Along with Kathleen Sebelius, Tom Harkin, and Debbie Stabenow, Tennessee governor Phil Bredesen is still high in the running for HHS. And many of the sources I've spoken to say he's one of the top contenders. But it's hard to imagine why. I can't overstate the opposition his nomination would engender in the health advocacy community. Bredesen presided over "the largest cuts in health coverage in our nation's history," says Families USA, the leading center-left health care group. The cut enraged them to the point that they released a book on Bredesen's cuts to Medicaid. "It is instructive to look beyond the numbers and see what has happened to the real people affected by the TennCare cuts," they said. "These stories show, without a doubt, that cuts in Medicaid and other public health programs devastate people's lives." The book is available for download here. Bredesen would begin his tenure facing deep mistrust amongst his potential allies.Nor do Bredesen's accomplishments make him an obvious fit for the role. Indeed, it would be failing upwards. Bredesen faced a horrific budget crisis. That much is true. But the anger of Tennessee's advocacy community came because Bredesen seemed unwilling to do everything possible to save the program. And much of what he did try verged on the bizarre. He eventually limited TennCare enrollees to four prescriptions per month, 12 doctors visits per year and 20 days in the hospital each year. He refused to allow Tennesseans to pay higher premiums to keep their coverage. Meanwhile, the cost saving ideas of advocates were largely cast aside. Once Bredesen decided to cut, he went deep. His cuts saved so much money that he was able to restore coverage to some Tennesseans the next year. He erred, in other words, on the side of cuts, not coverage. The effects were predictable. In 2008, Tennessee ranked 47th in the respected health rankings compiled by the Robert Woods Johnson Foundation. And they have worsened during Breden's tenure. Indeed, more than 20 percent of its adults are uninsured -- far above the national average. There are mitigating factors in much of this: Tennessee is poor, and it is conservative, and its legislature is viciously anti-tax. But the cold fact remains: Bredesen has not been a success as a health care governor. Promoting him to HHS would be failing him upward.And nor has he been free of embarrassing industry ties. In 2005, Andrea Conte, Bredesen's wife, embarked on a renovation of the governor's mansion. The total project would cost $9.4 million, and Conte quickly set about raising the required funds. The largest donor? BlueCross BlueShield of Tennessee. The Tennessean (yeah, I've spent the morning on Nexis) reported:Some people say it's ethically questionable for the first family and the Tennessee Executive Residence Foundation, the organization created to collect money from donors, to accept large sums of money from companies, as it could appear to be another way to buy access to or curry favor with the governor.Such donations are not capped as campaign contributions to candidates are, which means companies doing business with the state -- or that want to -- can write eye-popping checks to the Bredesen family's important cause. BlueCross BlueShield of Tennessee, for example, which provides health insurance for state employees, donated $150,000. Corrections Corporation of America, which runs several prisons for the state, donated $50,000.
It's hard to believe that those donations -- which don't even touch on the money Bredesen raised from industry interests for his campaigns -- wouldn't pose a problem achingly similar to Daschle's tax liabilities and paid speeches.The final concern with Bredesen was well articulated in a post Jon Cohn wrote yesterday. Bredesen, Cohn said, is "typical of the top figures in the health industry I've met over the years: Self-made entrepreneurs a bit too convinced of their own brilliance, completely unaware that the strategies for making private insurers profitable don't help--and often hurt--the sicker, poorer people whom insurance should ideally protect. Their biggest fans are often people who know a ton about health care at the macro level, but haven't spent much time observing it on the ground--where reality is often messier than the statistics suggest."This is not to suggest that Bredesen's time as an HMO entrepreneur leaves him with nothing to offer. To the contrary: That experience could be quite valuable. But not necessarily in the role of Secretary, much less as director of the Office of Health Reform. Part of what doomed Clinton's initiative was Magaziner's effort to champion certain theories of reform. What many learned in the aftermath was that reform should be run by a personality that seeks consensus rather than seeks to advocate a certain set of ideas and theories. At this point, there's little evidence that Bredesen is of the former, rather than the latter, bent. Bredesen is the sort of leader you might want weighing in on health care, but not running the reform process.Update: Jon Cohn, shockingly, has more.
