A Washington Examiner report relaying a Trump Administration official’s comments on diabetes elicited strong condemnation from diabetes advocacy organizations and people with diabetes over the weekend. However, the report didn’t quote Office of Management and Budget (OMB) Director Mick Mulvaney completely, nor did it mention that he was just one of several panel discussion participants who debated whether diabetes was a condition which deserved coverage.
The discussion on health care policy took place at the LIGHT (Leaders in Global Healthcare and Technology) Forum, held May 10th and May 11th at Stanford University in Palo Alto, California. The initial Examiner report, which didn’t include a link to a video of the panel discussion, quoted Director Mulvaney as saying, “That doesn’t mean we should take care of the person who sits at home, eats poorly and gets diabetes. Is that the same thing as Jimmy Kimmel’s kid? I don’t think that it is.” This quote was picked up by many news outlets, including Insulin Nation. The Examiner then used the quote again for follow-up commentary.
However, a video uploaded to Facebook shows that the quote had been condensed somewhat, but not in any way that alters its meaning. Around the 54:00 mark in the video, Mulvaney actually says, “That doesn’t mean that we want to take care of the person, or should be required to take care of the person, who sits home, drinks Coca-Cola, no offense, drinks sugary drinks, and doesn’t exercise, and eats poorly and gets diabetes. Is that the same thing as Jimmy Kimmel’s kid? And I don’t think that it is.”
Mulvaney was not the first panelist on stage to bring up diabetes during the panel discussion. It was first brought up by a Democrat, Gray Davis, a onetime governor of California who was recalled by California voters in 2003. Governor Davis first mentioned diabetes during a back-and-forth discussion about whether the Affordable Care Act disincentivized people from making healthy choices.
Peter Orszag, former OMB Director during President Obama’s first term in office, argued it was hard to create a health care policy that could distinguish between diseases that were caused by lifestyle choices and diseases based on genetics or other factors.
Davis interjected, “What about ‘I got diabetes because I….?’”
Orszag interrupted with “Okay, diabetes but…,”
After crosstalk between the two, Orszag said, “Diabetes is different, some of the chronic…but you’re not going to parse out ‘your insurance acts except for the diabetes-related coverage’. This is why this is complicated.”*
The discussion later veered toward whether health care was a fundamental right. Mulvaney outlined a libertarian point of view on the subject: “You go right to ‘life, liberty, and the pursuit of happiness,’ that really just requires me to not do anything to or for you,” he said. He later added, “If you have a right to health care, as a fundamental human right, that creates a burden on someone else to provide it to you.”
This type of rhetoric alarms some diabetes advocates partly because they fear that policymakers too often misunderstand the differences between Type 1 diabetes and Type 2 diabetes, and think of diabetes as a choice. JDRF posted a statement on its Facebook page that seemed focused on educating lawmakers on the distinction between the two types of diabetes. The post reads that the onset of Type 1 diabetes “has nothing to do with diet or lifestyle. There is currently nothing you can do to prevent it, and there is currently no cure, which is why JDRF is extremely concerned by the recent comments made by Mick Mulvaney, director of the White House Office of Management and Budget.”
The American Diabetes Association (ADA) put out a strongly worded statement condemning Mulvaney’s statement. Dr. Will Cefalu, Chief Scientific and Medical Officer for the ADA, then went on NPR’s Here and Now to underline the ADA’s stance.
“To say that we were disappointed at Director Mulvaney’s comments would be an understatement,” Dr. Cefalu said, adding that such rhetoric adds to the “unsound and damaging myth” that diabetes is a choice: ”Even Type 2 has a familial or genetic underpinning. People can be quite obese and never develop diabetes unless they have the genetic propensity for beta cell failure and not produce enough insulin.”
So far, Mulvaney has not pushed back against reports about his comment on diabetes. The OMB’s official Twitter account has been silent since March when it issued a flurry of tweets over an earlier controversy involving comments attributed to the director about the Meals on Wheels program. An email request for comment has not yet been answered.
*This quote may not be word-for-word accurate, as it was difficult to decipher in the video. If we obtain a transcript, we will correct any errors.