Brent Nyitray
Fairlington Blade
Let the mutherfuker burn!
jnc4p
Kevin S. Willis
Michigoose
lmsinca
markinaustin
Arcanaut
novahockey
quarterback
ScottC
yellojktI’m working on my fourth (and hopefully final) post about the Komen/Planned Parenthood debacle, and I’ve run into a conundrum. I’ve been using the term “anti-abortion” to describe the group of people that raised the ruckus over Planned Parenthood funding. For me, that narrows their focus down to a single point: abortion. “Pro-life” (again, for me) can encompass everything from no contraception to no death penalty, so I feel that “anti-abortion” suffices for my purposes in this argument.
But what is the converse? It’s not anti-life, it’s not pro-abortion (for reasons lms has pointed out), help me figure out the right term. I’d much prefer it to be “anti-something”, just because I think that using “anti” v “pro” terms is inherently combative and argumentative. I’d also like it to be narrowly defined: a medical procedure which is legal under US law to women up until 24 weeks after conception (a partially arbitrary date, but consistent with current viability outside the womb standards). If you can come up with two “pro” terms that would fit the criteria for both sides I’m willing to switch to that, too. And let’s not go into the weeds about the viability date; I’ll explain in the post when it goes up.
So what would be the best term(s) for me to use? I’m trying to provoke discussion here, not diatribes from either side, so I want to know what would be acceptable to most.
Filed under: Komen, Planned Parenthood, politics | Tagged: Abortion |
All Things in Moderation 
I roll with pro-life and pro-choice. More technically, I would say the two camps are pro- and anti-legalization. Regardless, we all know the issue.
If anyone wants to keep with different terminology, it’s not going to affect the arguments much.
BB
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FB, I don’t like pro-choice for the Planned Parenthood supporters because its converse, pro-life, implies that if you support PP you don’t support life. I don’t think that the options are choice and life–both words embrace more than the narrow argument I’m trying to focus on. And I don’t like pro-Planned Parenthood for the PP supporters because its converse implies that you’re against all of the other services that PP provides (whether Planned Parenthood is providing them or not).
Basically, since I feel passionately about the subject–and know that–but want to write about it without using inflammatory language I’m trying to figure out the best terminology. My own inclination is anti-abortion and pro-choice to describe the two sides, but pro-choice has its pitfalls.
Of course, it’s entirely possible that I’m putting myself in the weeds on this one, and I should just not worry about it so much. . .
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The Catholic Church has a fair claim on ‘pro-life’ based on two premises:
They believe that life begins at conception (sperm hits egg), so life in their case is the defining concept.
Being anti-abortion is only one part of their pro-life penumbra. The are also anti-euthanasia and anti-death penalty. The are also anti-contraception but only the methods that defy their sperm-hits-egg rubric (Plan B, IUDs) can technically fall under that description. The opposition to barrier methods are just plain anti-(non-procreative)sex.
I have no problem with pro-choice as it does encompass people like the Palins who choose to keep their unplanned pregnancies.
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yello,
I have no problem with pro-choice as it does encompass people like the Palins who choose to keep their unplanned pregnancies.
Where’s that sarcasm font when we need it??? 🙂
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Serious question: I thought the Catholic church was also against anti-implantation birth control methods (most forms of the Pill, from my [very casual] understanding). . . so that would cover the whole gamut.
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so that would cover the whole gamut.
All except the barrier methods (condoms, diaphragms, sponges) which they also oppose. This gives them a very bad reputation with anti-AIDS workers in Africa where they do a lot of missionary work.
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<engage sarcasm font
Gotta love that Catholic Church–pro-life AND pro-AIDS!!
/disengage sarcasm font
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‘Goose, I agree with Scott. And I only want to add that pro-choice does not imply anti-life.
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Mich:
You should use pro-life and pro-choice. Those are not going to inflame the people they are describing, and everyone knows that they indicate a specific political position on the issue of legal abortion. They are not going to implant some subliminal and deceptive message into the reader’s mind, thus biasing the reader one way or the other.
As
yelloFB points out, the most accurately descriptive terms would be pro-legalized abortion and anti-legalized abortion. Of course, those are both clunky, especially when used over and over again, and even those don’t accurately describe a lot of people, some of whom are in fact simply anti-Roe v Wade (like me), or pro-more -regulation-but-not-outright-banning-abortion.We shouldn’t forget that the whole point of words is communication, and as long as the receiver of the word understands it to mean what the user of the words wants to convey, then the word is doing its job, even if when parsed out it can be interpreted as something wholly different than intended. It is when a word conveys to the hearer/reader a different meaning than intended by the user that it becomes less than useful. If you say pro-life or pro-choice, everyone is going to know what you are talking about, and no one is going to take away that you are saying something you don’t intend to say.
BTW, this is why I hate all those brouhahas about sports team names being offensive, like the Redskins. The term “redskin” may be offensive as a pejorative for a native American, but virtually no one uses it or understands it in such a way anymore. If one were to drop the term redskin into a conversation, I would imagine that 99% of people would immediately think you were talking about the Washington football team, not some native American tribe. For that reason, the term simply cannot be legitimately taken to be offensive on its face. Anyone who is offended by it is imagining intent where it almost certainly doesn’t exist.
And speaking of native Americans, isn’t anyone who was born in the US in fact a native American? Yet another term that, when taken for what the words actually mean, conveys something totally different to what we all understand is meant to be conveyed.
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BTW…an amusing anecdote in regards to the whole meaning of words business.
Some time ago I was engaged in an internet discussion about race, and the person I was talking to, trying to be oh-so politically correct and avoid using the term “black”, made a hilarious reference to “British African-Americans.”
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As yello points out,
That was FairlingtonBlade.
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Mea culpa. Fixed it.
