What kind of surgeon general will Regina Benjamin be?

How to fix health policy.
July 13 2009 6:42 PM

What the President Ordered

Regina Benjamin is just the surgeon general Barack Obama needs.

Barack Obama and Dr. Regina Benjamin, the president's nominee to be surgeon general. Click image to expand.
Barack Obama and Dr. Regina Benjamin, the president's nominee to be surgeon general

While manufactured controversy raged Monday in the Senate confirmation hearing of Sonia Sotomayor, President Obama's nominee for surgeon general was generating a different kind of debate: Is she fantastic or, as some dissenters claim, merely marvelous?

Just about everyone with two hands applauded Obama's selection of Dr. Regina Benjamin. Health Care for America Now, which supports health care reform that includes a public plan, described her as someone who "appreciates the immediate need for comprehensive reform." The American Medical Association, on whose board Benjamin served, praised her as "a true professional who puts her patients first." Dr. Georges Benjamin, director of the American Public Health Association, says she's a "good choice." (And not just because they have the same name.)

Driving the praise was Benjamin's compelling personal story, which, along with a fitness obsession, now seems to be a prerequisite for serving in the Obama administration. Benjamin studied at Morehouse and the Alabama School of Medicine; started a family practice in a fishing village called Bayou la Batre, Ala.; got her MBA at Tulane; and converted her practice to a medical clinic for the poor. Those who couldn't pay, she treated for free. After Hurricanes George and Katrina twice destroyed the clinic, she went into debt to rebuild it. Along the way, she was named one of Time's "50 Future Leaders Age 40 and Under" and won a MacArthur "genius" grant. It's like something out of Reader's Digest. Oh wait—it is.

Whether Benjamin remains uncontroversial depends on what kind of surgeon general she tries to be. There are two basic models. The first is the activist surgeon general in the C. Everett Koop mold: high-profile and outspoken, even if it means ticking off your bosses. The other option is to lay low and avoid causing trouble. Remember Antonia Novello, David Satcher, and Richard Carmona? Exactly. For Benjamin, however, fading into the background may not be an option.

The traditional role of the surgeon general is to be "America's doctor." That means telling Americans how to stay healthy and providing information about any health hazards. As a family physician, Benjamin is pretty well-equipped to handle this part of the job.

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The surgeon general also oversees the country's Public Health Service Commissioned Corps, the uniformed group of doctors and medical professionals who deploy across the country during emergencies. But the surgeon general's role is largely titular, and some members of the corps want to see the position strengthened; they say Hurricane Katrina exposed flaws in the chain of command. During an emergency, for example, the surgeon general has to ask the heads of CDC and NIH for permission to deploy their scientists, which slows down response time. When a disaster forces a corps member to leave his job temporarily, there's often no one to take his place. Public health service officials are also trying to get funding for Health and Medical Response Teams that would be on call to respond to natural disasters and other health emergencies. It would be Benjamin's job to push for that kind of federal support.

Where Benjamin will really distinguish herself, though—or fall face first—is in the role of advocate. In a press conference introducing Benjamin, Obama took several minutes to plug his plan for health care reform, thus putting her nomination squarely in the context of the health care battle. Benjamin "has seen in a very personal way what is broken about our health care system," Obama said. Besides treating poor Americans in rural areas for years, she is a poster child for prevention. "My father died with diabetes and hypertension," she said. "My older brother, and only sibling, died at age 44 of HIV-related illness. My mother died of lung cancer, because as a young girl, she wanted to smoke just like her twin brother could." If Regina Benjamin did not already exist, Barack Obama would have invented her.

But advocacy may be harder than it looks. On the one hand, Benjamin will have to push for wellness and prevention without getting bogged down in politics. On the other hand, her perspective on reform is surely part of the reason she was picked. Past surgeons general have tried to avoid taking political stances. But even basic health decisions are often politically loaded. Richard Carmona, who served under George W. Bush, quit in 2006 after clashing with the administration over tobacco use. Joycelyn Elders, Clinton's first surgeon general, advocated masturbation and condom use, much to the administration's chagrin. Koop, a Reagan appointee, flouted administration priorities and cultural squeamishness to advocate against cigarettes and for AIDS prevention. Obama has already introduced Benjamin in the context of health care reform. Even if Benjamin wanted to stay above the fray, that may be impossible.

Thank goodness, then, for swine flu. However politicized her role becomes in the health care debate, an actual public health crisis would require the surgeon general to return to the traditional role of America's doctor. Even if the H1N1 virus does not reach epidemic proportions next winter, preparation and prevention will test Benjamin nearly as much as a full-on outbreak. Americans will look to her for advice on how to avoid getting the flu and where to go if they do. And as head of the Commissioned Officer Corps, she would be responsible for providing boots on the ground.

As a result, the job of surgeon general under Regina Benjamin will probably be both more and less political than usual. More so because of health care reform, and less so because of swine flu. At the very least, it will make a great story. Reader's Digest, take note.

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