When Tom Daschle's nomination was announced, so too was a new structure for the executive branch's health care efforts. Daschle, remember, was not simply a Secretary of Health and Human Services candidate. He was also to head up the White House Office of Health Reform. This was to ensure that the administration had a single point person on all things health care. In 1994, Donna Shalala, Ira Magaziner, Hillary Clinton, and a handful of others all presented themselves as authoritative access points for the health effort. Senators would get a commitment from one player and then rage when it wasn't carried out by another. The bureaucracy at HHS felt frozen out of the process. No one knew who to call, or how to get information. It was chaos. The joint HHS/OHR structure proposed by Obama and Daschle was an effort to end those communication problems. One player would be presented as the single authority on the whole of the Administration's health care efforts. The White House meetings would have the same chair as the HHS meetings. Jeanne Lambrew, the deputy director of the OHR, described the thinking yesterday in her speech to the AcademyHealth Policy Conference. "Health reform is such an all encompassing and important priority to the President that he needed someone in the White House coordinating the effort," she said. The question is whether he still does. OHR was created for Daschle at Daschle's request. Obama wanted Daschle in the White House. Will he want Daschle's successor in such close proximity? Will he split HHS and OHR?
