this is not a journal title

I'm not uptight about birth control. ;)

Religious conservatives are for one of two reasons or sometimes both. According to them, access to birth control (and condoms, and the HPV vaccine) encourages promiscuity and premarital sex. And according to them, birth control kills a human being - which is patently scientifically untrue. (Some older forms of hormonal birth control prevented the implantation of a fertilized egg, but modern hormonal birth control prevents ovulation, so there's no egg to even be fertilized. Emergency contraception pills such as Plan B are more likely to prevent implantation of a fertilized egg, but even then it's not the only mechanism of action.)

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calzephyr77.livejournal.com

Oh, present company excluded of course!

I find the religious conservative viewpoint so foreign...the HPV vaccine had barely any controversy here, even in the Catholic school system. Maybe our conservatives just aren't vocal too :-)

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Roman Catholics aren't the most vocal group, it's the Evangelical Protestants who are, and I believe that Evangelical Protestants are a purely US phenomenon, arising out of the Puritanical traditions. Roman Catholics are relatively moderate, and they just jump on the bandwagon after everyone else has already spoken up. (For example when they offered to take back the Anglicans who left that church over the main Anglican church allowing gay marriage.)

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Except that it -is- a Catholic group that has been strongly pushing all the anti-abortion language in the health reform bill.

The contraception being left out, well, that's because too many pinheads immediately leap to bullshit like "this will give money to Planned Parenthood, and therefore will fund abortions, so we can't cover any women's health at all."

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Do you have any more recent evidence about abortion/HBC/pelvic exams being left out? I'm asked about it below and I don't have anything more recent or specific than your post from a week or so ago.

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I don't. I haven't gone looking hard yet, but I haven't seen any changes (good or bad) mentioned in any of the usual places, so I suspect nothing has changed.

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While it would be bad if these things were left out of the health care reform bill, I cannot find any of the things you are talking about in H.R. 3590, the current Senate bill. Nowhere are birth control or contraceptives mentioned. Is there another word they use? It actually encourages education on contraception.

As far as abortions, the Senate bill actually has fewer restrictions than the House bill. And as far as I can tell, the restrictions only apply to federal funding. Private insurers can still cover anything they want. This does not overturn Roe v. Wade. Abortion is not outlawed. It's just that there are limits to what taxpayer money will cover. Both bills allow coverage in instances of rape, incest, or endangerment to the mother. Correct me if I'm wrong, but at the moment, you can't get an abortion on the government's dime, can you? So how is this reform any worse? And I have to admit, while I agree that women should have access to safe abortions, I don't think taxpayers should pay for non-medically necessary ones. There should be some consequence for just accidentally getting pregnant.

I also can't find pelvic exams mentioned anywhere in the bill. Is it just because they aren't specifically mentioned that it is believed they are not covered?

It's not that I believe these claims are made up, but I'm of the mindset that I need specific references in the bill(s) before I believe anything I read or hear about this topic. I really don't trust whatever I hear, even if I agree with it, until I see proof. Too many lies from both sides (though I'm pretty sure the Republicans are responsible for the bulk of them).

This is Tammy's husband, by the way, in case you hadn't already figured that out. She told me she read in your journal that hormonal birth control would not be covered, so I tried to find where it actually said that and couldn't. Obviously, it's a huge bill, so I definitely could have missed something.

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(My reply was too long, so this part is about the bill.)

I admit to not having read either the Senate or House version of the bill myself - there have been so many versions bandied about I'm not even sure where to start looking to find the full text of them. Do you have a link to the full text of both versions where it confirms that those are the versions that either were just approved or are currently under debate?

The source of my concern was a post by

hrafn , which links to this article (the link in her post is bad) and this one. I tried asking around to see if anyone knew conclusively if the current versions do include coverage for abortions, HBC, or pelvic exams, and when no one knew conclusively, I decided to write this letter anyway.

how is this reform any worse?

For two reasons: (1) I expect that more people will be on the new plan after this reform than currently are on Medicare/caid, and (2) I have read arguments that this will result in changes in the practices of private insurance companies. The arguments go that if a private insurance company also carries an option for federally subsidized insurance for low-income people, that the private insurance company would not want to have two entirely different sets of coverage but instead will reduce the options available to the private clients. I don't necessarily agree that this possibility is likely (my private insurer has dozens of different plan options already, why would they change?) but on the off-chance that it is likely I don't want to support anything that could possibly lead to it happening.

And finally (on this item) it's supposed to be REFORM, the point is to make things BETTER, not maintain status quo.

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I'm currently referring to HR 3590, the bill that it's in the Senate right now. I also previously read much of HR 3200, the previous House bill, though it changed a bit before passage.

I followed the links you provided, and it seems that the complaint is that birth control and pelvic exams are not specifically required by the bills. I can't be sure of the real reasons for their omissions, but even though the bills are quite large, I would be surprised if it would even be possible to detail every single procedure or medication that does or does not need to be covered. It doesn't say anything about prostate exams or erectile dysfunction drugs either, but I'm sure those will continue to be covered. While it is entirely possible that an insurer could take out coverage simply because it's not specifically required, I have a hard time believing that would happen. If that were true, they could stop covering all kinds of things. Who would purchase their policies then?

I really don't think private insurers will drop their plans to the bare minimum. They want to survive and compete, and to do that, they have to offer something the public plans do not. If they don't, they will fail.