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Michi, I have to agree with Scott here (sigh) about using “pro-life” and “pro-choice.” In a more general context, I have issues with “pro-life,” but in the context of discussion on ATiM, I can go with it.
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Need I ask who put up the quotation of the day? Payback?
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okie:
Payback?
Heh. My last one for a while, and lms had it coming.
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Michi, I probably come down with Scott and Okie, but I have no problem with anti-abortion, either.
I would like to amplify something else that Scott said. I also thought about pro-Roe and anti-Roe, but that sort of short-hand overlooks that there are many constitutional scholars who favor legalized abortion but agree that Roe was wrongly reasoned and wrongly decided and should be overruled. There are also many people on the pro-life side whose objection to Roe (and Casey) is related to but separate from or in addition to their objection to abortion itself. (I.e., it is a horrible legal decision based on horrible reasoning.)
Also, it is interesting and perhaps useful to try to use a precise definition of abortion for your post, but the one you propose would not be accurate or workable if it is meant to capture the prevailing legal framework. The currently governing “constitutional” (see what I did there?) scheme was established in Casey (more specifically the plurality’s opinion, as lowest common denominator), which jettisoned the trimester approach. Under Casey , the “law” (did it again) is that the government may not prohibit abortion at all up to fetal viability, and from viability to the moment of birth it may not prohibit abortion “where it is necessary, in appropriate medical judgment, for the preservation of the life or health of the mother.” Health includes mental and emotional health. Hence, as a practical matter, abortion remains legal to the moment of birth so long as the provider offers a medical judgment that it is necessary to preserve physical or mental health.
The Court’s rulings on partial-birth abortion introduce other complications which I will leave aside, except to note that a case like Gonzales may be useful in highlighting another problem with your definition. Gonzales reviewed a specifically defined procedure (defined in the Partial Birth Abortion Act). Generally speaking, however, for purposes of discussing the moral and legal questions, abortion of course is not a single “medical procedure.” It is, rather, the object of various procedures used to achieve it that is the real issue. Your definition does not address the salient issue of terminating pregnancy (and life) but is instead open-ended, referring only to a “medical procedure,” which might be anything. If the discussion takes a truly philosophical turn, then of course these distinctions become even more salient. (What happens to the law when someone invents a true artificial womb?) But in some manner the definition has to address the real issue, which is termination of pregnancy, and with it fetal life. In contradistinction, procedures for abortion, as opposed to their object, can be subject to government regulation, subject in turn to the “undue burden” standard in Casey‘s plurality decision. Interestingly, Wikipedia gives this definition: “Abortion is defined as the termination of pregnancy by the removal or expulsion from the uterus of a fetus or embryo prior to viability.” But that clearly is not an accurate definition as used in legal arguments, because, as Casey makes clear, the Supreme Court has held that post-viability abortion is constitutionally protected so long as necessary to protect the mother’s life or health. Post-viablity abortion by definition involoves terminating life (killing), thus going to the heart of the problem in a way that is unavoidable, and by doing so raises the problem of why viability separates life from non-life.
Where I am going with all this is that, while there is no reason why you can’t define abortion in a particular way for purposes of your discussion, defining it as proposed would not accurately capture the legal framework or the full range of issues that are contested between the sides. A more accurate definition might be along the lines of the intentional termination of pregnancy and fetal life, but I can already anticipate that such a definition will find objection as well.
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Scott:
lms had it coming.
Hey, what’s wrong with Socrates.
Looks like the consensus is pro-choice/pro-life Michi……works for me.
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Funny “Quotation of the Day” about women in the context of everyone missing the girls at the Plumline earlier.
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I have issues with “pro-life,”
And pro-lifers have a problem with the term “pro-choice”, as it doesn’t describe people who are pro-choice the way in which pro-lifers would describe them. And, clearly, in both cases, people who are not part of those self-labeled groups are not, on the obverse, either anti-choice or anti-life in some global sense.
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How about “pro-abortiion services”? For purposes of this particular discussion, it seems to me to be the most accurate description…but I defer to that side to determine if it is sufficiently non-combative enough and/or accurate. To me that indicates that someone wants those services available, regardless of whether they themselves would choose to use them.
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To pick an active issue, but one without as much baggage, consider marijuana. I think I’ve generally heard those in favor of loosening restrictions as favoring legalization or decriminalization. Choice and Life have been latched onto due to the emotional nature of this issue. It’s a difficult one in my view.
Another aspect that’s handy about the labels is that they encompass ranges from the most strict (abortion only to save the life of woman, as was effectively the case for Santorum) to allowing exceptions for rape, incest or “health” of the woman.
A particularly difficult dilemma would be the case of a severely malformed fetus. My wife miscarried at three months the first time she was pregnant. I won’t go through all the details, but in the end we had an ultrasound indicating development had stopped several weeks earlier. The options were to undergo a D&C (abortion), take a pill that induces a miscarriage (aborticant), or wait and let nature take its course. We decided to take the weekend to think about it. Or, rather, drink about it–we’d just seen Sideways and drank a lot of good Pinot Noir that weekend. The next night, she miscarried and that was that.
OK. Let’s consider birth defects. If the fetus were sufficiently malformed to be unable to survive, I suspect that the pro-life crew on that decision is relatively small. Now let’s go onto mental retardation. 90% of the time that Downs Syndrome is diagnosed, the fetus is aborted. Unless the vast majority people who have the screening test are pro-choice, that suggests an awful lot of ostensibly pro-life individuals are willing to consider abortion when neither the life of the child or mother is at stake.
There are layers on the other side as well. There are a number of restrictions to the availability of abortion. I fully support severe restrictions from the point of viability. This gets uncomfortable line for me as it suggests that the line is subject to medical technology. The first trimester line is arbitrary, but a biologically supported line works for me.
