The administration’s nominee for the Secretary of Health and Human Services, Alex Azar, testified Tuesday before the Senate Finance Committee, which will decide whether to send the nomination to the Senate floor.

The HHS position is a political hot seat. President Trump initially nominated Thomas Price for this post. Price was confirmed and served as HHS Secretary until September, then quit after taking sharp criticism over his use of chartered planes and military aircraft for travel. Trump expressed unhappiness about Price’s practices in this regard, but he allowed Price to resign rather than be fired.

Since then, there have been two acting Secretaries of HHS. Don J. Wright (who acted in this capacity for about two weeks) and Eric Hargan (who took over in mid-October and is still the acting Secretary today.)

The responsibilities of the department are weighty. They include assuring food and drug safety, administering the Medicare and Medicaid programs, improving material and infant health, administering the Head Start program (pre-school education and services) supporting faith-based and community initiatives, advancing the cause of substance abuse treatment and prevention, and responding to health emergencies.

Azar was a Deputy Secretary for HHS under President George W. Bush from 2005 to 2007. But much of the controversy about his nomination centers on a subsequent item of his resume. He was President of the U.S. Division of the giant pharmaceutical company, Eli Lilly, from 2012 until a year ago.

Left Wing View

Politico ran a story Monday, January 8, about how Eli Lilly, during Azar’s time there, allegedly gamed the patent system. The reporter, Sarah Karlin-Smith, wrote about how Lilly extended the patent on its erectile dysfunction drug, Cialis, by testing it on children, on the hypothesis that it might help a muscle-wasting disease that afflicts boys. Karlin-Smith said that this contrasts with Azar’s own assertions that he is “an opponent of abuse and gaming of the patent system by drug companies.”

A related controversy from Azar’s years at Lilly involves the price of insulin. Lilly is one of three drug companies that are defendants in a class action lawsuit over lock-step hikes in their insulin pricing. A Newsweek headline writer called Azar “the man making diabetes unaffordable.

Last month a health care advocacy group, National Nurses United, called Azar “directly responsible for price-gouging millions of patients in order to increase profits.”

A Sideshow

In the controversy over Azar’s nomination, the question of his ethnicity may be something of a side show. Still, the side show exists. Some writers have claimed that if Azar is confirmed, “he would be the first Arab-American to be in Trump’s cabinet.”

Others have responded that Lebanese is not Arabic; Azar is “Greek-Orthodox from Amioun,” as Nassim Nicholas Taleb puts it.

Right Wing View

Azar’s defenders emphasize his experience with the Bush administration’ HHS.  In the words of Senator Orrin Hatch (R-Utah), “Mr. Azar has demonstrated that he has what it takes to lead the Department of Health and Human Services and that he will tackle the challenges facing the American healthcare system head on.”

Two former majority leaders of the Senate, Bill Frist and Tom Daschle, co-authored a statement about Azar. It said that both of these gentlemen “have come to know” Mr. Azar and that both believe him to be “a person of integrity and competence.” Frist (R-Tenn.) was Majority leader from 2003 to 2007. Daschle (D-S.D.) held the same post in the two years before that. Daschle was himself once a nominee for the post of HHS Secretary. President Obama put his name forward in 2009, but Daschle pulled out of consideration when the accuracy of his income tax returns came under fire.

Azar has said that if confirmed he hopes to “harness the power of Medicare to shift the focus of our healthcare system from paying for procedures and sickness to paying for health and outcomes.”

Mario Molina, a health care advocate and the president of Golden Shore Medical, a California chain of clinics, said before the hearing began that he hoped to hear how Azar plans to “tamp down politics and drama of the past year and get policies and programs refocus on improving access to care.”