Tobacco Documents Online

--------- -. __~ _ ^~-- -F a -iot avernrnenf n1E asINRI ning and' health care reform. But now John H. Sununu, who as White House Chief of Staff held. an iron grip on do- mestic issues, is •gone. And Budget Di- rector Richard G. Darman's star no longer burns as bright. "This is Sulli'- van's biA testl" says one Administration official. "How he performs will deter- unprep or e cu roa attles he LOUIS SULLIVAN COMES OUT OF HIS FOXHOLE Can the low-profile HHS Secretary sell Bush's health reform plan? t f there's one thing that Health & Human Services Secretary Louis W. Sullivan learned early on, it's to keep his head down, Even before his confir- mation, the White House forced him to back off his pro~hoice stance om abor- tion. Then, when he said he favored giv- ing clean needles to drug addicts, it pres- sure& him to recant. Later,. Sullivan announced that the Administration supported' the medicare catastrophic in- surance bill, only to be re- versed hours later. For Washington's cognoscenti, it was all the proof they need- ed: The nation's top doctor had the political savvy of Pat Paulsen and' no control over policy. Sullivan has come a long way since he took over the ~ :65441 billion department three years ago. By picking ~~ his fights carefully; he has ~' won praise for expanding CC% ices to the poor and for cdbsades aira av an ustrv-worthy initiatives, to be sure, but small vic- tories at bes~~ USRNESS WEEK/FEBRUARY 17, 199$ ouse School of'Medicine in Atlanta was would have to wage to assert control over the divisive issues facing his sprawling department. After his rocky start. Sullivan seemed resigned to navigate within the con- straints imposed by White House ideo- logues and the budget deficit. The HHS Secretary decided to go with his strengths and concentrate on areas ~ where he thought he could have an im- pact. "Lou Sullivan is a man who looked' at thP R n ~d ots says~'a a itol Hill staffer: "He doesn"g ve to engage m a e onevery issue." Indeed, he was one of the few Cabinet members who worked' tirelessly to help Bush keep his promise of a kinder, gentler America. Sullivan has used his ra bMl IVm 211 t tn nr- a vgative hea~lth measur~ s. And'he has raised the visibil- ity within HHS of minority health issues and the social problems of black males- areas neglected in the past Sullivan "has done a fantas- tic job," says Deborah Steel- man, a lawyer who advises I Bush on domestic issues. .osua rounes. In an era of tightfisted' federal bud- gets, Sullivan also has been able to expand health ser- vices for the poor, such as community health centers and' programs to increase the number of physicians in underserved areas._He won wmR sRRMRRRRU oRR A1RS eAeMAM w/ARDUO. sUUMAN OAS ARR weMaRs mine whether the past' three years have paid' off as a first-class education or whether he has flunked!" From the beginning of his tenure, Sul- livan was a rare commodity in Washing- . o~4 w"tTie 58-year-old hematologist f'rom ~ Atlanta no longer has the luxury of a low profile and narrow niches. He is about to take center stage on what will be a pivotal issue during the Presidential election campaignt health care reform. President Bush was to unveil his health care plan in Cleveland on Feb. 6, and he has picked Sullivan as point man to sell his proposal. The HHS Secretary will ap- pear on talk shows, make speeches, debate Democrats, and try to soothe worried lobbyists and lawmakers. EXAM T1Mi. This lead role is clearly Sullivan's biggest challenge yet-and' a oppor- tunity to burnish his reputa- tion. Until this year, he was under the thumb of heavy- .weights in the White House and the Office of Manage- ment & Budget on major is- sues such as family plan- ton. A personal fri he laudits _for hi a s E~Fie ~,Mncnrchin n wome 'n~t~,nrt;ng p ontsti,~- ~ -- -smistt+~" markadrw of c s to chfl- dren. He has hired strong, wel -respec - ed managers to run his agencies (table). And he has used his position as the only black Cabinet member to influence Ad- ministration policy on civil rights issues. Yet if there is one policy arena that an ~ HHS Secretary should' lay claun to, it's health care reform. And here, while Sul- FOR SIILLIYAM, A M!lMD BILL OF NEALTN HIS STRENGTHS 0- Hires strong managers lt Took a high-profile stand against tobacco sales to minorities and chiidren 10, Won new dollars for public health programs ., 0- Raised the status of minority health issues HIS WEAKNESSES 0- Doesn't have full control of his own staff 0, Opposed tobacco ads and exports, then refused to back federal action 0, Pushed health care reform but failed to develop a detailed plan livan has made inroads, Dar- man has held sway-with what may be disastrous re- sults for the Administration Sullivan realized two years ago that the Bush Ad- ministration couldn't ignore the rising public clamor for reform much longer. But Sununu opposed' any over- haul and~refused to give Sul- livan a chance even to dis- cuss his views with Bush. So Sullivan began to deliver a N ~ ~ ~ 0 04 on W 0 0 a tc.a+i 'w

