President Clinton's nomination of David Satcher to be surgeon general has run into trouble, in the form of a filibuster by Sen. John Ashcroft (R., Mo.). Dr. Satcher's nomination, like nearly all nominations for surgeon general during the last three presidencies, has been ensnared in the abortion debate. Pro-choice members of Congress objected to President Reagan's appointment of C. Everett Koop; pro-life members objected to President Clinton's appointment of Joycelyn Elders and blocked his appointment of Henry W. Foster.
Today the Senate may vote to end Mr. Ashcroft's filibuster, in which case Dr. Satcher will probably be confirmed. But a better answer is simply to forget the whole thing.
We have not had a surgeon general for three years. Has anyone noticed? Is anyone's health at risk? Are people keeling over in unprecedented numbers?
No. According to the National Center for Health Statistics, life expectancy in the U.S. is at an all-time high. Death rates from cancer, heart disease and AIDS are falling. The gap between white and black life expectancies is narrowing. Infant mortality rates are lower than ever.
Given the surgeon general's job description, there's no reason to expect him to have any impact on the nation's health. The Department of Health and Human Services assigns the surgeon general only two functions: He "serves as a spokesperson to the Nation on matters of public health" and manages the personnel system of the Commissioned Corps of the Public Health Service.
As a result, the surgeon general's role has amounted to little more than warning people not to smoke, recommending condoms and, in Dr. Elders's case, advocating masturbation--a role perhaps more suitable for a captain of the Federal Behavior Bureau.
The second duty explains why the surgeon general dresses like an admiral even though he's called a general. In 1798--watch for bicentennial celebrations later this year--Congress established the U.S. Merchant Marine Hospitals to care for sick and injured merchant sailors. In the late 1800s, those hospitals were reorganized into a national hospital system, administered by the surgeon general. Congress anointed the doctors who worked in those hospitals the Commissioned Corps of the Public Health Service. Hence the nautical uniforms.
There are 6,300 officers in the Commissioned Corps. Some are physicians, some dentists, some nurses, some technicians, and many are health bureaucrats of one stripe or another. They are sprinkled throughout the federal government, many in the Department of Health and Human Services, but some in the Environmental Protection Agency, the Bureau of Prisons, the Park Service--you name it. In general, they work for and report to members of the civil service, not to higher-ranking officers of the corps.
Essentially, the Commissioned Corps is a personnel system that parallels the civil service. Over the years Congress has moved toward but stopped short of eliminating it. It's time to abandon the corps along with its chief personnel officer, the surgeon general. The members of the corps can be taken into the civil service.
About the only thing that would be lost with the disappearance of the corps would be the fancy uniforms won by its members. On HHS "Dress Up Days," Commissioned Corps officers can be seen wearing navy blue uniforms with the same badges of rank as naval and military officers who command destroyers, fighter squadrons and combat battalions. Never mind that no member of the corps has such command responsibilities.
Get rid of the surgeon general and the redundant personnel system that is the Commissioned Corps. No one will notice, except maybe some uniform makers.
Mr. Gough is director of science and risk studies at the Cato Institute. Mr. Milloy is executive director of the Advancement of Sound Science Coalition.
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