When President Obama delivers his first major speech to Congress next Tuesday, plans to overhaul the health care system are expected to play a featured role.
But the administration is still lacking one key element for its health effort — someone to lead it.
It takes on more urgency as the president is due to roll out his first budget two days later.
This was not the way it was supposed to happen.
Former Senate Majority Leader Tom Daschle was the hands-down favorite to head up the effort. He knows the issue — he recently authored a book on the subject. He knows Congress and has a long history of being able to cut deals across partisan lines. And, perhaps most important, Daschle has been a close confidante of the new President.
But Daschle's nomination to head both the Department of Health and Human Services and a new White House Office of Health Reform was derailed last month by revelations that he had paid more than $140,000 in back taxes and interest on more than $5 million in income he earned since leaving the Senate in 2005.
That's left a vacuum at the Department of Health and Human Services.
Not only is there no secretary, but there is also no chief for the Food and Drug Administration, with an extensive food-borne salmonella outbreak under way. And there's no head of the Medicaid program, one of the largest entitlement programs in the federal government. It was a major target of Mr. Obama's stimulus package, with tens of billions of dollars on the line.
"Obviously you can't pick your wide receivers until you know what kind of quarterback you've got," says Len Nichols, director of the health policy program at the New America Foundation.
Nichols says no real harm has been done yet. But he says it would have been helpful to have had an HHS secretary in place, for example, during the debate over the health provisions of the stimulus bill.
A controversy erupted when opponents charged that a measure to compare the effectiveness of medical treatments could lead to rationing.
"I think the reality is the members of Congress who have been following these issues for some time know that we need to invest in best-practice knowledge production so that we can actually deliver better quality care," says Nichols.
"So I think in the end we will get what we want. But I think there's no question that the debate was damaged by not having that [administration] health voice front and center."
Ron Pollack, executive director of the consumer advocacy group Families USA agrees that the administration needs a health care voice — and soon.
"Obviously you want the administration to take the leadership on that because they've got a bully pulpit and people will listen to them," he says.
Kansas Governor A Candidate
Pollack is hoping the president will choose the person who appears to be the leading candidate for the HHS post: Kansas Democratic Gov. Kathleen Sebelius.
He says Sebelius is "a very smart, determined and thoughtful person who would do great service for this administration."
She's also a former insurance commissioner who knows health care intimately, he says, so if she got the job, "she could hit the ground running."
Sebelius, a Democratic governor from a traditionally Republican state, also enjoys the support of the insurance industry.
"She would be a very good choice on the part of the president," says Karen Ignagni, president and CEO of America's Health Insurance Plans.
"And being a governor, coming from the trenches," Ignagni says, "she can talk very, very personally about what this health care crisis means to people in her state."
Tennessean Also A Contender
Also apparently still on President Obama's short list to head HHS is another Democratic governor from a largely Republican state: Tennessee's Phil Bredesen.
But the appointment of Bredesen, who earned millions as a managed health care executive before turning to politics, would be far more controversial than that of Sebelius.
"I think Gov. Bredesen would be a big mistake for the administration," says Pollack.
"He presided over the largest public health coverage cutbacks in the history of our nation," Pollack says, referring to Bredesen's decision in 2005 to eliminate state health benefits for some 200,000 state residents and cut benefits for another half a million in order to balance the state's budget.
"So this really would be viewed as an ironic appointment, and I just can't imagine that the president would do that," says Pollack.
Whoever the choice is, however, just about everyone who has been clamoring for a health care overhaul this year is hoping the decision will come soon.
"Time is not our friend," says Pollack.