It’s not my purpose to generate an abortion thread, though we may be off and running. Rather, that I think it’s not simply pro- vs. con-. Many of the laws being written right now are designed to appeal to those who identify as pro-choice.
BB
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I appreciated both thoughtful posts from qb, laying some of the legal ground for us, and FB, framing the debate in terms that I mostly agree with. Thanks you two. Now I think I’ll wait for Michi’s post to see what she brings to the table in terms of discussion.
Also, in the news, a compromise is in the works between the Obama Administration and the Catholic Bishops.
But what the White House will likely announce later today is that the relationship between the religious employer and the insurance company will not need to have any component involving contraception. The insurance company will reach out on its own to the women employees. This is better for both sides, the source says, since the religious organizations do not have to deal with medical care to which they object, and women employees will not have to be dependent upon an organization strongly opposed to that care in order to obtain it.
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“The insurance company will reach out on its own to the women employees. This is better for both sides, the source says, since the religious organizations do not have to deal with medical care to which they object, and women employees will not have to be dependent upon an organization strongly opposed to that care in order to obtain it.”
a crack in the armor of employer sponsored coverage? too bad nobody will notice the connection.
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Unless the vast majority people who have the screening test are pro-choice
This doesn’t seem unreasonable. We didn’t screen any of our pregnancies. We weren’t going to abort, and the procedure involved a needle and I think additional cost, so what was the point?
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The insurance company will reach out on its own to the women employees.
So, this would be a cafeteria plan? Free contraception if you opt out of orthodontic coverage or something?
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KW — I thinks it’s don’t ask, don’t tell.
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I think what it means is paying for the coverage out of pocket rather than through the employer benefit. I see that as a cave.
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Hot of the presses: WH fact sheet.
Thanks to the Affordable Care Act, most health insurance plans will cover women’s preventive services, including contraception, without charging a co-pay or deductible beginning in August, 2012. This new law will save money for millions of Americans and ensure Americans nationwide get the high-quality care they need to stay healthy.
Today, President Obama announced that his Administration will implement a policy that accommodates religious liberty while protecting the health of women. Today, nearly 99 percent of all women have used contraception at some point in their lives, but more than half of all women between the ages of 18-34 struggle to afford it.
Under the new policy announced today, women will have free preventive care that includes contraceptive services no matter where she works. The policy also ensures that if a woman works for religious employers with objections to providing contraceptive services as part of its health plan, the religious employer will not be required to provide contraception coverage but her insurance company will be required to offer contraceptive care free of charge.
The new policy ensures women can get contraception without paying a co-pay and addresses important concerns raised by religious groups by ensuring that objecting religious employers will not have to provide contraceptive coverage or refer women to organizations that provide contraception. Background on this policy is included below:
· Section 2713 of the Affordable Care Act, the Administration adopted new guidelines that will require most private health plans to cover preventive services for women without charging a co-pay starting on August 1, 2012. These preventive services include well women visits, domestic violence screening, and contraception, and all were recommended to the Secretary of Health and Human Services by the independent Institute of Medicine of the National Academy of Science.
· Today, the Obama Administration will publish final rules in the Federal Register that:
o Exempts churches, other houses of worship, and similar organizations from covering contraception on the basis of their religious objections.
o Establishes a one year transition period for religious organizations while this policy is being implemented.
· The President also announced that his Administration will propose and finalize a new regulation during this transition year to address the religious objections of the non-exempted religious organizations. The new regulation will require insurance companies to cover contraception if the non-exempted religious organization chooses not to. Under the policy:
o Religious organizations will not have to provide contraceptive coverage or refer their employees to organizations that provide contraception.
o Religious organizations will not be required to subsidize the cost of contraception.
o Contraception coverage will be offered to women by their employers’ insurance companies directly, with no role for religious employers who oppose contraception.
o Insurance companies will be required to provide contraception coverage to these women free of charge.
Covering contraception saves money for insurance companies by keeping women healthy and preventing spending on other health services. For example, there was no increase in premiums when contraception was added to the Federal Employees Health Benefit System and required of non-religious employers in Hawaii. One study found that covering contraception lowered premiums by 10 percent or more.
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Shoot….NoVa just beat me on covering this.
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Thanks NoVA, and ashot you know he’s the best corker here so just give up beating him to the punch. I don’t see this as a cave, just a compromise. Wonder what the Catholic Bishops will say or do.
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I don’t see this as a cave, just a compromise
Even if it is a cave, who cares? I need to think about it more but I just don’t see how this helps Obama’s political opponents. I wonder if this was the plan all along.
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I think this is an elegantly simple solution that avoids the political fight. It doesn’t put the bishops in their place, but you (I) can’t have everything.
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but you (I) can’t have everything.
Funny ABC. I’m putting the Book Review post up in a little while.
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” speaking of native Americans, isn’t anyone who was born in the US in fact a native American?”
Yes and no. Yes, anyone born in the US, but also anyone born in Canada, Mexico, Panama, etc down to Argentina.
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But not Hawaiians. Sorry president Obama …
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I don’t see this new rule as any meaningful compromise at all but as a devious attempt to disguise reality.
I need to wait to see more details of the difference between what Obama was demanding before and this new rule, but it looks to me at best to be a meaningless difference. More broadly, it reinforces and highlights the most obnoxious and objectionable aspects of ACA. It strips us of freedom and compels us to participate in a mandatory, universal system, with government dictating the “benefits” we must have and pay for.
Nothing is provided for free. When Obama says insurance companies will now have to provide birth control for free, it can only mean either that the employer must pay or we all have to pay for it through higher premiums. (Seriously, it’s 2012 and Democrats are still pretending there is a free lunch to be had if the government tells A to give lunch to B?) There is no essential difference between this and socialized, universal health care. The only difference is that government did not abolish the private sector; it just took it over through regulation: everyone must participate, and everyone must pay for the same benefits, whether they want them or not, and whether they violate one’s religious beliefs or not. This is a difference of form, not substance. Politically, of course, it remains the eternal scam: I, Barack Obama, have given everyone free health care.
