Obama's Brain Trust

Meet the Big Thinkers Behind His Health Care Plan

By Rebecca Adams

When Hillary Clinton’s health care proposal went down without passing either chamber in the fall of

1994, some analysts predicted it would be decades before Congress tried again. Now, many veterans of Clinton’s original team are hoping the time has come to launch a new initiative to cover the 47 million uninsured people in America and lower health care costs. Several of Obama’s advisers cut their teeth in health care policymaking during the Clinton administration debate. With subsequent experience working on Capitol Hill, in academia or in political campaigns, they say they have gained a great deal of perspective since the previous effort. As a result, the plan put forward by Obama is far different than the massive 1000-page bill proposed by Clinton in the 1990s. But the lessons learned go beyond changes in legislative language. The most basic one is to be inclusive and open during deliberations and to try to listen to criticism from stakeholders, such as the industries that would be affected.

David Cutler: This Harvard economist has been trying to guide Washington toward accepting universal health care since the Clinton administration. At 28, Cutler joined Clinton’s project to overhaul health care, serving in a joint position on the White House Council of Economic Advisers and the National Economic Council. He moved away from Washington after the health care initiative failed in 1994, but never left the effort behind. He advised Democratic presidential candidates Bill Bradley in 2000 and, to some extent, nominee John Kerry in 2004. Cutler, who is a professor of applied economics at Harvard’s John F. Kennedy School of Government, has focused on not just cutting short-term medical costs but trying to wring more long-term value from the health care dollar. Cutler advocates for efforts to pay doctors more for better management of patients’ conditions and encourages preventive care that keeps patients healthy. (Obama’s plan includes provisions that wouldrequire insurers in Medicare and other public programs to have disease management programs to manage chronic conditions.) Cutler describes the work in assisting Obama with his plan as “the most consensual I’ve ever been involved in” while advising policymakers.

David Blumenthal: Blumenthal has long been involved in health care policymaking for Democratic presidential candidates. Almost three decades ago, he advised Sen. Edward Kennedy on health care during his primary challenge to President Jimmy Carter and later assisted 1988 nominee Michael Dukakis. Blumenthal is among those who advocate leveraging the power of computers to better track patients, measure outcomes, electronically transfer or store medical information about patients, and electronically process claims. Blumenthal, director of the Institute for Health Policy at Massachusetts General Hospital and a professor of medicine and policy at Harvard, was brought on board with a nudge from Cutler. Blumenthal and Cutler also coordinate with another Harvard professor and Obama adviser, former Clinton administration economist Jeff Liebman, whose expertise is in tax and fiscal policy.

Jason Furman: The appointment this summer of Furman, Obama’s economic policy director under Heather Higginbottom, stirred some controversy among union activists because of his centrist approach to policymaking. Labor leaders and liberal activists say that Furman represents views on free trade, private accounts in Social Security, deficit reduction and business that undercut the rights of the American working class. One of Furman’s biggest supporters is former Clinton administration Treasury Secretary Robert Rubin, a free trade advocate who is now an investment banker. Rubin helped launch a project in 2006 at the Brookings Institution known as the Hamilton Project, and Furman served as director. The project studied pragmatic and somewhat moderate approaches to policymaking. Furman is part of a team with diverse ideas ranging from liberal to centrist. Furman also has worked as an economist at the Council of Economic Advisers, senior economic adviser to the chief economist of the World Bank, and director of economic policy for the Kerry-Edwards campaign.

Heather Higginbottom: Policy director Higginbottom “runs the show,” according to campaign staffers. She oversees health care issues as part of a broad portfolio. Some credit Higginbottom’s skillful management of diverse policy views as one reason why Obama wins kudos for the relative lack of internal drama among campaign staff. Higginbottom assumes a low public profi le despite her high-stature position and valuable previous campaign experience. She was recommended by 2004 Democratic nominee John Kerry. Higginbottom served in a variety of positions on Kerry’s Senate staff, most recently as legislative director, and worked as deputy national policy director for the Kerry-Edwards campaign. In her pre-Capitol Hill life, she worked on education issues at the non-profi t group Communities in Schools. She also coordinated the role of faith communities for President Clinton’s summit for America’s future.

Dora Hughes: Hughes could be diagnosing medical problems in patients, but she has chosen to diagnose problems in the health system instead. Hughes is a board certified internist who completed medical school at Vanderbilt University and residency at Brigham and Women’s Hospital in Boston. As Obama’s top health care adviser in his Senate office, Hughes often serves as a surrogate for the campaign in Washington and directs his health agenda on Capitol Hill. Before coming to the Hill, she served as senior program officer at The Commonwealth Fund, a New York-based national health foundation, and then joined the Committee on Health, Education, Labor and Pensions as deputy director for health for the panel’s top Democrat, Sen. Edward M. Kennedy of Massachusetts.

Neera Tanden: Tanden represents the evolving unification of the campaigns of former candidate Hillary Clinton and Obama. Tanden, who was Clinton’s policy director, serves as domestic policy director under Higginbottom. Tanden was among the architects of one of the main policy differences between Clinton, who favors a mandate on individuals to buy health insurance, and Obama, who prefers a mandate only for parents to buy coverage for their children. Tanden had served previously on Clinton’s Senate campaign staff, including a stint as legislative director in which she oversaw both foreign and domestic policy. She also worked in various top positions at the Center for American Progress, the research and educational institute that is a career home to many former Clinton administration aides. Neera also served on Hillary Clinton’s staff in the Clinton White House as the senior policy adviser to the first lady and associate director in the Domestic Policy Council where she managed children and family issues for the President, including childcare, early learning and after school programs. Tanden has said that her experience in recent years as a parent of two young children provides additional insights into policy questions on family and health care issues.

Rebecca Adams is a freelance journalist who has been writing about health care politics and policy for more than a decade.