I believe it was on September 3 when I first saw the news! The head of the Centers for Medicare and Medicaid, Mark D. McClellan was rumored to be resigning. I had an interesting array of feelings.

McClellan, an administrator under the Bush administration, has been the name on the front of the Medicare D drug program. And, in that light, what was his record? Maybe, just possibly, he did the best job he could in very hard circumstances.

It is expressed well in a quote from The Healthblog on September 8.
"He never looked too happy defending the stupid industry-based bills that the Congress sent him.
What he really wanted to do of course was turn Medicare into a real influential purchaser."

I had an opportunity to see Dr. McClellan speak at a CMS conference in May. It was just before the sign up deadline, and I wanted to ask him why the administration wouldn’t extend that sign up period. As I listened to him speak of the Deficit Reduction Act, and talk about gains made and things to come, I heard a man who was truly pleased with items like "Money Follows the Person" and I realized that he was not enthusiastic about everything including Medicare D. Maybe I made a snap judgment, but in that moment I lost my nerve to ask the question. How could he tell me, right out loud, that he couldn't do a thing about the politics.

In his letter acknowledging his resignation, sent to all users of CMS Email, McClellan says, "I'm confident that even better things lie ahead.

This includes delivering on and enhancing the benefits of the Medicare Modernization Act, the most important reforms in Medicare ever. We've worked with partners to get 90 percent of people with Medicare into drug coverage, and we've implemented the biggest transition in drug coverage ever in this country. We've found and fixed startup problems, we are delivering coverage at a cost at least 25 percent less than had been expected, and we are seeing beneficiary satisfaction rates of over 80 percent. For 2007, the benefit costs are going down further, and many drug plans will have lower premiums and options for enhanced coverage as well."

And, somehow, after all the news reading I've done about Medicare D and Medicaid, I believe Mark McClellan really tried. I wonder how much hair he pulled out during the time between July of 05 and now. Many snags, computer glitches and real problems plagued the Medicare D prescription program's rollout. And yet, they slowly but surely got fixed. And surveys tell us people really are satisfied.

Yes, there still a doughnut hole awaiting many seniors and people with disabilities. Yes, Medicare prices still can't be negotiated by the Government. Yes, there are claw back payments that will force states to pay millions of dollars to the Feds. But, if administration has anything to do with what's happened so far, I believe we can credit Dr. Mark D. McClellan for leadership in the face of some tough sledding.

The New York Times' Opinion section said, on September 8 "McClellan still worked to change Medicare from a mere bill-payer into a catalyst for reforming the health system. He has used its financial clout to press for studies to prove whether certain expensive treatments really work, and he has promoted efforts to measure the quality of care provided by hospitals, doctors and nursing homes.

McClellan wins praise from some Democrats and leaders of advocacy groups for focusing on important policy issues and responding to valid complaints. Some critics disparage him for toeing the administration line too uncritically. But even they think they will be lucky to get anyone so accomplished as his successor."

And, the Healthblog posting quoted earlier concludes that government negotiation of drug prices will happen "There's going to be a huge political fight about that, but it will happen eventually. And that's a role for which he'll be much better suited. Perhaps he'll come back then?"

When and if he does, let's hope that the long term care issue has moved toward independent living in the home for all people with disabilities. After all, ADAPT's Bob Kafka found that Mark McClellan was a good listener and an ally in the group's fight for freedom from nursing homes.

Let's also hope, that if Mark McClellan returns, it is in a more consumer friendly administration. Think how much great work can be done by a good administrator when there are friends there to cover his back.

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