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Dr. Atul Gawande For Senate?

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From the Think Progress Blog:

President Obama has told his staff that Dr. Gawande’s writings are “required reading” in the White House. Dr. Gawande has written extensively on sustaining health care reform and lowering health care costs over the long term. He previously worked for Rep. Jim Cooper (D-TN) and the 1992 Clinton presidential campaign, and he served on Clinton Health Care Task Force.

Gov. Patrick has a unique opportunity to advance and energize the health care debate by giving the Senate a powerful voice for change who understands what’s needed to fix our broken health care system. On the day he would step foot in the Senate, Dr. Gawande would be the most knowledgeable health policy expert in the chamber, an incredible resource for his fellow Senate colleagues, and a champion for reform.

Matt Yglesias thinks it’s a good idea:

Someone holding a Senate seat during a critical period but with no future political ambitions would have a pretty unique opportunity to play a kind of bold leadership role if the Senator in question were someone with the knowledge and credibility to really contribute to the debate.

What say all of you ?

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  1. If Gawande is full of great ideas about health care and has no legislative experience, he’ll probably be reduced to standing by helplessly while the Senate continues to colossally screw things up.  

    <

    p>On the other hand, no one is going to be particularly influential just being there a couple months, so appointing a doctor with health policy experience in and of itself will send a powerful political message.

  2. I can’t think of a single living person who could arrive in the Senate for a three-month gig and “play a bold kind of leadership role.”

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    p>(The person who comes closest in this environment is probably Bill Clinton–but not even he.)

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    p>If you want to make the case that there’s some nonpolitician the appointment of whom the Governor could use to his own credit, well, maybe. But in terms of getting health care done right, what we need is a reliable vote for the right stuff.

  3. While Atul Gawande has excellent credentials for cost saving measures for doctors and hospitals, the drive behind the interim Senator is supposed to be to garuntee another vote for insurance reform. Let’s find a supporter of the public option.

  4. I’m sure Dr. Gawande is a very qualified individual, but that Think Progress article is pretty silly. As it is quoted in the post:

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    p>

    On the day he would step foot in the Senate, Dr. Gawande would be the most knowledgeable health policy expert in the chamber, an incredible resource for his fellow Senate colleagues, and a champion for reform.

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    p>Uh-huh. I’m sure the other 99 Senators will listen to a new guy at the very bottom of the Senate ladder — someone they’ve never heard of — who is not only coming in near the end of the process but who they know won’t be there only about four months later. I don’t think so.

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    p>That said, as long as he’s a sure vote for health care, I’m fine with it. I’d be more comfortable with someone I can be quite sure will vote with Obama, though.

    • to someone who supports the public option.

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      p>I don’t see any point with replacing Kennedy’s seat with someone who does not share his vision for expanding health care coverage.

      • I’ve looked through the diary, comments, and provided links and cannot find anything about his position.  This is also the first I’m hearing of this person so I can’t go by any prior knowledge.

        • in his article, “Getting There from Here
          How should Obama reform health care?” in the New Yorker

          On the left, then, single-payer enthusiasts argue that the only coherent solution is to end private health insurance and replace it with a national insurance program. And, on the right, the free marketeers argue that the only coherent solution is to end public insurance and employer-controlled health benefits so that we can all buy our own coverage and put market forces to work.

          Neither side can stand the other. But both reserve special contempt for the pragmatists, who would build around the mess we have.

          and in a follow up interview with the New Yorker, Gawande stated:

          Replacing the entire health-financing system with Medicare would require most working-age people to leave their current insurance plans,” Gawande writes. “It would change the finances of every hospital and doctor in the country overnight. It would require replacing the premiums we pay with a tax, with massive numbers of both losers and winners. It seems simple in theory, but in practice it never is. This would be a whole new path for health care. No country has swept away their health system and simply replaced it like that. As I said in the article, one would have to be prepared for an overnight change in the way people get 3.5 billion prescriptions, 900 million office visits, 60 million operations – because how these are paid for is critical to whether and how they are provided. Doing away with private insurance coverage is no less sweeping than saying we’ll do away with public insurance programs or do away with employer-paid health care. No major country has simply swept away the way so many people’s care is paid for. And the reason is that people have legitimate fears about what will happen to them.

          <

          p>He worked for Jim Cooper who helped kill health reform in the 90’s and while his statements about the public option have been milder,in The Cost Conundrum he wrote,

          Advocates of a public option say government financing would save the most money by having leaner administrative costs and forcing doctors and hospitals to take lower payments than they get from private insurance. Opponents say doctors would skimp, quit, or game the system, and make us wait in line for our care; they maintain that private insurers are better at policing doctors. No, the skeptics say: all insurance companies do is reject applicants who need health care and stall on paying their bills. Then we have the economists who say that the people who should pay the doctors are the ones who use them. Have consumers pay with their own dollars, make sure that they have some “skin in the game,” and then they’ll get the care they deserve. These arguments miss the main issue. When it comes to making care better and cheaper, changing who pays the doctor will make no more difference than changing who pays the electrician.

