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Heedless Policy Cruelty



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In a recent commentary, Rebecca Powell-Doherty explored a marked social injustice perpetrated by major American health care institutions.[1] Powell-Doherty discovered an odd situation in the human rights and medical consent literature, in which major organizational actors, including the U.S. Food and Drug Administration (FDA), were willing to permit actions in developing nations otherwise considered unethical in the United States in drug testing protocols. Here is how she put the question she examined:

The currently agreed upon ethical standard, known as clinical equipoise, is that a placebo group is not appropriate if an approved treatment for the same disease or condition exists, and indeed, should a pharmaceutical company attempt to bypass this requirement in a study taking place in the United States, regulatory intervention would be swift and the penalty or cost imposed would be significant. Biomedical researchers are required to provide the existing standard as a baseline of care and determine whether the new treatment constitutes an improvement compared to the old, rather than with respect to nothing at all (a placebo). The ethical principles governing this specific issue are beneficence (efforts to ensure that benefits outweigh risks) and non-maleficence (do no harm).[2]

Nonetheless, she found that officials at the FDA, National Institutes of Health and Centers for Disease Control endorsed a series of pharmaceutical trials in developing nations sponsored by a drug company that deliberately eschewed the United States accepted ethical standard on the argument that the populations of those countries did not have access to the same level of care in the first instance. This stance violated long accepted moral injunctions and medical practice, and it did so ultimately by embracing a perspective that those from other nations may not be accorded the same value as human beings as those in the United States. In the calculated view of these institutions’ officials, such populations were not worth the investment of the cost of otherwise attainable U.S. treatment. This situation constitutes a moral and ethical outrage and a clear abrogation of the human rights of those it targeted.

I have been reminded of Powell-Doherty’s argument as I have reflected on President Donald Trump’s recently proposed budget outline, and on the moral and ethical travesty of his and the GOP House leadership’s determined efforts to obtain a vote this past week to repeal the Affordable Care Act. Each of these initiatives bespeaks an impoverished moral and ethical vision and a willingness to visit cruel harm on entire swathes of the population in the name of tax abatement for the wealthy. Each also ultimately reveals a cynical and ethically corrupt view that only rich citizens matter. These blueprints also represent a hubris that such costs can be exacted with impunity on those suffering them, since those groups can be manipulated by carefully wrought appeals to other fears and values to cheer for their imposed fate. Ironically, these officials seem confident that they can frame these ugly choices as necessary to prevent government-perpetrated injustice, or to punish “others” who allegedly have gained undue benefits at the public’s expense. President Trump and House Speaker Paul Ryan have been personally willing to lie about the implications of their policy choices, apparently on the view that voters ultimately will believe them and/or will not hold them accountable for their sordid behavior.

The President’s recent outline of budget proposals treating proposed discretionary federal expenditures called for draconian cuts in a wide range of such programs that play major roles in assisting the disadvantaged and vulnerable in the United States and beyond. Trump recommended the following:

  • A 16 percent reduction in federal education programs, a major share of which assist those with disabilities of various sorts,
  • A 29 percent reduction in Department of State and other development programs, especially those aimed at improving the lives and livelihoods of populations living in deep poverty in other nations,
  • A 12 percent reduction in Department of Housing and Urban Development programs, many of which seek to assist those who are homeless or require support to afford decent housing or live in disadvantage neighborhoods or communities
  • A 21 percent reduction in Department of Labor programs designed to ensure safe conditions and equitable treatment of the nation’s workforce,
  • A 16 percent reduction in Department of Health and Human Services programs, many of which are aimed at providing support for vulnerable populations, including women, infants and children.[3]

These recommendations were significant for their radical character and for their extremely harmful impacts on the populations they serve, were they to be enacted. They were also noteworthy because the President had given few hints during his campaign that he would offer a set of changes in national priorities with clearly negative implications for the millions who had voted for him. The important points about this proposed blueprint are its outsized impacts for the nation’s vulnerable populations, and the arrogance and utter disdain for those groups that it represents. In short, the Trump budget outline exhibits a willingness to distinguish between a “valuable us” and a “discardable them,” similar to that which national health officials evidenced in Powell-Doherty’s analysis. Like those representatives’ actions, the President’s budget priorities embrace steps that will redound to the deep detriment of those targeted as “less than” or unworthy of support and assistance or equal treatment.

