Is RFK, Jr., Better Suited To Be an Advisor than an Executive?
The Robert F. Kennedy, Jr. confirmation hearings and the non-stop media coverage have focused, among other things, on his views on vaccines, abortion, drug pricing, and the negative aspects of the health and dietary choices of the American people.
Unfortunately, there has been far more heat than light on these topics. The hearings have left many of us with no clear sense of who he is and what he really thinks.
Most of all, we have no idea how, if confirmed, he would carry out the massive responsibilities of HHS Secretary. This raises the question: is Robert F. Kennedy, Jr’s suitable to be Secretary of Health and Human Services, independent of his views on the issues.
Kennedy is a free-wheeling advocate; HHS has never been a pulpit. Even if there are substantial reductions in the size and scope of the federal government, HHS will still be a major government organization with a broad array of responsibilities that must be tended to. That consumes the bulk of the Secretary’s time.
Because it is not a particularly good pulpit, past Secretaries of HHS have never been chosen for the specific purpose of advocacy leadership. As a rule, they are chosen to run the department. The role of chief spokesperson has been barely more than a secondary consideration. Dr. Louis Sullivan (1989-1993) was probably the last Secretary to legitimately see himself as “hired to be a public health leader.”
Kennedy has no experience managing complex organizations; HHS leaders have always been chosen for their executive experience. HHS’ discretionary budget is more than $130 billion and the agency has more than 80,000 employees.[1] Given the size and complexity of HHS, the Secretary usually has experience running a large organization.
Since 1985, the post has been held by four former governors (Bowen, Thompson, Leavitt, Sebelius), two academic leaders (Sullivan and Shalala), the Director of the Office of Management and Budget (Burwell), a Deputy HHS Secretary and corporate executive (Azar), and the California Attorney General (Becerra).[2]
Kennedy has no experience of being held publicly accountable for his positions and actions; HHS leaders have all had that experience prior to their appointments. Not all managers are publicly visible and accountable. However, if—as is the case with HHS--part of your job is to testify before legislative bodies and face a barrage of reporters about a decision you made, then that is public accountability.
Since 1985, every Secretary of HHS had a prior history of public accountability. I do not think any of them would have been comfortable with Kennedy’s answers that often sounded like: “I prefer my rarely cited and discredited study to your frequently cited definitive study, Senator (Doctor) Cassidy.” They would know such statements come back to trouble you at a later date.
Conclusion: The degree of uncertainty about Robert F. Kennedy, Jr.’s positions may not be disqualifying, but it is discomforting to have so much unknown after two days of public testimony and thorough scrutiny of his career accomplishments.
More pertinent is whether the Secretary of HHS is the appropriate place for Kenndy to serve President Trump. The profiles of his predecessors (Republican and Democratic) have been similar to each other, but quite different from his.
One interpretation is that he is nominated for a position that ill-suits him. He would be a better counselor to the President or counselor to the Secretary where he would be able to research and expand his ideas:
without being pulled away by the hundreds of other responsibilities that go with being Secretary of HHS, and
without being weighed down by a Senate confirmation process that exposes much of the “in development” aspects of his vision of leading Americans to healthier lives and more nutritious diets.
[1] The Secretary oversees 13 operating divisions: Administration for Children and Families (ACF); Administration for Community Living (ACL); Agency for Healthcare Research and Quality (AHRQ);
Advanced Research Projects Agency for Health (ARPA-H); Administration for Strategic Preparedness and Response (ASPR); Agency for Toxic Substances and Disease Registry (ATSDR); Centers for Disease Control and Prevention (CDC); Centers for Medicare & Medicaid Services (CMS); Food and Drug Administration (FDA);
Health Resources and Services Administration (HRSA); Indian Health Service (IHS); National Institutes of Health (NIH); Substance Abuse and Mental Health Services Administration (SAMHSA).
[2] At the time of their appointment: Secretary Otis Bowen was a physician and former governor of Indiana. Secretary Louis Sullivan was physician and Founder/President of Morehouse School of Medicine. Secretary Donna Shalala was Chancellor of the University of Wisconsin-Madison and before that President of Hunter College and Assistant Secretary in the US Department of Housing and Urban Development.
After Shalala, there were three former governors: Tommy Thompson (Wisconsin), Mike Leavitt (Utah), and Katherine Sebelius (Kansas). Secretary Sylvia Matthews Burwell was Director of the Office of Management and Budget. Secretary Alex Azar had previously been General Counsel and then Deputy Secretary of HHS and was President of Eli Lilly USA. Secretary Xavier Becerra was Attorney General of California and prior to that was a Member of the House of Representatives for 24 years.
I have omitted Secretary Tom Price because he served only 7 months (between Burwell and Azar). However, he was also well-credentialed, having been a Member of the House for 12 years and served as Chair of the House Budget Committee.