What he is really doing is declaring it to be illegal to sell insurance without including “free” birth control. Insurance companies will provide it and pass the cost on to all of us, or the employer still must pay for it. “Free” to the user, at the cost to everyone else. This is effectively socialized medicine on a corporate-government model. Hence, another piece of our freedom is taken by Presidential decree. Obama is an authoritarian at heart, and this is just another example. Is no one on the left concerned that a President claims this kind of authority, or with the attack on freedom that it represents?
The whole issue is absurd in conception (see that?), given that birth control is not something that needs to be, or that rationally can be, a matter for insurance coverage. Health insurance costs what it does in large part because it isn’t insurance at all. It is a payment plan, but one under which people are led to believe that consumption of services and goods that is entirely predictable and foreseeable nontheless are insurable events. In this regard, I heard a report that Obama today talked about the importance of birth control drugs for other health issues. That is a completely different issue. Doctors can prescribe drugs for whatever they believe is appropriate; whether the uses are covered varies from insurer to insurer, but if they are medically valid uses they normally are covered.
One last thing I do not understand yet is how exactly the Obama Administration is going to publish a final rule on this that has not been published for comment. This is question of administrative law, but I have not run down the details of what the admin is doing here. Perhaps someone knows how they are doing this.
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Wow–excellent discussion on all points! Gotta run, but I’ll go with the consensus pro-life/pro-choice.
Madness–madness, I tell you, Lefties and Righties conversing without yelling!!!
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it just took it over through regulation: everyone must participate, and everyone must pay for the same benefits, whether they want them or not, and whether they violate one’s religious beliefs or not.
You forgot that the government also can review premium increases by private insurers and reject the increases. Just thought I would help you out there QB.
On the issue of birth control, NoVa pointed out that it actually lowers premiums. So you’re right when you say Obama isn’t giving it to everyone for free, he’s sort of paying people to have easier acces to using birth control if they so choose.
I’ve lost track of some of the ACA pilot programs and NoVa can correct me if I’m wrong, but isn’t the government actually granting exceptions to some of the regulations like Stark adn Ant-kickback in certain programs? I heard a professor in a public health program mention that. His hope was that if the abuses those regulations were meant to curb don’t suddenly reappear maybe those regulations would disappear. He said several times that the sheer amount of regulations is very problematic and needs to be adjusted.
*after the fact addition* I was right, there have been some regulation waivers for ACOs.
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QB, not sure I could have expressed my feelings on ACA better if I had spent all night writing it – my passion tends to get in the way of me producing a coherent, reasoned argument.. When the ACA was passed and because of the way it was passed, I vowed to never vote for anybody at any level with a -D next to their name. This issue and the the PP/Komen issue are the future of our healthcare debate unless this somehow gets undone. Arguing and posturing over what the government says should or shouldn’t be covered. Given my proclamation on voting, Obama was never going to get my vote. But these past couple of weeks as reminded me just how much this infuriates/depresses me.
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Thanks, Dave.
I’m afraid I may have ranted a bit much, but when I looked at what this compromise supposedly is, it really lit my fuse again, too. So I dashed off a rant. (It sounded so much more eloquent in my head while I was driving to my office.) I’m really passionate about this, too, not because I’m Catholic (I’m not) or upset about birth control but because of the assault on freedom and our Constitution. And yet my own party’s primary is unfolding as a train wreck. I am genuinely and gravely concerned about the future of the country my children and grandchildren will inherit.
Troll,
Why I oughta ….! I will get you back, just wait and see. I take a back seat to no one in my wingnutism.
ashot,
Thanks for the assist with my rant.
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I am genuinely and gravely concerned about the future of the country my children and grandchildren will inherit.
I am too, but not because there’s some outside chance we’ll end up with a universal or single payer health care system like every other civilized nation, I’m more worried that the rule of law and our civil liberties are being washed down the drain. There is no daylight between Republicans and Democrats on this right now and so while we quibble over whether women’s birth control should be covered by insurance or not, because that’s really the issue, no one in a position of power is objecting to the gradual but very effective undermining of the Bill of Rights.
I’m not all that crazy about ACA and then I remember there are a large number of people with insurance now, people who couldn’t get it before and not because of expense, because they were a little too sick, had been a little too sick in the past or were slightly too old and didn’t have the advantage of a large group policy subsidized by an employer. And then I also remember that 50% of people in the individual market who became seriously ill and were being dropped like flies with any excuse, have a little assurance that won’t happen to them now. Health care and the insurance industry are broken, unfortunately they’re still broken IMO, but a few more people have insurance that couldn’t get it before so I’ll take that little bit of good news. And if it saves a few families from financial ruin or even worse while we figure this stuff out I’ll take that also.
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“but a few more people have insurance that couldn’t get it before so I’ll take that little bit of good news. And if it saves a few families from financial ruin or even worse while we figure this stuff out I’ll take that also.”
access is the key. I’m legitimately concerned that come 2014 people will have gold-plated insurance and not enough providers to treat them.
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NoVA, most people won’t be able to afford gold-plated insurance. We can barely afford what we have now and it’s more like lead-plated. I doubt much will change in the price do you? If they’re going to do this, they need to offer plans that have the kind of cost sharing you guys want, that’s what a lot of us are already doing anyway.
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oh, i should rephrase that. but w/ the subsidies affordability shouldn’t be the issue.
but “churn” will be as people bounce from medicaid to the exchanges and back as their incomes fluctuate.
i just meant that I’m worried we didn’t solve the provider problem.
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You forgot that the government also can review premium increases by private insurers and reject the increases.
