Tag Archives: HHS

The Parade of Horribles

Res Ipsa Loquitur is a legal term meaning “the thing speaks for itself.” Donald Trump’s personnel selections aren’t just speaking–they’re screaming.

Trump has chosen people for cabinet positions who are unalterably opposed to the mission of the agencies they would lead. It is difficult–okay, impossible–to imagine a more terrifying–or less competent– group of cabinet nominees.

Betsy DeVos wants to destroy public education, so Trump wants her to be Secretary of Education. Jeff Sessions is a (marginally) “kinder, gentler” white supremacist, so of course Trump wants him at the Justice Department. And my cardiologist cousin just sent me the following rundown on Tom Price, nominated to run Health and Human Services (HHS).

I’m not going to paraphrase it: I’m just going to share it. And then I think I’ll go throw up.

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This is a summary of an article appearing in the New England Journal of Medicine (Jan 12, 2017). With regard to the department of health and human services (HHS), only two previous secretaries have been physicians. For the most part, all of us physicians work to defend not only our own patients, but society at large against dangers to health, and in the process, usually eschew venal and self oriented goals. That is why most of us chose this respected profession of care-giving in the first place.

Let us begin by describing the good doctors: Otis Bowen, our former Indiana Governor, was Ronald Reagan’s second HHS secretary, and he engineered the first major expansion of Medicare, championed comparative effectiveness research and, together with Surgeon General C. Everett Koop, another exemplary physician, led the fight against HIV-AIDS. Louis Sullivan, HHS secretary under President George H.W. Bush, focused his attention on care for vulnerable populations, campaigned against tobacco use, led the development of federally sponsored clinical guidelines, and introduced President Bush’s health insurance plan, which incorporated income-related tax credits and a system of risk adjustment. All these aforementioned physicians, serving in GOP administrations, drew on a long tradition of physicians as advocates for the most vulnerable, were defenders of public health, and enthusiastic proponents of scientific approaches to clinical care.

Now comes the bad: In sharp contrast with these previous examples, Tom Price, Trump’s pick for secretary of HHS, shows a record that demonstrates less concern for the sick, the poor, and the health of the public, in favor of greater concern for the economic well-being of the rich and the care-givers themselves.

To exemplify this point, let’s enumerate his previous positions.

1. Price has sponsored legislation opposing regulations on cigars and has voted against regulating tobacco as a drug, in reality, this product is actually far worse than most drugs!

2. In 2007, during the presidency of George W. Bush, he was one of only 47 representatives to vote against the Domenici-Wellstone Mental Health Parity and Addiction Equity Act, which improved coverage for mental health in private insurance plans.

3. He voted against funding for combating AIDS, malaria, and TB, and against expansion of the State Children’s Health Insurance Program, and in favor of allowing hospitals to turn away Medicaid and Medicare patients seeking nonemergency care if they could not afford copayments.

4. He favors converting Medicare to a premium-support system.

5. He opposed reauthorization of the Violence Against Women Act, and has voted against legislation prohibiting job discrimination against LGBT people and against enforcement of laws against anti-LGBT hate crimes.

6. He favors amending the Constitution to outlaw same-sex marriage.

7. He opposes stem-cell research and voted against expanding the NIH budget and against the recently enacted 21st Century Cures Act, showing particular animus toward the Cancer Moonshot. Would he continue this stance if he developed cancer himself?

8. He is a leader of the repeal of the ACA (“Obamacare”) in favor of a regressive “plan” which, without going into details, will offer much greater subsidies relative to income for purchasers with high incomes and more meager subsidies for those with low incomes. In effect, Price’s replacement proposal would make it much more difficult for low-income Americans to afford health insurance, diverting federal tax dollars to people who can already afford it, and also substantially reducing protections for those with preexisting conditions. The end result would be a shaky market dominated by health plans that offer limited coverage and high cost-sharing.

9. Strongly anti-abortion and advocating the defunding of Planned Parenthood, he has accepted the validity of the fraudulently modified videotapes used against this organization—despite their many pro-health programs for the poor.

The HHS Department oversees a broad set of health programs that touch about half of all Americans. Over five decades covering nine presidential tenures of both parties, HHS secretaries have used these programs to protect the most vulnerable Americans. The nomination of Tom Price highlights a sharp contrast between this tradition of compassionate leadership and the priorities of the incoming administration.

I am not at all proud of this “fellow” physician!

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A Political Eddie Haskell

As I was driving to work yesterday,  NPR was broadcasting a snippet of a speech made the night before by Mitt Romney. That’s when it hit me. I’d been trying for weeks to pin down who it was that Romney reminds me of, and with the patent insincerity of that speech, it finally clicked.

Mitt Romney is the Eddie Haskell of politics.

