Many of Joe Biden’s cabinet and sub-cabinet nominations have been puzzling. BuzzFeed’s Matthew Zeitlin compared it to a British prime minister’s method having “a list of guys who need jobs and a list of jobs who need guys, how they match up is kinda secondary.”
Every administration has some mismatches, usually born out of the need to include someone from a crucial geographic, factional, or demographic constituency. That sort of political appointment is as old as politics itself.
Biden’s selection of Pennsylvania’s Rachel Levine for the job of assistant secretary for health at the Department of Health and Human Service is a particularly egregious example of choosing political concerns over practical competence. This is even worse than usual given that, amid a worldwide pandemic, public health jobs matter more than ever.
In throwing a political bone to his transgender supporters by nominating one of their own, Biden will elevate one of the least effective state health officials to a federal job, rewarding Levine’s dangerous incompetence and shocking hypocrisy with a promotion.
Political Cronyism With A Modern Twist
Republicans who oppose Levine’s appointment will be smeared as being opposed to all transgender people, but Levine’s sexual identity is not the issue here. Still, whether Levine identifies as a man or a woman would be of no matter except that Levine’s current job in Pennsylvania’s state government was almost certainly inspired by Gov. Tom Wolf’s desire to nominate an openly transgendered person to an important job.
Wolf did not know quite how important that job would be when he appointed Levine. None of us did. Only a few medical professionals and political insiders even knew the name of the commonwealth’s secretary of health before the coronavirus thrust state health officials into the spotlight.
For a well-qualified public health expert, this could have been the moment to shine, but Wolf chose to nominate a pediatrician who had been active in political causes, including serving on the board of Equality Pennsylvania, a statewide gay activist group that backed him for governor in 2014 and again in 2018.
The COVID outbreak was the moment Wolf’s political favor became extremely harmful. As an editorial in Philadelphia’s Broad and Liberty explained last year, “Having a Pennsylvania Secretary of Health with an expertise in treating pediatric eating and addiction disorders may have been sufficient for the Commonwealth in normal times.”
There are plenty of state commissions on which a political ally may be safely appointed without compromising anything important. Not everything the government does is a matter of life or death — but this one is.
Incompetence and Hypocrisy
Levine’s first few years on the job, first as the state’s physician general, and then as secretary of health, were uneventful. There were news stories and interviews, but most focused on the political impact of a transgender person in a state senate-confirmed job.
In a lengthy Washington Post story from 2016, for example, Katie Zezima devotes roughly a paragraph to Levine’s qualifications and half the story to Levine’s personal life, transition, and fashion sense. That, however, is not Zezima’s fault. It was what Wolf wanted, a visible patronage job for a representative of a loyal constituency. Last year, though, he got something more: a top official who was overwhelmed by the job.
Pennsylvania was not the first state hit by COVID-19, but when it got hit, it got hit hard. Part of the early spike in the commonwealth was caused by state officials’ treatment of the most vulnerable population: elderly people in nursing homes.
By late April 2020, the Philadelphia Inquirer noted that while 20 percent of COVID deaths nationwide were in nursing homes, in Philadelphia they made up 50 percent of the total, with similar numbers statewide. By May, the state’s nursing homes accounted for 65 percent of coronavirus deaths — 80 percent in the Philadelphia area.
Why the disparity? At least part of the problem must be chalked up to Levine’s order that nursing homes readmit COVID-19 patients after they left the hospital. Guidance from Levine’s office was to leave uninfected residents in such facilities, too, even if there was an outbreak. They said the policy was perfectly safe and then kept the nursing home fatality numbers secret as long as possible, which meant no one could prove otherwise.
Levine attributed this policy decision to hospital overcrowding, but as the Bucks County Courier-Times reported, “hospitals in most counties were never overwhelmed with coronavirus patients.” Just this week, the Delaware Valley Journal reported more evidence of the administration’s failure to protect nursing home residents, forcing counties to fill the gap by doing the state’s job for it.
Meanwhile, Levine made the memorable decision to remove his 95-year old mother from the facility where she resided while other Pennsylvanians’ elderly loved ones were being banned from exiting while being quartered with COVID-positive patients. It was the kind of hypocrisy we have come to expect from corrupt public officials, like the strong supporters of public schools who nevertheless just happen to put their kids in expensive private academies. All of this two-faced behavior is metaphorically fatal to the public trust, but Levine’s version of it was fatal to thousands of elderly Pennsylvanians who followed the state’s decree.
Much of Biden’s campaign was centered on fear of COVID. Indeed, with lockdowns dominating the lives of every American for the past year, it’s hard to see how it could have been otherwise. Yet when given the chance to differentiate himself and his administration from the mistakes of the past, he decided to promote one of the most inept administrators in the country.
It didn’t have to be this way. Not every state botched its public health administration as badly as Pennsylvania did. There are plenty of competent state officials — many of whom are Democrats —Biden could choose to appoint.
Discussing the appointment on Twitter when news broke, Ohio physician Pradheep Shanker praised his state’s former public health director, Amy Acton, as “bipartisan, effective, and largely apolitical,” a much better choice than Levine. There are most assuredly others.
There are also plenty of political jobs for Biden supporters that do not require a high level of professional success or expertise. Wolf also chose politics over competence, but no one could have predicted how bad it would come back to haunt him. A year into this outbreak, Biden does know, which makes his decision to nominate Levine even more baffling.
Biden wants to present himself as the true successor to Barack Obama, but when Obama was president, he chose Harold Koh as assistant secretary for health. Koh was a public health professor with years of experience in the field.
Biden should find someone similar and take seriously his pledges to end America’s great public health crisis. Expertise, not political tokenism, is the way forward.