Sylvia Burwell, whom President Obama is expected to nominate to replace Kathleen Sebelius as the secretary of health and human services, has a long professional career in business and consulting, but lacks substantial professional or political experience with health care.
Her résumé, according to Dan Diamond of the Advisory Board, only includes a stint as a board member at the University of Washington Medical Center. “Burwell’s track record in health care is not well-established,” Diamond writes in a briefing for the Advisory Board, a health-care consulting firm.
Her predecessor, Secretary Sebelius, served as Kansas state insurance commissioner for eight years, giving her control over, for instance, regulating health insurers and approving or rejecting the premiums they set.
Burwell’s private-sector experience has been with McKinsey, where she did consulting for financial services firms, and the Gates and Walmart Foundations, where she held executive positions. In the public sector, she’s worked on the budget and economics side of things, working for the National Economic Council in the Clinton White House and, most recently, running the Obama administration’s Office of Management and Budget. There, she’s been widely praised, and the OMB does of course have to deal with the implementation of federal health-care programs.
To be fair, neither of George W. Bush’s HHS secretaries had private-sector health-care experience, but both of them were governors, and each state administers its own Medicaid program, which makes of the largest single expenditure in every state (I think). Moreover, they had experience implementing significant health-care reforms of their own: Tommy Thompson created BadgerCare while governor of Wisconsin, which expanded that state’s Medicaid system; Michael Leavitt did something similar as governor of Utah, implementing a reform program in 1994 called HealthPrint. Bill Clinton’s HHS secretary, Donna Shalala, doesn’t seem to have had health-care experience. None of them, one notes, had to implement a sweeping reform of the United States’ health-care system.