President Trump and the Republican Party in the House of Representatives have recently provided another example of a profound willingness to wreak serious harm on their constituents while lying about doing so, and then celebrating their action as a signal positive achievement. In fact, what Trump and Ryan achieved with their narrow symbolic “victory” to repeal the Affordable Care Act represented the most obvious indication to date of their readiness to disregard the suffering their actions would cause for millions so that they could reward the nation’s most wealthy with a huge tax reduction. To begin, the process the House employed to consider the repeal bill was extraordinary. No committee hearings of any kind were held to ponder its provisions or to hear the views of stakeholders. Indeed, Members did not even have complete copies of the bill when asked to vote on it. Moreover, to avoid accountability for the consequences of its elements, Ryan moved the repeal bill to the Floor for a vote before the Congressional Budget Office could release its independent analysis of the implications of its terms for Americans’ access to health care. Finally, Ryan and Trump pressed for a vote aware that every major health care organization, including the American Medical Association, opposed the bill’s passage.

As the New York Times has editorialized, this GOP proposal would impose distress on millions of Americans by eliminating a requirement that insurers ignore existing medical conditions; by deeply reducing support for Medicaid during the coming decade, which provides health care to approximately 74 million elderly, disabled and poor Americans; and by slashing aid for those who cannot obtain insurance via their employers, resulting in huge increases in their personal premiums and leaving many uninsured as a result. Meanwhile, this GOP “victory” would reduce Federal tax revenue by about $880 billion during the next 10 years, and nearly all of those tax cuts would go to the nation’s wealthy.[4]

The examples briefly outlined here provide evidence that the United States now stands at a dangerous pass as its President and dominant political party daily foist profound costs on a major share of the body politic, while arguing, and lying as they do so, that they are attacking those who are “undeserving,” and that such harms either will not occur or are the responsibility of a vilified “other,” including government itself. Those lies and the political frame these leaders have embraced are deeply cynical and antidemocratic. They constitute a moral bankruptcy apparently born of power mongering, arrogance and ideology. By every measure, these actions suggest that these leaders view those citizens as “less than” those who possess wealth (and who financially support their campaigns). They also reveal a world view that only the rich matter in the American polity.

The paradox evident here is real. President Trump narrowly gained office by attacking what he called a corrupt political class that he said had for too long refused to acknowledge the economic suffering wrought by globalization for millions of Americans. But in lieu of bending genuine policy efforts to aid those who supported him, Trump and the GOP have thus far worked tirelessly instead to impose unnecessary and vicious costs on those voters to reward the wealthy, while cynically seeking to persuade their supporters that they are not doing so. The result is a politics of cruel venality heedless of the costs it levies in the name of providing political and material advantage to those already privileged. It is now obvious that neither Trump nor his congressional GOP allies are willing to accord equal standing to all Americans. Instead, as Powell-Doherty found was true of U.S. health officials in the case she investigated, this group of elected leaders is willing to inflict deep costs on vast groups of citizens to privilege a small cadre of others. More, Trump and his allies have worked hard to mask that fact and to blame others for its consequences, so as to ensure that many of those harmed do not realize the injury being visited on them. This anti-democratic and morally indefensible scenario is the antithesis of self-governance and must not be allowed to continue. Citizens of good will of all partisan beliefs must demand more of their President and Congress and refuse to countenance the continued degradation of this nation’s deepest ideals.


[1] Rebecca Powell-Doherty published her essay in RE: Reflections and Explorations, an online series of commentaries on politics, public policy and governance sponsored by the Virginia Tech Institute for Policy and Governance. The archive may be accessed here:

[2] Powell-Doherty, Rebecca. “Ethics Versus Efficiency in Global Heath Care,” April 13, 2017, RE: Reflections and Explorations,, Accessed May 2, 2017.

[3] Parlapiano, Alicia and Gregory Aisch, “Who Wins and Loses Trump’s Proposed Budget,” The New York Times, March 16, 2017, , Accessed May 2, 2017.

[4] Editorial board, “The Trumpcare Disaster,” The New York Times, May 4, 2017,, Accessed May 4, 2017.

Publication Date

May 8, 2017