The Problem with “Principle”

Principles are necessary “rules of the road” for human and social conduct. We consult our guiding principles when we encounter real-world problems, in an effort to craft solutions that will be both practical and just.

When principles lose their connection to the real world, however, they lose their ability to guide us to good decisions.

There are a couple of ways principles get divorced from reality. One example was the Supreme Court’s decision in Citizens United. The Court applied an important abstract principle—upholding the widest possible marketplace of ideas—without a proper appreciation of the messy realities of money and American politics.

Isolation from the nitty-gritty of politics goes a long way to explain the Court’s disconnect from the likely real-world consequences of decisions like Citizens United. A different kind of isolation from reality can be seen in the ferocious attack by Republicans on the very idea of universal healthcare–what they contemptuously call “Obamacare.” It’s what happens when principles harden into rigid ideologies, and defending those ideologies becomes more important than solving real problems.

Recently, a friend emailed me to ask a question about the Komen/Planned Parenthood controversy. Her interest was more than casual: she has breast cancer. And as she explained,

“My husband and I are on the mend now but found ourselves in a terrifying situation. I was diagnosed in June, had my lumpectomy and chemo, radiation.  In the middle of all of this Tom had chest pains. He was in heart failure and could have died.  He had emergency open-heart surgery to correct a birth defect he had no idea he had.   The doctor replaced his aortic valve because it had 2 flaps instead of three. No blockages fortunately.

I am ashamed to admit this but we have no health insurance. This is because we are both self-employed, not part of a group, so our premiums increased yearly until we could no longer afford the $1700 per month premiums.

We thought we might even have to divorce to protect our home from creditors due to medical bills. We both have always worked hard and paid our bills but this was beyond our control.

 Through the Little Red Door we found Indianapolis Medical Society Project Health. They helped us both financially. Without them I do not know what we would have done.”

 According to the Medical Society’s website, Project Health is a community partnership to improve access to health care for low-income, uninsured residents of Indianapolis. It combines donated physician care, hospital services, medication assistance, and case management in order to wring the most out of existing community resources and service providers so that patients can receive timely and appropriate care.

Project Health and other nonprofit organizations make a valiant effort to help the uninsured, but in the real world, there is simply no way the nonprofit sector can address the needs of the estimated 45 million Americans who have no health insurance.

I have my own “principled” critique of the Affordable Care Act. It’s far from perfect. But it is an effort to help real people with real problems in the real world.

What I’d like to say to the (well-insured) politicians intent on mischaracterizing, savaging and repealing “Obamacare,” is this: It is entirely appropriate to suggest alternatives, to offer proposals that would improve coverage and efficiency. It is entirely appropriate to acknowledge that regulations accompanying universal coverage will generate conflicts of the sort we’ve seen with the recent flap over contraception, and to try to minimize those.

What is neither appropriate nor humane is your insistence that people continue to suffer and die for your political “principles.”