07 November 2008

The Promise of Obama

Now that Election Day has ended media speculation of whether Barack Obama can win, it has turned its attention to what he might try to accomplish in office once inaugurated.  Even ESPN is reporting on the impact of Mr. Obama on sports, from off-season baseball signings to luring the 2016 Olympics to Chicago to boosting the strength of Title IX.  Chief on everyone's mind is what Obama can or will do about the economy, which appears to die more each day despite the $700B bailout measures approved before the election.  First and foremost, though, is the hiring of a cabinet.

For the average voter, a president-elect's cabinet making process is little more than the media having nothing better to cover now that an election is over.  Nothing could be farther from the truth.  "He's going to be the president; he'll be in charge," you think.  And, yes, the buck stops at the presidency.  However, those top-level government positions serve two functions that should never be underestimated.  First, remember that a president does not legislate--he executes the law.  These men and women are his lieutenants, overseeing the various components of the government that make policy reality.  You wouldn't want the Secretary of State to be too antagonistic of the Pentagon and you wouldn't want the Surgeon General to be too friendly with pharmaceutical companies.  You wouldn't want these things because then you risk a military finding ways not to cooperate with the presidency and a greater push on doctors to write unwarranted prescriptions.

Secondly, no president is an expert in every field.  Some have favored economics, others warfare.  He must rely on those around him to guide him through the nuances of these important issues.  In his Eyewitness to Power, former presidential speechwriter and advisor David Gergen describes the influence of the White House Chief of Staff and cabinet members on Presidents Nixon, Ford, Reagan and Clinton.  Nowhere is the significance greater than in his perspective of what went wrong with the Nixon presidency.  Gergen identifies White House Chief of Staff H. Robert Haldeman as the man who daily worked to insulate the president from any dissenting opinions, provoking Nixon's paranoia and firing at will anyone who threatened his carefully cultivated bubble.

Make no mistake about it: with whom a president surrounds himself is of the utmost importance to the American people.  Many feel that President George W. Bush's neo-conservative cabinet betrayed the "compassionate conservative" image on which he ran for office in 2000, and might not have cast their ballot for him had they known the kind of people that would hold such important positions in the federal government.

Speaking as a Crohnie, I read with great interest an Associated Press article speculating what impact the Obama administration will have on the Food and Drug Administration.  Under President Bush, the FDA has repeatedly been caught with its pants down, approving and quickly having to recall several dangerous pharmaceuticals as well as food contamination issues.  Critics believe that these are the direct result of Bush's de-regulatory policies, which have greatly curtailed government agencies's effectiveness in monitoring public safety.

The final paragraph of the AP article conjectures that "industry officials expect the Obama administration to work with Congress to create a legal framework for the FDA to review and approve generic versions of biologic drugs."  For those who are unaware, biologics are a class of drugs crafted by medical scientists in labs to target and treat very specific conditions.  They are also so expensive that they are practically unattainable for uninsured patients.  A recent Washington Post article reports that 25% of those on the market have been issued safety warnings, indicating an alarming rate of patients experiencing harmful side effects.

A more conscientious FDA should translate into safer medications, and generic biologics will definitely improve treatment options for Americans suffering from various conditions from Crohn's disease to rheumatoid arthritis.  Even if Mr. Obama fails to deliver on his campaign pledge to compel insurance companies to cover pre-existing conditions, even if he does not find a way to offer more affordable health care for those of us without, these two areas have the potential to vastly improve the health of millions.

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