Cabinet member Donna Shalala has made great strides in the areas of health and human services. Now she must sit back while Congress decides the future of the Clinton healthcare plan.
By Judith Levine
After 18 months of being hacked, sliced, and spliced, President Clinton's l364‑page Health Security Act is finally in Congress. There it will compete with dozens of other plans, ranging from "single‑payer"‑which would eliminate private insurance and provide tax‑funded care to plans that would require everyone to buy insurance. The administration's ambitious proposals are both radical and moderate: They guarantee healthcare for all Americans and require employers to provide it; they also build the system around private insurers, whose profits add monumentally to medical costs. As Washington's summer heat intensifies, so will floor debate; hopefully, each congressional chamber will pass a bill, and these two documents‑eventually merged‑will return to find majority support by fall.
Whatever plan finally becomes law, it will be the whole Clinton team's victory. But there is one woman who will share the laurels with the First Couple: Donna E. Shalala, the razor-sharp, cut‑to‑the‑chase secretary of Health and Human Services (HHS), the department that ministers to America's health and security needs with 250 programs and agencies, including Medicaid, Medicare, Social Security, the National Institutes of Health, and the Food and Drug Administration. Shalala's cookie jar is the largest in Washington: $641 billion this year, almost 40 percent of federal spending.
There are those who say Shalala is the second most powerful woman in Washington‑after Hillary Rodham Clinton. But Shalala dismisses the suggestion, saying the perks of power are "irrelevant."
"There's one powerful person in this town," says Shalala, typically brusque. "That's the President of the United States. Everything else revolves around getting his attention. And I happen to have the agenda he cares about most in the world.
"I may not be the most powerful," concludes the woman whose competence and competitiveness have earned her the nickname Boom‑Boom. "But I have the best job in Washington."
Shalala, 53, started out as a political scientist, specializing in municipal finance, and held professorships at Columbia and Yale. During those years she befriended Carol Bellamy, then a New York City councilwoman and now head of the Peace Corps, Texas journalist Molly Ivins, who was working for The New York Times, and Robert F. Wagner, Jr., a New York politician and son of the former mayor. In 1975 Wagner recommended Shalala to direct the Municipal Assistance Corporation (MAC); after that, her career climbed: She served as an assistant secretary of housing and urban development in the Carter administration and as president of New York's Hunter College in the early '80s. In 1988 she became the first woman to head a Big Ten school: the University of Wisconsin at Madison.
Born into a working‑class Lebanese‑American family, Shalala says her political roots are in the civil rights, peace, and women's movements. Yet she has never considered herself an adversary of the powers‑that‑be. "I am a feminist committed to a wide range of progressive issues who's been a member of the establishment for a long time," she says. "I'm one of the few outsiders who are inside."
This contradiction miffs many observers. Coronated "the high priestess of political correctness" by conservative commentator Morton Kondracke when she was appointed, she lost that distinction rather quickly. "There was a perception of her before she came to town as a kind of gooey‑eyed liberal," comments National Public Radio's Cokie Roberts. "But that is not at all the case. She comes out of a culturally conservative background; she has all this experience in managing enormous bureaucratic institutions. Does that mean she doesn't have a commitment to children or families? Of course she does. But she [has] a practical, commonsense approach to these things, instead of having some ideological underpinnings."
Some see Shalala's "pragmatism" as a betrayal of the political movements that nurtured her. This is nowhere more evident than in the minefield of welfare reform, which has come to mean requiring recipients ‑eventually‑ to work. While that idea enjoys wide bipartisan support, many of the administration's proposals have been savaged by some of Shalala's best friends. Marian Wright Edelman, head of the Children's Defense Fund, which both Shalala and the First Lady have chaired, signed a memo saying that proposed time limits on benefits would "destroy the safety net." Asked about such provisions, Shalala responds, "The time limit is a minor problem. Seventy percent [of recipients] get off in two years." But it is that substantial other 30 percent, along with families in the states where HHS has approved even more severe measures, that critics worry about. Arkansas, Georgia, and New Jersey, for instance, refuse additional payments to women who give birth while on welfare.
Shalala undoubtedly considers such proposals the practical way to get poor women into the workforce, but they also reflect a personal value: "I'm much more sympathetic to the waitress with no healthcare who's struggling to bring up a young son than I am to the person who wants me to pay for her to stay out of the workforce for 8 years," she says, evoking the image of the lazy welfare mother ‑a stereotype she'd undone minutes before.
Even critics, however, trust Shalala's compassion. "We have found Donna to be not only sensitive to the issues of [women of color] but receptive to hearing our views," says Julia Scott, director of public education and policy at the National Black Women's Health Project. Adds the Center for Women Policy Studies' Leslie Wolfe: "I have absolute faith that Donna understands what we're talking about. It is our responsibility as outside advocates to hold our friends inside accountable and to try to keep pushing them. It's theirs to work in ways that are likely to be successful. Donna isn't going to win it all; if she does, we elevate her to god."
Dressed in a red Armani jacket to which she has brazenly attached black velvet elbow patches, Shalala appears to possess an almost godlike immunity to self‑doubt. Asked what part of her job she's most skillful at ‑policy, strategy, or politicking‑ she answers: "I'm most skillful at all of them." This towering confidence can be perceived as arrogance, claims one HHS staffer, and Shalala has butted up against other strong personalities, such as Ira Magaziner, the White House healthcare point man, and New York's Senator Daniel Patrick Moynihan, who has dominated the welfare turf since the '60s. But such clashes are inevitable in Washington, and the secretary is respected by friend and foe as a fair and skillful player.
Mostly, her aggressive focus has been trained on making some impressive gains: a low‑income child‑immunization program; funding for Head Start, the NIH, and AIDS; revamping of her agency's bureaucracy; and, of course, the healthcare initiative. It's probably good that Secretary Shalala has no internal demons, because the external ones are huge: the economy and the Reagan‑Bush legacy. "It's going to take us a long time to rebuild," she says, "in fundamental rights, in programs for the poor, the disadvantaged, and kids." But ‑not surprising‑ she's completely unfazed: "We've waited 12 years to get back here, with a lot of pent-up optimism and energy. It's just exploding."