The Cabinet: Who’s In It Says A Lot About Who Put Them There—In The Government Or In Academia

The Cabinet: Who’s In It Says A Lot About Who Put Them There—In The Government Or In Academia


Leonard Zwelling

         I remember the Kennedy Cabinet. Dean Rusk, Douglas Dillon, Robert McNamara, Bobby Kennedy, Adlai Stevenson, and Arthur Goldberg—these guys were legends in the making—both good and bad. The only one who was controversial was Bobby because he was the President’s brother, not because he was incapable.

         Flash forward. Mr. Trump has started to appoint people to high-level posts. Some are questionable, particularly Steve Bannon and Jeff Sessions. General Flynn may also be a less than perfect choice, but we are still early in the process. But you have to note that five out of five are white, Anglo men. Hmm….so much for looking like America even if they look like Trump voters.

         So do the people who surround President DePinho look more like the Kennedy appointees or the ones being nominated currently?

         I am not about to name names, but we all know who they are as they seem to be appearing in a daily email coming to your inbox telling you about the latest financial bad news befalling the number one place for cancer care in America. We will see how they handle a real crisis because it seems that they are in one now.

         My concern is that I cannot exactly determine why there is such a shortfall in MD Anderson’s finances or if the Cabinet has, those in it haven’t shared their wisdom.

         EPIC is the usual suspect, but there have been two months since EPIC was installed when the deficit was quite small before exploding in September and October.

         Maybe the payer mix is no good. There are too many patients spending too little time and too little money at MD Anderson either because they come once and then go home, come once and then go to a satellite clinic, or come once and are too sick to ever come back. It will be important to determine if any of these things are going on before a solution can be found. Are there fewer patients chasing too many providers? Are clinic templates going unfilled for lack of demand? Are the type of patient showing up of a sort that generates few lab tests or imaging studies? It would seem obvious that these question must be answered if a solution to these deficits is to be found.

         Finally. Dr. DePinho’s Cabinet seems firmly fixated on the revenue side. What about the expenses? If there is less clinical activity, do you really need 21,000 to fill the slots supporting a decreasing revenue stream? I think not.

         I am going to predict that there will be a substantial (over 1000 persons) layoff shortly after the holidays or else Chancellor McRaven may have to write Dr. DePinho a large check to pay the light bill.

         The Cuban Missile Crisis was a true test for the Kennedy Cabinet. It passed that test, but it was close. The current deficit is not to MD Anderson what the Cuban Missile Crisis was to America in October of 1962, but this financial shortfall is a test nonetheless. So far, DePinho’s Cabinet is falling substantially short.

         There is little doubt that if someone takes the fall for the deficit, it will resemble an American style blame rather than one that would occur in a parliamentary democracy where the prime minister would resign. At MD Anderson the President will be the last to go unless his boss decides otherwise.

         Either way, if DePinho’s guys (and it’s mostly guys) cannot work their way out of the crisis they are clearly in, it is logical to assume that they will be replaced by people the President thinks can help him through the problem.

         I cannot see that the current incumbents in the DePinho Cabinet have the skill sets needed to weather this storm. Whether DePinho himself does will need to be addressed in Austin.

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