The Surgeon General Has No Opinion on Health Insurance?

The Surgeon General Has No Opinion on Health Insurance?

First, to be clear about my point of view when it comes to those individuals chief executives like mayors and governors and presidents nominate or appoint to key positions in their administration:

If the individual is appointed to serve as the executive’s senior staff, in the personal sense of that phrase, then I accept that the individual may prove remarkably uninformative when questioned about beliefs and opinions. Those are for the ears of the executive alone.

If the individual is appointed to run an agency that delivers basic services, where the work is pretty well defined by setting priorities and delivering on them while abiding by the appropriate laws and ethical guidelines, then I accept that their public pronouncements may be limited. They should be prepared to answer, however, because their duty is not only to the executive, but to the unit of government in which their department is housed and to the people that government serves. We have a right to know, for example, that the water is clean according to accepted professional standards, or that the intersection was designed in a manner consistent with established engineering practices.

Those aren’t simply expressions of personal opinion (truth to tell, I don’t care what the opinion of the director of the water department is with regard to the accepted standards. I do care that the standards are being met.) Those are professional affirmations that the work being done is being done in accordance with accepted professional practice.

But if the individual is appointed to run an agency whose portfolio ought not to be merely doing what the chief executive wants, consistent with professional practice, then I expect something more. When constitutional rights are involved, or important questions of life and health about which professionals actually disagree, then the public has a right to know the thinking of the appointee so as to gauge the advice they will give the executive and the leadership they will provide their agency.

I’m fine with those opinions matching the opinions of the executive. It’s his/her appointee, after all.

But someone whose opinions on such subjects is likely to be solicited, not only by the executive, but by the public, ought to be able to express them.

This is where Florida’s Surgeon General John Armstrong, who has been reappointed to the post by Governor Scott but requires Senate confirmation, ran into trouble Tuesday.

In a hearing before the Senate Health Policy Committee, General Armstrong sounded . . . well, sorry, but rather foolish.

I had no problem with the surgeon general punting on the specifics of the legislation being debated in the Senate to expand Medicaid (sort of) to about 800,000 Floridians. It’s a work in progress and, in fairness, he might not be sure he had seen the latest iteration, nor had time to digest all of its implications. So a cautious comment such as the surgeon general gave, indicating awareness of the “conversation” taking place in the Legislature, I can live with.

But when asked, “As a physician and primary health officer in this state, you have no opinion as to whether additional health care coverage is good for health care outcomes?” as he was by Senator Don Gaetz, “awareness of the conversation” no longer is enough.

Every doctor I know . . . indeed, nearly every health care professional I know, has opinions about the effect on health outcomes, on the viability of their particular profession, on the quality of care, and on potential shortages of certain key specialties, of extending some kind of insurance to the uninsured.

For a physician not to have an opinion about whether one ought to find a way to extend coverage to those without it is like a mechanic not having an opinion about whether one ought to spend the money to change the oil every 3,000 miles.

Of course he has an opinion.

We may agree with the opinion, or we may not. But if we’re going to be taking the state’s health care system to the surgeon general for maintenance and a tune up, we’re entitled to that opinion.

Nuance the opinion, qualify it, indicate what one bases it on, and what one remains uncertain about. Fine. Do all of that like so many Federal Reserve chairman of the past. Fine.

But have an opinion, and have enough respect for the people to express it.

The Senate panel was, in my opinion, absolutely right to postpone a vote on confirmation.

It seems that all sorts of folks in Tallahassee these days have become remarkably uncommunicative about matters of importance to Floridians: the conduct of criminal investigations, the safety of our prisons, and whether or not the well-documented rise in sea level along the coast of Florida just might be a threat to cities lying low along the shore, to name a few.

The men and women who lead the agencies responsible for public health and safety have a duty that transcends political loyalty (or career advancement). It would be encouraging to see the surgeon general, for one, acknowledge that.