That’s sure to make access to quality healthcare easier!
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What percentage of people will receive subsidies do you think? And doesn’t that say as much about the economic condition people are facing now as it does about the cost of health care and insurance? That’s what I’m worried about, if the cost doesn’t go down we’re all screwed.
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I am too, but not because there’s some outside chance we’ll end up with a universal or single payer health care system like every other civilized nation, I’m more worried that the rule of law and our civil liberties are being washed down the drain. There is no daylight between Republicans and Democrats on this right now and so while we quibble over whether women’s birth control should be covered by insurance or not, because that’s really the issue, no one in a position of power is objecting to the gradual but very effective undermining of the Bill of Rights.
I concur as regards the latter part, although as to the former, I would point out there is nothing more civilized about nationalized healthcare vs. a rational free market for healthcare, should such a thing exist. However, I’m not sure the ACA is superior to a limited single-payer system where the basics are covered and coverage for what is not covered by single-payer is sold by insurance companies that compete in that market across state lines.
But civil liberties? Pish-posh, when we can be arguing about birth control!
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I’ve got data on that somewhere (dig if up for you next week?)
but play around this this to get a sense of the out-of-pocket costs people will face.
http://healthreform.kff.org/SubsidyCalculator.aspx
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NoVA:
i just meant that I’m worried we didn’t solve the provider problem.
Totally co-sign. Any sign that there is political will to do that? Or are we going to continue kicking that can down the road?
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” Nothing is provided for free. When Obama says insurance companies will now have to provide birth control for free, it can only mean either that the employer must pay or we all have to pay for it through higher premiums.”
Perhaps insurance companies calculate that contraception is cheaper than pregnancies; particularly those carried to term. Have you seen what it costs to give birth lately?
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Thanks NoVA, I’ll check it out and look forward to more info next week. They’re rolling this stuff out so slowly, I can’t even remember half of what’s in it. And this is from a totally personal stand point, and I know I probably shouldn’t even mention it, but this reminds me of why I actually cried when ACA passed; my oldest daughter has insurance now, very high deductible and fairly expensive for a 32 year old, and if my niece had waited about 3 years to get sick, she might still be with us. I’m sorry to bring that up because I know it’s uncomfortable, but it’s what goes through my mind when I think of ACA on a purely individual level. I doubt I’m the only one either. It’s one of the reasons I have to show the other side of the argument even though realistically I know ACA isn’t what we really needed to fix the mess.
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I think of ACA on a purely individual level. I doubt I’m the only one either.
I think one point of ACA, and the individual mandate, is useful: expanding the risk pool. There might be a better way to do it (none occur immediately, aside from single payer), but in a perfect world where everybody who could afford insurance bought insurance (and insurance could be sold across state lines), I think costs would be less of an issue. Arguably, single-payer provides for this expansion of the risk pool as well and would deliver some of the benefits, but I recently took this test where it said the government is always wasteful and inefficient . . . 😉
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“Any sign that there is political will to do that? Or are we going to continue kicking that can down the road?”
Not one bit. there’s not even a kicking of the can. it’s not not being addressed seriously at all at the national level. meanwhile, they’re doing short term extensions of the “doc fix” — i know more than few docs, young ones, are seriously thinking of quitting and doing something else.
that said, the ACA did contain some funding and other provisons designed to increase the number of docs. http://www.healthreform.gov/newsroom/primarycareworkforce.html
the real action is at the state level. state’s are starting to play around with licensing and scope of practice laws to expand what lower-level providers can do.
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” realistically I know ACA isn’t what we really needed to fix the mess.”
Why stop at the ACA?
collectively there is zero political will to address any of the problems we face. Last night my dad started ranting about the costs of entitlements. Well, sure. But I didn’t want to get into it and point out that his entitlements are the problem – SS & Medicare.
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and insurance could be sold across state lines
It’s funny you mention that. When our oldest daughter lost her insurance at the end of her college years (she paid for a policy through the school), and we realized she really couldn’t get insurance, no matter the price, we tried a few of these outside insurance groups. The first thing they do when you call is ask where you’re calling from, as they’re only allowed to take calls from certain states and apparently CA was one of them. Then they asked a few basic questions, very unlike the questions asked from the legit companies, then they ask for money……..lol. The person on the other end of the line can’t even answer basic questions about the policy or the benefits. It doesn’t take you long to realize it’s a scam. There’s a site on the internet where you can put in the phone number and read the customers comments and some of the stories would have been hilarious if it wasn’t so infuriating.
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Why stop at the ACA?
I hope we don’t. I’m not convinced anyone knows how or even if it’ll come together by the time the exchanges are up and running. It’s one of the reasons I’m always picking NoVA’s brain, I keep hoping someone’s doing something behind the scenes that will make something work within the framework they’ve designed. I do think some of the states individually have some good ideas and as far as I know they have a little leeway built in to experiment. Personally, I think MarkinAustin has the best ideas which is why I wish he’d run for office……. 😉 He keeps ignoring me on that though. Once I found out we were both Post Modern, it all made sense.
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qb-question for you. I know government can be the worst thing in the world–e.g., the totalitarian states of the 20th century. I also know why this birth control dispute has raised my ire against the institutional Catholic church. It goes back to the devastating loss of my best cousin who tried to follow what she’d been told was ironclad dogma by nuns and priests who didn’t have to live the life they’d prescribed for her, one that led to a large, unintended family, destroyed health and, then, motherless children.
So I know why I’m angry. I think a lot of our anger against large institutions comes from personal stories. Is that the case for you?
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Seeking information. My concern all along about insurance sold across state lines is regulation. It is my understanding there currently is no federal regulation of insurance companies, it’s all at the state level. Is this correct? If so, how would they be regulated (for just the kind of thing lms mentions). Would it be like corporations flocking to Delaware, i.e., the insurance companies will find the least restrictive state to be based in, and then the rest of us even if our state has stronger regulations are stuck with minimal regulation by the company’s home state for which we have no input?
