As the nation’s top health official and head of one of the largest departments in the federal government, the Secretary of Health and Human Services makes life-and-death decisions every day that affect millions of Americans.
But not all important work is serious.
A former HHS secretary, Kathleen Sebelius, recalled a highlight of her tenure: recording a public service message with “Sesame Street.” “The Elmo commercial was for teaching kids to sneeze,” she said. “We were trying to spread good health habits.”
The script called for Sebelius to ask his co-star to “bend his elbow and sneeze into his arm.”
“Elmo has no elbow,” replied the beloved red Muppet, deviating from the script. So, Sebelius said, they swapped roles: “Elmo taught me how to sneeze.”
His story marked a rare and intimate conversation Wednesday with three HHS secretaries, past and present, and across party lines. Secretary Xavier Becerra, the agency’s current head, joined Sebelius, who worked with then-President Barack Obama from 2009 to 2014, and Alex Azar, who worked with then-President Donald Trump from 2018 to 2021. Their candid conversation took place at Aspen Ideas. : Health, part of the Aspen Ideas Festival, about the work that each of them had.
The panel discussion, recorded in Aspen, Colorado, before a standing room crowd, was presented as a live episode of KFF Health News’ weekly political news podcast, “What the Health?”, and is now available to stream.
Becerra, Azar and Sebelius spoke not only about the common bullet on their resumes, but also about their shared understanding of what it means to lead the agency at a time when health care is at the forefront of American minds, and in the crosshairs of politics. american. Becerra and Azar led HHS during the covid-19 pandemic, and Sebelius was in charge during the implementation of the Affordable Care Act.
They offered candid and sometimes surprisingly similar perspectives on running a department with more than 80,000 employees; a budget of more than 1.5 trillion dollars; and an agenda set most often by outside events or by your boss at 1600 Pennsylvania Ave.
Azar, who described receiving “two to five” phone calls a day from Trump, which could come in at almost any hour, said he began his days meeting with high-level staff “to discuss what could hit us in the face today.”
“The White House is not a place for patients,” said Becerra, who described losing Americans equivalent to 11 twin towers to Covid-19 every day when he took over. “They want answers quickly.”
“It really is life or death at HHS,” Becerra added. “Gravity, it hits you. And it’s non-stop.”
The panel offered some behind-the-scenes views on today’s biggest issues, including the painful fights over skyrocketing drug prices under Trump and ACA birth control coverage under Obama.
Deciding which “hills you will die on” was Azar’s main challenge as HHS secretary, he said. “When do you fight and when do you not fight with, say, the White House?” He pointed to his push to eliminate drug maker rebates paid to health plans and pharmacy benefit managers, which drug makers and others have criticized for raising drug costs.
“I left a lot of blood on the battlefield just to try to ban pharmaceutical reimbursements,” he said.
The three secretaries agreed that one of the least understood but most important aspects of the department’s work occurs outside the United States, conducting what Sebelius called “soft diplomacy.” While many countries are reluctant to welcome State Department or military officials, “they welcome health professionals,” he said. “They appreciate the opportunity to learn.”
When asked what they didn’t feel prepared for when they got the job, Azar, who had previously worked at HHS as general counsel and then deputy secretary, replied: “The Trump administration.”
Coming from the administration of former President George W. Bush and later as president of the US division of drugmaker Eli Lilly, Azar said he was “used to certain processes and ways that people interact.” Working in the Trump administration, “it was different.”
The atypical gathering of current and former political officials also provided an opportunity for some unusually friendly banter.
Becerra said one of the reasons he was familiar with HHS programs was because he had filed numerous lawsuits challenging the agency’s actions when he was California’s attorney general.
“Oh, it took a lot out of me,” Azar joked, as the group laughed. “Calf vs. Chanceall over the place.”
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