The Doctor In The House

My first real exposure to the Surgeon General, that I remember, was C. Everett Koop. This was before I'd really come out, and the reports about AIDS were just coming out.  Koop, this distinctive looking older guy - who'd been opposed for SG by women's groups concerned about his pro-life leanings - was suddenly everywhere talking about risky gay sex, and the need for condom use. 

As history now tells us, in many ways, Koop was a little late; AIDS was already a growing public health disaster, andthe time for common sense discussion of prevention was much earlier. But in the Reagan years, Koop was a good antidote to the high moralism of the religious right, that substituted moral judgements for medical policy, speaking plain truth and talking about practical problems, based on the science surrounding them.

A few years later, Bill Clinton appointed Joycelyn Elders, the head of his Araknsas Public Health office, as Surgeron General.  Elders, too, was a plain-spoken advocate for basic ideas of public health, more able - and more encouraged - to talk about AIDS issues, but also discussed the need for greater sex education at younger ages, exploding notions that teen pregnancy and STDs are increased by the appropriate information.

And it wasn't until Ezra Klein reminded me about them, Koop and Elders, that the news of the selection of Sanjay Gupta as Surgeon General became a topic worth writing on.

Gupta, as you probably know, is CNN's Cheif Medical Correspondent.  You may not know, unless you watch a lot, that Gupta is also a neurosurgeon who took time from his reporting in Iraq to operate on severe head injuries. He's eminently qualified, as a medical expert, to lead the Public Health Service.

It's just that he's also probably the most telegenic person picked for the post. At least on purpose.

As Surgeon General, Gupta is expected to have a key role in developing health policy in the Obama Aministration, including crafting the health care plan they still want to pursue, expanding insurance coverage to most Americans.  Gupta, as initial reaction suggests, is seen as someone who can serve as a great explainer/educator on health issues and the positive aspects of the Obama plans.

Some have criticized Gupta as being to beholden to industry, suggesting ties to big pharma.  That's probably not the case.  More problematic, perhaps, is simply his status as a medical doc; Gupta's reporting generally reflects the American percpetions of healthcare as doctor driven, hospital based care first, and he's likely to be a voice for docs in crafting a plan. Many have pointed to Gupta's hard press on Michael Moore's Sicko as proof that he's no fan of Universal Healthcare. 

I don't buy that one follows from the other - as I said at the time, Moore's film, for people who care about healthcare issues, is a problematic one at best for understanding the complexities of our system, and the hurdles we would face adopting other systems from other countries. Gupta, rather correctly, took Moore to task for an overly sunny presentation of international healthcare options, especially those in Cuba.

But Gupta does present problems as Surgeon General... and they go back to understanding C. Everett Koop.

Koop was, in fact, a whistleblower: he was a high-ranking official who took on the status quo, and his won President when a health crisis necessitated it. Ignoring the political needs of Reagan (and AIDS is one area where the Reagan Right tends to ignore that Their Hero was indeed a failure), Koop made it clear that AIDS was a health problem to be dealt with, not a moral quandary to be judged, and dealt with it as such.  In so doing he not only pissed off the right, but also gay advocates who felt that his frank discussion of the risks of anal intercourse were meant to blame gays.  When, of course, that form of sexual activity - by anyone - was the chief means of transmission, outside of transfusions and needle sharing.

The question for Gupta is not "can he sell Obama's health plan"... I suspect he can. The question is, do we want him to? The selling of a health plan is a political role; it's goal is a political accomplishment.  As Surgeon General, Gupta's role is to protect Public Health.  That means dealing with the science, and at times, the hard realities, when politcal policies do not help the nation's health.  Can Gupta be expected to criticize Daschle when needed, or Obama himslef?  Can he talk about healthcare beyond the questions of insurance and emergency rooms and other issues that the Obama folks are bound to ewant to tackle right away?  And can he, as a developer of a forward thinking plan, look beyond the status quo - indeed, the role of his own profession - to daring new ideas of how nest to deliver care,= to the people who need it, when and where they need it?

I think these are open, and troubling, questions.... ones that are not solved by Gupta's celebrity status as America's best known, if not smartest, doc.   Indeed, I think some of the lingering questions about the position more generally - why not an epidemiologist, for one thing, rather than a narrow specialization like neurosurgeon? - are also reasons to wonder if Gupta's really the person needed to address public health issues we face today.

At the same time, thoguh, I think Gupta represents Obama's real skill at reshaping the game of appointments - by picking a well known medical professional, Obama neutralizes much of the far right's know-nothing campaigns against various sensible notions of public health: pseudo science against abortion and contraception and sex education won't wash when confronted Gupta's smooth, educated professional approach to issues. Gupta will stand in stark relief to the right's failure to craft real response to our real health care dilemmas. And in the end, I think, all we can do is hope for the est - that in a health crisis, Gupta's medical expertise and instincts will guide him to go where the science takes him... wherever that may lead. I'm not entirely convinced... but it's nice to know that there's a doctor in the house, regardless.

Comments

[Redstar]

I don't know Gupta at all, other than knowing he works for CNN. Are you concerns about his ability/willingness to sell Obama's plans specific to him? Why? What is it about him that worries you? Is he a non-political person?