HEALTH CARE/Joan Retsinas

Principles Override People

The People-Be-Damned awards go to the righteous folk who barrel ahead with a Principle, regardless of the impact of victory, regardless of the spike in more than a few poor souls’ Misery Index. The hallmark of the winners: they don’t care. If people suffer, so be it. The victims are collateral damage, suffering in the name of The Principle. Here are the winners.

Rep. Denny Rothberg (R-Mont.) is holding high the principle of Hard Science vs. Soft Science. Specifically, he wants the Food and Drug Administration to rescind its troublesome restrictions on the substances included in tobacco. Under Soft Science, the congressman includes considerations of “cost and consumer behavior.” Hard science implies total certainty, backed by the kind of double-blind experimental studies that are rarely possible in the real world. The reliance on Hard Science would return menthol to cigarettes. The Hard Science take is that menthol-flavored cigarettes are not more harmful than the non-flavored kind. But a team of scientists recognized the still-real dangers: menthol-tinged cigarettes are especially alluring, especially addictive, to young neophyte smokers. So two years ago Congress, in a bipartisan measure, allowed the FDA to ban menthol. Anti-smoking and public health groups cheered. Rep. Rothberg’s rider would re-open the gates to menthol. Teenagers be damned.

The other Republicans on the House Appropriations Committee deserve awards. They too embrace Hard Science. The FDA wants to limit the use of antibiotics in the pigs, cows and chickens that we eventually eat. But in directions to the Department of Agriculture, the House Republicans want to nix that initiative. Scientists have blamed the rise of antibiotic-resistant bacteria on the over-use of antibiotics in humans as well as in livestock. But these solons have argued for Hard Science: can we definitively prove beyond any doubt that antibiotics injected into our meat-source contribute to the rise of resistant bacteria? Not surprisingly, the tobacco companies, coupled with the livestock producers, are lauding The Principle (fortuitously for them the Principle dovetails with the Principle for profit). The public be damned.

Indiana Gov. Mitch Daniels, with his Republican state legislature, should take a bow. Daniels, along with a lot of the voting public, abhors abortion. That is their moral choice. Furthermore, they don’t want government money to pay for abortions. In a democracy, the majority of taxpayers can rule on the use of government money and, in the charged debate over abortion, the government will not fund most abortions. But the federal government’s Medicaid program does allow women to seek care from “any qualified provider.”

Planned Parenthood is a qualified provider. It provides women with Pap smears, breast exams, treatment for sexually transmitted diseases and contraception. Planned Parenthood offers abortions, but that is a minor offering.

Nevertheless, the governor of Indiana wants to bar the use of Medicaid funds for Planned Parenthood, totally. It is the Principle. The federal government has challenged Indiana; the courts will rule. Meanwhile, the 9,300 Indiana women who depend on Medicaid – they-be-damned.

CIGNA gets the last award. Fourteen years ago the health insurance company altered its pension plan, notifying employees of the change, which the company touted as an improvement. Over 25,000 employees, who would suffer from the improvement, sued (Amara v. CIGNA). They said that the company hadn’t lived up to its promises. The case meandered through the courts, raising concerns among health care and disability advocates. If a company could downgrade its pension plan with impunity, it could downgrade other benefits. Recently the Supreme Court ruled for the employees: CIGNA will have to make good on its promised benefits. A company that lies, or “misrepresents,” the facts may need to pay up. But – a huge but – the question of an employer’s obligation to be candid remains in discussion. Unanimously the Supreme Court ruled that the summary document presented to employees need not jibe with the actual plan. Employees should look to the plan, not the summary, for the facts. That opens the door for summaries that omit, or obfuscate, key details. For CIGNA, the Principal is clear: Management rules.

A Principled life can be cruel. The Public-Be-Damned awards go to people courageous enough to be cruel.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.

From The Progressive Populist, August 1, 2011