Obama Chooses Orszag as OMB Director; Position Will Have Broader Role in Developing Approaches to Health Care, Other Issues

President-elect Barack Obama on Tuesday announced the nomination of Congressional Budget Office Director Peter Orszag as the new director of the White House Office of Management and Budget and indicated that Orszag will have a role in health care reform efforts, the Washington Post reports (Connolly, Washington Post, 11/26). After the announcement, Orszag resigned his position at CBO (Eggen/Fletcher, Washington Post, 11/26).

In the past, Orszag has served as an economic policy adviser in the Clinton administration (McKinnon, Wall Street Journal, 11/25). He also has worked in the private sector and at the University of California-Berkeley, Georgetown University and the London School of Economics. In addition, Orszag co-founded the Hamilton Project at the Brookings Institution (Connolly, Washington Post, 11/26).

Obama on Tuesday also nominated Rob Nabors, staff director of the House Appropriations Committee, as the new deputy director of OMB (Eggen/Fletcher, Washington Post, 11/26). Nabors previously has served as a senior aide to Jack Lew, the last OMB director in the Clinton administration (McKinnon, Wall Street Journal, 11/25).

Larger Role
According to the Post, the nomination of Orszag as the new OMB director indicates that "the job will have a more expansive portfolio in his administration," with Orszag likely to help shape new approaches on health care, education and the environment in addition to the "traditional duties of overseeing the federal budget and weighing in on economic policy" (Connolly, Washington Post, 11/26). "Unlike many of his predecessors, who hewed closely to pure number-crunching, Orszag has carved out a niche as a leading thinker on health care policy," the Post reports (Eggen/Fletcher, Washington Post, 11/26).

"People close to him said Mr. Orszag, if confirmed, hopes to focus on one of the country's biggest problems: soaring health care costs," according to the Wall Street Journal (Bendavid/McKinnon, Wall Street Journal, 11/26). Orszag has said that increased health care costs represent the "central fiscal challenge facing the country" (Connolly, Washington Post, 11/26). On his CBO blog, Orszag "has written frequently about the pitfalls of an over-complicated bureaucracy and the benefits of simple, common-sense approaches to reducing health care costs, such as getting people to take their medicine and exercise," the Journal reports (Bendavid/McKinnon, Wall Street Journal, 11/26). In one post written earlier this year, Orszag cited the need for programs "that are more in tune with the realities of human behavior in such diverse settings as doctors' offices and federal nutrition programs [that] might help to improve a range of health outcomes" (McKinnon, Wall Street Journal, 11/25).

CBO next month plans to release a two-volume report produced during his tenure that examines proposals to expand health insurance, modernize the health care system and reduce inefficiencies in the system that cost as much as $700 billion annually (Connolly, Washington Post, 11/26).

Budget Issues
Obama said that Orszag as one his first duties will examine the federal budget and make recommendations on which programs to eliminate based on their effectiveness. Obama said that the effort will complement an economic stimulus package that he plans to propose after he takes office (Eggen/Fletcher, Washington Post, 11/26). According to the Journal, although "Obama didn't provide many specifics" and "gave little sense of how he would tackle entitlement programs like Medicare and Social Security," few "experts believe the budget deficit can be brought under control without trimming spending on these programs" (Bendavid/McKinnon, Wall Street Journal, 11/26).

Obama also said that he would find savings for consumers and the federal government through increased efficiency in the health care system (Thomma, McClatchy/Hartford Courant, 11/26). Obama said that health information technology offers a "twofer" -- an area "where we're getting both a short-term stimulus and we're also laying the groundwork for long-term economic growth" (Reichard/Nylen, CQ HealthBeat, 11/25).

Health Care Reform a Priority
Obama will continue to focus on health care reform during his efforts to address the current economic downturn, Obama aide Neera Tanden said on Tuesday during a health care policy conference at the University of Minnesota, the St. Paul Pioneer Press reports. The conference focused on proposals to improve the efficiency of the health care system, such as increased focus on preventive care and disease management programs.

Tanden said, "We can't really afford not to do health care," adding, "Costs are spiraling out of control." In addition, she said, "We will not get out of the hole we are digging if we are spending 16% of GDP (gross domestic product) on a system which doesn't provide better quality."

Other participants at the conference included John Wennberg of Dartmouth Medical School, Denis Cortese of the Mayo Clinic, George Isham of HealthPartners, Sen. Amy Klobuchar (D-Minn.) and former Sen. David Durenberger (R-Minn.) (Olson, St. Paul Pioneer Press, 11/25).

Reform at FDA?
FDA "desperately needs an infusion of strong leadership, money, technology and personnel -- and perhaps a major restructuring," according to former agency officials, lawmakers, consumer advocacy groups and a number of government reports, the Post reports. According to the Post, the Obama administration will have to address an FDA "widely seen as struggling to protect Americans from unsafe medication, contaminated food and a flood of questionable imports from China and other countries."

William Hubbard, a former FDA official, said, "FDA is close to being at a tipping point -- the agency is hanging on by its fingertips in protecting us," adding, "If something is not done, they could become a failed institution, and no one wants that. The FDA is not only important to protecting the public health but also to the industries it regulates."

David Ross, a former medication reviewer at FDA, said, "I'm afraid we're going to see more horrible things happen if we don't get our act together on this."

FDA also needs to focus on food safety, according to Christopher Waldrop of the Consumer Federation of America. He said, "The drug side tends to get much more attention than the food side. Food is equally important and needs to get the attention it deserves" (Stein, Washington Post, 11/26).

The Post examined possible nominees for FDA commissioner. According to the Post, possible nominees include Robert Califf, vice chancellor for clinical research and director of the Translational Medicine Institute and professor of medicine in the division of cardiology at the Duke University School of Medicine; Steven Nissen, chair of the Department of Cardiovascular Medicine at the Cleveland Clinic Foundation; Joshua Sharfstein, health commissioner for Baltimore; and Susan Wood, a research professor at the George Washington University School of Public Health and Health Services (Washington Post, 11/26).

Broadcast Coverage

• ABC's "World News Tonight" on Tuesday reported on the Orszag nomination (Tapper, "World News Tonight," ABC, 11/25).
  
  
• American Public Media's "Marketplace" on Tuesday examined the continued importance of health care as an issue during the current economic downturn. The segment includes comments from Stanford University economist and health care expert Victor Fuchs (Ryssdal, "Marketplace," American Public Media, 11/25).
  
  
• CNN's "Newsroom" on Tuesday reported on the Orszag nomination (Phillips, "Newsroom," CNN, 11/25). A transcript of the show is available online.
  
  
• NPR's "All Things Considered" on Tuesday reported on the Orszag nomination (Horsley, "All Things Considered," NPR, 11/25).