Health Policy Speech Options on the Eve of the State of the Union

It's the eve of Mr. Obama's State of the Union address (or, as the beltway cognoscenti apparently refer to it, "SOTU").

What better way for the Disease Management Care Blog readers to mark this momentous occasion than by pretending that we're in the Oval Office advising the President on the best way forward?

Here are some your options in helping our Chief Executive dispatch the problematic sequester, sustainable growth rate, Medicare and health reform.  Who knows, maybe someone from the White House is paying attention.....

Realizing that the sequester is both a bad deal for Medicare and a trap for the Democratic party, you recommend:

1. compromising,
2. changing the subject back to "evil insurers,"
3. a series of heartland speeches with nodding fawning accountants sharing the stage that explains to the American people the federal budget sequester and why you signed the enabling legislation in the first place,
4. hiring a Kardashian lawyer because he'll know how to arrange a quickie divorce from the sequester deal.

To fix the SGR and prevent a physician flight from Medicare participation, you recommend:

1. compromising,
2. changing the subject to "oil companies,"
3. applying the vast anticipated 2016 savings from the "Medical Home" and ACOs to this year's budget shortfall; if necessary add another zero or two,
4. re-tasking the controversial military drone program to drop freshly minted $100 bills on doctors' offices.

You want mention Marilyn Tavenner, Acting Director for CMS, and ask that she confirmed by the Senate.  To make this happen, you advise the President to:

1. nominate her in the regular course of business and trust the Senate will do the right thing,
2. ask her to change the subject to the White House meme of "corporate jets,"
3. announce she will expand the care management program for FFS Medicare beneficiaries, ignoring, for the moment, that that is the largest insured population in the U.S. without that benefit,
4. fix the Chuck Hagel debacle by changing Ms. Taveneer's nomination to Secretary of Defense

 Knowing that the President risks having his second-term being stymied by a defiant opposition party, you suggest Mr. Obama neutralize them by:

1. reaching out with Lincoln-esque "malice toward none and charity for all."
2. characterizing Republicans as "hateful munchkins"
3. recycling the "previous administration" blame strategy by reminding listeners it was Mr. Bush who kicked off the electronic health record mess in a previous State of the Union address and that its yet-unfulfilled promise is not your fault either.
4. suggesting everyone get out of their closed partisan information loops by regularly reading the Disease Management Care Blog.

Since 2014 promises to be the watershed year for Obamacare, you remind the President to:

1. avoid the subject because everyone's projections are turning out to be wrong
2. decide now between the red pill and the blue pill
3.  announce that his White House advisors know more than any commercial health insurance executive about the underlying actuarial equivalence of an essential health benefit
4. in contrast to the 2010 SOTU, be respectful to the Supreme Court because they saved your Obamacare as*.

Who Is CMS Administrator Marilyn Tavenner and What Does Her Nomination Mean?

Say hello to the CMS Administrator

Bowing to the implacably oppositional Republicans, President Obama's first selection for Administrator of CMS tendered his resignation and made way for second-in-command Marilyn Tavenner.  What's more, instead of using a recess appointment, the White House has submitted her nomination to the U.S. Senate.

So who, asks the Disease Management Care Blog, is she?

According to this biosketch (scroll down, you'll find her), Ms. Tavenner has a 25 year hospital administrator pedigree that includes being CEO at two Virginia Hospital Corporation of America hospitals (Chippenham and Johston Willis).  That part of her career culminated in her being the company's "President of Outpatient Services."  As the DMCB understands it, she entered the major leagues of public service in 2006 when Democratic Governor Tim Kaine tapped her as Virginia's Secretary of Health and Human Resources.  Thanks in part to her links with Mr. Kaine, she later jumped to CMS, where she became the "Principal Deputy Administrator and Chief Operating Officer."  Unsurprisingly, her duties have included loyally defending the Affordable Care Act (ACA).  You can see her in action here on C-SPAN.

By the way, did the DMCB mention that Ms. Tavenner is a registered nurse?

She has an Virginia Commonwealth University BSN undergraduate degree and apparently climbed the HCA ranks one patient care unit at a time.  Somewhere along the line she also nabbed a Masters in Health Administration.

Four initial thoughts from the DMCB:

1. The new CMS nominee is another example of the emergence of nurses as go-to health leaders.  Not only does the public trust them, they're able to bring a real-world understanding of hands-on patient care to the high falutin' mix of operations, policy, politics and finance.  The good ones know how to deal with grumpy doctors and neutralize clueless administrators.  That being said, the physician DMCB can't help it and still wishes there was a doc at CMS' helm. 

2. In its long career, DMCB has witnessed the Dark Side Transformation of many well-meaning physician or nurse administrators to a type that places profits over patients. What's more, few have become hospital CEOs without making some enemies along the way.  Will any past foes come forward with unpleasant anecdotes from an otherwise forgotten past?  Stay tuned.

3. Despite lots of searching, the DMCB couldn't find much of a track record outside some speaking gigs and serving on some boards.  As far as it can tell, she has no peer-reviewed publications and her public statements have been pretty vanilla.  While that may impair Mr. Obama's foes' ability to attack Ms. Tavenner's record, the DMCB wants to know more about someone who is going to be leading the world's largest health insurer.

4.  The absence of a track record doesn't mean that the nomination process isn't an opportunity for politically motivated mischief.  It remains to be seen how well Ms. Tavenner testimony holds up to the Republicans' intense "gotcha" scrutiny and whether her nomination ultimately becomes a toxic partisan (re)hearing on the merits of the ACA.