C. Everett Koop and the Trouble With the Senate Confirmation Process

Surgeon General Dr. C. Everett Koop in 1987 Photograph by Terry Ashe//Time Life Pictures via Getty Images

Norman Mineta was an easy choice for secretary of transportation in January 2001. He had been the first Asian American to hold a Cabinet-level position as Bill Clinton’s commerce secretary; he was George W. Bush’s only Democratic nominee. During his confirmation hearing, he named airport congestion as a priority, and he joked that the only short-term fix for it was a recession, though he wasn’t planning to recommend one. Senators John McCain and John Breaux fell over themselves to praise his mastery of transportation issues, and the entire Senate voted to confirm him, 100-0, before the hearing was over.

Then, eight months later, he had to decide within an hour whether to ground every plane in America. A transportation secretary had never had to do this before. The next year he got his recession, too. The world does not cooperate with presidents and their appointees. They start with issues—airport congestion, say—and end up with events. Issues test ideas, but events test flexibility, efficiency, and the ability to make new decisions on old principles. Events test character.

Charles Everett Koop, in part from his experience operating on children with birth defects at Philadelphia Children’s Hospital, became a devout opponent of abortion of any kind, comparing it to “the beginnings of the political climate that led to Auschwitz, Dachau, and Belsen.” In part because of this, Ronald Reagan nominated him in 1981 to become surgeon general. Because of it, he also almost did not become surgeon general. Democrats in the House and Senate protested his absolutism on abortion. “He scares me,” said Henry Waxman, a Democratic congressman from California and later a friend to Koop, who died yesterday at the age of 96.

The Senate was still considering Koop, in June 1981, when the Centers for Disease Control reported that five gay men in Los Angeles had died of Pneumocystis carinii, a rare form of pneumonia that preys on compromised immune systems. The White House kept its surgeon general away from the topic of AIDS until 1986, when it asked for a report. It got one, drafted by Koop himself, writing at a stand-up desk at the National Institute of Health. It treated the disease as a public health crisis preventable not with changes in morality, but with condoms and sex education. Koop’s office mailed a version of the report to every house in America. “My position on AIDS was dictated by scientific integrity and Christian compassion,” he said later. It was dictated by character.

Had Senate Democrats managed to do to C. Everett Koop what they later did to Robert Bork, Koop would never have had the chance to show this compassion, borne of the same convictions that determined his opposition to abortion. The U.S. Senate cannot predict events like Sept. 11 or the AIDS epidemic. This does not mean that it should abandon its obligation to advise and consent on White House nominees. But it does mean that adherence to any set of issues is not a great predictor of performance in office. No one asked Hillary Clinton about the Arab Spring during her confirmation hearings for secretary of state. No one asked John Roberts what he thought about health-care mandates.

But there are no interest groups for character. The political machinery that doomed Bork’s nomination to the Supreme Court—denunciations, coordinated intransigence, and advertising—runs with even crueler efficiency now than it did in the 1980s, and there is more money to fuel it. It has gotten easier for private citizens to police nominees for fidelity to ideas, to issues. It has gotten no easier for senators to test for character.

This year the nomination of Chuck Hagel, the White House’s pick for defense secretary, has been held up because of some things he’s said about Israel. Leave aside, for a moment, the question of whether it’s acceptable for the U.S. secretary of defense to have ever disagreed with the prime minister of Israel. Ask instead: Certainly something will happen in the next four years that we can’t now imagine. It will have nothing to do with Israel. Is the White House’s nominee the kind of person we trust to respond? Because when it happens, it won’t matter at all whether the Senate Republicans who now oppose Hagel were right or wrong about Israel. It will matter whether they were right or wrong about Hagel.

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