Dr. Sanjay Gupta? Really?

In a sentence I never, ever thought I'd be writing, Dr. Sanjay Gupta is being strongly considered for the role of Surgeon General.  Without a doubt, Dr. Gupta is an engaging reporter on health issues, and is one of the more recognizable public voices on health education.  He is also a board-certified and practicing neurosurgeon of well-deserved renown.  But does he truly fit on the team Obama has assembled, particularly when it comes to health care reform?  It's a mixed bag, with some major red flags.  But, after some soul-searching, there are five reasons why I learned to stop worrying and love the Gupta.

First the red flags:

1.)  He's still young in his career, and his experience is restricted to the practice of medicine and journalism on health issues, plus some honorifics related to the above.  Traditionally our Surgeon Generals have either been long on military service (Richard Carmona) or had an incredibly long and impressive medical career (David Satcher) -- or both.  In either case, the phasers were set to "Gravitas."

Also, more often than not, they were set for "Wicked Impressive Beard."

2.)  You're going to give a former Sexiest Man of the Year nominee the rank of Admiral and expect him to be taken seriously around the Pentagon.  Good luck with that!

3.)  Many progressives -- myself included -- don't want to see him in the inner circle on health care reform.  First of all, his qualifications on health care policy are much more slender than on health issues in general.  He was a White House Fellow working for Hillary Clinton, and then... what?  As Niko Karvounis explains on Health Beat Blog, the media is actually pretty bad -- no, strike that, TERRIBLE at reporting health care policy.  He cites a Kaiser report that health care policy only was reported as a "health issue" story 27.4% of the time.  Ask a random person about what Dr. Sanjay Gupta story they remember, and they might say the surgeries he performed in Iraq, or his Katrina stories, or one of his "Fit Nation" profiles.  They're not likely to remember him talking about insurance regulation and cost control.

And then there's this...

Honestly, neither Dr. Gupta nor Michael Moore acquit themselves well here.  They spend a lot of time playing, "Whose numbers are right?" rather than making a coherent argument.

But for many progressives -- myself included -- this is an indelible image.  Dr. Gupta may have thought he was asking the tough questions or doing his job as a reporter, but his antagonistic logic on the issue is wrong-headed, bordering on mean.  There's the focus on minute mistakes, as though if one detail was wrong, your whole argument fails.  There's the smug rejoinder, "We've got Michael Moore speechless."  There's the put-down of government's ability to care for its citizens.  Even eighteen months later, it's hard to watch this and not see Dr. Gupta in the guise of a supporter of our broken status quo.

Suffice to say, President-elect Obama's track record is better than mine at making political appointments.  So I thought about it some more.  Here are the 5 ways I talked myself off the ledge:

1.)    I’m a jerk when it comes to numbers, too.

As frustrated as I am by the nit-picky “You can’t mix and match numbers from different sources” back and forth that takes up the entire first ten minutes of the Larry King clip – I have to admit, that sure sounds like something I would do.  When it comes to nerdy numbers about health care policy, there’s a little Dr. Gupta in all of us.

2.)    The surgeon general doesn’t have much to do with health care reform – really!

It seems counter-intuitive that the chief public health officer has given comprehensive reform a skip for the past 40 years, but that’s the history. Jesse L. Steinfeld played no significant role when Nixon was pushing for universal health care.  Jocelyn Elders made an unfortunate big splash during her tenure, but had no hand in the Clinton reform plan.  Richard Carmona didn’t have a hand in Medicare Part D.  It’s not their bag, baby.

But let’s say Dr. Gupta demands to be part of the health care reform team as a condition of his appointment.  Imagine the meeting in the Roosevelt Room when the White House Office of Health Care Reform meets with the relevant Democratic legislators in the Senate and House.  You’ve got Barack Obama, Tom Daschle, Jeanne Lambrew, Pete Orszag, Zeke and Rahm Emmanuel, Harry Reid, Ted Kennedy, Max Baucus, Nancy Pelosi, John Dingell, Pete Stark, Henry Waxman, Charlie Rangel… and Dr. Sanjay Gupta around the table.

Which one of these folks is least likely to get a word in edgewise, would you say?

3.)    The surgeon general role has changed in the past 25 years.

Leaving aside the military tradition angle, which doesn’t have anywhere near the relevance to the general public that it does within the military, what does the public imagine the Surgeon General’s role to be?

Say what you will about C. Everett Koop, but his celebrity during the Reagan years codified what we imagine the Surgeon General to be –- a deeply knowledgeable authority on issues of health education.  A trusted source.  Someone whose job it is to inform the public of ways to increase help and avoid harm.  A specialist in communicating public health issues with authority.

Isn’t that why Dr. Gupta does now for his televised audience?  Hasn't he had more of an impact on educating the public than the current acting-Surgeon General... you don't even know his name, do you?

(It's Steven Galson.  And yes, I had to look it up.)
4.)    Dr. Gupta is excellent on the issues we’ll need him to be excellent on.

Obesity.  Nutrition.  Food safety.  Infectious diseases like avian flu.  Post-traumatic stress disorder.   AIDS.  Global health issues and how they intersect with climate change.  These are the public health challenges we face in 21st century America.  They are also the topics for which Dr. Gupta has received the most accolades for his coverage.

5.)    Charisma counts when you’re rehabilitating the role

Being the chief public health officer means you deal with hard science.  Therefore, the past 8 years have not been kind.  When former Surgeon General Richard Carmona testified before Congress in 2007, his story would have been shocking if it were not already par for the course.  The man charged with being the trusted authority on public health was ordered by the Bush Administration to censor himself time and again on the effects of tobacco and second hand smoke, stem-cell research and contraception.

The public health and pandemic implications global warming were even worse.  As Carmona testified:

"I remember thinking, 'I know why they want me here, they want me to discuss the science; they don't understand the science.' So I had this scientific discussion for about a half an hour, and I was never invited back to the meeting."

And people think the Sexiest Man Alive nomination would be an insult to the office?

There’s no doubt that health education, based on hard science and the best available medical evidence, needs to reclaim its good name.  It’s been sacrificed for too long to politics and ideology.  If the celebrity of Dr. Gupta at the bully pulpit of the Surgeon General’s desk can spark a national debate about public health that improves our quality of life, then I don’t care how silly he looks in an Admiral’s uniform.

(Though if you’re reading this, Dr. Gupta, might I suggest an impressive beard?)