          <

          p>In his Washington Post interview he stated,

          We’re hoping that Medicare versus Aetna will be more effective at making me do my operations differently? I don’t get that. Neither one has been very effective thus far.

          <

          p>Dr, Gawande consistently argues in support of employer based health insurance system and in  “Getting There from Here: How should Obama reform health care?” writes,

          Massachusetts, where I live and work, recently became the first state to adopt a system of universal health coverage for its residents. It didn’t organize a government takeover of the state’s hospitals or insurance companies, or force people into a new system of state-run clinics. It built on what existed. On July 1, 2007, the state began offering an online choice of four private insurance plans for people without health coverage. The cost is zero for the poor; for the rest, it is limited to no more than about eight per cent of income. The vast majority of families, who had insurance through work, didn’t notice a thing when the program was launched. But those who had no coverage had to enroll in a plan or incur a tax penalty.

          The results have been remarkable. After a year, 97.4 per cent of Massachusetts residents had coverage, and the remaining gap continues to close. Despite the requirement that individuals buy insurance and that employers either provide coverage or pay a tax, the program has remained extremely popular. Repeated surveys have found that at least two-thirds of the state’s residents support the reform.

          <

          p>His work on controlling costs at medical centers is worthy and valuable, but the pending bill in the Senate deals with insurance reform and Dr. Gawande’s has fought against Kennedy’s position.

  6. we need his vote and his expertise on health care from today until Jan 8. In my book Dr. Atul Gawande or Dr. Dean would be good choices for this short assignment.  

  7. The guy should be in DC right now, hanging out with staff of all kinds of senators, working this thing through.

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    p>But being a senator isn’t about being an expert in a specific area.  It’s about getting legislation done.  Gawande’s got no experience that we know of in this area.

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    p>Furthermore, while it’s true that the health care vote will be the big vote, it sure as hell isn’t the only vote the Senate will take.  What makes this guy a good choice for any other vote?

    <

    p>

    <

    p>Bah.  Pick an elder statesman who’ll vote for a public option but can also handle the pressures, influences, and concerns that a US Senator faces every day.  We don’t need a miracle working interim senator — we need one who’s not going to screw it up.

  8. health care package than any other member of Congress?

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    p>From a diary Lux wrote at openleft.com

    I was part of the Clinton White House team on the health care reform issue in 1993/94, and no Democrat did more to destroy our chances in that fight than Jim Cooper. We had laid down a marker very early that we thought universal coverage was the most essential element to getting a good package, saying we were to happy to negotiate over the details but that universality was our bottom line.

    Cooper, a leader of conservative Dems on the health care issue, instead of working with us, came out early and said universality was unimportant, and came out with a bill that did almost nothing in terms of covering the uninsured. He quickly became the leading spokesman on the Dem side for the insurance industry position, and undercut us at every possible opportunity, basically ending any hopes we had for a unified Democratic Party position. I was never so delighted to see a Democrat lose as when he went down in the 1994 GOP tide.

    Unfortunately, he came back, like a bad penny.
    It is such a huge mistake for Obama to use a guy like this to defend their position on health care. The signal it sends to reporters, organizations, and activists like myself who know something about the old health care battles is that Obama truly doesn’t care about comprehensive health care reform or universal coverage, and that the health care package you would propose if President would be a conservative, pro-insurance industry bill. The campaign ought to be trying to reassure folks who care about this issue, and using a guy like Cooper does just the opposite.

    <

    p>What is this? A signal that the President’s good friend – our Governor, would appoint, because maybe he’s been asked to – someone who would back the Baucus bill? Someone who has worked with Jim Cooper?

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    p>Color me disgusted.

    • he wrote it on Feb.18,2008

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      p>Talk about prescient about what kind of a bill that ends up as the White Houses’ favorite in 2009 –

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      p>Again, for emphasis:

      that the health care package you would propose if President would be a conservative, pro-insurance industry bill.

      <

      p>Baucus did all the ‘groundwork’ and now put the ‘reliever’- Dr. Gawande – in to sell it.

      <

      p>We should all ask ourselves why this guy’s name – I mean really, who besides wonks have heard of him?, would be floated now when the State Reps and Senators are trying to sell the interim Senator idea with one component being who could deal with constituent services????? And secure funding for projects? There are multiple reasons why we need 2 voices at this moment. Not just health care.

      <

      p>Sounds like a plant to me.

      <

      p>Who planted it the idea is what I want to know.

  9. publications and both his books, and he’s immensely sensible.  Gawande can bring an expertise to this thing that is sorely needed as well as a fresh perspective.  

    <

    p>I’d just assume see a fresh face than see a party sacred cow get in there, candidly.  The party is incestuous enough.  Dukakis?  No thanks.  This isn’t about the glory days (or inglorious days) of the past; it’s about the future.  Fresh faces, new voices.  Love it.

