Do you know who Sanjay Gupta is? Well, if you don’t watch a lot of CNN, you probably don’t. But he may very well be the most famous doctor in America (McSteamy and McDreamy aside).
According to press reports, President-elect Obama will tap Dr. Gupta, CNN’s health correspondent and neurosurgeon at Atlanta’s Grady Memorial Hospital, to be the next Surgeon General.
Surgeon General is an odd position. Because the federal government spends massive amounts of money on health care, there are bureaucrats with greater direct influence over the health care system than the Surgeon General. The Secretary of Health and Human Services, as well as the head of the Veteran’s Health Administration, control much more money and have much more power than the Surgeon General, who actually reports to a deputy of the Secretary of Health and Human Services.
As far as formal responsibilities, the Surgeon General is head of the Public Health Commissioned Corps, a group of 6,000 health professionals– doctors and nurses — who can be dispatched by the Secretary of Health and Human Services to assist in some sort of public health emergency. They also award a variety of medals for achievement in the world of public health. So, pretty boring, anodyne stuff? So why would this telegenic, talented and successful media-medical superstar take this job?
Well, that’s because just about no one knows or cares about the Surgeon General’s formal responsibilities. Instead, we know about the Surgeon General for two main reasons. The warning on cigarettes, and their occasional pronouncements on public health. C. Everett Koop, who was Surgeon General during the Reagan administration, is widely acknowledged as the first “celebrity” Surgeon General, and he became famous for his pronouncements on the public health risk of HIV/AIDS and the addictive qualities of nicotine. At a time when many were scared to talk about AIDS, Koop forthrightly put the issue in the public square, arguing for safe-sex and empathy for those infected, and campaigning against stigmatization.
So,what does all this have to do with Sanjay Gupta? First we need to compare Koop and Gupta. Koop, before he came into office, was a pediatric surgeon in Philadelphia. He had no prior experience in government and, except for a book and documentary outlining his pro-life views, was hardly a public figure. Gupta, on the other hand is “America’s most famous doctor” according to Ezra Klein of The American Prospect. Whereas Koop was a large, elderly looking man with an academic’s beard, Gupta is a fresh-faced, young-looking TV star with teeth resembling chicklets (He was on of People’s Sexiest Men in 2003).
That means when Gupta takes on the de facto responsibilities of the Surgeon General – informing the public on how to live a healthy life – he will be a credible, effective messager. Although Koop managed to get across the importance of not smoking and of safe sex, he first became a comedic figure: a tall, stooped, bearded old man telling everyone to use condoms. Gupta won’t have such problems.
But why should we care about having an effective media presence in the role of Surgeon General? What’s so good about public health? Do we really need this TV superstar to tell us to get mammograms, pap smears, flu vaccines as well as reminding us to drink less soda and exercise more? What about the fact that health care is increasingly unaffordable?
It turns out that preventative care and healthy lifestyles are hugely important for maintaining a healthy society and driving down health care costs.
For example, it’s much cheaper to start exercising regularly at young than to get heart surgery or start taking expensive drugs in middle age. Also, since only about half of treatments provided by doctors are evidence-based and proven to be effective (and that bad half can actually kill you, 98,000 die every year from medical error, while 126,000 die from failing to get proper treatment for “hypertension, heart attacks, pneumonia, and colorectal cancer.”), taking proactive steps to stay healthy are incredibly valuable.
The second area where Gupta could use his considerable abilities is in promoting some type of broad-based health reform. There is no debate that America’s health care system is incredibly flawed. Not only are 46 million (18 percent of the population) or so American uninsured, but we also have the world’s most expensive health care system. According to an article in the journal Health Affairs from 2005, America’s per capita expenditure on health care is $5,267 a year, 30 percent more than any other industrialized nation. The real shame is that there is next to no evidence that we’re getting anything more for our health care dollars.
And oh yeah, with unemployment climbing higher and higher, the 177 million Americans who get their insurance through their employers will be at risk of losing their coverage or having to get more expensive coverage on the individual market. And how could I forget that health insurance premiums went up 78 percent between 2001 and 2007, while inflation adjusted wages only went up 2 percent?
We clearly have a problem, and something resembling Obama’s health care plan would do a lot to alleviate the issues of cost and access. In short, the Obama plan would provide subsidies to families to buy insurance, while also creating a public, government-sponsored plan which anyone could enroll in. It would also encourage health care providers to use electronic medical records, which would lower the cost of care and improve its quality by ensuring that doctors have access to the most recent information about their patients. Obama’s plan would also ban insurers from discriminating against those with preexisting medical conditions. Today, if you have some sort of medical condition which could potentially result in you needing expensive health care, insurers can reject you or charge you very high premiums.
Aside from the weedy details of the program, the main point is that it will need to be sold to the public. Bill Clinton’s big push for universal health care in 1993 was done in because the administration was never able to properly make their case to the public or Congress. The main advocates for the plan weren’t media savvy doctors with great journalism connections; they were instead Hillary Clinton and former management consultant Ira Magaziner. With Gupta on their side, the Obama administration will have a genuine media superstar as one of their most prominent advocates and supporters.
In 1993, the Health Insurance Association of America produced the famous “Harry and Louise” ads. They featured a middle class couple lamenting the bureaucratic inflexibility of Clinton’s proposed health plan. The reason these ads struck a chord was because the Clinton plan was thought up in secret without consultation with relevant interest groups and then was publicly pushed by people who could easily be portrayed as out-of-touch, pointy-headed bureaucrats. Since the insurance industry and their allies successfully painted a picture of normal Americans versus overweening and ineffective big government, the Clinton health care reform floundered. With Sanjay Gupta on Obama’s side, however, the American public will instead see America’s most popular and trusted doctor on the side of massive reform. It could very well be the difference.