The vitally important election issue that almost no one discusses

Former North Carolina HHS Secretary and current Centers for Disease Control and Prevention Director Mandy Cohen testifies before the U.S. House Oversight and Investigations Subcommittee November 30, 2023 in Washington, DC. Cohen’s skillful work in North Carolina during the COVID-19 pandemic is emblematic of how the appointees of presidents and governors can be among their most impactful decisions. (Photo by Win McNamee/Getty Images)

American voters love to fall in love (or hate). When it comes to assessing our politicians and their qualifications to serve – especially those seeking chief executive jobs like president and governor – we tend to vote with our hearts.

Emotion-packed, reptilian brain questions — Do I like this candidate as a person? Do they look and sound like me? Do their speeches move me? What is their personal and family background? – play an outsized role in the decisions that many voters make.

And while substantive issues – Do they support abortion rights? What is their position on guns or climate change or racial equality or immigration? – can certainly influence some voters, it seems that hardly anyone bases their choices on a thing that is arguably a chief executive’s most impactful job: staffing and leading the government bureaucracy.

Think about it. When it comes to the day-to-day impact that government has on the lives of average constituents, it’s hard to top the importance of the people the president or governor selects to run the day-to-day operations of government.

Do they bring a commitment to the agency’s mission or are they ideologues bent on tearing it down? Do they have the people, political and managerial skills to shepherd a large bureaucracy or are they chiefly focused on grabbing headlines and advancing their own political careers? Can they fashion a working relationship with congressional and/or legislative leaders of a different party? Do they have the intelligence and intestinal fortitude to tell their boss they’re wrong? Will they stick around? Are they corrupt and on the make?

In recent years, we’ve seen high-level appointees in Washington and Raleigh who ended up on the positive and negative sides of all of these questions.

Here in North Carolina, the leadership of one very large and important state agency stands out as a classic recent example of how appointees can make a big difference.

In 2013, after winning the governorship, Republican Pat McCrory selected Dr. Aldona Wos – the spouse of a wealthy GOP donor — to lead the state department of Health and Human Services. At first blush, it seemed a creative and potentially innovative selection. Wos, who resided in Greensboro, was a physician and an immigrant with an interesting personal story. She had served as an ambassador in eastern Europe during the administration of President George W. Bush.

But within a short time of assuming the helm of a complex agency with numerous divisions and thousands of employees, it became clear that Wos lacked the background, skills and temperament to lead. She hired inexperienced political operatives, a high-priced outside consultant from her husband’s company, and a conservative social warrior at handsome salaries to handle jobs to which they brought questionable qualifications. She muddled through a series of IT snafus, and abetted the disastrous GOP blockade of Medicaid expansion, and just generally brought a steady diet of quirks and turmoil to the agency. When she resigned two-and-a-half years later, the chief reaction in most places was relief.

Now compare this to the leadership that Gov. Roy Cooper’s two talented HHS appointees – Dr. Mandy Cohen and Kody Kinsley – have brought to the job.

Despite facing the massive and unenviable task of leading the agency through the COVID-19 pandemic, Cohen excelled. Her calm leadership and science-based policies saved the lives of thousands of North Carolinians. Indeed, one shudders to imagine what would have happened had Wos still been at the helm of HHS during the dark winter of 2020.

Cohen also ably oversaw the transition of the state’s Medicaid program to a managed care model and, despite obvious differences, worked relatively well with the Republican-led legislature. It was no surprise after she departed in 2021 that President Biden tapped Cohen to lead the national Centers for Disease Control and Prevention.

Kinsley has followed Cohen’s lead in numerous areas and done an outstanding job of overseeing Medicaid expansion.

But the contrast between the different leaders at HHS is hardly unique. We’ve seen a similar pattern at work in Washington in recent years, where President Biden’s selections to lead various agencies – Antony Blinken at the State Department, Janet Yellen at Treasury, Attorney General Merrick Garland, Lloyd Austin at Defense, Pete Buttigieg at Transportation, Michael Regan at EPA – have brought a welcome degree of sobriety, stability and competence to cabinet agencies at which turnover and turmoil were a constant during the previous administration.

And this isn’t a mere partisan observation. One need only turn back the clock and recall the command that one-time Secretary of State James Baker III brought to the Reagan and first Bush administrations or, here in North Carolina, the basic competence that Republican HHS Secretary Lanier Cansler brought to the administration of former Democratic governor Bev Perdue, to confirm this truth.

In the end, of course, the things candidates say and the images they project will be the top factors for most voters in the current election. But to gauge what each candidate might actually do in office, few things provide a more useful bellwether than a careful look at the people with whom they surround themselves during the campaign, and those to whom they are likely to turn come Inauguration Day.