Still Waiting, and Meeting in the Executive Branch

No word yet on the Speaker's office, nor have I heard from Senate Finance.

I just met with Jennifer Boulanger (Deputy Director) and Allison Orris (Medicaid/CHIP Group) at the CMS Office of Legislation; she is very interested in the idea of having a Fellow to work with them on operationalizing the new legislation as it comes down the pike. They have space, and seem to understand the role of the fellow in their office; Ms. Boulanger is career CMS, with a strong focus on Medicare both here and in Baltimore; she spent the last 5 years working with J + J on Medicare D rules, and rejoined CMS in April. Ms. Orris was a fellow with the ASPE, and stayed as staff for 3 years, working with Peggy Hamburg, then law school, 2 years as a lobbyist/lawyer with Powell,Goldstein, then 3 years with Center for Budget and Policy Priorities, joining CMS in April as well.

They spend much of their time learning looking at how legislative language moves to regulatory language, helping Congress to understand what is possible, and what is not. They see themselves as advisors to the Administrator, are situated down the hall for the Office of the Administrator, and will interact with that person once they are appointed. They see their group as collegial and diverse. They want a fellow, who would develop his or her own portfolio, and think that there is more than enough work to go around.

Cubicle is large, place is quiet. Overheard one conversation with a Congressional office on impending language in long term care bill. Could be an interesting place to work. I am not sure that it would be enough of a big picture to be useful. It seems to me that this would be a bit of an "out of the way" placement for me, but they were nice people and they do seem to make a difference. I'll keep them on the list.

Meeting with the IOS on Friday. We will continue to see.

Waiting in Casablanca (Updated)

I am assuming at this point that one of my colleagues has gotten the call from the Speaker's office, and that in 2 hours I will find out who gets to spend the next nine months hanging out with Wendall Primus. While there is a possibility that he has not yet made up his mind, the lack of a message in my inbox probably means that I am out of the running. It is interesting how I cope with that sort of stress- I externalize it, meaning I talk about it a lot, and that probably makes me a bit less fun to be around. I must get a handle on that.

I sent this summary to Marie today:

Thanks again so much for your skill in getting us an audience within the "Immediate Office of the Secretary". It really sounds like there is a lot to do, and that some of us will be able to make a contribution there.
I have not heard anything regarding the Speaker's office, Senate Finance nor Ways and Means. I am looking forward to seeing which of us will work with Wendall. It really was a privilege to get to meet with him. As you know, I am very interested in Senate Finance; if there is anything that I can do to enhance my chance of landing that placement, please let me know.
I have been asked to schedule interviews with Senator Stabenow's office and the Office of Legislation of CMS (Jennifer Boulanger, who we met when we visited the Humphrey Building the first time.) I should be meeting with them next week.
I have ra equests for interview out to Meghan Taira and I intend to send one to Rima Cohen. I will let you know if I hear back.
Have a great Thanksgiving, and thanks again for all of your efforts on our behalf.

I think that actually sums up my thinking so far. Senate Finance made me realize that, while it is fun to walk the corridors of power, I am really not about power for its own sake; I want the opportunity to make a difference for children. For me, there actually are better venues than the Speaker's office: Finance, Stabenow, CMS, HHS- all offer me a platform where I could make a difference. So, while I am disappointed that I wasn't selected (yes, I am that competitive), that choice will likely allow me to do more for kids than I would be able to do working for Wendall. Now what is taking the Senate Finance Committee so long to make up their minds? Could be that small detail called Health Reform. I can be almost certain that it has nothing to do with me.

And so, like Rick in Casablanca, we wait.

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Update: Great group meeting with Jocelyn from Jay Rockefeller's office; what a dynamic place that would be to work. None of us (Peggy, Barb, Shale, me or Sheldon) have heard from the Speaker's office yet, which led to much speculation that some other APSA Fellow was going to be selected. It did occur to me that Senate Finance may well have interviewed and accepted someone else. If I don't hear anything from them by next week, I will need to look into that. I have an interview at CMS in the Office of Legislative Policy next week, and Senator Stabenow wants to meet me next week as well. I sent my stuff in to Senator Rockefeller's office and the in Immediate Office of the Secretary at HHS. At least I know that I am still marketable and that there are still options.

The First of Us in In: I interviewed with Ways and Means

There are essentially three committee's in Congress that do children's issues; HELP, Finance and Energy and Commerce. Today, Andy Bindman took his position with the majority side on Energy and Commerce. Good call on his part, and it is a good match, but it really reduces my chances of being able to weigh in on kids issues, since HELP told us that they are not taking a Fellow this year. So, my anxiety level is a bit raised as I entered my interview in Ways and Means.

Great people on that one- lots of people and a dynamic leader in Cybele Bjorkland. She talked a lot about the team, about their desire to keep in eye on mental health issues as they moved into health reform, and about the potential, under Mr. Stark's leadership, to branch out a bit, and to do more on Kid's issues, even if it stretched the realm of the Committee a bit. I'd learn Medicare there, I guess, but my heart wasn't in the interview (and I am not sure that I can keep that from showing). We met Debbie Stabenow's people today; guess I'll put in a call to them to try to see if I can get in to the Finance through a back door if the front doesn't open.

