CMS Needs Consistent Leadership

By Joanne Conroy, MD

Gilbert Gaul noted in his March 9 Washington Post editorial that, at health care reform’s key agency, no one stays in charge for long. We’ve noticed! As accepting as we are of the vagaries of the political process, the fact that the head of CMS turns over so frequently is a serious obstacle to building a delivery system that works.

Gaul writes, “Since its creation in 1977, the Centers for Medicare and Medicaid Services (CMS) has had 29 administrators — with an average tenure of just 14 months. The longest-serving administrator held the job for four years and five months …The Senate hasn’t confirmed a full-time administrator since 2006, a problem that Thomas A. Scully, a CMS administrator under President George W. Bush, once likened to going two years without a secretary of defense.”

What are the advantages of consistent leadership? Two systems that work pretty well, Germany’s and Switzerland’s, have some strong leaders with real longevity.

Ulla Schmidt served in Germany’s Federal Ministry of Health from 2001 to 2009. During her tenure, she was responsible for maintaining the effectiveness and efficiency of Germany’s health insurance system and maintaining and enhancing the quality of its health care system, as well as other components of an integrated health system: strengthening the interests of patients; maintaining economic viability and stabilization of contribution levels; preventive and prophylactic health care; and establishing guidelines for the manufacture, clinical trial, approval, distribution, and monitoring of medicines and medical devices.

In the United States, we have more than 40 agencies that have something to do with health care. Wouldn’t it be better if they were all integrated?

In 1991, the Swiss government appointed Thomas Zeltner, MD, JD, as the 8th Director-General of the Swiss National Health Authority and Secretary of Health of Switzerland, a position he held until the end of 2009. He focused on substance abuse prevention but also created harm-reduction policies in Switzerland that are considered the most innovative worldwide. He helped transform the regulated market model of health care in Switzerland to a more consumer-driven system. He pushed for quality, price transparency, and for bringing research from bench to bedside more quickly. The Swiss model guarantees access to a comprehensive benefit package of health services and goods to all residents.

There are a few lessons here:

You can’t build sustainable health policy overnight. We all felt that Don Berwick, former head of CMS, had incredible pressure to deliver in a short time frame. He had less than 18 months to pull off a change in culture and kick-start innovation in care delivery. He did a tremendous job considering the unrealistic deadline.

The “who’s right” of partisan politics gets in the way of what’s right. Our health care system is too important to be a political football.

Stable leadership does not remove the input of elected officials. It just makes recruitment of health care leaders to government service and the implementation of sound policy more efficient if you are not playing musical chairs every 18 months.

Ulla or Tom: Are you looking for a job?

—Joanne Conroy, MD, is Chief Health Care Officer at the Association of American Medical Colleges. She can be reached at Follow her on Twitter @joanneconroymd


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