When it's not your conscience they're talking about. When it's not your religious freedom the division serves to protect. When other people's "conscience" and "religious freedom" supersede your constitutional freedoms. And when it's your health care at stake.
President Donald Trump may have campaigned on a wall between the United States and Mexico, but his appointees are busily dismantling the wall between our secular government institutions and a particular strain of activist Christian evangelicalism.
To bolster its semantic credibility, the new division (its creation was announced last week) is situated within Health and Human Services' Office for Civil Rights
. We rely on that office to ensure fair and equal access to the care we need, from making sure that hospitals provide sign-language interpreters for deaf patients to demanding that nursing homes accept patients with HIV.
The office is led by Roger Severino, a Trump appointee who once worked for the Heritage Foundation, the conservative think tank, where he wrote a paper
excoriating Obamacare for trampling on the "freedom of conscience of many in the medical community." The piece explains exactly who he's concerned about helping, and it's not the patient.
Severino expressed worry
about institutions like hospitals that don't want to accommodate transgender people, or employers who don't want their insurance plans to cover gender reassignment surgeries when "doing so conflicts with their sincere beliefs." An extremely personal and agonizing choice such as an abortion might violate your employer's beliefs, for example. Even your birth control might make a corporation's holding family cringe in horror, as we saw in the Hobby Lobby case, in which the Supreme Court ruled that the owners of closely held corporations could opt out, on religious grounds, of covering contraceptives under Obamacare.
Severino pretended that the law could compel a surgeon to perform a gender reassignment surgery he or she felt unable to do. That's not a realistic concern. It's fundamental to the medical profession that doctors only perform medicine where they are personally convinced they are doing no harm, meaning they have the adequate skills and expertise to deliver the relevant service. A surgeon who doesn't want to perform a technique doesn't get trained in that technique, and doesn't seek clearance to perform it. Medical practice is rather different than decorating a cake.
The more realistic concern is if the physician staff of a hospital, able and willing to perform such procedures, found itself blocked by the religious beliefs of a board or administrative officers, or if individual ancillary staff at the hospital balked at providing postoperative support to such a patient.
But Severino's priorities extend well beyond blocking medical procedures for people he apparently doesn't value. He's eager to see health care providers freely disrespect their gay and transgender patients.
He wrote: "Gender identity and sexual orientation, unlike race or sex, are changeable, self-reported, and entirely self-defined characteristics. Government should not grant special privileges on such bases when legal recognition of a group as a 'protected class' is, with few exceptions, reserved for groups with objectively identifiable immutable characteristics." Presumably Mr. Severino thinks any religious values health care providers hold are more "immutable" than their patients' beliefs.
This latest Trump administration action is part of a slew of recent health care policies that our government is using to wage culture wars rather than treat health care as a vital service we all need.
Besides OCR's new Conscience division, we've seen the Republican government allow Medicaid work requirements
, and implicate Medicaid access
in the opioid crisis. We've seen the President appoint unqualified people
to key jobs in drug policy and health care agencies
, and propose slashing the budget of the Office of National Drug Control Policy
. The Trump administration even appointed a contraception opponent
to lead an HHS program involving contraception.
The unifying theme of it all is an anti-humanist mindset that equates any difficulty or need to a moral failing. If you're poor in America, or perhaps simply not rich enough to be entirely self-reliant (maybe you work for someone else rather than leading your own highly successful enterprise), everyone wants to be your judge and jury, chief among us a President who equates economic success with personal fulfillment and validation.
As President Trump celebrated himself in front of a crowd of global corporate leaders at the recent World Economic Forum in Davos, Switzerland, we're reminded who his government really cares about. Whether you're from a "shithole country," or are simply not a multimillionaire, the bottom line is that you're disposable.
There's nothing wrong with encouraging people to work. There's everything wrong with our government declaring that if you don't work, we'll let you die like the scum that you are. Decent people, and a decent government, don't predicate basic health care on whether or not we are employed, gay, female or transgender. Our president and his party make themselves out to be moral arbiters and are right now using our most essential government functions to play out this charade.
Health care is not a ministry, and it's not a golden opportunity for companies to rule their employees' lives. It is simply a precondition of life itself. Doctors and nurses make no attempt to judge the people we serve. But our government, mistaking itself for a higher power, wants that role. In turn, it is our government we must judge.