This post is a part of our Bioethics in the News series

By Sean A. Valles, PhD

The recently abandoned effort to pass the American Health Care Act (AHCA) was a massive blunder for the Trump administration, failing in its effort to “repeal and replace” Obama’s signature Affordable Care Act, despite Republican control over the House, Senate, and the White House. Less attention has been given to the Trump administration’s second major health policy reform. On March 28, Trump signed an executive order initiating a reversal of Obama-era clean energy plans and seeking “an end to the war on coal.” It was presented as an economic policy reform and an energy policy reform, but it is also a health policy reform since it will have drastic effects on U.S. health.

A short blog entry does not allow me to do justice to the incredible range of ways that coal power plants harm our health. For those interested, Epstein et al. (2011) survey the issue: Coal is one of the leading sources of mercury emissions in the U.S., with horrific effects such as neurological damage in developing fetuses. Meanwhile, much like breathing cigarette smoke, the mix of particles emitted from coal power plants causes increased rates of heart disease, asthma, bronchitis and a host of other diseases.

Obama’s Clean Power Plan, already delayed by legal challenges, was designed to hasten the process of replacing U.S. coal power with other energy sources (natural gas, wind, etc.). That replacement process had already been underway because of old-fashioned capitalist market forces. Natural gas recently surpassed coal in U.S. power plants because natural gas is getting cheaper, and renewable sources like wind power are also cutting into the coal market. Meanwhile, manual laborers across the country are finding themselves displaced by new technologies, so even a stable coal industry would offer a diminishing number of coal mining jobs.

The Clean Power Plan was projected, by 2030, to save 1,500-3,600 people from dying prematurely, prevent “90,000 asthma attacks in children,” and prevent “300,000 missed school and work days” (among other benefits). Coal is already struggling to economically compete with other fuel sources, but is even more expensive than it looks if one factors in the harmful side effects it brings into our world: “Accounting for the damages conservatively doubles to triples the price of electricity from coal per [kilowatt hour] generated.”

It is telling that the economists who have defended Trump’s executive order avoid addressing the health data above. Stephen Moore and Nicolas Loris both insist that coal power has gotten much cleaner. Neither of them acknowledges how much harm coal still does, nor how much death and illness the Clean Power Plan would have averted. Loris tries to change the subject, claiming that the Clean Power Plan was really about carbon emissions and climate change, not “pollutants known to harm human health and the environment”. But, climate change causes health harms too, such as the (worsening) heat waves that aggravate cardiovascular and respiratory diseases (see my previous post for Bioethics in the News).

We do not need to choose between caring about health vs. caring about coal industry employees whose jobs are at risk; we should do both. The U.S. safety net leaves much to be desired, but it at least offers: job retraining programs, coordinated by the Department of Labor; access to temporary housing for those who lose their homes, coordinated by the Department of Housing and Urban Development; food assistance for the families that will go hungry, provided by the Department of Agriculture. But… Trump plans to drastically cut the budgets of all of those agencies. And, as if to remove all doubt that his declarations of concern for coal workers are hollow, he specifically wants to eliminate the two federal agencies tasked with improving the economy in struggling coal-producing regions: the Appalachian Regional Commission and the U.S. Economic Development Administration.

We are at a tipping point in U.S. health. The most recent CDC data show that our national life expectancy is actually decreasing, while other countries’ expectancies are rising. Meanwhile, new data on the strengths and limitations of healthcare in the U.S. show us that the benefits of health insurance coverage are ethically essential, but frustratingly limited in their power. Insurance coverage protects people from getting unfairly trapped in medical debt after an unexpected illness, but just having access to doctors and medicines doesn’t automatically make people healthier.

Our health is the cumulative effect of our everyday lives: the food we eat, the air we breathe and so on. It is unethically deceptive and cruel for the Trump administration to advertise dubious economic benefits of reviving the coal industry while there is an abundance of evidence that doing so will cause unethical harms to the millions who will be increasingly left to breathe more soot and eat more mercury. As many of my neighbors in the Great Lakes region already know, mercury deposits from coal have left many of our local fish too contaminated to eat more than occasionally. Adding insult to injury, Trump wants to eliminate the Great Lakes Restoration Initiative that is now working to decontaminate the lakes (a rare program with bipartisan political support at the local and national levels).

Trump earned plenty of criticism for bungling his first major legislative effort, the AHCA healthcare reform bill. The bill infamously tried to slash Medicaid spending by $839 billion over the next decade, the safety net program which—among many other benefits—“covers the costs of nearly half of all births in the United States.” (Note: some rumors are true; yes, the U.S. infant mortality rate is more than double the rate in Sweden and, yes, Cuba is also beating us by a healthy margin). Even his own party refused to rally behind the bill. Trump’s second health policy is his effort to reignite the coal industry with an executive order. But, the U.S. remains a representative democracy and your local legislators have the power to step in and, well, legislate. By all means, tell them what you think of Trump’s second health reform policy.

Sean A. Valles, PhD, is an Associate Professor in the Lyman Briggs College and Department of Philosophy at Michigan State University. He is a philosopher specializing in ethical and evidentiary issues in contemporary population health sciences.

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More from Dr. Valles: Climate Change and Medical Risk; Politics and the Other Lead Poisoning: The Public Health Ethics of Gun Violence

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