Health Care: Hardly An Orphan

On Monday, the Washington Post ran a piece indicating that Tom Daschle's double-withdrawal from both HHS and White House Office of Health Reform (OHR) has health care reform advocates worried that, Obama's reassurances to the contrary notwithstanding, their agenda might be stalled out for now. But James Capretta at The Corner (yes, that The Corner) makes the point that even without Daschle, health care has an eager and capable advocate in the White House:

But it’s seems just as likely that Obama’s health agenda is still moving forward, just with the Office of Management and Budget (OMB), not HHS, in the driver’s seat â€" at least for now.

OMB’s power tends to rise at the beginning of a new presidency anyway. Cabinet departments and agencies take months to get re-organized when their political leadership leaves en masse, as they did at HHS on January 20th. That leaves a power vacuum which OMB’s staff is eager to fill.

Capretta goes on to note that OMB's new Director, Peter Orszag, chosen in large measure because of his knowledge of and advocacy for serious, structural health care reform.

On one level, this makes sense. Orszag knows the issue, and you probably won't find a better source of insight on how the Senate -- as well as the all-important CBO, which Orszag used to head -- will react to any given reform proposal. Plus, putting health care reform with OMB would be a powerful way of sticking with the administration's argument that it is complementary to, rather than in opposition with, fiscal austerity. That said, I think it also raises two concerns:

• What happens to Jeanne Lambrew? She's currently Deputy Director of an office that doesn't have a Director, and while no one doubts her ability, I get the sense that she's not a heavy enough hitter to have the ear of the President the way that a Tom Daschle would have. Having OMB step in to fill the health care vacuum temporarily is fine, but if they try to take lead on the issue long-term -- which The Law Of Bureaucractic Inertia suggests they might -- there's going to be some major internal confusion about what, exactly, Ms. Lambrew is supposed to be doing. With all the external stakeholders that health care reform is likely to involve, this could spell doom.
• Would this portend the abandonment of a public-centric approach to selling health care reform? One of the lessons that Team O has allegedly learned from the stimulus debate is that their boss strengthens his hand by going on the road, and probably weakens it when he stays in DC. Daschle's perfunctory tenure was rife with YouTube videos, town hall meetings, and other similar public outreach initiatives; it's hard to imagine that OMB could or would want to duplicate that effort. Orszag may be an expert navigator of the Senate, but navigating isn't the same as manipulating, and ultimately, most Senators are going to vote whichever way they think gets them re-elected. In other words, public pressure is key.

Don't get me wrong; Orszag was a great choice for OMB and would probably be a good steward of the administration's health care reform agenda while the search for Daschle v.2.0 is ongoing. But letting that portfolio mission-creep its way over to OMB in the longer term could wind up really complicating things.

UPDATE: Ezra Klein has a more in-depth look at the various players emerging into the health care vacuum, and why it could mean the dawn of the Age Of Wyden!