"Managing the unmanageable" the U.S. Department of Health and Human Services, 1989-1993.

The author served as the 17th U.S. Secretary of Health and Human Services, from March 1, 1989 until January 20, 1993. The department had 250 programs and 38 percent of the expenditures of the federal government ($600.0 billion), the fourth largest budget in the world. The history of the department included the fact that the tenure of previous Secretaries had ranged from only eight months up to 37 months, and had averaged 27.5 months, resulting in the view that the department was unmanageable. The author's tenure as Secretary was 47 months, and, in the author's view, the department was indeed manageable. The United States Department of Health, Education and Welfare (DHEW) was created as a cabinet agency in 1953, during the administration of President Dwight D. Eisenhower. The Department was formed by bringing together the Social Security Administration (founded in 1935), the United States Commissioner of Education, and the United States Public Health Service (founded in 1798) to serve the United States Merchant Marines). This new cabinet department contained the nation's major domestic programs concerned with income security, public health and education. Oveta Culp Hobby of Texas was the first Secretary of the Department. By 1989, the department's programs had increased to more than 250, including Medicare, Medicaid, Headstart, Welfare, and others. During the administration of President Jimmy Carter, the Education programs were separated into a new cabinet agency, the U.S. Department of Education, and the name of the U.S. Department of Health, Education and Welfare became the U.S. Department of Health and Human Services (DHHS).