Weekly Pulse: America’s Next Top Doctor

2009 already is shaping up to be a year of surprises. Yesterday, we learned that America's favorite TV doctor, Dr. Sanjay Gupta, will likely be the next Surgeon General of the United States. President-elect Barack Obama is assembling a healthcare dream team. In November 2009, Obama named former Senate Majority Leader Tom Daschle as Health Czar and Secretary of Health and Human Services. The Daschle pick was widely taken as a sign that Obama was determined to pass a healthcare plan. Daschle's political skills will be critical to getting a plan through Congress. While Daschle will be in charge of selling the politicians on Obama's healthcare agenda, Gupta will be tasked with winning over the general public. Ezra Klein of the American Prospect is delighted with prospect of Gupta for Surgeon General: Gupta is a great pick. To illustrate why, here's another question: Who's the current surgeon general? Odds that you just blurted out Steven K. Galson are low. That's not necessarily a problem. The surgeon general isn't just the guy who writes warnings for cigarette labels. He commands the 6,000 health professionals in the Public Health Commissioned Corps. He gives out awards. There's no evidence Galson is failing in those duties. But Gupta is not leaving CNN and Time to give out medals. The surgeon general has an informal role as the country's leading medical and lifestyle educator, and it's that role the Gupta is uniquely positioned to fill. There's not a doctor in this country with half his media training and experience, nor one with a rolodex of editors and reporters a tenth as large. Steve Benen of the Washington Monthly is cautiously optimistic, even if Gupta isn't what you'd call red meat for the progressive base. Benen recalls a famous 2007 exchange between liberal documentarian Michael Moore and Gupta in which Moore took Gupta to task for a number of errors in Gupta's "fact-check" of Moore's healthcare film, Sicko. (See video, above.) Clearly, Gupta will be the biggest star to occupy the office of Surgeon General since C. Everett Koop. Certainly, the 39-year-old will be the first Surgeon General in history to have been deemed one of the Sexist Men Alive by People Magazine. Gupta hasn't officially accepted yet, but he's expected to say yes, if all goes well with the final vetting process. However, Gupta is reportedly concerned that he'll have to take a pay cut to become America's next top doc. The Gupta pick won't get rave reviews from everyone. He's a great communicator, but his political experience is limited--though he did serve as a White House fellow in the late 1990's and advised Hillary Clinton on healthcare. Howie Kurtz of the Washington Post claims that Gupta has a longstanding interest in health policy and that he has even negotiated an expanded policy role for himself as Surgeon General. However, surprisingly little is known about which policies Gupta, a Michigan-born brain surgeon, actually supports. The choice of a celebrity commentator with a background in high-tech, interventionist medicine will make some public health professionals uneasy. The Surgeon General is America's top public health official. Ezra Klein anticipates that Gupta will be an effective public advocate for obesity prevention and other public health goals. However, it's not clear from Gupta's record if he will be a good administrator or an effective leader of America's public health professionals. In other healthcare news this week, Mother Jones kicks off the New Year with a miscellany of facts and figures on obesity in America. Last month, the Washington Post reported that Barack Obama is setting an example when it comes to physical fitness, noting that the president elect had been to the gym every day for at least 48 days. It's only a matter of time before conservatives start blaming eating disorders on an imaginary "Obamarexia" epidemic. But maybe prevention is overrated. At the American Prospect, M. Gregg Bloche says that preventative medicine won't save the healthcare system money in the long run. Yes, it costs less to prevent a case of diabetes than it does to treat the condition once it sets in. But people who avoid diabetes tend to live longer. And the longer we live, the more healthcare resources we consume: If we're to get better at averting illness, we're going to have to spend more. The Tufts Medical Center Cost-Effectiveness Analysis project tracks published data on the costs and benefits of thousands of tests and treatments, including 279 preventive measures. Fewer than 20 percent of these measures actually save money, the Tufts group recently reported in the New England Journal of Medicine. The rest raise medical spending, and that's not even counting the extra costs patients incur down the line, for illnesses they could have avoided by dying. That doesn't mean that we shouldn't spend money on preventative medicine, Bloche says. We just have to think of prevention in terms of value, not savings. In other words, prevention may be expensive, but it's worth it because it works better than treatment. Preventing diabetes may turn out to be expensive in the long run, but someone who never gets the disease will live a longer, healthier life compared to a patient who depends on insulin and drugs. In December, Obama sparked controversy when he picked conservative mega-church Pastor Rick Warren to give the invocation at the inauguration ceremony. As we've discussed before in the Weekly Pulse, Warren's worldly political agenda makes him a troubling pick. The pastor opposes abortion, gay rights, and science-based sex education. He favors the discredited abstinence-only until hetero-marriage approach to preventing STDs and unplanned pregnancies home and abroad. Warren is clearly positioning himself for a prominent role in shaping the Obama administration policy on healthcare and international development, especially AIDS in Africa. Elsewhere on the reproductive health front, Mike Ervin, writing for the Progressive, urges President Elect Obama and the new Democratic Congress to swiftly repeal the eleventh hour regulations that raise out-of-pocket costs for Medicaid services. Erwin notes that higher Medicaid costs disproportionately burden poor and disabled Americans and may discourage them from seeking treatment. In RH Reality Check, Sam Sedai outlines the key reproductive health policy decisions facing the incoming administration. One of the most important questions is the fate of Bush administration's radical "conscience clause" rules, which allow federal healthcare workers with religious qualms to opt out of virtually any task connected to birth control or abortion. Clearly, 2009 holds many challenges and a great deal of opportunity in store for advocates of progressive health policy.