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Diplomacy That Heals

By David S. Broder
Thursday, January 15, 2009

When George W. Bush was running for the presidency, he said he aspired to be an education president. He followed through in his first year by pressing Congress to pass the bipartisan No Child Left Behind Act. He found an effective partner in Margaret Spellings, who served first as the White House staff person in charge of drafting the legislation and then as secretary of education.

The president was initially much less engaged in the business of the Department of Health and Human Services, but he was exceptionally fortunate to find two of the ablest fellow governors in his party to run that giant and vital agency.

In his first term, it was Tommy Thompson of Wisconsin; in his second, Mike Leavitt of Utah. Both were leaders of the National Governors Association, where I got to know them, and both earned the trust of governors and legislators of both parties even before they took up their Washington duties.

Last week, I did an exit interview with Leavitt, as I had done four years earlier with Thompson.

The two men shared responsibility for one of the biggest innovations and achievements of this administration, the addition of a prescription drug benefit to Medicare. The law was passed in the first term, and I well remember Thompson out on the House floor, imploring reluctant Republican conservatives to furnish the last few votes.

It fell to Leavitt to make it work, and the start-up was highly controversial. Democrats lambasted the administration for rejecting price-setting powers and direct negotiation with pharmaceutical companies on the drug costs.

Leavitt told me that the competitive model employed for the new Medicare Part D has worked "better than anyone expected" and that costs to the beneficiaries and the Treasury are running almost 40 percent below the original budget, with 85 percent customer satisfaction.

Leavitt advocates using a similar market mechanism to control costs in the portions of Medicare that cover hospital and doctor services -- a controversial approach very much at odds with the position staked out by President-elect Barack Obama during the campaign.

Nonetheless, Leavitt is highly complimentary of the person picked to succeed him at HHS, former Senate Democratic leader Tom Daschle. And he has advice for Obama and the incoming administration.

I was struck by the fact that one of his strongest recommendations echoed something that Thompson had told me. When I interviewed him in January 2005, Thompson said he had developed a passion for "medical diplomacy." "I have traveled to 37 countries," he said, "helping deliver medicine for AIDS, malaria and other diseases. I dedicated a hospital for women and children in Kabul, Afghanistan. The gratitude of people for what America, with its wealth of medical talent, can bring is overwhelming."

Four years later, Leavitt has reached exactly the same conclusion. As he told me, "The language of health is heard by the heart."

In one of his summing-up reports, Leavitt spelled out the message: "Give a mother with HIV-AIDS hope that she can raise her children, and her gratitude will never wane. Heal a father's child, and he will never forget. Give a teen with disfigured legs the mobility of a wheelchair, and he will praise your name forever. As Iraqi Prime Minister Nouri al-Maliki said to me, 'Health is a good messenger of peace.' "

Leavitt said that since the Bush administration took office, overseas medical assistance financed by both government and the nonprofit sector has expanded markedly. But there is so much more that can and should be done.

He points out that the Castro regime in Cuba and now Venezuela's Hugo Chávez have dispatched doctors by the thousands to assist poor populations in Latin America.

The United States could do so much more than those countries and, in the process, begin to reap the rewards that it deserves for its generosity.

When two Republican Cabinet members who have seen the potential with their own eyes offer such a suggestion to the incoming Democratic administration, it's probably worth listening to them.

davidbroder@washpost.com

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