Saturday, March 14, 2009

Obama's Health Care Czar to Convert Community Hospitals to For-Profit?

What's more disturbing than using a "czar" title to reform health care? The background of the person in charge. Nancy Ann-DeParle's positions and pocketbook carry a clear for-profit healthcare bias. Her Legacy Hospital Partners struck a deal transforming a nonprofit community hospital in Idaho into an investor owner facility. This is important, as community hospitals struggle financially. The Chicago Tribune reported:

Robert Gibbs, the White House press secretary, tried to explain how authority would be divided between DeParle and Sebelius in steering health reform through Congress.

At first, he declared DeParle that “will be in charge.” Then, he acknowledged a role for Sebelius and others.

“I think obviously this is something that spans across many platforms, not unlike, say, something like energy independence, that a lot of people that work in this building and in different agencies will be involved in,” he said, pledging to get back to reporters with details about how the bifurcated health policy team will work.

The author of the czar system is John Podesta, President Obama's White House Transition Director. The Tribune reported:

Before the inauguration, Obama’s transition director, John Podesta, said in an interview that Obama was deliberately building a strong, centralized White House organization, one that grew naturally out of Obama’s disciplined presidential campaign.

Podesta saw little potential for the czars to undermine the authority of cabinet agencies. “As long as the White House staff is respectful of the power and authority of the people in the cabinet, as I know they will be, I think it will be a very workable model,” Podesta said last January.

Senator Robert Byrd isn't taken with the czar model. A Byrd spokesman said:

If the czars are working behind the scenes and the secretaries will be the mouthpieces of the administration, it calls into question who is actually making the policy decision,” he said. “Whoever is making the policy decisions needs to be accountable and available to Congress and the American public.”

That's not the plan, Senator Byrd. Rahm Emanuel and Nancy-Ann DeParle must rework health care for corporations in the shadows. Obama czars can't push the global lowest common denominator on worker health insurance in the light of day. Nonprofit community hospitals can't become cheap acquisition targets for their for-profit counterparts under transparency and accountability. Virginia Governor Tim Kaine led the way with a similar appointment, President Obama's team follows.

Done well, transparency and accountability are insufficient for comprehensive management transformation. Performed manipulatively, they haven't a chance.

No comments: