President-elect Barack Obama has chosen former Senate majority leader Thomas A. Daschle to run the Department of Health and Human Services (HHS) and he expects Daschle to run the administration in a different fashion than has been traditionally done.  Not only will Daschle oversee operations of one of the largest government administrations, he is expected to usher reform legislation through Congress, too.

As Secretary of HHS, Daschle will be dealing with 65,000 employees, an annual budget that tops $707 billion, and an administration that involves 11 of the most complex government programs in existence today, including the Food and Drug Administration (FDA), the Centers for Disease Control and Prevention (CDC), the National Institutes of Health, and the Centers for Medicare and Medicaid Services.  The HHS budget represents about 25% of all federal government expenditures, second only to that of the Department of Defense.

To accomplish his mission, Daschle will need the assistance of a strong team of deputies that has yet to be announced.  Led by a strong second-in-command, the deputies will probably devote the bulk of their on-going efforts to improving HHS operations at all levels while Daschle focuses on healthcare reform legislation.

While the rest of the world is writing letters to Santa, the healthcare reform wish lists offered by various agencies and individuals include:

• Addressing “persistent, neglected and potentially deadly” gaps in the system’s infrastructure.
• Improving the nation’s emergency response strategies in the event of natural or man-made crises so as to avoid the bureaucratic debacle witnessed during the aftermath of Hurricane Katrina.
• Better management of chronic illnesses, such as diabetes.
• Better preparedness for dealing with the aging population and its long-term healthcare needs.
• Valuing improved health outcomes over the expectations of the insurance industry.
• Addressing preventable illnesses, including those associated with childhood obesity.
• Overcoming racial disparity within the current healthcare system.
• Reversing some of the ideological and political decisions made by the Bush administration, with special attention paid to issues of sexuality, reproductive health, embryonic stem cell research, and the current administration’s willingness to allow private firms to shape the Medicare program.
• Stabilization of the much-troubled FDA, including strengthened safety measures for both food and drugs.
• More science-savvy administrators for the NIH and CDC.
• Bolstering the nation’s system of preparedness to combat terroristic attacks of a biological, chemical, radiological, or nuclear nature.
• Vigorous promotion of the use of electronic medical records.
• Expansion of the Medicaid program in such a way that more Americans are covered.

The list is daunting but perhaps the toughest hurdle to jump will be getting individual states to underwrite programs of reform.  A large and growing list of state governments are, quite simply, out of money.