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Okie
I was thinking about your question and don’t really know the answer, but anecdotally, we are no longer getting those 2 to 3 faxes every day at work advertising health insurance at reasonable rates with no denials. The thing that’s interesting is that someone like me who is very cynical about health insurance and other corporate entities, and absolutely knows if something seems to good to be true it probably is, called the damn numbers anyway.
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ashot:
On the issue of birth control, NoVa pointed out that it actually lowers premiums.
Where did he point this out? I am curious because it seems highly counterintuitive to me that it would. It makes sense to me that an agreement to use birth control would lower the premiums that one would otherwise have to pay, but it doesn’t make sense to me that an insurance company taking on the cost of providing it would. The analogy I used on a different thread still holds…putting in an alarm system in your house will lower your house insurance premiums, but the insurance company isn’t going to do it for you, and if it did, your premiums would rise by whatever the cost of the alarm system was.
The relevant question is how many people have insurance but do not use any birth control simply because it is not covered, and what is the cost of the resulting pregnancies, versus how many people already pay for birth control outside of their insurance, and what is the increased cost to the insurance company of picking up that tab for them.
I find it highly doubtful that the numbers and cost of the former are larger than the latter. Indeed, I would expect that the latter would overwhelm the former by multiples.
(Sorry, this may be a bit of a drive-by, but I would like to know exactly what nova said which ashot is referring to.)
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Scott, NoVAH was quoting, I think, at 8:22 am on 2/10.
The assertion is made that including bc saved costs for the insurers in the fed employees bidding process, and the coverage was thus extended at “no increase in tuition”.
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I am too much of a libertarian to want to force bc on anyone, and enough of an economic conservative that, if I did, I would want to push bc to poor people, who might otherwise have trouble supporting their own kids.
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ABC,
I’m not clear about what you are asking me in your question, but I am going to assume you are asking whether my passionate opposition to Barack Obama, ACA, his contraceptive rule, and big government in general is a result of traumatic or dramatic personal experience. As I reflect on it, I think the answer is, no. While all of our views are shaped by our own experiences, for me these are more matters of principle and alarm at where the country is going. My views are not a result of a single or even a few traumatic or searing personal experiences. This is a long answer, but an attempt an honest explanation, so apologies if it goes off on tangents.
There certainly are areas where I can cite personal experiences as reinforcing or influencing my views. I look at something as routine as the shocking amounts of money the government takes from me, and how progressives like Obama demonize people like me as “rich” and undeserving even though that is laughably untrue. (While I listen to Obama constantly talk about how I still don’t pay enough, last night we had to discuss how to stretch our budget until my main draw in a couple of months, meanwhile advancing Uncle Sam what we paid last year + 10%.) I also have strong views about government racial policy in connection with which I could point to many reinforcing experiences going back 30+ years and indeed continuing to the present. Some of those things were very personal and probably changed the course of my life quite drastically. They also cause me to contemplate the fact — and it is a fact — that my children will face discrimination (one already does, the younger will face worse because of her race), and that surely angers me. But I would probably have the same basic views had I not had those personal experiences. Indeed, I had these views before the personal experiences, as a matter of principle.
More often than not, however, if you looked at my life history you probably would not see a pattern of experiences that to your mind would lead to my being a right-winger. A number of commenters over at PL have challenged (more like attacked) me on the ground that I must have grown up wealthy and privileged, without any idea what it is like to struggle. Those assumptions could not be much farther from the truth. I grew up with very little and as a young man was uneducated, unemployeed, on my own, and without hope. I eventually found a steady job, worked hard, saved, got married, etc.
From it all, though, I developed, or rather reinforced, strongly conservative (and economically libertarian) beliefs and views. I see the rising costs of things like health care and education as being (to me quite obviously and predictably) consequences of misguided big government, continually made worse by its continued interference to make them better. My father died in a Catholic charity hospital years ago, less than six months after being diagnosed with stage IV cancer. He never saw a doctor for years before that and had no insurance. (Complicated story.) I did not conclude from this that we needed socialized medicine but more like reform in the opposite direction. My family’s lives were definitely and dramatically changed by the housing and financial crash, but I again blame that primarily on government, not “banksters” and all that. Does it anger me? Sure it does, but again I don’t believe what I believe about big government just because of that.
I am passionate about these things from a deeper philosophical level. I truly believe that Barack Obama is leading an assault on our traditional freedoms and our constitutional system itself, and I fear for the future toward which we are inexorably being driven. It astonishes me that so many are so willing to surrender their freedom to this movement, so willing to say, for example, why not stretch the Commerce Clause just a little farther to provide everyone with “free” health care? What’s the big deal? Why not pretend this is what the Constitution means? Free education. Free everything.
I believe that we are seeing the incremental yet profoundly consequential replacement of our system of constitutional government, our tradition of freedom, and our very body of social mores and values with a set of radical ideologies that are inimical to that heritage. They postulate and foster class, racial, and religious conflicts, and work by inciting resentment, blame, and envy. They are hostile to the concept of freedom from government to order our own affairs and instead proffer the counterfeit but tempting notion of “rights” and entitlements to things provided by government. They despise religion, family, and other institutions of civil society, as is evident in this latest power grab by Obama. I have seen this particular hostility overtly expressed in the past few days, with many on the left openly cheering for government to clamp down on the Catholic Church, “put them in their place,” or even “put the bastards down” (if I recall that particular phrasing).
