WASHINGTON – It's not a glitzy job. In fact, it's kind of boring. But these days, the Office of the Surgeon General is at the center of a political storm -- as Republicans stall the president's pick for the post of America's top doc.
The controversy over nominee Vivek Murthy, though, raises two questions: Who would he replace, and does America even need a surgeon general anymore?
The answer to the first question is Rear Adm. Boris Lushniak, not a household name since his appointment by President Obama last July.
But the answer to the second question is open for debate.
While the title of surgeon general is considered prestigious, it actually doesn't carry much clout. The responsibilities have morphed from making sure members of the Navy had access to medical care in the 19th century to acting as part-cheerleader, part-national nanny ready at a moment's notice to push the president's pet projects.
"They nag us to stop smoking, lose weight, always use a condom and exercise more," Michael Tanner, senior fellow at the Cato Institute, told FoxNews.com. "It's not the government's job to tell us these things."
Tanner argues those health reminders might be better off coming from private groups, as opposed to a surgeon general, whose $181,500 salary is funded by taxpayers. The budget for the Office of the Surgeon General also has grown in the past five years to $2.3 million in 2014, from $1.5 million in 2010, according to the Department of Health and Human Services.
"The American Lung Association can tell us not to smoke. Alcoholics Anonymous can preach sobriety. The American Lung Association can lecture couch potatoes on the benefits of losing weight and exercising more. Planned Parenthood and the Family Research Council can fight it out over when and how we should have sex," Tanner said.
With Murthy's nomination on hold for now, a closer look into the surgeon general's job shows how the role has changed over the decades.
Often referred to as "America's doctor," the surgeon general also is the top officer in the U.S. Public Health Service Commissioned Corps, which is made up of about 6,700 people who work in a handful of government agencies including the National Institutes of Health and the Food and Drug Administration. The commissioned corps' operating budget is not part of the Office of the Surgeon General budget.
As a political appointee, the surgeon general ranks three levels below a presidential Cabinet member -- in fact, the position doesn't even report to a Cabinet member but instead to an assistant health secretary.
Most of America's past surgeon generals have quietly gone about their duties with varied success during their time in office.
The country's first surgeon general, Dr. John Woodworth, was appointed by Ulysses S. Grant in 1871. The title at the time was called "Supervising Surgeon of the Marine Hospital Service." The Service had its origins in a 1798 Act of Congress "for the relief of sick and disabled seamen."
Since then, surgeon generals have had success in promoting awareness on the health hazards of smoking as well as AIDS -- and in doing so, have raised the profile of the office.
On Jan. 11, 1964, Surgeon General Luther Terry released a landmark report that said smoking cigarettes caused illness and led to death. Moreover, he said the government should do something about it. At the time, more than 42 percent of U.S. adults smoked. Cigarettes were allowed in restaurants, airplanes and office workspaces.
Terry's report led to Congress requiring all cigarette packages to carry a surgeon general's health warning in 1965, and led to banning cigarette ads on TV and radio stations in September 1970. A 1958 Gallup poll found 44 percent of Americans believed smoking caused cancer. A decade later, the number had jumped to 78 percent -- signaling a major shift in public thinking.
While Terry's cancer cautions swayed public perception, the role and responsibilities he held as a surgeon general weren't widely known.
"For years, no one ever knew the name of the surgeon general," Tanner said. "That all changed with C. Everett Koop."
Koop, a Republican pediatric surgeon appointed by President Reagan, used the media to move his messages on AIDS and smoking from political issues to national health priorities.
In 1986, Koop wrote a controversial report about AIDS which debuted to both widespread acclaim and criticism. Koop, who wrote the report himself in his basement, allayed growing fears that AIDS could be spread casually. His report, which wasn't exactly embraced by conservative politicians or his boss Reagan, pushed for a national education campaign on the topic and increased use of condoms.
Koop's report was "crucial in changing public understanding of the disease," according to the National Library of Medicine. "First regarded as a devastating pandemic necessitating mandatory testing and quarantine, the public now conceived of AIDS as a chronic disease, treatable and survivable, and one that did not exclude its carriers from full participation in society."
But since Koop's day, the surgeon general hasn't made as much of a splash.
In 2004, the office released a report on bone health and osteoporosis. In January 2011, Surgeon General Regina Benjamin released "Call to Action to Support Breastfeeding," which outlines steps to "remove some of the obstacles faced by women who want to breastfeed their babies."
But other health agencies, particularly with the passage of the Affordable Care Act, have taken on a much higher-profile role in recent years. Arguably, first lady Michelle Obama's anti-obesity "Let's Move!" campaign is far more influential than the surgeon general's current "Every Body Walk!" initiative.
One candidate who could have brought some celebrity to the job, CNN's Sanjay Gupta, withdrew his name from consideration back in 2009. Rather than signing up for the public health PR post, Gupta opted to keep running his health media empire -- whose most recent contribution was a feature on Tabasco sauce.
Under ObamaCare, the office did get an additional responsibility. The law designated the surgeon general as chair of the new National Prevention Council.
The influence of the post depends, in large part, on who occupies it.
"For the position to matter, the surgeon general should be a weighty independent, accomplished health leader, respected across the political spectrum at home and abroad," Dr. Bruce Lawrence, a board certified pulmonary and critical care internist in Seattle, wrote in an opinion piece in USA Today late last year. "The role can be key in forging a consensus to bring science and compassion in medicine to the forefront in health policy even when politics might get in the way."
The White House was evidently looking for a vocal advocate for its public health policies when President Obama tapped Murthy, a 36-year-old Harvard-educated doctor who also backed the Affordable Care Act, as the next surgeon general.
But the White House is now slowing that confirmation push amid resistance from Republicans and nervousness among Democrats facing reelection.
The National Rifle Association earlier announced it opposes Murthy's nomination, saying he supports tighter restrictions on gun control. So far, 10 Democrats are rumored to be opposing Murthy -- enough to stall the nomination for now.
The Office of the Surgeon General did not respond to requests for comment for this article.