Opinion — The Big Picture: Flying beneath the radar

Share this content:

Schoolchildren rarely notice when the district superintendent leaves. Nor do rank-and-file employees get too excited when a new vice president joins another division.

When you're slogging along on the front lines, it makes little difference when nameplates are being changed in the "ivory tower." So it hardly resonated with many long-term care operators when the administrator at the Centers for Medicare & Medicaid Services recently announced he'd be stepping down. And that's too bad.
By most accounts, Dr. Mark McClellan didn't do just a commendable job under tough conditions. His actions and legacy may affect future career prospects for many of this magazine's readers.
McClellan will likely be remembered for two things. The first is the masterful way he removed the stink bomb deposited by his predecessor, Tom Scully. Scully served briefly but memorably at the helm of CMS, leaving behind a smell that would impress a skunk colony. The knock against Scully isn't just that he was a prototypical member of Washington's legal/lobbying combine. It was his uncommon combination of ignorance, ethical ambiguity and hubris that separated Scully from the herd.
When an actuary informed Scully that the real cost of implementing a Medicare drug plan would exceed the administration's promised ceiling — and therefore ensure the plan would not get approval from Congress — guess what he did? If your guess is that he told the actuary to keep his mouth shut or lose his job, you're correct. Nor was Scully above soliciting employment offers when he should have been working.
McClellan proved to be a refreshing alternative. Maybe it's because he's a doctor and economist by training, maybe it's because he didn't lose his moral compass and maybe it's because he had more experience dealing with Washington insiders. Regardless, McClellan quickly earned the respect of providers, lawmakers, regulators and consumers.
McClellan spent the better part of the past two years crisscrossing the nation to promote the new prescription drug plan known as Part D. The jury's still out on how well it's going. Eight in 10 seniors in a recent poll said they like the new drug benefit, which took effect Jan. 1. But the dizzying array of plans administered by private insurers also caused confusion. And nursing homes are scrambling to serve dual eligibles.
McClellan's successor will face a tough job that includes harnessing growth in Medicare and Medicaid, while also addressing growing ranks of the uninsured. It won't be easy. But if the new person does it well, he or she will earn the best reward a Washington bureaucrat can hope for: not being noticed.
John O'Connor, is vice president, McKnight's Long-Term Care News. Contact him at john.oconnor@mltcn.com