It is also the movement that cheers courts’ rewriting constitutions suddenly to redefine marriage and condemn disagreement with the recognition of a “right” to same-sex marriage as irrational bigotry. Twenty years ago, this would have been viewed as sheer lunacy by most of the public. I predicted it was coming, to friends who were completely disbelieving they would ever see the argument in public forums. (People like Greg Sargent call us culture warriors, the height of irony, given that the culture war is being waged by the left.)
I could assemble a litany of things Obama has done and said that I believe support this portrait, although I recognize that is not really the point here. I am quite aware that it seems alarmist and hyperbolic to my friends on the left. Some even claim that Obama is a “conservative” or just another “right-wing corporatist.” But I am not being hyperbolic at all. When Obama scorned dissenters as bitter people clinging to their guns and religion, he was speaking a language that I knew quite well from studying radical ideologies. His explanation of these bitter clingers is a Marxian one, and his solutions flow from that same Marxian-progressive stream; they are just modulated a bit for public consumption among the remnants of constitutionalism in 21st Century America: if we can spread the wealth around, get people in unions, tax the rich, and give the bitter clingers enough free material goods, they will stop their bitter clinging. They will turn against their backward churches and realize the arbitrary and oppressive nature of their little family platoons. They’ll get with the program of depending on government and realizing it is good for them.
This is what I see in Obama’s vast expansion of federal and Presidential power to force everyone into a government-mandated and regulated health insurance system, and this current episode of his trying to use the take-over as an occasion to force religious institutions to violate their own teachings. The more of our lives government consumes, the more of civil society it destroys, the more of our heritage is stolen, never to be given back, and that I believe is not just the consequence but the intent of his program. That is why I am passionate.
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The point Scott makes above about insurability and the cost of birth control seems to me critically importan to understand.
Even if we assume that the cost of birth control is less than the cost of “no birth control” on a population basis, it does not make the cost of birth control any more an insurable cost, i.e., one that can ever fall within the purpose of insurance. If an insurer pays for it, it is not doing so on the same basis of spreading risk on which it pays for, e.g., the cost of a broken leg or heart attack that is unpredictable on an individual basis. Use of birth control is a choice that is entirely predictable on an individual basis. If an insurer covers it, it is simply shifting its cost from those who choose to use it and predictably will use it to those who do not. That simply isn’t insurance.
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QB, why can’t an actuary think about it as minimizing the risk of unwanted pregnancy which results in known health care costs? Surely the industry has developed a statistical history of the incidence of unwanted pregnancy, and the cost.
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Mark,
No doubt they can do that, and pay for it if they think that is a good business decision (good marketing if nothing else). The point I’m trying to make, and that I think Scott is making, is only that a cost of reducing a risk is not the same as the cost of the risk (or rather the cost of the realization of the risk), and the latter is really the purpose of insurance while the former is not. Reducing the risk of pregnancy is really what the makers and sellers of contraceptives are selling. Protection against the realization of the risk is what an insurer is selling. I think our society confuses the two. Does that make sense?
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…a cost of reducing a risk is not the same as the cost of the risk (or rather the cost of the realization of the risk), and the latter is really the purpose of insurance while the former is not.
You may have already made the point, or perhaps NoVAH did, that health insurance, generally, is unlike other insurance in exactly this way. If a preventative pharmaceutical is available that is effective and relatively inexpensive, a medical insurance policy is likely to cover its cost to the insured and charge a premium, or not, as warranted.
Insurance will cover anti-plaque buildup drugs, for example, for persons who might otherwise be at risk for stroke or heart attack.
But casualty insurance will not pay for your lightning arrestors because your property is at risk from lightning.
Have I made sense?
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Mark, yes, I think I get your point. We use health insurance more like the access point for all healh than like true insurance. While I understand the rationale for this, to me it is one of the problems with our system.
Update: I am still thinking about how this works and why it seems problematic to me. Does the fact that we treat routine preventive care, predictable sinus infections, and other minor and predictable issues as “insurable” events lull us into believing that we should pay much less in premiums than the total cost of all this predictable usage of the system? I think it does. What we pay in large part simply covers costs of routine and predictable care, averaged out, of course, but nonetheless not catastrophic events actually needing to be insured. We could just as easily pay that 10–20k per year out of pocket. But we say it is covered by insurance, so it seems like we are overpaying for what we consume.
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“why can’t an actuary think about it as minimizing the risk of unwanted pregnancy which results in known health care costs?”
I might change ‘unwanted’ to ‘unplanned’, but that is the crux of the issue. How is the rate of pregnancies for which the insurance company is liable going to change when they offer birth control coverage vs. not?
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“I truly believe that Barack Obama is leading an assault on our traditional freedoms and our constitutional system itself, and I fear for the future toward which we are inexorably being driven.”
My dad was in town this week & expressed a similar concern. He went on to compliment Speaker Gingrich for his detailed plans & policy positions (particularly in comparison to Romney; but that’s not the point here). He cited in particular Speaker Gingrich’s position on immigration, which includes a de facto amnesty for people who’ve lived here for a long time & are members of the communities in which they live. I thought: how is that different from the Obama admin’s proposals?
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QB, I appreciate that long and careful answer. I intend to copy it into a Word document and read it over, probably more than once. While some of it sounds baffling to my more liberal ears, one of the reasons I’ve spent time on political blogs in the last years is that I’ve wondered why there is such a chasm between right and left, why our passions fall out so differently. I think what you’ve written will give me one new way of thinking about this, so I thank you.
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I might suggest that QB’s reply above is sufficient for a separate post and a permanent link. I clearly disagree with some of the conclusions, but the underlying reasons are eloquently stated.
Back on one point (and sorry for the interruption in service). I wonder if I should be posting with a Scottish accent at this point as I’m in Glasgow (the reason for said interruption in service).
