The unexpected withdrawal of former Senate Majority Leader Tom Daschle (D-S.D.) from his nomination for secretary of HHS and White House health czar shook things up badly. His acknowledgment of responsibility for $140,000 in unpaid taxes would perhaps not been so serious had it not been related to three years of chauffeured limo service, compliments of a company that itself is now mired in tax fraud allegations.

The loss of Mr. Daschle is very concerning regarding the prospects of health system reform. The ACC supported many of the ideas Daschle articulated in his book on health care reform, and reform principles he crafted as part of the Mayo Clinic’s board. He was steering away from a single payer system and toward a middle of the road approach, combining government action with market based reforms. I expected this good man to be confirmed — I think everyone did — but, the tax issues he faced clearly weren’t in line with the new administration’s pledge to promote higher ethics.

It’s critically important who they nominate in his place, and the speculation is about seeking now a Governor who has managed a state Medicaid program well, such as Kathleen Sibelius (KS) or former governor John Kitzhaber (OR). Many hope it’s not the polarizing ex-Governor of Vermont, Howard Dean. Ex-Congressman Dick Gephardt is also a possibility — he’s fluent in health policy matters, and respected on the Hill. Ahnold of California has been mentioned also, and who wouldn’t want to get away from a $40 Billion deficit?

But none of those names could necessarily bring Ds and Rs together to achieve a consensus around divisive issues and constituencies -- and, the appointees Daschle has already hired to work with him already might not be the people with whom the next Secretary designee wants to work. Complicated. The Senate HELP (Kennedy et al) and Finance (Baucus et al) Committees are still planning to move the reform agenda, but we need somebody on the Administration side to help bring things together.

The FDA appointment was not announced as promised this week. The Daschle events eclipsed this. I am hearing Dr. Califf’s name more frequently whispered of late (Mr. Waxman is supporting his former staffer instead). For the CMS job, academics Don Berwick, M.D. (pediatrician and IHI founder), Ken Thorpe, Ph.D. (Emory University for former Clinton policy appointee in HHS), and Bob Berenson, M.D. (Urban Institute researcher and former CMS senior staff) are names in the rumor mills (among others). There’s nothing more about Sanjay Gupta for SG. C’mon, Tim Garson.   

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