Health Insurance Blog

Political interference often prevents the nation’’s top public health official from dispensing unvarnished medical opinions, two powerful Democratic lawmakers want to make the position of surgeon general more independent by giving the president less of a free hand in selecting nominees.

Sen. Edward Kennedy, chairman of the Senate Health, Education, Labor, and Pensions Committee, and Rep. Henry Waxman, chairman of the House Oversight and Government Reform Committee, introduced their measures in the wake of testimony last month by former Surgeons General Richard Carmona, David Satcher, and Everett Koop that the position is becoming too politicized. Carmona, who served from 2002 to 2006, accused top Bush administration officials of censoring his speeches and preventing him from speaking out on embryonic-stem-cell research, sex education, and emergency contraception.

Satcher, a Clinton appointee who served from 1998 to 2002, and Koop, a Reagan appointee who held the post from 1982 to 1989, joined Carmona before Waxman’’s committee on July 10, but testified of less severe meddling during the Reagan, Bush I, and Clinton administrations. Waxman, D-Calif., told the three, “The position of surgeon general is a revered post in our government. Fixing what’’s wrong and making the office work again should be a bipartisan priority.”Carmona, Satcher, and Koop contend that the best way to strengthen the surgeon general’’s hand is to make the nomination process less political and to give the office an independent budget and staff.

With a budget of $19 million and a staff of 115 employees, the Surgeon General’’s Office has the responsibility of spotlighting important health concerns by issuing statements that promote public health education, analyze health policy, and identify research priorities for health professionals.

The surgeon general also advises the president and the secretary of Health and Human Services, and directs the 6,000-member Commissioned Corps of the Public Health Service. Waxman and Kennedy based their legislation on the notion that the best way to safeguard the surgeon general’’s objectivity is to begin by making the selection process less overtly political.

As of now, the president is free to nominate anyone to be surgeon general. If confirmed by the Senate, the appointee serves a four-year term. But until the late 1960s, surgeons general were required to come from the Commissioned Corps of the Public Health Service. Under Waxman’’s bill, a surgeon general’’s report or call to action (a report that outlines steps that need to be taken to address an urgent health problem) could be blocked only by the HHS secretary, who would then have 10 days to notify Congress of that decision and its rationale.

Waxman would also change the chain of command so that the surgeon general would report directly to the secretary, instead of the assistant secretary, and his bill would make it harder for a president to get rid of a surgeon general because of ideological differencesIn 1994, after 15 months as surgeon general, Joycelyn Elders resigned at President Clinton’’s request after making controversial statements about masturbation and sex education and being criticized as too liberal.

With the Elders example still fresh in observers” minds, Waxman says that fear of losing the job could lead surgeons general to be inappropriately circumspect when the time comes to deliver hard-hitting health care messages. The Bush administration is predictably cool to the Waxman and Kennedy proposals. “We are reviewing the legislation, and we believe that the Office of the Surgeon General functions very well,” says White House spokeswoman Emily Lawrimore. Michael Tanner, director of health and welfare studies at the Cato Institute, says that the Republicans who wanted to get rid of the position in 1995 and the Democrats who want the surgeon general to be less under the thumb of the White House are missing the point. “The surgeon general has no real nonpolitical purpose,” Tanner said. “This is a political appointee put in a position that is primarily designed to espouse political policies.” Because the position is inherently political but is expected to produce health care advisories that are objective and scientific, he says, there will always be critics pushing for pointless reforms.

“This is a silly debate — and one we”re doomed to every couple of years,” Tanner says.