Donna Shalala : The Administration’s Point Woman at Health and Human Services

When President Bill Clinton announced last December his intention to name Donna Shalala to head the government’s largest civilian bureaucracy--the Department of Health and Human Services--conservative activists chortled.

Dubbing her the “high priestess of political correctness” and threatening to attack her record as chancellor of the University of Wisconsin, the conservatives predicted Shalala--a 52-year-old career public administrator and an associate of Hillary Rodham Clinton’s at the Children’s Defense Fund--would become the center of the new Administration’s liberal wing.

Shalala survived those attacks and won confirmation easily. But she soon came under fire from within. White House aides accused her of involving them in politically damaging arguments over, for example, admitting Haitians infected with the HIV virus into the country. An early proposal to have the government buy up the nation’s supply of childhood vaccines and guarantee immunizations for all came under attack in Congress and had to be pulled back. Some White House aides even predicted that Shalala would be the first of Clinton’s Cabinet to resign.

The critics underestimated her. A tough, experienced manager--she headed New York’s Hunter College and was assistant secretary of Housing and Urban Development in the Carter Administration before taking the Wisconsin job--Shalala is smart, indefatigable, well connected with the Clintons and not afraid to remind her opponents of any of those facts.

Nor has she turned out to be the uncompromising liberal that many conservatives feared--and many liberal activists had hoped for. Instead, Shalala has bluntly urged her former colleagues on the Democratic Party’s left to recognize the new realities of fiscal tightness and the need to reform programs, such as welfare, that have lost public support.

In an interview as she headed West for a series of appearances highlighting health-care reform and the needs of children--two favorite issues--Shalala discussed the Administration’s rocky start, her sense of today’s political realities and the priorities her department will pursue in such areas as welfare reform.

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Question: Beyond your line responsibilities, what do you see as your role in the Administration?

Answer: I have long ties to the women’s community. I bring other constituencies--I also have ties to minority communities. And obviously, to the world of world-class research universities. So I can bring some constituencies that I’m used to working with. I’m used to dealing with the press. I’ll be one of the spokespeople, one of the people who sells the Administration’s plans. Because I bring stature to my job independent of the Administration, I can help. I’m one of the people they’ll turn to to help.

The other thing is, I’m one of the handful of people they have that actually knows how to run something, that’s an experienced administrator.

My responsibilities are so wide-ranging, my long-term friendships with the President and the First Lady are so deep, that I’m going to have lots of opportunities. I spent most of my career running big, complex places in which I’ve been described as “energetic and skillful.” That’s the way I’ll end up at the end of this Administration. It’s not going to be much different. That’s what I do. And if we can do enough of it, the President can get reelected.

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Q: Were you afraid coming in, that people would try to stereotype you?

A: They’re not treating me like I’m the house liberal. They’re not assuming that I represent some wing of the party.

I’ve spent my whole life with people underestimating me. (It’s) the best way to come in. That stuff was over in a month. It began with that political correctness stuff, but it disappeared after my hearing. You noticed that with everything that everybody reported before my hearing, none of it was there. The press got hoodwinked. Everybody got snookered. The right wing told them there was all that stuff there, and it turned out there was nothing there. Nothing.

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Q: What are your priorities?

A: Probably three things. One is to make the department more user-friendly. To bring back some of the credibility that we really can do some things right. The government is fully capable of delivering services. Even complex services.

The second is prevention, earlier investment. And I include in that the National Institutes of Health, immunization, a whole set of women’s health issues, AIDS, sex education, reducing the number of kids that smoke, a whole slew of things.

The third is independence--that we have to rework our programs so what they do is increase people’s responsibilities for themselves, for their own lives; empowering them to go out, get off the public dole and go to work.

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Q: Which is the hardest of those?

A: The independence.

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Q: Why?

A: Because it’s a fundamentally different way for government to think. It involves people taking more responsibility for their lives, particularly low-income people, that have been beaten down over the years. It involves a change in culture. Asking the government to help you for short periods of time is different than asking the government to take care of you for the rest of your life.

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Q: When you start trying to make that change in orientation, obviously there’s a lot of suspicion that it’s all just fancy-sounding language to justify cutbacks. How do you get past that?

A: You’ve got to build up credibility. The fact is that unless we start doing some of these things, there won’t be any benefits. The people who pay the bills are fed up.

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Q: What’s it like for you to be the person who has to deliver that message--cutting programs you’ve supported in the past?

A: The world changes . . . . We can’t afford as a nation--not because of money but because of our social fabric--to have large numbers of people who are not working. We have to mainstream everybody. No matter what their circumstances when they were growing up. Part of that is knowing that after they’re finished with school, everybody in this country gets up and goes to work.

