Counsel of Elders

Far from the madding capital, the former Surgeon General reflects on health care reform and her own downfall

By Divina Infusino
Published September 30, 1996 7:00PM (EDT)

Dr. Joycelyn Elders sits in her University of Arkansas Medical School office, calm, safe and far removed from the political maelstrom that once centered around her in Washington.

True, her 15-month tenure as Surgeon General still gets hurled into the presidential campaign's crossfire as evidence of President Clinton's closet liberalism. Elders is, after all, pro-choice, pro-gay rights, and favors sex education, drug education and the distribution of condoms in the schools -- not all popular positions in Washington these days. Nor was Elders particularly adroit in expressing her views. Her candor eventually prompted President Clinton to force her resignation in December, 1994, shortly after the Republican congressional landslide.

Now that the hysteria has died down and she has returned to teaching and treating patients with endocrine problems, Elders is attempting to set the record straight with her book, "Joycelyn Elders, M.D.: From Sharecropper's Daughter to Surgeon General of the United States of America" (William Morrow).
She writes about her difficult nomination process, her son's arrest for drugs and her swift removal from office.

Do you think your directness caused your problems in Washington?

I really felt that my ideas went over well with most of Washington. But there was a very well-organized, greased machine that was opposed to everything Joycelyn Elders is about -- the Christian Coalition. They were opposed to health education, family planning, abortion and they were very anti-gay. They were determined that I would never be Surgeon General, and once I became Surgeon General they spent all of their energies to get me out.

In hindsight, is there anything you would have done differently in Washington?

No. I loved being Surgeon General. I did it the way I thought it should be done. And if I had to do it again, I'd do it the same way. You could say I'm a slow learner and I didn't learn anything -- maybe so. But one of my biggest concerns has always been children. And children were not for sale for me. Children are used as political pawns in Washington. Everyone gets up and talks about the children, but no one wants to do anything for them. And I was the part of the administration that was saying, "You are not doing anything for them."

What was the reaction after you returned to Arkansas?

About 90 percent of the people were warm and welcoming. But the Republicans in our state legislature tried to keep me from getting my tenured professorship back. They said I would contaminate young medical students' minds. They held the medical school's budget hostage, contingent on deleting my salary. Eventually the governor told them that I was a tenured professor and if I did not get my position back, I could sue the state.

You were Clinton's health director for six years in Arkansas. How was it different dealing with him in Washington?

While he was governor, I could always go and discuss an issue with him. And sometimes we would agree to disagree. But in Washington, I felt that you were supposed to put out the party line. And if you disagreed you were still supposed to put out the party line. I never had to do that when the President was in Arkansas, and I didn't feel that I had to do that in Washington.

Do you think the Clinton administration has been a success?

Yes, the President has tried to show genuine leadership and that he cares about America. He's always talking about his economic success, but I see mostly a lot of low-level jobs that have been created. I think he has improved the social/health index of America. The previous administration was almost cruel in terms of gays and lesbians and women. The President is proud of putting more policemen on the street, but I would rather see more education. We have built bigger, better prisons, rather than reform the lives of young people.

You were involved in Clinton's attempted health care reform bill. In the book, you state that you felt it failed because it was too complicated to defend and created a level of paper work that was cumbersome and might have thrown existing programs into disarray.

I feel there were two or three major problems with the health care bill. Before you go in to make a major reform, you need a buy-in from the providers, the doctors, nurses, hospitals. I don't think we ever tried to get that. You need to talk with them, fight and discuss with them, and then when we go out to the streets, we are all on the same page.

But the way it was developed, the physicians did not feel it was their plan. The health industry did not feel it was their plan. Medicare/Medicaid felt that we were exchanging something that was good for something that was unknown.

There had been so much talk and tussle about health care reform during the elections that everyone wanted it to be their plan. So much so that we ended up with nothing.

Meanwhile, our society has ignored the one thing that we can do to improve health care the most -- and that is education and prevention. We invest less than 1 percent in keeping people healthy. We have a very expensive sick care system.

Why is there resistance to health care as prevention?

Probably because we have not been educated about health. We've been educated about sickness. We want everyone to be taken care of when they are sick. They don't consider health care that keeps people well as being cost-effective. But think of clean drinking water, exercise, nutrition, immunizations. Those things have done more to improve health than all of our doctoring.

What do you think of the welfare reform bill in terms of health care?

This is the one thing I cannot forgive the President for. It is not a reform bill. It is a divisive measure against children who are underserved and under-represented. It bothers me that children in America cannot have an opportunity for basic things like food, clothing and shelter. That is a cruel society.

How do you see the future for black Americans?

The future is bright. But we are going to have to get very involved. The changes we need are not going to come from policies made in Washington. It will come from attitudes and policies made in our churches, communities and schools. Public schools have turned mostly black in the South, and we are going to have to make those schools become responsive to the needs of the children. We have blamed other people too long. We thought that once we got the the civil rights bill passed, that was all we had to do. We are going to be the ones to stop the violence, drugs, teenage pregnancy. The fight has just begun. And we have to stop letting other people dictate the strategy.

You are talking about grassroots community organizing.

Yes. And we are going to have to do it around the black churches. That is all we've got left. We have got to use those to lead the revolution to get where we want to be. That is what the Christian Coalition has done. We black people have let them take our idea and beat us over the head with it.

Do you think that is why black churches are being attacked now?

I can't say that. But it is the last stronghold that is left to educate and organize around.

Quote of the day

Fountain of youth

"What about jazz helps keep you young? You're searching to create something every time you're playing, the joy of being involved in such a fluid creative form. You have to look for something new within yourself, and within that lies the refurbishment of life."

-- Jazz pianist Oscar Peterson, 71, who is being honored Tuesday night with a special concert at Town Hall in New York City. Peterson recently recovered the full use of his left hand after it was paralyzed by a stroke in 1993 (from "An All-Star Oscar Night," in Monday's New York Daily News).

Divina Infusino

Divina Infusino has written about Hispanic issues and culture for The New York Times Syndicate and The San Diego Union.

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