To calm my e-mailers down: The fact that the White House might dump the Office of Health Reform does not mean they're dumping health reform. Quite the opposite, in fact. The White House Office of Health Reform was an agency created at Tom Daschle's request to carry out Tom Daschle's vision of health reform. Its deputy director, Jeanne Lambrew, was co-author of Daschle's book on health care. Mark Childress, who would be jointly serve as chief of staff at HHS and the other deputy director at the Office of Health Reform, was Daschle's former chief counsel. This was Daschle's show -- his structure, his people, his strategy. Daschle believed this consolidation would solve a very specific problem that had confronted the Clinton administration in 1994: Unclear lines of authority. By uniting the White House's health reform effort and the Department of Health and Human Services under one principal, there would be no doubt who the administration's point of contact was in health care. That would streamline the process: Congressmen would know where to go for information, industry would know how to plead their case, and the media would know who to actually listen to. That vision, crucially, relied on the authority vested in him by the President of the United States. The health czar only matters if he's understood to have Obama's ear on the issue. And Daschle did have Obama's ear. Obama trusted Daschle. He trusted him to be the administration's point of contact with the Senate, he trusted his knowledge and instincts on the issue, he trusted his ability to manage a large bureaucracy. But the administration has not found a suitable replacement. Daschle has not -- and will not -- be replaced. And if he's not replaced, then the structure built around his person has to change. Indeed, there's a strong argument that filling that spot with someone else would actually undermine the original intent of the office. Daschle presided over the early conversations on health reform. His authority on the issue was understood and respected by the other players in the room. But his withdrawal did not derail the administration's internal health policy process. The room simply changed. Other players stepped into larger roles. Peter Orszag and his health deputy Zeke Emanuel emerged as key participants. Jason Furman and Diana Farrell at the National Economic Council. Jeanne Lambrew and Mark Childress retain significant roles. Larry Summers, of course, has influence, though it's not clear if he's directly involved at this juncture. Tossing a new "czar" into this mix -- at least a new player who isn't John Podesta -- could lead to power struggles and overlapping lines of authority. At the least, there would be a learning curve during a period when the White House doesn't seem interested in slowing down. And it's simply not clear that anyone who's not Tom Daschle -- or, again, John Podesta -- would be seen as powerful enough -- both in the president's estimation and in the everyday workings of the process -- to serve as sole point of contact. Which calls into question the need for a new agency called the Office of Health Reform: No one wants a department that was supposed to streamline the process to instead add to the clutter. If they decide to dump the Office of Health Reform, it's not because they've abandoned health care reform. It's because they haven't, and they're building a post-Daschle strategy.
