barack obama has been president of the united states for eight months , and the change in the public mood is palpable . the misguided and misbegotten george w bush regime is slowly fading from our collective and still traumatized memory . the fresh faces and far more inspiring proposals of the obama white house dominate the public scene . from the point of view of genome medicine , obama has made two vital policy decisions , one of which we mentioned in our initial commentary on the obama effect ( genome medicine : volume 1 , issue 3 ) . he has finally chosen a new director of the national institutes of health ( nih ) . he is a highly accomplished clinical investigator with long experience at nih who has made outstanding contributions to genome medicine from cystic fibrosis to progeria . he brought the public sequencing of the human genome to fruition on time and on budget , and he splendidly led the national human genome research institute in which he developed an excellent intramural program from scratch . there are some who hold that collins ' commitment to large - scale sequencing efforts embarrasses individual investigator - initiated research grant budgets ( discussed in genome medicine : volume 1 , issue 1 ) , but we believe that he has the right sense of balance between traditional investigator - initiated and large - scale research priorities . his own interests and record should guarantee that he will be committed to clinical research - a critical issue and one that is not , in our view , salvaged by huge consortium efforts such as the clinical translational science awards program initiated by collins ' predecessor , elias zerhouni . they can not believe that an open - minded biomedical scientist could be ' encumbered ' by irrational faith . collins has written about his faith , and that book has , perhaps , stirred up concerns about his capacity to analyze data without prejudice . we believe he is a splendid choice and will be a fine influence on the nih campus , in the broad academic biomedical research community , and above all in the halls of the congress where lurk his most influential potential critics and supporters . the proposed change in united states healthcare policy is a second major initiative of the obama administration that will have profound effects on genome medicine and , indeed , all of academic medicine . we will not belabor the details of the obama proposals because they change as the congress , which has been charged with the development of the program , deals with the gordian complexities . the united states has the most expensive and probably the least efficient healthcare system in the developed world , and our healthcare record is among the worst in the developed world . forty - five million us citizens lack any health insurance and millions more are vastly under - insured . we are very good at new technology accrual and application and very bad at preventive medicine and primary care . we desperately need to expand the latter while preserving the former and simultaneously reducing the rate of acceleration of our already burdensome healthcare costs . congress has dealt with the issue by fruitlessly searching for a population to tax heavily enough to pay for a huge extension of medical care insurance , but has done nothing to accomplish the most essential missions : the lowering of costs and an effective reduction of the acceleration of costs . both of these requirements are politically unpalatable because they require reductions in payments to physicians , hospitals and all their employees , pharmaceutical companies , and medical device companies . some states , our own included , have become highly dependent on health care and healthcare research to sustain their economies . the skill in all of this is to accomplish all of the necessary cost controls without destroying the financial fabric of academic medicine and the teaching / research hospitals in which most clinically relevant discoveries are made . if a blunt axe is taken to the budgets of major teaching / research hospitals , the entire nih effort will be brought to its knees and clinical research , including genome medicine , will be truncated . but the present session of congress came to a wheezing close in august , and none of the bills that have emerged are anywhere close to being useful . it seems that the white house simply wants almost any bill , even two totally different bills , to get through both the house of representatives and the senate . those of us writhing on the sidelines gaze at this kabuki theatre with mingled doubt and hope . if congress and the president do n't get this right , we will have no better health care , at even more crushing cost , and a highly endangered biomedical research program in which genome medicine hangs on by its fingernails .
from the point of view of genome medicine , barack obama has made two vital policy decisions : he has chosen a new director of the national institutes of health , and his proposed change in united states healthcare policy will have profound effects on genome medicine and , indeed , all of academic medicine .