Senate Majority Leader John Thune (R–S.D.) is under White House pressure to speed the process of confirming President Donald Trump’s nominees, among them Casey Means, the pick for surgeon general. While she has the support of her alma mater, the Stanford School of Medicine, Means is controversial because she lacks an active medical license and has a nontraditional career as a wellness influencer. But before debating whether Means is a good choice for surgeon general, Congress should consider whether the U.S. really needs that often meddlesome office at all or the public health bureaucracy it leads.
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The term “public health” has come into well-deserved disrepute in recent years because of the overreach of government officials during the COVID-19 pandemic. Panic often drives people to seek salvation from officials eager to exploit opportunities to expand their power. With little scientific basis and no consideration for tradeoffs, governments imposed lockdowns and mask mandates, limited travel, intervened in economies, and otherwise limited our freedom in the name of public health. As I noted in 2021—after Professor Neil Ferguson, a prominent advisor on pandemic policy to Britain’s government, opened up about the sources of his colleagues’ policy ideas—”the public health professionals behind the lockdowns took their inspiration from totalitarian China.”
These interventions made the world poorer, nuttier, and more crime-ridden. Years later, we’re recovering. But some of those ill effects will be with us for a long time to come. George Will wrote two weeks ago that “the coronavirus pandemic is over. What it revealed lingers: intellectual malpractice and authoritarian impulses infecting governmental, scientific, academic and media institutions.”
But public health professionals beclowned themselves long before that one virus spread around the world. As Cato Institute senior fellow Jeffrey Singer, an Arizona surgeon, commented this week, “If confirmed, Dr. Means would not be the first controversial surgeon general. In recent decades, surgeons general have undermined their intended role as public health officials by inserting themselves into issues that extend far beyond the classical liberal conception of ‘public health’: protecting people from harms like infectious disease and pollution that they didn’t consent to.” In the name of public health, he continued, previous surgeon generals have “used taxpayer dollars to weigh in on everything from media violence, pornography, and education to poverty, guns, and inequality—and more recently, on parenting, labor, loneliness, and social media—often supporting new regulations, subsidies, and gun control laws.”
With Akiva Malamet, Bautista Vivanco, and Michael F. Cannon, Singer co-authored Unnecessary Relics, a report questioning the justifications for the continued existence of the U.S. surgeon general and the 6,000-member Public Health Service Commissioned Corps led by that office.
As the report points out, “the role of US surgeon general (SG) has morphed from an apolitical supervisor of medical personnel to a divisive activist who undermines public health efforts.” Originally intended to oversee hospitals established for the sailors of the merchant marine and the doctors that staffed them, over time the office and its expanding bureaucracy took on a more amorphous responsibility for “preventing the spread of contagious diseases throughout the United States,” according to the Centers for Disease Control. At one time, the surgeon general headed the entire public health service, but now leads only the uniformed Public Health Service Commissioned Corps.
Yes, that does lead to competing bureaucracies with overlapping responsibilities. Even more confusing, though, the report adds, “Corps officers work in an array of federal agencies, including many outside of HHS that lack a direct connection to public health or health care.” Members of the Commissioned Corps can be found in the Department of Commerce, Department of Justice, and National Park Service, among others. Fifty-one percent of assignments, the report notes, “have a minimal relation to public health.”
Uniformed “public health” officers are often working in unrelated bureaucracies that have their own chains of command and employees. “Both the structure and funding of the Commissioned Corps create unnecessary bureaucracy, contradictory lines of authority, opaque accounting, and inefficiency,” according to the report.
The accounting for this arrangement is complicated. “Host” agencies pay salaries and administrative costs for the Corps officers working for them, but the Corps foots the bill for health and retirement benefits. That’s an attractive arrangement for host agencies, but not for taxpayers. “In 2010, the average Corps officer cost was $169,000, which at the time was $22,000 or 15 percent higher than the cost of employing a civilian equivalent,” the Cato report notes. Because the Corps is a uniformed service, its officers have access to military perks including TRICARE health insurance, lodging on military bases, and the Veterans Benefits Administration Home Loan Guaranty program. Their use of these services potentially competes with demand by actual military personnel and veterans.
How much does this distribution of costs add up to for taxpayers? That’s a great question—and not an easy one to answer. Because the bill is split among multiple departments and agencies, there’s no single budget item. But it’s fair to say it all costs far more than it should.
While Corps officers are off doing non-health duties for the National Park Service, their nominal boss, the surgeon general, is often busy creating a nuisance. From managing hospitals and quarantine measures, surgeons general have shifted toward weighing in on social and political issues. That change in emphasis became obvious with Surgeon General Luther Terry’s 1964 conclusion that smoking may be hazardous to your health. That led to health warning labels on cigarettes and a huge preoccupation with tobacco. In 1988, we got surgeon general’s warning labels on alcoholic beverages.
Last year, then-Surgeon General Vivek Murthy called for “banning assault weapons and large capacity magazines for civilian use” along with other gun control measures. Of course, he justified his demand as a “public health” imperative.
The office of the surgeon general is now a professional activist position intended to dress up the (usually authoritarian) policies of whoever is in the White House with medical trimmings. The amorphous bureaucracy under that office is expensive and purposeless. With public health already in low esteem, there’s little excuse for maintaining the meddlesome office or the uniformed bureaucracy it heads.
“Congress should abolish the Office of the Surgeon General, eliminate the office’s non–public health activities, and reassign its public health responsibilities to the CDC or other appropriate federal agencies,” the Cato report concludes. “Eliminating the office’s divisive political advocacy would be a step toward restoring trust and confidence in federal public health officials.” The authors also recommend that “Congress should likewise abolish the PHS Commissioned Corps.”
There’s no need to argue over the surgeon general nominee when there’s an opportunity to dispose of that office along with its unnecessary bureaucracy and expense.
