Opinions: The Healthcare System In The U.S


Posted on: Sun 26-10-2014

 
Something I learned during the first two years of the Obama administration, when the staff infighting was at its worst: if you wanted to get somebody to say something nice, ask them about Ron Klain.
 
Klain entered the administration as Vice President Joe Biden's chief of staff. This was, itself, notable: Klain has been chief of staff to Vice President Al Gore, too, making him the only person to serve in that position for two different vice presidents.
 
But the esteem for Klain wasn't based on his resume. Rather, he had a mix of policy, political, and bureaucratic chops that everyone agreed was rare. The policy people spoke admiringly of his policy savvy, and they all agreed he lapped them in political instincts. The political people admired his political instincts, but recognized he was better at policy. And everyone agreed Klain knew how to run an interagency process.
 
EVERYONE AGREED KLAIN KNEW HOW TO RUN AN INTERAGENCY PROCESS
"He understands the intersection of politics and policy better than anyone I've ever worked with," says economist Jared Bernstein, who worked closely with Klain in Biden's office, "and is thus uniquely effective in getting things done."
 
What the Ebola czar needs to do:
The White House announced that Klain was named "Ebola czar." It's a good choice because it shows a healthy respect for how hard the bureaucratic job of coordinating the Ebola response really is. The Ebola response involves various arms of the Department of Health and Human Services (particularly, though not solely, the Centers for Disease Control and Prevention), the Pentagon, the State Department, the National Security Council, the World Bank, the World Health Organization, President Obama's office, private stakeholders, and many, many more.
 
The "czar" position requires someone who knows how these different agencies and institutions work, who's got the stature to corral their efforts, who knows who to call when something unusual is needed, who can keep the policy straight. The need to rationalize a massive process is something Obama focused on in his remarks Thursday night:
 
Those of you who don't know, Lisa Monaco, who does a lot of my counterterrorism work as well as national security work, has been working with our Secretary of Health and Human Services, and Tom Frieden at the CDC. It may be appropriate for me to appoint an additional person, not because the three of these folks have not been doing an outstanding job — I should mention, and Susan Rice, my National Security Advisor. It's not that they haven't been doing an outstanding job really working hard on this issue, but they also are responsible for a whole bunch of other stuff. So Lisa is also dealing, as Susan is, with ISIL. And we're going into flu season, which means, by the way, that people should be looking to get their flu shots. We know that every year tens of thousands of people potentially die of the flu, and a hundred- thousand or more may be actually going to the emergency room and hospitalized because of the flu. So that's something that Tom also is responsible for.
 
So it may make sense for us to have one person, in part just so that after this initial surge of activity we can have a more regular process just to make sure that we're crossing all the T's and dotting all the I's going forward.
 
It would have been tempting for the Obama administration to nominate an Ebola czar who sounded good: someone with a long list of medical credentials to her name, or someone with a reassuring public profile. But the federal government has plenty of skilled epidemiologists, and this position needs to do more than look good on the Sunday talk shows.
 
THE FEDERAL GOVERNMENT HAS PLENTY OF SKILLED EPIDEMIOLOGISTS, AND THIS POSITION NEEDS TO DO MORE THAN THE SUNDAY TALK SHOWS
I've seen some people arguing that there would be no need for an Ebola czar if the Senate would simply confirm Dr. Vivek Murthy, Obama's nominee for surgeon general, who's being blocked because the National Rifle Association doesn't believe gun violence is a public-health issue. Murthy should be confirmed, but it would be a mistake to make him Ebola czar; he's a newcomer to government, and would need to learn, on the job, how to manage the various agencies and principals involved in the response effort. He'd likely get sidelined as players with more weight and bureaucratic skill began going around him.
 
Actual government experience is badly underrated in Washington. Politicians run for office promising that they know how to run businesses, not Senate offices.
 
"Bureaucrat" is often lobbed as an insult. But in processes like this one, government experience really matters. Nominating Klain suggests the White House is thinking about this correctly: as an effort that requires the coordination of already ample resources, where the danger is that the federal government will be too slow in sharing information across agencies and getting the resources where they need to go.
 
Sent In By Joseph John