Washington Post, ‘NewsHour’ Interviews Shalala
In an exit interview with the Washington Post today, outgoing HHS Secretary Donna Shalala stressed the importance of bipartisan and bureaucratic teamwork in governing and managing the department. Citing the failed attempt at universal health care in 1994, Shalala said from that point forward "we have never done anything in which we did not try to build bipartisan support from the beginning. Every major bill, from Head Start reauthorization to FDA reform to children's health insurance -- major, tricky legislation -- and all our appropriations, we have had bipartisan support." Shalala also recounted to the Post how she overcame challenges associated with "making the separate agencies [of HHS] function as a department." She said the first step was to recruit agency heads who were not just "some of the world's great experts in their fields," but were also "team players." To further integrate the separate HHS agencies, Shalala said she held annual budget hearings in which each agency head sat in on every other agency head's presentation. In doing so, "[t]hey learn what other people are doing and get ideas for possible collaborations, and they have a stronger commitment to the institution," Shalala said. As a result, the agency heads "don't just cover for themselves; they help each other," she said, adding, "over the eight years, you can see the department becoming one. And as a result, they don't undercut each other on the Hill. We've had almost no end-running with Congress, [which is] the classic bureaucratic strategy of saying, 'Take the money from someone else'" (Broder, Washington Post, 1/17).
In an interview on PBS' "NewsHour" last night, Shalala reflected on HHS' Medicare reform efforts. "One thing we did do is manage [Medicare] well. We reduced the waste and the fraud in the system," Shalala said. Also, Medicare is now "managed at a lower overall cost than anything in the private sector," Shalala added, noting that the administrative costs for the program are now at about 3%. "We did stabilize the program," Shalala said, and "it is not growing as fast as it did before." She also noted that the managed care industry "has changed -- perhaps out of fear that we might put them in jail ... they have new accounting systems and they're charging Medicare more accurately." Looking ahead, Shalala warned, "There's still a problem ... We need to put additional resources [into Medicare]; the program has to get more competitive; we have to get better pricing for what we buy for our Medicare recipients; and we must get a pharmaceutical benefit." She added, "You can't have a first quality program if you can't afford to pay for drugs." But Shalala indicated that the groundwork has been laid to accomplish these goals in the next few years, leaving the next administration "in good shape to move on to other kinds of reform that need to get done." Shalala said if she had had another two years at HHS, the agency could have accomplished Medicare reform. She explained, "The surplus would help us to do that, but more importantly, we know a lot about what we need to do in terms of competitive pricing. We know a lot about how to put in place a pharmaceutical benefit for seniors." Because the program is "so much better managed than it was before," Shalala added, "I think we have the integrity and the skill now to do that" (PBS "NewsHour", 1/16). A transcript of the interview will be available later today at http://www.pbs.org/newshour/newshour_index.html#tuesday.This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.