Speaking of assembling a health care team, many have overlooked the appointment of Peter Orzag as the director of the Office of Management and Budget (OMB), which is a big-deal position. Orzag was the well-respected head of the Congressional Budget Office (CBO), and actually ran a well-regarded blog where he posted on key issues, especially health care.
Ezra Klein at the American Prospect says this bodes well for the prospects health reform, given his clear views about how the federal budget and economy is simply unsustainable in the absence of health reform, and his significant knowledge about the medicine and economics.
But the flip side is that Orzag’s former position at CBO was as crucial to the success of health reform. In the early 1990s, many people thought that one of the main obstacles to reform was the way that the CBO at the time “scored” the Clinton health plan, a detachment fromt he process, and the reticence to book savings. Here in California, the CBO-equivalent Legislative Analyst’s Office (LAO) has come up with controversial analyses of health reform proposals, from single-payer to the ABx1 1, helping to stall the latter. The analyses, from a place of detachment, tended to overstate the risks of reform, while not making a comparison to the risks of inaction. The LAO only answered what was asked, but under the criteria used, no reform was possible.
Health reformers was heartened that Orzag would not fall into these problems at the CBO, with his efforts to be transparent about assumptions, and his knowledge about the value of prevention and systems reforms and attempts to quantify realistic savings from such efforts. Most of all, Orzag would include in any analysis a comparison with the problems of the status quo.
So it’s good that Orzag will be helping craft, rather than simply evaluate, the health care proposal. But then who replaces him? The Acting CBO Director is now Robert A. Sunshine. Orzag beefed up the CBO health staff from 30 to 50 FTEs, and perhaps provided a perspective and direction into the next year. Will Sunshine continue this ray of hope? Or even the blog?