This is a bit stressful. More later.

The Speaker's Office: What Can One Say?

So, last Friday I got to visit with Wendall Primus, one of the premiere health economist in the universe and top aide to Speaker Pelosi. It was very cool. I entered the Congress building on the House side, walked up to the Speaker's office, and we told by the scheduler to take to elevator to the 4th floor, where Wendall would meet me. Waited for about 10 minutes, on a couch staring at the picture of Nancy Pelosi gaveling in the Congress as Speaker in 2007. (Note that the same picture was taken from a right -wing blog which condemn's her- people do feel strongly about the Speaker). Wendall is a gem- soft-spoken, smart as hell, a mover and shaker in the area of welfare economics. We had a great conversation. He wanted to know my story, my reasons for being here, my thoughts on a few issues (autism, EPSDT). He was almost professorial in his outlook, talking about the 6 Ps of public policy (process, policy, politics, people, public and press). He told me that I would have to begin with the "easy" stuff- meeting with the various interest groups who will want to have a piece of the conference with which he will be intimately involved in the near future. On the way out, I invited him to take in the Washington Chorus concert next month- he politely took my card. Ran into Deb Trautman on the way out, who had just had her "going away" party. I left feeling like he had a good sense of who I was, and that he hopes to make his decision by next Friday. I left with a sense that, to be a fly on the wall of the Speaker's office would be of tremendous value, but not with the same sense of joy that I felt when leaving the Senate Finance Committee. On the one hand, I am excited by the prospect of the visit. On the other, I wonder if I am invited to both places, which would I really like to take on. Probably I will be invited to neither, and will just feel down about the whole thing.

Second Interview: Senate Finance Committee

I went into the interview with a series of questions:

• What does a day look like for a Fellow at the Committee?
• What are the strong points of this Committee? What are the challenges?
• How are Fellows supported in their work (mentoring, advice)?
• What would you envision as my portfolio? How flexible is that portfolio?
• How does the Committee handle mistakes?
• How would you describe the culture of the office?
• Would I be able to participate in Fellowship activities?
• Relationship with the Members?
• Participation in Washington Chorus?

I came out of the interview with a renewed excitement about the possibility of joining this amazing group of people for the task ahead. Let me take you through the interview.

Group 1: Liz, David, Yvette:

This is the senior management team. Liz Fowler is on her second tour of duty with the Committee- she was out in the world, including the insurance industry, before being brought back into the fight. David Schwarz is their man on Medicaid, Yvette Fontenot is handling the new stuff- insurance markets and exchanges. She is pregnant, and so a portfolio will be opening up. All spoke of the need for teamwork in the office, of the incredible amount of work that needed to be done quickly and accurately, and of the ways in which they support the Fellows while relying on them to do the work. As a Fellow, you will have enough rope to hang yourself, as they are serious about putting good people to good use. David told me a story about a mistake in information given to the Senator on the floor- no drama, just deep disappoint. They acknowledge their humanity, but not often. Key talents are writing clearly and effectively. A lot. I would charge up a hill for these people.

Group 2: Chris, Neleen, Tony. Medicare A, Medicare B, and, well, the new guy, who has picked up pieces of both along with FDA and devices. Tony lived in Webster for a while; his father was the priest at the Greek-Orthodox Church there. Again, super nice people. We talked about the need to be flexible, about how the new person has to develop their own portfolio and about how everyone really needs to pull their own weight to make this work. Quarters are close and tight- you have to be able to move in and out of the moment. Tony likes to through things. I wold charge up a hill will these people.

Group 3: Shawn and Diedra: Gold. Shawn tried to tell me that she is somewhat difficult to work with; I don't believe it. She gives Liz complete credit for pulling together such a remarkable team. She said that, for a new person, it is always a steep learning curve. Joining this group in the midst of conference will be a steeper and tougher learning curve than usual. Diedra does TANF (which will be reauthorized this year) as well as Title IV and Title V. She wants to fix Title V and, as we spoke of home visiting and care coordination, I got really excited about the notion of bolstering the Title V MCH program. She asked if I would be willing to do it; now I am willing to take a bullet for these people.

Group 4: The Bullpen: Matt Kazan, Kelly Whitener, Scott Berkowitz are the new folks. Scott is actually a Fellow. Love the place, love the work, have no outside lives. They are the people would be taking the bullets with me. Good comrades.

I could grow the love this place. We will see how it goes.

First Interview: Notes from Senate Finance Meeting with Andrew Hu

Very interesting meeting today. The sequence of events is: I had e-mailed my interest to Mr. Hu (Senate-Finance-Majority) last Tuesday, and had heard nothing- I e-mailed again on Sunday, and was invited to interview today. He met me at 4:45 PM this evening, and we had what I thought was a productive 30 minute chat. He explained to me that he joined the Committee staff in September 2008, and that he really didn't know much about what the Committee was like during normal time- for him it had been all health reform all of the time. He explained again how the Committee's agenda "after health care" was quite unclear; he said that many people would be leaving after this "battle" was done, and that he thought that the focus for next year would be fixes and oversight.

