Almost two months after his first secretary of Health and Human Services (HHS) stepped down, Donald Trump has finally nominated a replacement: Alex Azar, the former president of Eli Lilly’s operations.
Azar’s name is not widely known outside Washington, or even particularly well known here inside the Beltway. He’s an interesting choice, not just because of his background as a pharmaceutical executive, but also because of what his nomination suggests the administration has learned over the past year.
When Trump came into office, promising to “drain the swamp,” supporters hoped that he represented a new era in Washington, one in which the apparatchiks of the old regime would be replaced by outsiders — business people, insurgent populists like Steve Bannon, and, I guess, minor celebrities like Omarosa. The president has indeed brought such outsiders, and the expected chaos. But the swamp has not been drained.
There are two areas where Trump supporters can point to meaningful progress. The first is the appointment of judges. A lot of people who didn’t support Trump in the primary nonetheless pulled the lever for him in the general election, because they wanted more conservative judges on our nation’s courts, particularly the highest one. Those people got at least one thing that they wanted.
The other area where the Trump administration can point to achievements is in regulatory reform. These achievements are modest, to be sure, not the fulfillment of the swashbuckling “burn it all down” hopes that were sometimes expressed. But at least in some agencies, a reformist agenda is moving forward. Perhaps ironically, those places tend to be run by denizens of the swamp, like Ajit Pai at the FCC and Scott Gottlieb at the FDA.
It would probably surprise a lot of people to hear that some of the most effective work of the Trump administration is being done by the very insiders his campaign so denigrated. And yet, it’s entirely predictable. The romantic notion of the outsider who comes in and shakes things up? It rarely works in real life.