The Secretary-Designate—A Scenario
The phone rings, and a senior leader in U.S. domestic or health policy, relaxing at home on the Saturday evening after Thanksgiving, answers. The President-elect is calling to ask this widely respected individual to serve as the twenty-first secretary of the U.S. Department of Health and Human Services. The request elicits an enthusiastic, “I will be honored to serve.”
Even though this call was not a surprise, the new secretary-designate feels a mix of excitement and trepidation. The excitement comes from having the opportunity to bring direction and transformative ideas to the $2 trillion health sector. The trepidation lies in the challenge of bringing order to a department with a $737 billion budget and 300 programs.
Soon the briefing process is under way. The appointee must simultaneously prepare to lead the department and for confirmation hearings:
By January 19, the next secretary has barely had time to think. But that day, the Senate recognizes the appointee’s round-the-clock preparations with a vote in favor of confirmation—a signal of confidence in the nominee’s ability to make a positive difference.
The next day, as the new chief architect of U.S. health policy, the appointee attends the inaugural ceremony, and somberly takes the oath of office in the presence of immediate family. Then the real work begins.