Finding long-term solutions

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John O'Connor, Editorial Director
John O'Connor, Editorial Director
There's a famous scene in The Wizard of Oz where Dorothy is urged to ignore “that man behind the curtain.” At that point, we realize the jig is up. It has become obvious that the “great and powerful” Wizard really can't deliver the goods.

The modern-day equivalent can be seen at the Centers for Medicare & Medicaid Services. This federal agency boasts a $600 billion budget and is responsible for managing the federal government's two largest healthcare programs. But it's run by a pretender. 

As lifers at the Department of Health and Human Services go, Kerry Weems seems like a decent enough fellow. But he's clearly acting in his current role. In fact, his business card says as much. That really is too bad because if there were ever an agency in need of a leader with some gravitas, it's CMS. 

There are going to be some very tricky and difficult policy and payment battles this summer. CMS really could use a seasoned pro with good standing on the Hill rather than an order-taker who gets his cues from the White House.

In fairness, Weems is not to blame for the “acting” part of his title. It happened because his bosses chose the path of least resistance. A clever lawyer or two in the White House concluded that by simply giving him the “acting” moniker for the duration of the Bush presidency, they could get the best of both worlds: an administrator with full authority, but without the aggravation, hassle and possible embarrassment that more Senate hearings might bring. The administration has made many appointments this way recently.

But even former CIA Director George Tenet would be hard-pressed to call this maneuver a slam dunk. While Weems might not have to squirm in a committee room hot seat, he also has forfeited the seal of approval and the sense of full authority that a confirmation would have delivered.

And if you don't think Washington abhors a power vacuum, consider what happened in November. That's when one of Weems' underlings (whose identity so far has remained a mystery) decided to give nursing home industry officials the names of “special focus facilities.” 

For some strange reason, many people wondered why lobbyists were given access to this information while those without political clout were not. That little public relations mess took several months to clean up and resulted in a lot more transparency than CMS otherwise would have allowed.

The double standard gaffe might not have been enough to make us forget about FEMA's performance in New Orleans after Hurricane Katrina. But it never would have happened if CMS had had a boss who really was in charge.