The buzz in Washington is audible everywhere. The anticipation of major changes in health care and the possibility of real system reform continues to grow.

Peter Orzag, the brilliant economist who headed up CBO (Congressional Budget Office), and who declared earlier this year that fixing health care must be the nation’s biggest overall economic imperative, has accepted the OMB (Office of Management and Budget) job in the White House. I was a bit disappointed about that at first -- CBO is a powerful platform to push for reform and Congress will need sound advice. But Orzag shared with me that he will be charged with looking for ways to reduce unnecessary spending throughout all government agencies to free up more dollars for health care -- something he couldn’t do at CBO. That sounds promising. There is a lot of waste in health care, but there is certainly even more waste in government! Ironically, at the end of the Bush era, government is bigger than it has ever been in history -- so it’s a good source of resources for health reform. Orzag also wants to be in the center of Obama’s planning for health reform. So does everybody else.

Obama -- with some advice from Daschle, Orzag and others -- has also said he wants some of the “stimulus” dollars to go to promote health IT. That IS exciting. There is also a lot of buzz -- we’re helping to foster it -- that the new administration should bite the bullet and set interoperability standards over the objections of industry to promote open data exchanges among all vendors and systems. That would really speed reform activities along. All the IT vendors will object, but we need to do this. There is also talk of using “stimulus” dollars to promote sCHIP expansion. These are encouraging ideas.

Along the lines of HIT reform, note that ACC Presidents Jim Dove and Doug Weaver have suggested on the Hill in multiple venues that the nation also needs to find ways to overcome legitimate privacy concerns and move toward establishing a national patient identifier to promote research, chronic disease management, and quality improvement. There are tough privacy issues to be addressed, but the quality and disease management challenges on the absence of a consistent patient identifier are daunting. ACC is planning meeting with privacy advocates to see if there might be ways to reduce their opposition to a national patient identifier.