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Executive Summary

Stuart Altman, PhD, is heading President-elect Bill Clinton's health care policy development group, one of three major groups working under the health care transition team directed by Judith Feder, PhD, and Atul Gawande. Altman's policy development group is charged with drafting health care reform legislative options for the president-elect's transition team. As head of the policy development group, Altman currently is organizing working groups on cost containment; financing and delivery; the health professions and manpower issues; quality of care; and long-term care. Two other major groups within the health transition team are handling budget issues and outreach programs. The budget group is headed by Kenneth Thorpe, MD, and outreach is being led jointly by Bruce Fried and Christopher Jennings. A health economist, Altman has chaired the Medicare Prospective Payment Assessment Commission since the grou's inception in 1985. Altman has served two Republican administrations (under Presidents Nixon and Ford). His being named by the incoming Clinton Administration may signal a desire to tap someone regardless of party affiliation with historical knowledge and technical background in health reform strategies in an effort to move beyond earlier proposals. From 1971-1976, Altman was deputy assistant secretary for planning and evaluation at the then-Health Education and Welfare Department and concurrently served as deputy director for health of the President's Cost of Living Council in 1973-1974. Altman was centrally involved in developing national health insurance proposals during those years and oversaw development of the council's health cost-containment programs. Altman is dean of the Florence Heller Graduate School for Social Policy and has been at Brandeis since 1977. He previously has taught at Brown University and the University of California-Berkeley and received his PhD in economics from UCLA. In testimony last May before the Senate Finance Committee, Altman supported employer mandates, global budgets and an all- payer reimbursement system. He also suggested that low-wage firms (primarily small businesses) be given tax credits to help pay for employee coverage. The suggestion later was incorporated into Clinton's recommendations for health care reform. In addition, Altman supported a pre-election Families USA/Lewin ICF study that concluded that the Clinton reform plan would save significantly more money and cover more Americans than the proposals offered by President Bush. Thorpe, as head of the health transition team's budget group, is working with the Congressional Budget Office and the Office of Management and Budget to develop consensus on budgetary and economic projections for health reform policy options. Thorpe is a professor of health policy at the University of North Carolina ("The Pink Sheet" Nov. 30, p. 5). Outreach group cochair Jennings is corresponding with congressional staff, including liberal and conservative Democrats and the leadership of both parties, as well as the states. He also will work with pharmaceutical firms, elder advocacy groups and small business, all of which he has had previous contact with as a Senate committee aide. Fried will head outreach efforts aimed at public and private sector interest groups, including providers and insurance carriers. Jennings has taken a leave of absence from his duties as deputy staff director of the Senate Special Committee on Aging, chaired by Sen. Pryor (D-Ark.). Fried is a lobbyist with the Wexler Group and chaired the Clinton for President Health Care Advisory Committee. It is of particular interest to the pharmaceutical industry that Jennings is the contact to the incoming administration for drug issues. As a key Pryor staffer, Jennings over the last several years has found himself on the opposite side of a number of contentious issues from the industry. Such issues included the Medicare outpatient drug benefit legislation, the Medicaid drug price rebate law, S 2000 (a bill to modify Sec. 936 tax credits for companies that raise prices faster than general inflation) and a number of proposals that, though not yet introduced, would reduce patent terms of drugs whose prices are raised faster than inflation and would establish a Canadian- style pharmaceutical price review board. In addition to the health policy, budget/economic and outreach groups, the health transition team has two subgroups, for public health/women's issues and AIDS. Both groups are headed by counsels to House Energy and Commerce/Health Subcommittee Chairman Waxman (D-Calif.): Ruth Katz heads the former and Timothy Westmoreland is in charge of the AIDS subgroup. The health transition team is directed by Judith Feder and Atul Gawande. Others who have been named to the health team include Steve Edelstein, who worked with Feder on the staff of the Pepper Commission; former OMB health official Lynn Etheridge; Charlotte Hayes, an aide in the Senate office of Vice President- elect Al Gore (D-Tenn.); and Ann Lewis, a health aide to Sen. Harris Wofford (D-Penn.). The health policy group was scheduled to meet with staffs of key congressional Democrats on Dec. 7. The meeting reportedly is intended both as a courtesy call and as an opportunity to discuss health care reform policy options. Transition team staffers emphasized that their mission is to develop policy options for Clinton, who will make all decisions regarding health care policy. A separate branch of the transition team was expanded when Peter Knight was named deputy director for personnel to Gov. Richard Riley. A longtime friend of Clinton and former Democratic governor of South Carolina, Riley is the transition's director for personnel and is charged with filling administration positions below the cabinet level. Knight was an administrative aide to Vice President-Elect Gore in both the House and Senate. More recently Knight was vice president and counsel for the drug company Medicis.

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