SHALALA DOESN'T WANT TO BE THE U.S. 'NANNY'

When it comes to health, the public looks to the federal government in many
of the same ways as children do to parents.

They think parents should pay for everything they want. They expect parents
to keep them safe. But they don't want to be forced to do something, even if
it's good for them.

A recent visit by U.S. Health and Human Services Secretary Donna Shalala
illustrated the widely different approaches that federal officials take when
it comes to playing parent and wielding authority over public health. She
discussed:

Her refusal to allow federal money to be used for needle exchange programs
to help prevent AIDS.

Her recent order that the organ transplant system be overhauled.

Her view of how the federal government should respond to the nation's
worsening obesity epidemic.

And she warned: "We have to be pretty careful about being the country's
nanny. We're not the country's nanny."

Shalala is no C. Everett Koop or David Satcher. The differences are not just
in style, but also in the substance of their jobs.

Koop perfected the art of using the surgeon general's office as a bully
pulpit for championing public health, to such a degree that he has continued
to have wide influence and credibility as a health spokesman, years after
leaving the job.

Satcher, who became surgeon general in February, seems to be of similar ilk.
He expressed disappointment with Shalala's stance on needle exchange and has
pledged to use his position to get Americans to be more active, to eat
better and to have healthier behaviors.

But surgeons general can do little more than give lip service to health
issues. Shalala's job -- a cabinet position -- lets her put money and
authority where her mouth is.

In an interview at the Journal Sentinel, Shalala acknowledged that there are
no guidelines for deciding which health initiatives to back and which ones
to deny. The examples she discussed illustrate the diversity of her policies
on health issues.

On transplants, she used the government's rule-making power to its fullest
capabilities when she ordered transplant officials to devise a new system
for allocating organs so that the sickest patients will get priority
regardless of where they live. She said she acted because of gross
unfairness in the current system.

On needle exchange, advocates tried to win over Shalala and President
Clinton with studies showing that such programs cut HIV transmission and
don't encourage drug abuse. Shalala first attacked the research, saying it
was based on good programs that include drug abuse counseling, but that
"there's a lot of lousy needle exchange out there. People are just passing
out needles."

Next, she suggested that the research was irrelevant, because the government
doesn't pay for everything that's good for health.

"The federal government doesn't always fund every life-saving science" or
treatment, she said, giving the example of Medicare not covering
prescription drugs even though doing so clearly would benefit health.

On obesity, Shalala noted that under new federal guidelines, 55% of
Americans will be classified as overweight. People can choose what to eat or
whether to exercise, and it's not an appropriate area for government
regulation, she said.

But there is a critical need to help the public make informed choices on
diet and exercise. A key strategy has been "finding private-sector partners
to take responsibility" for the health messages they send, Shalala said. She
recently worked with popular TV offerings such as "ER", MTV and even soap
operas on portraying health issues and is working with Avon on a program
aimed at healthy behaviors in 9-to-14-year-old girls.

But there's one policy we won't see her propose: a "sin tax" on junk food.

"Not with this president," Shalala said flatly. "You're talking about a junk
food tax with Bill Clinton? Not a chance. You can quote me, with a big smile
on my face."

Checked-by: "Rolf Ernst"