month was the unseating of long-standing Chair Dingell (D-Mich.) from Energy and Commerce by Henry Waxman (D-Calif.). What does that mean? Waxman is an expert of Medicaid and public programs (other than Medicare), but he understands a lot about Medicare as well. He loves health care policy. Dingell has pretty much delegated it. Waxman leans pretty far to the left for a lot of Blue Dog Dems, and he is a good friend of Ms. Pelosi -- he also loves regulations. But, one bit of good news; I have been a friend of his for over 20 years. I respect him, and can argue with him without making him mad. He will accelerate the reform process and be a player. He’s very big in bird-dogging conflicts with industry and oversight activities, including fraud and abuse. We’ll be fine with that.

With the apparent but surprising decision to have Hillary Clinton become the Secretary of State (this is gutsy of Obama), we lose a health advocate in the Senate who could have filled in for Senator Kennedy on his Health, Education, Labor and Pensions Committee if he unfortunately were to be unable to stay in that role. 

It’s safe to say that there is still a lot of excitement and enthusiasm buzzing in Washington about the prospects of moving the health reform agenda forward in a big way next year. Daschle will be able to help sell a strategy to his buddies in the House and Senate very effectively. Too bad he also has to be saddled with solving the SGRrrr nightmare. That looms as an ugly $300 billion mess. But, this evolution of this presidential transition -- so far at least -- is generally quite positive for us I think.

There are clearly a lot of folks who are still adjusting to the fact that Senator Obama is our next President. Two-thirds of the country -- a much higher percentage of people than voted for him -- say they are optimistic. Of course, that means one third is worried. But, so far the man is acting very Presidential, particularly in laying low, staying out of D.C. and the limelight, and allowing George Bush to finish his term. That shows some class -- and wisdom. For ACC, and given that we don’t know yet who the HHS appointment will be -- or even who will be leaders of the health transition team -- we’re mainly watching. There have no new reliable hints to report in these regards as yet.

We’re hoping for bipartisan positioning, and for appointees in HHS and CMS who can bring all parties together. But, some interesting things have already been noted by the election pundits. Most of the Dems elected to Congress are of the moderate Blue Dog breed, many of whom, for example, are opposed to abortion. Only bipartisan leadership will overcome gridlock on many issues.

While there is still the reality of racism in this country (and certainly much more so in the world at large), this election could hopefully put a lot of those negative attitudes in retreat. Further, during the campaign there was some attempt to negatively paint Obama as an intellectual -- as contrasted to a Joe Six-Pack regular guy. John Kennedy may have been the last powerful Dem considered an ‘intellectual,’ and William F. Buckley Jr. was often cited as the intellectual influence on the Republican side. Now that Obama’s actually the President and the election rhetoric is over, hopefully more folks (Dem and Moderate) are thinking it may not be such a bad thing to have a smart, analytical mind in the Oval Office, and a President who is not threatened in surrounding himself with intelligent people to challenge him as Cabinet heads.

I have confirmed that the transition team is seriously considering both Drs. Nissen and Califf as possible FDA appointees (good news for cardiology); and here’s a new and positive additional rumor to consider also:

Governor Tim Kaine of Virginia has nominated ACC Past President and U of VA Provost Tim Garson to be Surgeon General. We plan to get behind this nomination as best we can. That prospect would be terrific for ACC and for the country. Don’t yet know what other names may be floated there. More later…..

Congrats to Sen. Barack Obama! With Obama now president-elect, some are saying that's its only a matter of time before a reform package is introduced. Ted Kennedy (D-Mass., and the “Lion” of the Senate) is virtually at work in the Senate from his home in Massachusetts on development of a bipartisan, universal health care package. Sen. Kennedy wants to introduce the bill, which hopefully would embrace some of Obama’s health reform goals, as soon as a new Congress convenes. For all his colleagues in the Congress, there would be great sentiment in having a national reform strategy proposed in Kennedy’s name, and in honor of his many years of advocating for expanded access to care. The Senator’s longevity, given his struggle with glioblastoma, is uncertain, making this a potential motivation for moving system reform along faster than might otherwise occur. Senator Baucus and the Senate Finance staff are collaborating.

ACC is monitoring this progress, and will be ready to discuss these ideas, the Ron Wyden concept, and whatever else emerges after the elections in anticipation of our second Health Reform Summit in early 2009. 

David Blumenthal, M.D., M.P.P., director of the Institute for Health Policy and an advisor to the Obama campaign, earlier this month published a sharp critique of Sen. McCain’s health care plan in the New England Journal of Medicine. "Primum Non Nocere — The McCain Plan for Health Insecurity" identifies McCain’s proposals with the Bush administration’s health policies, and warns that the Republican candidate’s plan would decimate the current employer-sponsored health insurance system.

Of course, in one sense no surprise -- the NEJM emanates from a very liberal area, and Blumenthal is an Obama advisor. But, I think there’s something of interest here for you, regardless of who you support in the presidential campaign. McCain wants to unleash the free market to lower costs, promote choice, and improve quality... Who can argue with that? But, given the complexity of health care, moving toward that goal precipitously could create a crisis even bigger than the current banking nightmare. Blumenthal has to be seen as partisan; but there are concerns there that I wish McCain’s advisors (Doug Holtz-Eakin and others) had thought through more carefully before putting incomplete ideas out there  Not that Obama’s ideas are complete strategies either. As I’ve shared previously, I think both party platforms are worrisome for doctors and ACC. That’s why we need to engage and get involved in the final products. But this makes thoughtful reading if you extract the partisan bias. I’d be interested in your thoughts.