-13- CC" 10 ~9T ~ ~senes of policy speeches laying out the direction an Administration health policy shouldl take. He also circumvented Su- nunu s control in August by mailing Bush a letter to his private post office box in 3laine, imploring him to move on the matter. Bush's final plan is expected to; include many of the proposals Sulli+ t-an, had tieem pushing. "We have had a major-no. the major-impact," Sullivan told BCSI\ESS WEEK. ; 'SIXTH FLOOR SwAMr.1 But officials close to the deliberations say that though Sullivan ~ laid the groundwork, he never came up with a final, detailed plan. Darman rushed in to fill' the vacu- um. According to sources, Darman is running the meetings that Sullivan and ~ other top officials attend and is coordi- nating the work of various agencies. '-Sullivan himself could~ have had every- thing readyy by now," says one official involved in the process. "He could have costed it out and made sure evervthing matched."' Darman's control has not served the Administration well. however. After an uproar from uoP lawmakers, the White House at the last minute was forced to delete references in its 1993 budget to a proposal that would have taxed the health benefits of affluent families-a proposal Sullivan had opposed'internally. Health care reformI is only the most visible evidence of Sullivan's inability to control his agency's issues. Last spring, when he came up with a pet program to combat infant mortality, Darman re- fused to~ give him new, mmoney, forcing tlHS to take funds from other poverty and health programs. It was Sununu. When Sullivan came up with a pet program to combat infant mortality, Darman refused to provide any money for it not Sullivan, who negotiated with fam- ily-planning groups to reach a compro- mi,e that woul& overturn a Lt. S. Su- preme Court ruling and allow clinics j funded li•c HHS to counsel patients on ~ abortion. Talks failed, and Bush vetoed ~ the hill. L•4,t l)ctober. Sullivan announced that rthe White House would veto a Demo- I rr.ttic hill that would have given the The Kentucky Post, ThundsY, ,JalKiary 30, 1992 The smoke gets in their lungs By Cryatal Harden KKteiI Post atafl MparW The cigarette smoke fogging the air in Kenton County's court- rooms is upsetting a small gi'oup of employees. But their request to ban smoking In the courthouse re- ceived less-than-enthusiastic support from county commis- sioneza Wednesday. Keith Hedlund, who spoke for eight workers, said he is worried about breathing in the smoke ex- haled by others. "Twenty years from now I don't want to find out I have cancer from second-hand smoke," he said. '"I'he big problem is in the courtrooms upstairs - the third to the sixth floors," Hedlund said. "There's smoke all over the place, cigarette butts every- Where. "People are usually here only an hour or less. It's not unrea- sonable to ask them not to smoke.•• Hedlund, a probation and pa- role ofIIcer for the state, works on the seventh floor. Employees could go outside to smoke, he said. Hedlund argued. the county could reduce maintenance ex- penses and health-care costs by enforcing a smoking ban. A no-smoking policy also would cut general cleaning and save money by reducing health- blems related to smoking, he Commissioner Charlie Summe said the county has more pressing concerns than stopping people from smoking. County officials said they will discuss the proposal but added that a smokire ban would be dii- ficult to enforce. Bush calls for 'healthy' behavior San~....rwV. S.ndcs SAN' DIEGO-Bemoaning run- away medical costs, President Bush yesterday lectured Americans to stay healthier by exercising more, drinking less, eating right and avoiding drugs and.rishy sex. "Let's change the behavior that costs society tens of billions-this is no exaggeration-tens of billions of dol- lars in lost earnings and productivity, treatment-related programs, accidents and certainly crime, ' the President said in a speech to the Rotary Club. - Bush offered his "old-fashioned" pt+~scription for good health as a foi- loiwp to his $100 billion proposal of tax t~ed'tts and deductions to help poor and middle-class Americans buy medical care. Food & Drug Adtninistration new en- forcement powers. HHS had earlier I penned a similar billI but acked off after n ustry o ' yists ound a s euc e ounci o ("omoer_ir_iyenes_s_ a ~ e de iee- reside u av le. ome ld minis tra tion insiders com- plain that the HHS chief doesn't even have full control over his own staff. De- cisions he makes sometimes get bogged down in the "sixth floor swamp." For instance, last year, Sullivan verbally signed off on a controversial regulation changing the way medicare reviews new technology to determine if it should cov- er its use. But aides have yet to send'the rule to the o?vtB for review, sources say. Given the White House's determina• tiow to dominate domestic policy, Sulli- van's prospects for success may have been limited from the start. But now, with health care reform propelling him into the l'tmelight, he has a chance to prove his mettle. The next few months could demonstrate whether the kindly doctor from Atlanta will be a forceful player or just a nice guy with good in- tentions. By Susan B. Garland uith John Carey, in Washington THE STAR-LEDGER, Saturday, F.bruary b 1!!2 ~ ~