An eminent ER doctor and health policy expert has warned that President Donald Trump’s government shutdown talk about “deserving” patients mirrors a “eugenics” policy adopted by the Nazis.
The shutdown is about to enter its fourth week after Congress failed to pass full-year funding. The White House and Speaker Mike Johnson are demanding spending cuts and immigration concessions, while Senate Democrats insist on extending ACA subsidies and undoing the summer healthcare cuts before reopening agencies.
Dr. Craig Spencer, who lectures on the history of health and eugenics at Brown University and is one of the country’s most influential clinician voices on emergency care, said the administration’s framing echoes America’s 1920s policy of sorting people by “worthiness… cloaked in what’s ‘acceptable’ by the state.”
“It’s not a stretch to say this administration is touting a eugenics agenda, which was perfected by the U.S. in the 1920s and 1930s and later adopted by the Nazis. People don’t want to call it that because it feels unsayable. But it’s real,” Spencer told the Daily Beast.
In 1920s America, eugenics was a mainstream policy movement that used bogus “race science” to justify restrictive immigration laws and state-mandated sterilization of people labeled “unfit.”
The language of Trump’s government, Spencer said, is “almost the same on immigration, access to healthcare, and who deserves the fruits of government,” and its “logical conclusion—while they won’t say it out loud—is letting certain people die.”
“I’ve been reluctant to compare what’s happening now to the eugenics movement 100 years ago, but as every new day goes by I’m less reluctant,” he added.
Spencer—who treated Ebola with Médecins Sans Frontières and made headlines when he survived the virus in 2014—argues the shutdown fight is part of a wider pattern in Trump-era health policy of deep federal cuts and tighter eligibility rules about who “deserves” help.
Republicans have cast Democrats as pushing “free healthcare” for undocumented people, which fact checkers say is false. Democrats, he noted, are focused on extending expiring ACA subsidies and reversing the summer cuts.
Spencer—an emergency physician of 18 years, currently based in Rhode Island—says it won’t work in practice and, at the bedside, the politics collapse. He admitted he never asks about immigration status and “almost never about insurance,” because the job is to treat the emergency in front of him.
Spencer says he doesn’t know a single colleague who would withhold life-saving care for lack of “the right papers.”
Whatever the rhetoric in Washington, federal law still governs emergency rooms. Under the Emergency Medical Treatment & Labor Act (EMTLA), Medicare-participating hospitals must screen and stabilize anyone who comes through the door, regardless of their ability to pay or their immigration status
On Oct. 3, White House Press Secretary Karoline Leavitt avoided giving a direct answer on whether ERs should treat undocumented patients, pivoting to immigration talking points.
However, when pressed later, Johnson said that Republicans don’t intend to change the EMTLA. “Emergency care is provided without question to anyone who comes in,” the speaker said.
“If you’re hemorrhaging and you show up in an emergency room, you get treated,” Johnson continued. “That’s very good law. That’s something we all support.”
“I think that’s part of the Hippocratic oath,” Senate Majority Leader John Thune told HuffPost. “If somebody, anybody comes into the ER, hospitals, clinics, doctors are going to treat them.”
Which is handy, says Spencer. Because, as the shutdown grinds on and the White House pursues workforce cuts, emergency rooms are where D.C. talking points are most likely to have genuine life-or-death consequences.
“There’s zero way you can tell me to stop resuscitating someone because they’re undocumented,” he says. “In seconds, I have to decide about airway, meds, imaging, surgery—not hunt a federal database.”
“We will do right by the patient every single time—documented or undocumented, insured or uninsured,” Spencer vowed, “no matter how or whether they can pay.”
The White House and the Department of Health and Human Services did not respond to a request for comment by the Daily Beast.
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