    • I think Gawande has Ben Franklin-level intelligence, competence, and perspective.  I wouldn’t want him to become a longterm senator, because he only has one lifetime.  Rather, I think he can have the biggest positive impact by not expanding his lifelong focus too much beyond human health.

      <

      p>But a “sabbatical” in the Senate would bring Gawande’s depth of insight and influence into the most important issues facing the country at this moment, while providing him a deep education into the workings of the government.

      <

      p>His inexperience would be no great barrier.  Other senators would at their peril marginalize someone who wields a pen as effectively and insightfully as Gawande does.

      <

      p>For those who’ve never heard of Gawande, please read this before coming to any conclusions.

    • I’d just assume see a fresh face than see a party sacred cow get in there, candidly.

      <

      p>That isn’t what the current Senators would like, frankly.  And given that this interim Senator’s only job will be to do what little s/he can to move a decent health care bill through the Senate, I’m willing to bend on my desire to send a message by sending an unknown to Capitol Hill.

  11. …she’s been the most frank and honest person dealing with the financial crisis and her brains and outspoken nature would inject a serious dose of reality into our public debate.

    • Unless she could go back to that job after being an interim for a few months.  Maybe she could; in that case, it’s an interesting idea.

      • …why don’t we have people like Warren or Gawande moving in and out of elected office and back into their chosen profession like our founders envisioned.  Instead our choices seem to boil down to career politicians who are either blowhards, cautious critters, rich egos or legacies.  Our system is not set up for people of substance and policy accomplishments (mostly because they have no interest spending 80% of their time raising money or sucking up to the special interests that make up both the Republican and Democratic Parties–we have met the enemy and it is US.

        • more highly qualified people like Warren getting involved in elected office, though I’m not as pessimistic as you are. I do think there are a number of examples of quality, intelligent, and knowledgeable politicians today (Obama is one obvious example).

          <

          p>Plus, the fact of “career politicians who are either blowhards, cautious critters, rich egos or legacies” is nothing new. You’d find plenty of those types of guys back in the 19th century as well!

        • …that somehow our founders envisioned people just legislating as a hobby.  The federal constitution contains no term limits after all though I believe such was debated. Plenty of them were just as much career politicians as many are today, protestations to the contrary notwithstanding.  Governing today requires professionalism and experience just as much as any other profession.  Plus, what’s wrong with it?  Obviously they need to be elected, but if I decide that want a career in elected office that should be just as valid as if I decided I wanted to have a career in academia, law, medicine, etc.

          • General Washington following the example of his hero Cincinnatus went back to his farm after his Presidency. So did John Adams, Jefferson, Madison, and Monroe. One could argue Quincy Adams was our first ‘career’ politician President having been in the diplomatic corps since he was 17 and serving in government until the day he died. But before that almost all of them favored a legislature that convened temporarily and with citizen legislators that could return to their farms. Also most of the men, especially in the Senate, had incomes coming in from those plantations and thus did not need to live off their political career.

            <

            p>Frankly there are days I wish they had listened to Robert Morris and adopted the Athenian policy of having a legislature determined by lots.

            • …these men spent the majority of their adult lives in public office of some sort.  I stand by what I said regarding my own preference.  Governing was a very different enterprise then.

            • I can’t help but wonder… how many of them were laboring in their own fields 12+ hours each day, and how many of them were merely managing a farm of slave or paid labor, essentially living in retirement while managing their assets?

              <

              p>Look, modern day issues are complex.  They require intense study.  Furthermore, there’s far more social mobility and opportunity now than ever before in American political history.  For example, check out the list of US Senators and take note of where they went to college, keeping in mind that almost every US Senator has a graduate degree, often law).  Sure, 11 of the 99 did some time at Harvard, 8 at Yale, 2 at Princeton, 2 at Columbia, etc.  But of the 99 US Senators, 59 attended a public college (including service academies, and Oxford on a Rhodes).

              <

              p>So the way I see it, the US Senate is far more open to the “common man” than it was before — but that man of humble origins better be damned smart and understand the art of the possible… not something that Joe Blow drawing lots — or even Joe Sports Team Owner or Joe Doctor for that matter — can just walk in to.  Sure, some folks enter politics from other occupations, but it’s somewhat rare.  The fact is, we like to elect US Senators who have spent time in the minor leagues, whether because we as voters simply require it or because those who we like do in fact get polished there.

              <

              p>To me, that points to politics as profession, not as a mid-life-crisis lark or for he who draws the short straw.

  12. Senators were expected to be lifetime legislators which is why they were originally chosen by their peers instead of by the people. Thus, free of having constituents to report to, they would deliberate in a bubble not influenced by national opinion and simply do what was right for the national interest and the interests of their state. In many ways this system worked better than the Senate does today.  

    • Sure, if Hamilton had his way, but we deliberately nixed the House of Lords model.  Now you seem to be arguing the opposite extreme from citizen legislators.

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