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Washington Post Staff Writer
Thursday, May 14, 2009

Nancy-Ann DeParle was dubious. She had not even settled into her job as White House health czar when the nation's big insurance companies made her an offer.

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Eager to be at the bargaining table for this year's health-care reform debate, Karen Ignagni, president of America's Health Insurance Plans, told DeParle that the health industry was willing to wring about $2 trillion in savings out of health spending over the next decade.

"I was skeptical," DeParle recalled in an interview this week. She thought, "They probably don't even know what these numbers mean."

A few weeks later, in mid-April, Ignagni, who opposed President Bill Clinton's reform effort in the early 1990s, enlisted a hospital group and a labor union. DeParle still wasn't satisfied. "I need to see that it's more than just the three of you," she said she told them.

Over the next month, as DeParle kept a wary distance, a coalition was built and the proposal refined. Finally DeParle was sold, and on Monday she brought the group to the White House, where industry titans better known for killing health-care reform 15 years ago found themselves basking in presidential praise.

"This is a historic day," President Obama declared, "a watershed event in the long and elusive quest for health-care reform."

Seated to his left in the State Dining Room was DeParle, a woman Obama had not met until he hired her in March to run the White House Office of Health Reform.

On her petite shoulders rests the administration's top domestic policy goal: to cover millions of uninsured Americans, improve care nationwide and control skyrocketing medical bills that are devouring personal, corporate and government budgets.

She was not Obama's first choice for the post. But when former senator Thomas A. Daschle withdrew because of tax troubles, White House Chief of Staff Rahm Emanuel persuaded his former Clinton administration colleague to leave the lucrative private sector and return to government.

Her first gambit in the health battle -- Monday's splashy White House event -- illustrates well the challenges DeParle faces in a role she never sought. Touted by Obama backers as a "game-changer," the industry pledge has been ridiculed by economists as an unenforceable wish list from less-than-virtuous players.

"On the one hand, it's an empty gesture," said Uwe Reinhardt, a Princeton University scholar and DeParle admirer. Yet the image of all those "erstwhile insurgents" seated at the table sans weapons was also "a stroke of genius," he said.

"It was a PR coup," he added.

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