Eddie Haskell, for those of you too young to remember, was the disgusting little sycophant on “Leave it to Beaver.” The character was so vivid, his very name became synonymous with dishonest sucking up.

In the speech fragment I heard, Romney was feigning outrage over the new regulations promulgated by HHS, requiring all employers who offer health insurance–including religious employers like hospitals and universities–to include coverage for contraception. As I previously blogged, there are legitimate concerns when government issues regulations that are intended to protect or benefit the general public when those rules run afoul of some folk’s religious beliefs. But there was no such nuance in Romney’s attack–not to mention any recognition of the fact that several states have imposed similar regulations for years. Nope, according to Mitt, Obama was purposely attacking religion, and he wouldn’t do that if he were President. No siree!

Let’s just deconstruct that attack.

Romney is a Mormon, and the federal government long ago outlawed polygamy. The effect of that prohibition was to deny Mormons the ability to live by what was at the time considered an essential tenet of their religion, yet Romney has never criticized that restriction–indeed, he has said he agrees with it. The HHS regulation, on the other hand, does not require anyone to use birth control in contravention of their religious beliefs; it merely requires them to make that option available to employees who come from different religious traditions and/or hold different beliefs. The regulation doesn’t apply to churches–just to large religiously-run organizations like hospitals and universities, where employees represent a wide diversity of backgrounds and faith traditions.

There are plenty of laws that have incidental effects on religious practices. For example,laws requiring schoolchildren to be vaccinated pose problems for Christian Scientists. Quakers believe they should not be required to pay taxes that support wars (the courts have not been receptive to that argument). Laws requiring photo IDs for driver’s licenses are a genuine dilemma for fundamentalist Muslim women whose beliefs require them to wear full burkas. (Somehow, I doubt Mitt would get too worked up over that one, since the base he is so shamelessly pandering to tends to be virulently anti-Muslim.)

None of these “attacks on religion” have merited even a passing mention from Mitt Romney.

That’s the problem with channelling Eddie Haskell. The insincerity overwhelms the message.

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God and Caesar

In his regular Monday e-letter today, noted theologian Martin Marty tackles the recent uproar over HHS regulations requiring religious institutions—including charities, hospitals and schools–to provide health insurance to their employees that covers some procedures with which their church and members disagree. He notes that this sort of conflict between government rule making and religious dogma is hardly new.

“We could have added any number of others that had to do with the collision of interests pitting “the common good” versus “individual freedom,” especially freedom of religion. Pasteurization of milk, vaccination, and chlorination of water were among them. Beyond the needs of the body but dealing with the body politic have been vast numbers of others: the military draft, Sabbath and Sunday laws, and compulsory flag-salutes were or are among them. Often small religious groups best raise conscience matters. Jehovah’s Witnesses, Christian Scientists, Scientist, Seventh-Day Adventists, Latter-Day Saints, the Amish. None of the issues could be resolved to everyone’s satisfaction, so majorities of voters or legislatures or justices ruled. This means that they used “coercion against conscience,” driving some citizens to inconvenience and prison. There were often accommodations and compromises along the way. Somehow the republic survived.”

 These are uncomfortable issues, because they don’t fall neatly into the American presumption that every argument has a “right side” and a “wrong side.” In these situations, policymakers are faced with a conflict of rights. 

Citizens have the right to believe as they see fit, although the practice of those beliefs has often been curtailed by the courts. You can believe in smoking peyote, for example, but if “laws of general application” forbid drug use, you can’t actually smoke it. (For what it’s worth, I think the Court was wrong in that case, but what if your religion required sacrificing your first-born? Certainly, the government could intervene.) The law requires parents to provide medical treatment to their seriously ill children even when their religion rejects such treatment.  Etc.

The conflict, as Marty points out, is between what we believe to be necessary for the public good and respect for the beliefs of all citizens. The resolution of that conflict requires us to exercise restraint–it is not enough to say “the majority of people want this.” The Bill of Rights is–as I keep telling students–a counter-majoritarian document. In America, the majority does not always rule. We are obliged to respect the beliefs and practices of people with whom we disagree so long as those beliefs and practices do not harm others.

What constitutes harm, as Marty reminds us, has been a matter of debate throughout American history.

In this case, the harm was to the many thousands of employees of religious organizations who don’t share that organization’s beliefs. Should a Protestant nurse working in a Catholic hospital be denied coverage for birth control, when such coverage is required in other places of employment? On the other hand, should the religious employer providing that insurance be forced to enable her use of contraception? What does respect for individual rights and religious liberty require?

I tend to feel the Administration made the right call on this particular issue, but in a country that truly respects religious autonomy, these conflicts between God and Caesar are never inconsequential.

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