Tommy Thompson: On being a Cabinet secretary
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In December 2000 when I was asked by President George W. Bush to serve as the 19th secretary for the Department of Health and Human Services (HHS), I knew it was a big, complex job. Before HHS, as governor of Wisconsin, I had worked with HHS and Congress on welfare and Medicaid reform and as a result, I felt I had a good sense of what it would take to be a successful HHS secretary.

Prior to the signing of the 1996 Welfare federal reform plan into law, Wisconsin had already reformed our welfare program (which the federal law was based on). We based our reform on the simple idea that if we invest in people (through job training and incentives), people would have a better opportunity to enter the workforce.


While this was an idea we believed would work, prior to introducing legislation we wanted to see what others thought. So we met with welfare recipients all over the State and they reinforced our ideas. These mothers told us they wanted to work but they faced several hurdles, which we set out to remove.

The end result was that tens of thousands of former welfare recipients moved into Wisconsin’s workforce, which cut our welfare payments by more than half. As part of our reform plan, we also developed Badger Care, which helped mothers and their children get access to healthcare, one of the obstacles they told us they faced — a lack of access to affordable health care.

Besides meeting with citizens, we also engaged and enlisted the support of the employees at the various departments and agencies whose help we’d need to achieve our objectives. We worked to get buy-in from everyone with a stake in the outcome — from beneficiaries to those who would implement and regulate the reforms. Everyone needed to feel like they had a stake in success.

As HHS secretary, I applied these principles of direct engagement because we had some big plans but also would face some huge challenges we did not predict. I wanted to get the buy-in of HHS employees for our agenda but I before I could get their support, I needed to know what was on their minds.

Therefore, one of the first actions I took was to announce that I was going to spend a week at the largest agencies — CMS, NIH, FDA, CDC, HRSA and ACF learning about their missions, meet as many employees as I could and talk with them about what I hoped to we could accomplish together. In several instances I was the first HHS secretary to visit.

During these visits, not only did I learn about the vast reach the Department has, but also the commitment of its employees to the various programs — everything from Medicare to fighting HIV/AIDS to welfare to public health preparedness. It also became apparent that most of these programs required the agencies work together.

Also, every chance I had, whether privately or publically, I spoke about the thousands of employees at HHS and how committed they were to their jobs. I believed and bragged I had the best employees of any federal agency. Also, because of their deep knowledge, I frequently brought career staff into the secretary’s office to participate in briefings and/or had my staff engage with them to get their perspective and thoughts on issues.

As a former governor who worked closely with state employees as we made big changes to important programs that made a significant positive difference in the lives of Wisconsinites, I knew it was important that I do the same at HHS. But it was more than just a management philosophy. These dedicated employees at HHS did some of the most important work that truly helped move Americans and America forward.

The mission of HHS touches nearly every American. HHS is the engine for much of the most important and groundbreaking medical research that saves lives; it plans, monitors, helps fund and responds to disease outbreaks (man-made or natural); it reviews and approves lifesaving drugs and devices; oversees the largest health insurance program in Medicare (and related health insurance programs); and oversee two of the most critical safety-net programs — Medicaid and welfare (to name just a few of its programs).

While I was secretary, among our many accomplishments I was most proud of our success in passing and implementing a drug benefit for seniors, which has proven to be highly successful; created a new office that coordinates and helps prepare for public health emergencies and started a campaign that still goes on today to reduce our obesity rate and has brought attention to the need for better prevention and management of chronic diseases. We could not have accomplished any of it without the 70,000 HHS employees being part of the team.

Every new administration brings with it new ideas about how to improve programs and laws, all with the goal of improving the lives of all Americans. To do this each Cabinet secretary must engage with the employees under their leadership because at the end of the day, any changes that are made will be done by the thousands of federal employees who work tirelessly on what they truly believe are critical programs. And they do so on behalf of the American people.

That’s a lesson I learned while I had the privilege of serving as secretary of the Department of Health and Human Services.


Tommy G. Thompson was the 42nd and longest serving governor of Wisconsin (1987-2001) and the 19th secretary of the Department of Health and Human Services for President George W. Bush.

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