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Q: Is there a sense in which--like only Nixon could go to China--that people are more willing to accept that sort of message from you than from a Republican?

A: I don’t have any sense of that. I think the message is tough, no matter who delivers it. I think anyone that thought that we were coming in as a bunch of liberal Democrats to deliver more large-scale social programs was nuts. I sure didn’t expect it.

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Q: There was a lot of pent-up demand out there. People felt for 12 years they had had to defer things that needed to be done--

A: I think so, but not necessarily for a huge expansion of the role of government. I know a lot of things that (Bush) Administration did were offensive. Whether it was the fetal-tissue research ban or the gag rule or ignoring minorities. I mean some of it was just plain symbolism that was wrong. Some of it was just dreadful. It wasn’t our government.

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Q: Still, it’s one thing to know it intellectually. It’s another to see Congress vote to cut $50 billion out of Medicare.

A: That’s right. That’s a shock. But people are getting some sense of the winds. The deficit thing, once adopted by the Democrats, was going to drive policy. That’s precisely what happened.

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Q: In that environment, it must be difficult to propose things, even things you know will save money in the long run--such as welfare reform--because there just isn’t room.

A: That’s correct, but it’s a presidential priority. Remember, these are his domestic priorities, which means he’s willing to sacrifice other things to get them done.

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Q: Are you sure?

A: Yeah. I am. I think he’s dead serious about welfare reform. How much he’s prepared to spend, how much front-end stuff we’re going to be able to do, how much we’re going to be able to help the states with their jobs programs I can’t tell you right now, but I do know he’s dead serious about welfare reform.

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Q: What principles guide you on that?

A: We want to make work work. We want to empower people so they take responsibility for their own lives. We want to help people become independent of government. It’s not a matter of getting people out of dependency, it’s really to empower them so they become independent, so they take responsibility for their own futures.

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Q: There’s a trade-off in almost anything you do in that area.

A: Oh, the trade-off is there. And more importantly, it’s that transition period from welfare to work that is tricky. There have been experiments in places like Riverside, for example, that show you how tough it is. And there is going to be some toughness involved with how much money you want to spend. Whether you put money in on the front end as a way of saving money in the long run. Whether you have real prevention strategies that reduce the number of teen-age pregnancies, and therefore, the number of dependent young mothers.

What do you want to say to kids about expectations? If the way in which a young woman becomes independent is by getting pregnant and having a baby, you’ve got to take that idea out of her head.

I have a friend who says that we ought to focus on above the waist, not below the waist. Sex education has to do with what’s in people’s head.

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Q: Prevention hasn’t been much of an overriding idea for the last 12 years.

A: There have been no overriding ideas of what government is doing over the last 12 years. You’d be hard pressed to identify a set of themes. The government has to limit itself to what it can do--the areas where it can provide some leadership. One obvious area is prevention, early investment.

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Q: You’ve got this whole bureaucracy that’s used to a certain way of doing things. How difficult is it to get all those people thinking in your terms?

A: It’s difficult. It’s not that they personally don’t want to be responsive, it’s just that they’ve been doing something one way for a very long period of time. But the other thing that’s happening is there aren’t going to be a lot of jobs around. They’ve got good jobs and they’re anxious to keep those jobs and to be responsive.

I think many of them have been waiting around for us. Not particularly because they’re Democrats, but because people like to do something. You’ve got to start with the assumption that people like to get up in the morning and go to an interesting job.

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Q: You had some problems early on. Looking back, what went wrong?

A: I have to admit, in January and February I was in an absolute fuzz. I had no one on board. It wasn’t that I didn’t know what I was doing, but we didn’t have all the pieces put together. We didn’t have our political pieces. I think it was me and the chief of staff and the assistant secretary for legislation. Out of 126,000 employees, there were probably four of us in the department for more than a month. And the difference between how we would have handled one of those issues then and now, it’s night and day.

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Q: How about the proposal to have the government buy up vaccines to guarantee immunizations?

A: What we didn’t anticipate is the viciousness of the drug companies. It wasn’t Congress, it was the drug companies weighing in on a threat to their profit. Big profit.

The thing that you have to remember about HHS is that there never is going to be a clear winner or clear losers. It’s a complicated agency with complicated constituencies, and it’s how we manage our way through that and get some things done that people will, in the end, judge our success or failure as an Administration. No issue is ever going to be pure for us. If I wanted something like that I should have taken a smaller agency where there were some more straight-forward decisions, where you could just reverse a bunch of things the Bush Administration did and walk away.