Republicans in Congress Seek to Eliminate Surgeon General’s Post : Public health: GOP proposal stirs debate over whether job has become too political or merely obsolete. White House, medical groups defend it.

Does America need a national “family doctor”?

With the bitter battle over surgeon general nominee Henry W. Foster Jr. ending in defeat for President Clinton, Republicans on Capitol Hill are expected to escalate their efforts to do away with the job entirely, stirring fierce debate over the role of the nation’s top doctor.

Has the job of surgeon general become so ideological, so political and so divisive that it has outlived and diminished its usefulness? After all, a surgeon general has no real policy-making authority, and his or her effectiveness rests largely on strength of personality and determination to press public health issues.

Many Administration officials and their congressional allies firmly believe the job is vital. “The surgeon general is the health conscience of the nation,” said a senior Administration health official who requested anonymity. “It should be preserved.”

But the Senate’s fiscal 1996 budget resolution calls for eliminating the post, and some House conservatives are urging their budget conferees to accept the Senate language. Republicans in particular tend to believe the job has become largely symbolic and therefore obsolete.

Despite the uncertainty, the White House is expected to begin searching for a new nominee, and many public health officials say they intend to fight vigorously to save the position. The last surgeon general, Dr. Joycelyn Elders, was abruptly dismissed by Clinton in December for making what he felt were inappropriate public comments about masturbation.

Although the surgeon general operates with a budget and staff considered almost minuscule by Washington standards, the position has a rich and colorful history. It dates back 125 years, when Congress established a “supervising surgeon,” later renamed surgeon general.

The unusual nature of the position is obvious even at first glance: At public events and even on some routine workdays, the surgeon general dons a resplendent military uniform, complete with gold buttons, ribbons and braids, that makes its wearer look more like an admiral about to put out to sea than a physician.

Over the decades, the surgeon general’s office has been marked by long, moribund periods, punctuated by occasional instances of high controversy and intense public debate.

The office has had its landmark moments. In 1964, Surgeon General Luther Terry issued a report linking smoking to lung cancer. In the Ronald Reagan and George Bush administrations, Surgeon General C. Everett Koop launched a relentless campaign against smoking and AIDS.

Advocates say it is particularly important to preserve the job at this time in light of another change under consideration by the White House: The “reinventing government” blueprint endorsed by Clinton and Vice President Al Gore calls for diminishing the power of the government’s only other high-ranking health official, the assistant secretary of health. That assistant secretary, typically a physician, oversees the Public Health Service and signs off on all public health policy decisions. Under the Clinton-Gore proposal, the job would be reduced to an advisory staff position.

“The American people will always need a physician at a high level to advise the public on public health issues,” said James Stacey, spokesman for the American Medical Assn.

Katherine McCarter, associate executive director of the American Public Health Assn., agrees that the surgeon general’s role remains essential. “This is an individual who, by the nature of the position, is vested with a great deal of authority and credibility to speak out on important health issues. It will not be the same if the secretary does it.”

Others are more skeptical. Gary Bauer, director of the conservative Family Research Council and a former White House aide during the Reagan Administration, questions the value of having a surgeon general “in this day and age when so many hot-button issues that divide the country are often involved.”

“It was easier to speak out about [health] issues 30 years ago,” said Bauer, who admitted having “mixed emotions” about abolishing the job. “But today, when so many discussions involve issues like abortion or condoms, the bully pulpit will be neutralized by the fact that there are so many divisions.

“For example, everyone in the country--even smokers--know that smoking is no good for them. But when a surgeon general talks about condom distribution in the schools, the country is split down the middle.”

Mark Barnes, executive director of the AIDS Action Council, points out that controversy is nothing new to the office. He cites as an example Thomas Parran, President Franklin D. Roosevelt’s surgeon general, who waged a campaign to prevent sexually transmitted diseases at a time when the subject was not discussed in public.

Koop, who accelerated the war against tobacco use, challenged the policies of his own President by calling for greater regulation of tobacco products. He began his tenure with a firestorm over the so-called Baby Doe regulations, which required medical professionals to feed and treat badly deformed newborns and not allow them to die. Later, he wrote what is widely regarded as a compassionate, literate and scientifically documented report about AIDS, sending one to every household in the country.

Koop’s successor, Dr. Antonia Coello Novello, came across as more low-key but was just as indefatigable in her zeal to prevent teen-agers from consuming alcohol.

“The office has a long history and has been involved in significant health care warnings,” said Stacey, the AMA spokesman. “It would be misguided to attempt to function without one.”