Kevin commented that it didn’t seem unreasonable that the vast majority of those who screen are pro-choice. Such an assumption is unwarranted. My wife and I too did not screen. At the time, I mistakenly believed the odds of a miscarriage arising from amnio were similar to the odds of detecting an abnormality. The technique is much improved and so the odds are much lower. We too would have carried a child to term with Down Syndrome to term. As it happens, there was a child in one of my sons’ pre-K special needs classes with Down Syndrome. He was a pleasure to be around.
On the other hand, Sarah Palin DID get the test. There are reasons to be tested, even if you plan to carry a child to term. Getting ready, for one thing. I don’t know for what reason she chose to have the tests, but she is ardently pro-life and was tested while carrying Trig. Ironically, I think Sarah Palin made an eloquent cases for choice. There are pro-lifers who choose to have prenatal testing and some pro-choicers who don’t. Below are a couple of interesting links that flesh this out in further detail. While hunting for information, I discovered that George Will has an adult son with Down Syndrome. He characterized prenatal testing as a search and destroy mission.
http://www.rhtp.org/fertility/prenatal/default.asp
This gets into something else that I feel is either a misconception or misconceived hypocrisy. I consider myself pro-choice in that I feel abortion should be legal with restrictions. If my wife were to become unexpectedly pregnant (we’re not planning on a third), I would never consider abortion.
Why the apparent hyprocrisy? I’ll be very clear. I’m not certain at what point one could say human life begins. Once an egg is fertilized, all the DNA of whom that egg may become is set. I use the word “may” as the odds of a fertilized egg resulting in the birth of a child lie under 50%. I am uncertain as to the correct characterization, but I am most comfortable with potential human life. That uncertainty is why I’m uncomfortable with forcing a woman to carry a child to term, but would refuse to countenance an abortion. And, yes, my wife and I have had that discussion and are in firm agreement on both ends of it.
Well, I’m off in search of a pint of 70 schilling (Scottish heavy ale).
Cheers!
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bsimon,
I thought about making that comment a post after I wrote it and saw its length, but I did not think its quality warranted it, and I didn’t want to take the time I thought it would need to make it what it should be.
ABC,
Your question was thought provoking. I started out thinking that the answer was simpler than it was. In any event, trying to be transparent and explanatory is the main reason we are all here (okay, some of us like to argue), but it seemed like a good occasion to try to put my frank thoughts in response to your question out there. Honest statements of what we think and why are of high value here. The little essay still seems pathetically inadequate when I read it back, but appreciate your thanks for trying.
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The columns I read by George will are so affecting that I felt they deserved separate links.
http://www.epm.org/resources/2010/Mar/30/jon-wills-aptitudes/
http://hvcljournal.typepad.com/lifenet/2007/02/george_will_on_.html
BB
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Thanks for the Will columns, bb. He wrote a very good one this morning, btw. In Glasgow, do you order coffee with milk or half and half or cream, or coffee white?
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Nova
a crack in the armor of employer sponsored coverage? too bad nobody will notice the connection.
Nova you’re just watch the wrong cable networks. This was one of the lead stories on almost everyone of the MSNBC shows….that this is just the beginning of the end of the current system as we move inexorably to the only system that has proven effective on this planet..a single payer system…although there are plenty of socialized systems that may wish to argue that point,,,there is NO example of a successful “private insurance” system of health care.
If we have been ignoring the needs of a very large swath of our citizens and then suddenly decide they deserve health care coverage, then Nova’s point about potential shortages of providers is certainly valid….but he has also answered his own question when he pointed out (correctly IMHO) that we all better get used to having a much more triaged approach to health care with first visits to medical providers not always being to doctors but perhaps to Nurse Practioners or other auxiliary personnel.
I think the licensure, qualifications, and management of this “newer” group of providers needs to be carefully monitored and managed, otherwise I have no problem with this. Imagine if you have a horrible accident, the first person who gets to you is frequently someone like Nova or other first responder not a physician. If first responders can treat and triage the kind of gore they see out on the streets why can’t a Nurse Practioner handle common colds and flu’s and perhaps help manage the many cases of hypochondria in our nation.
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I was upgraded to “club” status, because I’m staying for two weeks. So, I have free coffee (from a machine admittedly, but it wasn’t bad). Back when I lived in the UK, I found an American style coffee shop that I liked. It was a nice touch of home. There was also a quite good Italian restaurant that had a coffee bar out front that I liked. So, it’s cafe con leche and pretty good.
There’s an amusing story about coffee chains. A couple of Brits living in Seattle fell in love with Starbucks, but couldn’t find anything like it when they returned. So, they formed the Seattle Coffee Company (I think that was its name) and used pretty much the same model. When Starbucks decided to invade the UK, it was simpler to by out that company and rename them all Starbucks.
BB
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“we all better get used to having a much more triaged approach to health care with first visits to medical providers not always being to doctors”
A recent experience leads me to believe that can be good policy, and provide more efficient – and thus lower cost – services. I broke my hand in December, on a Sunday morning. I went to the urgent care, where a doctor saw me, had my hand x-rayed, confirmed it was broken & referred me to an orthopedic doctor on Monday. He gave me a crude, one-size-fits-all splint and a prescription for painkillers (despite me reporting minimal pain). In other words, the visit was nearly useless – he told me what I already knew & did nothing to solve the problem. On Monday I called an orthopedic clinic at 7 am for a 9 AM appointment. I saw a physicians’ assistant, who advised I might need surgery. While I waited, he consulted with a hand specialist who said I did not. By 9:45 my hand was in a splint & I was on my way. Had I gone directly to the Ortho place on Sunday, I would’ve avoided the wasted trip to urgent care & been in a splint & on my way within a couple hours of injury.
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A lot of companies (including mine, but I have insurance through my teacher wife) are going to high deductible plans coupled with flexible spending accounts. This gives all medical treatment tax free status while making insurance more of the unexpected-events-only coverage that qb is using as a paradigm.
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