Dusty Johnson may be surrendering his frontrunner status in South Dakota’s gubernatorial race by handing his Republican primary opponents an easy attack line: Dusty Johnson wants bigger government!
When a moderator asked the candidates what they would do to reduce maternal and infant mortality rates, U.S. Rep. Dusty Johnson of Mitchell pledged to create a state surgeon general position. He said the state needs “somebody who can think in an innovative way about how to better deliver care.” He also pledged to move the management of government-funded health care for low-income people, known as Medicaid, from the state Department of Social Services to the state Department of Health so it could be treated like a “health care program” instead of a “welfare program.”
Moving Medicaid from Human Services to Health poses no problem, but the comment in Monday’s GOP candidates’ debate on SDPB about creating a big new government job is an invitation to Larry Rhoden, Jon Hansen, and/or Toby Doeden to make mean little tweets.
I can find only five states that have surgeons general: Pennsylvania (which created the first such state-level position in 1996), Arkansas, Florida, Louisiana, and California. Michigan tried surgeon generaling for a few years but eliminated the position in 2010.
Surgeon and Cato Institute fellow Jeffrey Singer argues that Trump’s failure to fill the federal surgeon general position shows that the federal government could follow Michigan’s example and do no harm:
…Americans have gone over 430 days without a “nation’s doctor,” as the surgeon general is often called—and few, if any, have noticed. That should raise a more fundamental question: not who should serve as surgeon general, but whether we need one at all.
The surgeon general and the U.S. Public Health Service Commissioned Corps are vestiges of a bygone era—institutions that persist not because they are essential, but because they have never been seriously reconsidered. Today, federal public health activity is dominated by sprawling agencies like the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health. The surgeon general’s role has diminished to mainly a national spokesperson, issuing advisories that are more symbolic than practical—and that can become a platform for unnecessary political and cultural conflicts.
The Commissioned Corps, for its part—formally led by the surgeon general, though ultimately overseen by the assistant secretary for health—maintains the trappings of a uniformed service but performs functions that largely overlap with those carried out by other federal, state, and local health agencies. However well-intentioned, they add another layer to an already crowded public health apparatus. The past 430 days have offered an unintentional experiment—and the results are telling: The system continues to function just fine without a surgeon general.
…And the office itself is hardly indispensable. President Lyndon Johnson effectively eliminated the position during his administration. Unfortunately, in 1979 the breakup of the Department of Health, Education, and Welfare into the Department of Health and Human Services and the Department of Education caused the position’s resurrection. That history makes something clear: The surgeon general is not a cornerstone of the public health system; it’s a legacy position that persists largely because no one has seriously asked whether it still needs to exist [Jeffrey A. Singer, “America Has Gone More Than a Year Without a Surgeon General. Has Anyone Noticed?” Reason, 2026.04.01].
As Louisiana demonstrates, a state surgeon general may just promulgate RFK-style anti-science rather than the innovative care delivery Johnson blurbs. Maybe pledging to appoint Allen Unruh to the position would boost Dusty’s primary score, but on face, creating another Cabinet-level position smells of government bloat.
And smell is all it takes to beat up a primary opponent. In the 2018 GOP gubernatorial primary, Marty Jackley said he’d have more volunteer commissions and task forces to get ideas on pheasants and economic development, and Kristi Noem hollered big government! and beat Jackley in June. Noem’s successor Rhoden could easily take that page from his benefactress’s playbook and reassert himself as the one true conservative in the race, leaving Johnson sputtering in defense of a new government job for which there hasn’t been much popular demand.
Dusty, you’d save more lives if you would Amendment 25 your buddy DJT. You gonna seek his endorsement?
Use an agentic animated AI cartoon character for the new Surgeon General position and save money. Make it LEGO.
Wyoming dumps tons of mercury and other heavy metal oxides every year on South Dakota from coal burning power plants and researchers at the South Dakota School of Mines know most of the toxins in the state’s lakes have precipitated from emissions released by plants in North Dakota, Montana and Wyoming. And, if South Dakota had a Democratic attorney general she’d sue those states for the poisoned legacy created by Colstrip, Basin Electric and Black Hills Energy. One of the most polluted reaches of the Belle Fourche River goes right through current Republican Attorney General Marty Jackley’s boyhood ranch.
So pick your poisons, Republicans.
Since Republicans want women’s health issues to be limited and on a public and political stage, perhaps a surgeon general could help that operation along. Republicans don’t want Medicaid, so maybe a surgeon general could slice that program to bits. Dusty’s head is up his butt and even a surgeon general can’t help with that.
We haven’t had a real President for over a year either. We definitely need one.
A surgeon general in South Dakota. Its a doctor do little position for sure.
This General Surgeon idea is just more bloat to hire a fatcat crony into a position that will need more minions to serve them and create more meaningless red tape for the citizens.
grudznick hoped better from young Mr. Dusty. Roll some heads, don’t add more.