If the U.S. Senate confirms the nomination of Representative Tom Price to serve as the 23rd U.S. Secretary of Health and Human Services (HHS) he will be only the third physician to lead that department since its formation in 1953. The first was Otis Bowen from Indiana, who served from 1985 to 1989 under President Ronald Reagan. I was the second physician, and served during the presidency of George H.W. Bush from 1989 to 1993. Since then, three eight-year presidencies have passed without an MD or other health professional in the department’s top role. Indeed, more lawyers than health professionals have led the department — which leads me to wonder how the public, Congress, and the legal profession would respond if a physician (or anyone, really, with no legal training) was appointed to lead the Justice Department.
When I became Secretary in 1989, the Department of Health and Human Services (HHS) had 124,000 employees and more than 250 programs in agencies that included NIH, CDC, FDA, HCFA, the Social Security Administration, the Agency for Children and Families, and more.
Leading such a large department with such far-ranging programs presented a number of challenges and opportunities. The first was to articulate the mission of the department and the key priorities for HHS during the George H.W. Bush administration. These priorities included: (1) improving the health of the nation; (2) reforming the health care system to make it more efficient, more effective, and less costly; (3) reducing the use of tobacco and other addicting substances; (4) enhancing the department’s support for prevention programs, wellness activities, and improving healthy behaviors of Americans; and (5) increasing the racial, ethnic, and gender diversity of the department’s leadership to make it more representative of our nation’s population.
As I took office, I knew well from my experience as a physician that an individual’s health and the health of communities are affected by a wide array of factors that reach beyond the formal health system: such as people’s income, educational achievement, social customs, culture, belief systems, access to clean water and clean air, and the presence of social stress and tensions. It is with all of these factors in mind that I made it a priority to regularly communicate with and engage other secretaries leading the Departments of Education, Agriculture, Housing, Labor Interior, Defense, Commerce, and State, for example. This was a process that echoed my work treating patients, listening to their concerns, consulting with other specialists, and working together to find the most effective interventions to achieve the best possible outcomes.
Later, in my collaboration with other cabinet officials, I found that although we did not always agree on every policy decision, we did share the common goals of serving the American people, improving their health, and supporting them in their quest for a more meaningful, successful, fulfilling life. These are the same goals that I underscored in the process of selecting, supporting, and motivating leaders within HHS — one of the most fundamental tasks I faced in my time as Secretary. I made it a priority to empower them to adopt and take ownership of our departmental priorities. And I ensured they felt they could give me honest feedback, advice, and recommendations. I am hopeful that Rep. Price will take a similar approach.
Together, I believe we achieved many of our priorities during my time as secretary — with the notable exception of reforming the health care system. We did develop a promising plan President George H.W. Bush presented in a speech he gave to the Cleveland City Club in February 1992. But that was an election year of course and Congressional committees did not hold hearings or report the bill out for action by the full House and Senate.
After unsuccessful health reform efforts in the Clinton Administration, Congress did enact the Affordable Care Act during the Obama Administration in March 2010. Although the legislation has resulted in a number of positive outcomes—20 million more Americans with health insurance and elimination of lifetime limits on health expenditures by insurance companies—the law did have some significant challenges exemplified by ongoing concerns about the continued rise in health care costs. What is more, there are deep philosophical differences among policymakers about key provisions, such as the government mandate for all citizens to have health insurance (or a financial penalty for those who fail to get covered).
Both the new Congress and the incoming Trump administration have made it clear that they seek “to repeal and replace” the Affordable Care Act, without causing significant financial and emotional trauma to our citizens by loss of health insurance coverage. This will not be easy. All Americans—and physicians in particular, myself included—are looking to Rep. Price to work closely with Congress to develop a realistic plan for changing the Affordable Care Act in a way that actually improves the law, without interrupting Americans’ access to health insurance coverage and high-quality care. This will be Secretary-Designee Tom Price’s first, and possibly most important, test. As he takes on this important work, I know that he will have foremost in his thoughts the first tenet in the Oath of Hippocrates, to which all physicians’ pledge: “First, do no harm.” For most physicians, this oath applies to one’s everyday encounters with individual patients seeking treatment and advice. For Price, the Hippocratic Oath must guide his actions as a policymaker in service to all Americans.