In sickness and in health in Augusta

Sometimes, politics is a sickness. Wait, strike that. Reverse it. Sickness is making politics, at least this week.

Paid sick leave continues to make headlines. This Maine Legislature’s “LD 1” — the trophy proposal of Democratic majorities — deals with preexisting medical conditions and other parts of “Obamacare.” And, lest it be forgotten, the debate over vaccinations arose with full force on Wednesday.

A full moon shines over the State House in Augusta early in the morning on Feb. 19, 2019. Photo courtesy of Ron Lovaglio

These areas highlight fault lines between the differing philosophical camps, with some exceptions. Democrats generally want to enact legal requirements dictating how sick leave must be provided in Maine. They want to eliminate personal philosophical decision-making when it comes to specific medical treatment; in this case, vaccines. And they wish to write insurance policies via the statute books.

Predictably, the GOP takes the opposite tack on each issue. They prefer to let employers and employees decide the terms of compensation, to include paid time off. Rather than limit “outs” on vaccines to reviewable medical decisions, they suggest parents should make the best possible decision for their children in accordance with their beliefs. When it comes to health insurance, they will generally take a more nuanced approach to regulation.

The tension between these two worldviews comes into the sharpest relief with the vaccine debate. “Legally-required injections” sounds like something from a dystopian novel, while “my body, my choice” is a common refrain from the left. Yet vaccination exemptions invert the argument, with good reason.

Side effects from vaccines are minuscule when extrapolated out across a population. The diseases they prevent are horrific; mortality has decreased markedly due to their widespread use. Further, protecting those with compromised immune systems is best achieved by keeping others healthy. An ounce of prevention in others — administered intramuscularly — is worth a pound of cure.

However, whatever logic, science, and reason underlie the purpose of requiring vaccines for children to enter school, there is still something eliciting a visceral reaction about the idea of a government requiring its citizens to put something into their bodies.

Similar questions arise when we deal with health insurance coverage for preexisting conditions. If a person has a disease obtained through no fault of their own, like Type I diabetes, society wants to hold that person blameless. Requiring insurers to cover that malady without regard to its particular cost is a social subsidy from the healthy to the sick. It is like making healthy people get vaccines in order to protect those susceptible to disease.

But when the “preexisting condition” is liver disease from alcoholism? Or throat cancer from decades of smoking? Where should the lines be drawn? There is no easy answer, and the competing principles of wanting to help others and bolstering personal responsibility makes it an unsolvable question.

As the Maine Legislature continues to debate and hash through these significant policy questions, a political fever will cause passions to run particularly high. Sometimes, the best medicine is treating the symptoms and letting the body do what it does.

There will be temptation to launch a lot of loaded terms, accusing the “other side” of numerous bad things. It will be up to elected officials to fight this virulent strain and lower the temperature. Hopefully, with a little bit of time, the body politic can reach a responsible solution.

Personal responsibility and autonomy are undoubtedly values of society. Preventing outbreaks of measles and whooping cough can literally save lives. Finding the right balance is a near impossible task. But it is a pre-existing condition of Maine law the Legislature will need to deal with.

And taking a paid sick day won’t make it go away.

Michael Cianchette

About Michael Cianchette

Michael Cianchette was the chief counsel to Gov. Paul LePage from 2012-2013 and deputy counsel from 2011-2012. A Navy reservist, he was deployed to Afghanistan from 2013-2014 as a trainer and adviser to the Afghan National Police. He is an alumnus of the Leadership Maine program and holds a BA in economics and political science from Boston College along with a JD and an MBA from Suffolk University. He works as in-house counsel and financial manager for a number of affiliated companies in southern Maine.