WASHINGTON—Former Health and Human Services Secretary Tommy Thompson railed Thursday about his frustrations with Washington's political bureaucracy and said his inability to restructure Medicaid was his biggest public-policy regret.
Speaking to a luncheon of health policy experts, Thompson said another major frustration was Congress' refusal to let him and future HHS secretaries negotiate drug prices for the new Medicare prescription-drug plan. Critics say using Medicare's 42 million enrollees as bargaining leverage in price negotiations—a tactic that Congress never seriously considered—could save the program billions of dollars.
Thompson's trademark candor, which often irritated his Republican colleagues, was on full display during a rambling question-and-answer session at the Kaiser Family Foundation, a nonprofit Washington health-care research group. He stepped down as HHS secretary in January.
Thompson said he was thwarted in his effort to transform Medicaid, the state and federal health program for the poor, elderly and people with disabilities. He wanted to shift most of its acute medical-care costs to the states while having the federal government assume the bulk of costly long-term nursing home care, but the plan failed.
"I tried, but I was unable to convince the governors that this is what they should do," said Thompson, a former Wisconsin governor. Medicaid is now the subject of fierce debate as lawmakers consider cutting billions in federal money for the program to help trim the budget deficit.
Thompson, who now splits his time between Washington and his native Wisconsin, said, "You can't continue on with Medicaid the way it is. It's got to have a complete transformation."
After serving in various levels of state politics, where ideas become policies more quickly, Thompson lamented having to vet ideas through "67,000 individuals" at HHS who "all have their own individual biases and opinions."
Those obstacles only increased at the executive level, where, Thompson said, the White House Office of Management and Budget, which acts as the White House's policy enforcer over the rest of the executive branch, acted as "super God."
"They turn you down nine times out of 10 just to show you they are the boss," Thompson said. From the OMB, policy proposals then go to the "super intelligentsia" of White House advisers, "who do not believe that anything smart or original can come from a secretary or a department," he said.
A proposal that a president's advisers and the president do support goes to Congress. "And if Congress ever does approve it, it's time to retire," Thompson said. "That's why nothing gets done in Washington."
After 38 years in public service, Thompson now chairs the Deloitte Center for Health Care Management and Transformation at the Washington office of Deloitte & Touche USA LLP, an accounting and business services firm. He's also a partner at the Akin Gump law firm in Washington and the president of Logistics Health Inc., a homeland-security and military contractor in La Crosse, Wis.
Thompson said official trips to 38 countries during his four-year term at HHS, particularly small African nations ravaged by AIDS, had made him a more compassionate person with a broader, more enlightened worldview. He said sharing U.S. medical technology and expertise was the best way to relieve world suffering and improve America's relations with hostile nations.
"I think if we really want to win this war on terror, it's going to be (done) much better through humanitarian aid and through medical diplomacy than through any other means," Thompson said.
(c) 2005, Knight Ridder/Tribune Information Services.
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