WASHINGTON — Washington. THIS WEEK, Louis Sullivan announced the government's latest dietary guidelines, urging that Americans eat more fruits and vegetables. Surprisingly, his audience did not ask whether he would prevail on his boss, the nation's premier role model, to start eating broccoli.
People are kind to Dr. Sullivan, the secretary of Health and Human Services, because they understand that he must be embarrassed every day by the conflicts between his beliefs and his president's policies.
Mr. Bush's well-publicized loathing for broccoli is the least of it, a personal quirk good for a few laughs and perhaps a few votes. The rest of it is politics, which keeps colliding head-on with Dr. Sullivan's public-health concerns. The secretary handles the contrasts diplomatically; he doesn't try to be provocative. His conscience comes through in the nuances.
At breakfast, he waves away an offering of ham and eggs. Mr. Bush is, when the cameras are rolling and he is in his Bubba mode, a conspicuous consumer of cholesterol-laden pork rinds.
Dr. Sullivan shows up wearing in his lapel not an American flag or Masonic pin, but a no-smoking button. Mr. Bush doesn't smoke and does jog, so there is no lifestyle conflict with Dr. Sullivan's outspoken crusade against tobacco or his call for more exercise. The contradiction, again, is political.
The president himself makes no gesture against smoking or against tobacco subsidies, lest he offend a Jesse Helms voter. While the secretary will not say he considers Mr. Helms a hazard to health, he does say he and the senator ''are in diametrically opposing camps. Tobacco has no redeeming values. It is the only legal product that causes death.''
Neither will he comment directly on the current Supreme Court case challenging government regulations against abortion counseling in federally funded clinics. ''While we oppose abortion,'' he says, ''there is no question that pregnancy can be a threat to the life of the mother'' -- and in such cases it is a physician's responsibility to help.
He is an M.D. himself, the dean of Morehouse Medical School before Mr. Bush tapped him at Barbara's urging. Knowing that helps to read between his lines. He also is black, which helps to understand what he says about Mr. Bush's veto of the Civil Rights Act of 1990.
''I'm committed, as is the president, to civil rights,'' he says. Mr. Bush has been thus committed since his days in the Texas legislature and in Congress, he adds.
Perhaps Dr. Sullivan is inexpert about the president's record on this subject because he'd rather not know. In fact, Mr. Bush was never in the Texas legislature. When he ran unsuccessfully for the Senate in 1964, he opposed the most important civil-rights bill in modern history. His voting record in Congress was mixed.
About this year's bill, Dr. Sullivan says ''there is a legitimate question among lawyers'' about quotas, but ''I don't get the nuances.''
Those who hear him do -- and appreciate that he is trying to be loyal to the man who brought him to Washington without being disloyal to himself. And once listeners, e.g. columnists, get past that distracting tension, they hear Dr. Sullivan saying urgently sensible things about the state of the nation's health.
He is concerned that spending has tilted so far toward expensive high technology and curative medicine that preventive medicine, which can cut those expenses, has been short-changed. The greatest road to improvement is in health behavior, personal responsibility -- which must be taught.
Medical schools and older physicians are still more oriented toward surgery and radiation, for example, than to preventing cancer. A significant percentage of all medical spending is devoted to the last six months of life.
To Dr. Sullivan, smoking is the No. 1 health problem. Tremendous advances have been made against cancer, but the five-year survival rate with lung cancer is still only 5 percent. Smokers over 60 can still cut their cancer rate by stopping. He is campaigning for stronger warnings on cigarette packs, for banning sales to minors, for making every U.S. hospital, Health and Human Services grant institution and federal department smoke-free.
But he is no monomaniac. He notes the shameful fact that two-thirds of the Americans without medical insurance are workers. He has a list of ways to make coverage broader and cheaper. His ''guiding principle'' is that every American should have access to basic medical care. He may be lonely, but he is much more than a token presence in Washington.