“First, do no harm.”
That phrase is often associated with the Hippocratic oath, which every physician learns on entering medical school. Though it’s not explicitly stated in that oath, it remains a guiding principle throughout our careers: Does the benefit outweigh the risk?
We are not politicians, lawyers or Supreme Court justices. It is not in our domain of expertise to interpret the law or to legislate. However, we would posit that “first, do no harm” is applicable to all public servants. The recent passing of Justice Ruth Bader Ginsburg brings this into sharp focus.
What does it mean for a politician to “do no harm”? For a Supreme Court justice?
It has been a long-standing tenet of conservatism that there is no guarantee in the Constitution of the right to health care. When programs such as Medicare and Medicaid were first proposed in the 1960s, they were opposed vociferously by conservatives, who even then labeled those programs as a path to socialism.
In response to the rising success of the Affordable Care Act in the marketplace, Republicans introduced legislation in 2017 to “repeal and replace” the act. That effort — backed by President Donald Trump — was famously torpedoed by Sen. John McCain’s thumbs-down.
Denied a legislative victory, conservatives turned in 2018 to the courts. Their target: the Affordable Care Act’s individual mandate, which required Americans to have at least minimal health insurance or pay a penalty.
When that penalty was set to zero dollars in the 2017 Tax Cuts and Jobs Act, conservatives began to argue that the individual mandate was no longer valid. Further, they argued that the individual mandate could not be separated from the law as a whole, and therefore the entire Affordable Care Act should be struck down.
In 2018, two Republican governors and 18 Republican attorneys general initiated a lawsuit, California v. Texas, challenging the validity of the Affordable Care Act on the above grounds. Trump has repeatedly voiced support for this court challenge.
It now has reached the Supreme Court, with oral arguments to be held Nov. 10 — just a week after the presidential election.
Let’s be clear. If the Republican case prevails in the Supreme Court, the ensuing loss of preexisting condition coverage will deprive more than 50 million Americans of reliable health care coverage (COVID-19 likely will count as a preexisting condition, too).
The unfulfilled promises of the current administration to provide coverage for preexisting conditions flies in the face of the long-standing conservative mandate to keep the federal government out of health care. Those with preexisting conditions will pay more for coverage. A lot more. Most likely, prohibitively more.
An executive order Trump signed Sept. 24 has little practical impact. It merely says it “has been and will continue to be the policy of the United States” to “ensure that Americans with preexisting conditions can obtain the insurance of their choice at affordable rates.”
It lacks credibility. There can be no GOP health care plan that actually covers preexisting conditions in any substantive way. The inescapable fact is that preexisting conditions cost money to treat. And money is what conservatives refuse to commit to spending on health care. Many millions will lose health care coverage and could face financial ruin because of medical debt, or risk needless suffering and death. The COVID-19 pandemic has made these realities all too clear.
Enter the wolves. Many with inexpensive, so-called “skinny” health insurance plans have already learned the hard way — when faced with bills they were led to believe would be covered — that the conservative version of affordable insurance is more facade than factual.
Patients will face a return to the days of insurance companies finding ever more creative ways to attract the premium dollars of the healthy while denying coverage to those who actually need care. Employer-sponsored insurance is only helpful if you can stay healthy enough to keep your job. That is, if your position even provides a health insurance benefit at all.
Are conservative politicians acknowledging the wisdom of that credo — “First, do no harm” — to their constituents? It would seem not. Can we hope for better from the judicial system?
The Trump administration has filled judicial slots with judges of a conservative persuasion. California v. Texas initially was deemed a frivolous lawsuit. It is a very tenuous thread to say that a zero-dollar penalty is not a tax and thus the individual mandate is not only invalid but also inseverable from the Affordable Care Act as a whole, and so the entire law is invalid. But that argument is now a very real threat to the law’s survival. Even before the passing of Justice Ginsburg, the fate in a 5-4 court balance rested with Chief Justice John Roberts.
In a 5-3 court without Justice Ginsburg, or a 6-3 court if nominee Judge Amy Coney Barrett is pushed through by a hypocritically partisan GOP Senate, then the Affordable Care Act’s demise is an all too real possibility. If a court that conservative had been the nation’s highest court in the 1960s, would Medicare exist today?
Vote for a president who will “first, do no harm” to your health insurance coverage. If you like Medicare and Social Security, or benefit from Medicaid, don’t yield to the GOP’s cries of “socialism.” There are many paths to universal coverage. Every major Western economy has found workable solutions. All have their fair share of challenges, but none of them turn their backs on their citizens in times of greatest need.
We can do better. But first, our elected representatives and judges must agree to do no harm. On Nov. 3, vote for Joe Biden and Kamala Harris. And please vote safely. If by mail, then as soon as you receive your ballot. If in-person, then avoid long lines, wear a mask and sanitize your hands.
Dwight Eichelberger, M.D., practices family medicine and resides in West Donegal Township. This op-ed is co-signed by Ajay Marwaha, M.D.; Alan S. Peterson, M.D.; Stephen T. Olin, M.D.; Lisa Allen, M.D.; Susan Ciampaglia, D.O.; Rebecca Shepherd, M.D.; Brian Jones, M.D.; Amit Varma, M.D.; Matt Wiggins, M.D.; Kanchana Herath, M.D.; Doreen Bett, D.O.; David Somerman, D.O.; Rolf Andersen, M.D.; Valerie Salmons, M.D.; Brian Young, M.D.; Nitin Tanna, M.D.; Ansar Khan, M.D.; Roddy Canosa, D.O.; Daniel Wert, D.O.; Kelly Reese, M.D.; Laurence Carroll, M.D.; Kara Jones, M.D.; Christopher Wenger, D.O.; and William Fife, M.D.