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January 20, 2009

What Is the Top Priority for Obama?

Catherine New
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Linda V. Green: He should give top priority to changing the diagnosis-related group (DRG) system, which is the hospital payment system for Medicare (and which is used by private insurers, as well). This system is highly skewed toward compensating for procedures rather than medical care. As a result, hospitals tend to invest in profitable areas, such as cardiac and orthopedic surgery, but neglect to add capacity to often over-crowded clinical units that care for patients suffering from strokes, heart attacks, pneumonia and kidney failure. This has caused the nation to experience increasing emergency department congestion and ambulance diversions, which lead to sometimes-fatal consequences. Also as a result, many unnecessary, expensive procedures and surgeries are being performed. Current estimates are that up to 45% of cardiac bypass surgeries and perhaps the majority of angioplasties are unnecessary. So changing the DRG system would result in both lower costs and better quality.

Murray Low: The top priority has to be to restore confidence in our institutions, both government and business. In recent years there has been a huge erosion of trust because of self-dealing by those in leadership positions. We need to have leaders that inspire.

Garrett van Ryzin: Restore the world’s faith and trust in the American ideal.

Michael Feiner: The most important issues are trust and transparency. If those are addressed, Obama will get it right as it relates to healthcare, the economy and education and so on. People need a dose of the optimism that has characterized the American mindset. And the optics of trust and transparency are as important as substantive fixes and solutions in each area. The first thing to do is hire great people, which he has done for the most part — he has gone for quality, not cronies. The second thing is to become vocal, frank and communicative frequently — both with press and American people. This is not the time to hide and manage and spin the data. He needs to communicate his plans and where he is against those plans. He needs to demonstrate that he will reach out to foreign powers and that he is more collaborative and less isolationist. There are lots of public things he can do using pulpit of presidency to show that the administration will do things very differently.

Photo credit: Jay Tamboli