Ethics in Politics: Reconstructing a Broken System
The year was 1988. I was serving as chair of emergency medicine at a community hospital in a steel town in the Upper Ohio Valley. A patient had a complex situation that raised issues in biomedical ethics. The chair of family medicine was the patient's primary care doctor. At the end of our discussion we agreed that our hospital needed an ethics committee to deliberate on such cases. We recruited the director of the ICU, and his wife, a medical ethicist, and we formed a committee.
In the nearly three decades since I have been immersed in the study of ethics: not just biomedical and professional ethics, but the ethics of human societies.
This immersion has convinced me of many things. One of these is that access to basic health care of high quality should belong to everyone living in American society. Right now it doesn't. We have an absurdly fragmented non-system for financing health care. You can have employer-based health insurance. You can be elderly or disabled and qualify for Medicare. You can be impoverished and qualify for Medicaid. You can be in the military service or a veteran and have access to care in that system.
But you can also have no coverage and no access. The United States is virtually alone among First World nations in having a significant segment of its population in that last category.
Here is what I think the situation should be in a society with sound ethical values that are put into practice: if you are a member of our species, and you are on American soil, we take care of you when you are sick or injured. You may worry that the world will flood America's borders with refugees desperately seeking health care, and you may want to find ways to prevent that. But right now we have nearly 30 million Americans without health care coverage and access, and tens of millions more whose coverage and access are woefully inadequate.
Why don't we have universal health care now? Is it because most Americans are cruel and heartless? Is it because most of the 535 Members of Congress, our Senators and Representatives, are unethical beasts who care not a whit about the common man?
We have some among us, and some in Congress, to be sure, who care too little about the have nots of our society. But a large part of this failure is the result of having a profit-driven health care system.
Think about it. The most efficient way to take care of absolutely everyone would be to have a uniform system, like Medicare, that covers all Americans. But that would eliminate the private health insurance industry, an industry that is very profitable. It would surely clamp down on prices charged by the pharmaceutical industry - an even more profitable sector. And those industries protect their turf by contributing to the election and re-election campaigns of the people on Capitol Hill who make these decisions.
The middle class family looking at eye-popping health insurance premiums, the struggling single mom who makes a little too much money to qualify for Medicaid, and the down-and-out homeless person living in a cardboard appliance box over a subway grate or sleeping under a bridge - these are all people with no political power because they are not part of the system of campaign financing.
These very same forces keep Members of Congress from doing the right thing in many other areas - including improving the environment and protecting consumers - because on the other side of those issues are corporations and wealthy and powerful individuals with their own agenda. And their agenda and ours are completely different.
The member of the House of Representatives elected by the people of my congressional district is a fellow named Tim Murphy. Over the years I have thought of Murphy as a decent and ethical fellow, even if he sometimes voted in a way that I thought was too friendly to corporations, especially those in the health insurance and pharmaceutical industries.
Then along came the American Health Care Act (AHCA) - the House version of the effort to "repeal and replace" the Affordable Care Act. According to the best available data, the number of non-elderly people in our congressional district who would be tossed out of the Medicaid program, promptly joining the ranks of the uninsured, is 37,000 - among a population of about 700,000.
That's right: more than 5% of the population kicked off their health insurance. And Mr. Murphy voted for that. I was shocked. Then I realized I shouldn't be. Those 37,000 people don't make campaign contributions. Heck, many of them probably don't even vote.
We must bring strong ethical values into our political system. We want our elected representatives to make good decisions: decisions that are best for all of us; decisions that give us cleaner air and water, that avoid atmospheric changes that will bring calamity to global climate and acidify the oceans; decisions that protect consumers from businesses that, driven by profit, would abuse them in an unregulated free market.
I couldn't help but notice that Murphy had no Democratic opponent in 2016 or 2014. Why should he vote anything except the Republican party line? I thought about that question, a great deal. And I decided I must do something to give him a reason. I must give the voters of Pennsylvania's 18th congressional district a choice.
And so I have filed with the Federal Election Commission to be a candidate for the Democratic nomination for this seat in the House. I have gathered smart, energetic, politically attuned people around me, people who are committed to bringing this kind of change to the system. And, because no race for a seat in Congress can succeed without funding, I have begun raising money. This is a grass roots campaign. No money from the corporate world will be flowing into my campaign treasury. There will be individual contributions and very little else. If a PAC that strongly supports universal healthcare wants to contribute, we will talk. But I intend to serve the interests of the people, not the powerful, and that is how my campaign will be funded.
In the latter third of the 19th Century this nation attempted a Reconstruction to include in our political system people who were left out by our original Constitution: people who counted as three fifths of a person for purposes of determining a state's representation in the House but who were not themselves citizens and did not have the right to vote. It is time for another Reconstruction, this time one that will bring back control of our government to all the people, and not only those who have the money to buy a share of it.
For more than three decades in the practice of my specialty of emergency medicine, I have been making human connections with people in crisis caused by illness or injury, from the well-to-do to the destitute, from Americans whose ancestors were among the earliest colonists to immigrants from Africa and Asia doing their best to communicate with me in very rudimentary English. You will not find many in the halls of government who know the people of the district as I have come to know them. I have come to know them, and I will do what is right for them in Washington, DC.
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