He told me (a bit indirectly) that he had interviewed Andy on Friday, and then had been told by his "higher ups" that he needed to interview more people than that, hence my interview today. I got the sense that he had just wanted to offer Andy the job and be done with it. I think by the end of the interview he thought I would be acceptable as well, and that he would e-mail Liz Fowler that information going forward. He told me to expect to hear from them with in a week.

He seemed to think that he should interview some other folks, but wasn't clear on who would be best to interview; his "higher ups" felt that he should interview everyone who was "interested". I suggested that he should discuss with you who else was "really interested" in this position, since we were all keeping in close touch with you. You may wish to proactively suggest others that he should invite to be interviewed; he seemed very focused on the immediate issue of health reform, and hoped to interview as few people as possible to move this process forward, which is apparently different than the usual process.

My assessment is that this assignment would afford me an excellent opportunity to learn about the relationship between finance and systems of care, and that moves it ahead of Ways and Means for now. I will see how my interview with them on Thursday goes.

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E-mail today:

Hi David,

I’ve spoken to Liz and she feels it would be worthwhile for you to come in for an interview with the staff. So I’ve set up the schedule for tomorrow, Wednesday, November 18th, starting at 1:00 PM. Hopefully, everyone will be able to hold this schedule and you’ll have a chance to meet with everyone. But please come to Dirksen 205, I should be the first desk you see and I will direct you to folks as they come. Thanks!

Interview Schedule for Dr. David Keller

1:00-1:30 – Liz, David, Yvette
1:30-2:00 – Chris, Neleen, Tony
2:00-2:30 – Shawn, Diedra
2:30-3:00 – Bullpen


Andrew Hu
Health Research Assistant
Senate Committee on Finance
(202) 224-4515

Jumbled Thoughts on the DC Experience

So, I said I was going to blog, for my audience of one, and instead I find that we have been talking. Apparently, I go on and on about the politics of health policy and the policy at the core of the Washington’s current peculiar politics. It occurs to me that if I write some of this down, I won’t have to go into thinkgs in such excruciating detail. So hear goes:

This whole thing has been so much more than I imagined, I have found it hard to write about. I really am learning how to look differently at the problem of translating the knowledge that we acquire through science into the language and thought processes of policy, while acknowledging and using the tools of politics. I’ve learned some of this through my community work; but this is doing it on a much larger scale than I would have thought possible. A few “bon mots”:

1 Our government is designed to make action difficult in most cases unless most people agree that something is necessary. We do this in many ways: through a bicameral legislature with different constituencies and different operations; through a series of restrictions on what government cannot ever do; through a strong tradition of states that often guard their rights and through a public that has as its default position the notion that government is the last resort of a free economy. WHEN THINGS HAPPEN, IT IS THROUGH THE ALIGNMENT OF THE IRON TRIANGLE

Executive

Stateholders

Legislative

The executive is kind of obvious- but not. Used to be that there was the President, and the Cabinet. Now there there is an “executive office of the president” that houses things like the National Security Council and the Office of Domestic Policy, and those folks are the President’s connection to the various Cabinet posts. So, you have to think- who is actually in charge. Also shows how important health reform was to Obama- he but both the Cabinet Post and the EOP post in the hands of Tom Daschle, only to have his plan thwarted by a limo ride. Well, a few limo rides. Crazy. Anyway, the Federal Health Bureaucracy is vast and confusing and spread out across a number of places. It is functional and dysfunctional at the same time, and has good people stuck in the middle of many a bad system.

The legislative is the House and Senate, they of vastly different cultures. The House is America, warts and all, a Walt Whitman of a legislative body. The Senate is more classical, like Longfellow or Robert Frost. It does not sing the body electric- it sings of our rural roots. Health is divvied up into a morass of non-corresponding committees- for the House, Ways and Means for Medicare A/B, Energy and Commerce for Medicaid and Medicare C/D and other miscellany, Education and Labor for a small bit left over. For the Senate, Finance for Medicare and Medicaid, HELP for everything else. Makes it complitcated to follow a bill.

Then there are the stakeholders, able to drive a stake through anything that they don’t like. We’ve met lobbyists, advocates, pundits, think tankers – all the people talking policy from all around D.C. These folks can give you facts, stories, spin,. Legislative language- you name it, they will supply it for you. This is also the major place in which data and analysis enters into the process; but it is filtered and sorted in ways that don’t always make sense.

Our government is based on the alignment of interests. If you have an iron triangle, then, in order to get anything done, you need to get the Executive, the Legislative and the Stakeholders all on the same page. This, it turns out, is not easy to do. But we keep trying.

I’ll think about more things later. But we are being placed now.