America Has Gone More Than a Year Without a Surgeon General. Has Anyone Noticed?

The article adopts a libertarian-inflected critique of government institutions, arguing for elimination or consolidation rather than reform. While the framing is presented as practical efficiency analysis, it centers a think-tank perspective (Cato Institute) and uses language emphasizing redundancy and waste ('legacy structure,' 'legacy position').

Primary voices: elected official, think-tank analyst, state or recognized government

• This article does not address the surgeon general's role during public health emergencies (e.g., COVID-19, monkeypox) or whether vacancy during crises would have measurable public health consequences.
• This article does not discuss why Trump chose to nominate Means or Nesheiwat, or whether political considerations (beyond resume issues) drove the nomination withdrawals.
• This article does not examine the Commissioned Corps' deployment during natural disasters, epidemiological responses, or other contingencies where a uniformed service structure may provide operational advantages.