American health care leaders are not blameless today


It is a very sad day for America. Roughly 30% of our country is part of a quasi-religious cult. In general these people reject science and the enlightenment. This week the Jan 6th committee has shown they are prepared to use and support any tools or tactics–up to and including the overthrow of the government, in order to get what they want. 

The overturning of Roe vs Wade is the most visible artifact of a 40-year campaign. The campaign was funded by business leaders like the Koch brothers who want to revoke all environmental, labor and rational restrictions on their activities. Using dark money and the passion of religious zealots who want to control women’s bodies and discriminate against anybody who doesn’t believe what they believe, they have turned this nation back to the 18th century, using the Supreme Court as their vehicle.

The biggest of those dominos has now fallen and women’s right to control their own bodies has been taken away in most states. We can assume a nationwide ban (such as happened in Poland) will be coming here soon, maybe as soon as 2025 if the Republicans win the 2024 elections. And note that the rolling coup described by the witnesses at the Jan 6 hearings show that the Republicans are already blatantly taking over the supposedly neutral election process.

But the American health-care system is not blameless. Abortion and other reproductive health services are clearly part of health care. Yet uniquely in this country the provision of the services has not been from mainstream health care institutions. The leaders of our health care organizations, in particular our major hospital systems, have completely avoided delivering these services. They have been more than happy to allow Planned Parenthood and other specialist organizations to provide reproductive care, and have just looked the other way in the debate. 

Worse, many of our religiously affiliated institutions,  particularly those with a Catholic heritage which represent an enormous amount of hospitals in this country, have banned not only abortion but many other forms of reproductive health care such as female sterilization. The Hyde Amendment, ironically named after a religious bigot who was an appalling adulterer and hypocrite to boot, bans Federal funding for abortions. That means that private Medicaid plans which now cover most births in this country have never offered a full suite of reproductive health care.

Even in recent weeks when the fate of Roe became clear I have heard nothing from major leaders of hospital systems or health plans about this. Some of the newer provider organizations focusing on women, such as Maven and Tia, have been outspoken, as have many non health care-related employers. But the general silence from all major health care organizations in America on this topic has been deafening.

Today there is plenty of shame and blame to go around.

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4 replies »

  1. A Statement from The College of Physicians of Philadelphia
    on Dobbs v. Jackson

    When The College of Physicians of Philadelphia was created in 1787, its overarching goal was “to advance the science of medicine and to thereby lessen human misery.” With yesterday’s decision by the Supreme Court of the United States in Dobbs v. Jackson to overturn the 49-year precedent of Roe v. Wade, the College finds itself looking back on social and medical history and dreading what analysis of evidence shows the decision can mean for pregnant individuals, for physicians and other professionals who care for them, and for the health of the public at large.
    The Court’s decision, allowing states to effectively ban abortions, gives state legislatures tremendous power over a medical decision that should be made between a patient and her physician, in confidence and without government intervention. The restriction of reproductive rights has significant implications for access to reproductive services, as well as the potential for criminalizing healthcare services that internationally are considered a fundamental right. Allowing states to ban abortions will not ban all abortion, only safe abortions. The evidence is clear that lack of access to safe reproductive care will increase maternal mortality and also affect children and families. Restricting access will disproportionately affect individuals from historically disadvantaged communities and those without financial resources and will unnecessarily increase health disparities.
    Our mission to advance the cause of health while upholding the ideals and heritage of medicine includes critically examining the history of medicine, with its successes and its failures. History has shown that limiting access to healthcare results in dangerous alternatives and devastating outcomes, with complications that threaten mental and physical health. Patients and their physicians may now be forced to suffer while leaders who do not learn from history condemn us to repeat it. The future of reproductive healthcare is in jeopardy with the criminalization of medical practice, and we as physicians, healthcare professionals, and public health advocates voice our outrage at the current decision, and our dismay at its impact on future generations.

  2. The College of Physicians of Philadelphia issued a formal statement today

  3. Thanks for this, Matthew. The same holds true for the AMA and its Federation.

    On September 21, 2021, the AMA with 25 other medical organizations filed an amicus brief in opposition to the restrictive Mississippi abortion law, Dobbs v. Jackson Women’s Health Organization. On October 12, 2021, 19 medical societies, with the AMA in the lead, filed an amicus brief in U.S. v. Texas, the abortion vigilante law signed by Gov. Greg Abbott.

    But in the court of public opinion, there has been minimal investment of time and resources of their vast lobbying machine by these same medical associations over the past months considering all that is at stake in the upcoming Supreme Court decision.

    Attacks on women’s rights are the underpinning of current and future assaults on democracy. With women’s rights comes trust in physicians (and the patient-physician relationship) to help negotiate the individual and complex choices that come with child bearing. Loss of that trust could be the death blow to professional autonomy and societal influence that have been historic hallmarks of Medicine.