Andrew Coates: The Court of Public Opinion

May 3, 2013

Last week I had the privilege to visit West Virginia. I've been there before. My first impressions, made years ago, returned. If our everyday consciousness results from our everyday experience, it must be intense to live in West Virginia. There the phrase "king coal" leapt to mind at every turn.

Coal miners. Coal trains. Coal trucks. Barges of coal. Mountains of coal. And whole mountains devastated by open mining, called "mountaintop removal." A simple trip across town, an afternoon walk, almost any regular activity, and upon your mind the great social importance of coal will amass and weigh.

One of my physician friends who lives in the state capital, Charleston, used the phrase "coal is king in West Virginia" on several occasions. "King Coal" is a 1917 novel by Upton Sinclair, inspired by the Colorado "coal wars," of 99 years ago. Sinclair explored the human consequences of the duplicitous inhumanity of the coal companies.

This week in a St. Louis Bankruptcy Court a company called Patriot Coal has proposed to liquidate the retirement benefits for about 13,000 retirees and their families. When Patriot Coal was created as a spinoff from Peabody in 2007, the miners explain, it took 16 percent Peabody's assets but 60 percent of Peabody's obligations to retirees. Arch Coal had also spun off a part its business in a similar manner in 2005. These companies, also loaded with pension and benefit obligations to Arch Coal retirees, were later acquired by Patriot Coal.

A lawsuit filed by the United Mine Workers of America against the Peabody Energy Corporation and Arch Coal, Incorporated, alleges that these two companies deliberately set up Patriot Coal as a way to cheat the retirees and their families.

In addition to litigation, over recent months miners, their families and their allies have been protesting across the nation, exposing the perfidy of king coal and demanding justice. In an official statement Peabody Energy sounded a note of contempt. "The UMWA is fully aware that this is a matter solely between the union and Patriot Coal, and the proper process for deciding such issues is through the bankruptcy court – not the court of public opinion," the company's statement read.

When I was in West Virginia what was mostly on my mind, besides coal, and what I discussed with my host and colleagues, and also participants in the discussions there, were ideas about the concept of caregiving. In medicine we champion our commitment to caregiving. We work to achieve expertise in diagnosis, prognosis and treatment. Yet to provide care we keep the human aspect in the forefront.

When confronting illness this is inescapable. In the end, we physicians and nurses and all of us in the allied healing professions, offer our services with a consciousness of "there but for the grace of God go I." We recognize that our patients do not choose to suffer. We recognize that in our lives we too depend on our own caregivers.

This thinking raises the concept of a continuity of caregiving, from family members and friends to professionals and even systems of support, institutions for care. We might think of a continuity of caregiving through history and across cultures.

By ditching its obligations to retired miners in a bankruptcy proceeding, Patriot Coal aims to break the continuity of care in retirement these people earned for their families. The injustice is great, for benefits were never graciously and paternalistically granted, but wrested and won through self-sacrifice and solidarity of union activism. And we all know that the bankruptcy court is designed to work in favor of the company. As Woody Guthrie sang, "some will rob you with a six gun and some with a fountain pen."

So we might take a moment to reflect on caregiving and the court of public opinion. Isn't the purpose of having a society -- of mining coal for electricity and other purposes for that matter -- ultimately in order to share time with each other -- our loved ones and friends? When it comes to access to care, and good quality in caregiving, absolute necessities of modern life -- isn't the court of public opinion the proper place for the discussion of what to do with our caregiving resources?

Dr. Andrew Coates practices internal medicine in upstate New York. He is President of Physicians for a National Health Program.

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