I do think this reform bill makes things better. The reason that it is so large is that it covers many topics. I know most people don't have the time to read the whole thing, but just skimming the topics gives you an idea of the scope of what it's trying to accomplish. It's far from perfect, and there have been compromises, but if nothing gets passed because of a few provisions, a lot of good stuff goes by the wayside. It's impossible to please everyone. The initial argument of the open letter is that this bill will set back women's rights by decades. I think that's an exaggeration and is based on speculation. It does not specifically take anything away. It leaves it up to the insurers, which is no different from today. Insurers have already decided what is in their best interest to cover or not cover. I know they cover hormonal birth control (Tammy is on it). I'm pretty sure they cover pelvic exams. I don't know what private insurers cover with regards to abortions, but whatever it is is unlikely to change. But that is to be seen. I just know that pushing broader coverage of them will likely kill the bill.

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I don't think taxpayers should pay for non-medically necessary ones. There should be some consequence for just accidentally getting pregnant.

I know that you didn't intend to insult the intelligence of women when you said this, but please be aware that that is how it comes out. (Your words imply that women don't understand that abortions are a major medical procedure; your words imply that women are not able to decide what is a "worthy" reason for abortion and that someone else needs to decide it for them.) You are speaking from a place of privilege in this conversation, and you need to be careful with the words and phrases you choose not to perpetuate the inequities.

Abortions are a major medical procedure. Women are unlikely to go get abortions on a whim or for a lark. If a woman wants to prevent a pregnancy and is educated about birth control methods, she will choose a prevention option earlier than abortion. Sure some of the women seeking out abortions may be doing it because they "just accidentally got pregnant," but I think it's worth risking that to protect the MANY other women who need abortions for valid reasons. I am against frivolous abortions, but I am strongly pro-abortion rights, no questions asked.

There are many cases where an abortion may not be medically necessary but is still necessary. For example, many people are just not sufficiently educated about contraception options, such as teens having sex who don't get sex ed in school, conservative Christians who are deceived into thinking that the rhythm method is effective, and there are also failed methods of birth control (condoms break, pills fail, even vasectomies and tubal ligations have a failure rate), or women who are not able to legally make decisions (such as severe developmental disabilities [commonly called retardation]). These are special cases that I feel should have access to non-medically necessary abortions, and I don't feel that attempting to legislate every last specific case is something we can or should do.

Both bills allow coverage in instances of ... endangerment to the mother.

Who decides the line between "medically necessary" and not? And what about endangerment to the fetus or potential child? I am 31 years old and I am still considering having a child of my own biology. I feel that I should have the right to test for Down syndrome and abort if it is present. I'm not sure I would actually do it, but I feel that it is a decision that should be made by the potential parents. Is this medically necessary? Depends on how you define it, and certainly the pregnant woman's life is not at risk. I have one gene for a type of anemia called thalassemia. If my child inherited two genes of it, s/he would either die in the first few weeks of life or at best would need massive blood transfusions every 6 months. Is aborting a child like that medically necessary? It would be a crime to injure someone to the same degree, many people wouldn't want to force a potential child of theirs to have to go through such an experience. If the child is going to die in the first few weeks of life and live in pain during that time, slowly suffocating, the merciful thing is to abort before it even is a child. However this isn't medically necessary, and it certainly doesn't endanger the woman's life.

Also: in discussions about abortion, the correct term for the pregnant woman is "pregnant woman". She is NOT a mother because she does not have a child, she has a fetus or an embryo. "Mother" is a very loaded word and using it confers the status of "living breathing human being" upon a lump of undifferentiated cells that often wouldn't be noticed if it were flushed down the toilet. Calling the pregnant woman the "potential mother" is slightly more appropriate than just calling her the "mother," but is still very loaded.

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I realize my comment was oversimplified and condescending, and I apologize. I know there are consequences beyond monetary concerns for unwanted or dangerous pregnancies. I just think people put a lot of emphasis on the fixing of the problem rather than the prevention. The bill addresses some of that. Nobody wants to get an abortion, but I feel that while there's not enough education out there about contraception, there's also not enough education out there about what an abortion entails. Many women don't really learn about it until it's too late. I think tax dollars would be well spent on that. But if it does happen, then yes, you should have the option of abortion, and it should be your choice after adequate counselling on options. Using taxpayer money for it doesn't sit well with me, but if the woman has no other reasonable choice, then I guess I'm ok with it. But in relation to the open letter, I don't think the bill takes a step backward. It just doesn't go forward very much.

Abortion is a very conflicting subject for me. On the one hand I believe in a woman's right to choose and the many reasons for not going through with a pregnancy, but on the other hand, I'm adopted. I'm Vietnamese and was born during the Vietnam War. I could have easily been aborted. After all, what chance does a baby born to a single mother in a war torn country have? Yet I've lived a very happy and productive life. My mother could have easily decided I didn't stand a chance. Perhaps she even only went through with it because she couldn't afford an abortion. If she had had adequate insurance, would I be alive right now? It's hard for me to completely get behind affordable abortions, even though I know they are necessary in many cases. I'd also like people to consider adoptions more when they can't conceive. Too many people are hell bent on having their child share their genes when so many other children need parents. Being a parent doesn't have to be about DNA.

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Both bills allow coverage in instances of rape, incest

Exceptions for rape and incest put the burden of proof on the victim, and few of these victims actually report when the incident takes place. There is no way to effectively put in a clause that forbids abortion except in cases of rape and incest that does not exclude the majority of rape and incest victims. The only way to make sure that the majority of rape and incest victims have access to abortions is to not ask any questions about the reason for the abortion. Don't worry, women know when they've been raped, you don't need a doctor or police officer to double-check.

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While rape may be tricky to prove sometimes, it doesn't seem like incest would be. Couldn't a DNA test confirm that? Or does the baby actually have to be born for a test to be performed?

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Proving it would not be difficult - an amniocentesis can get fetal DNA, that's how they screen for Down syndrome. I'm not sure if they can tell from just fetal DNA and the woman's DNA that the fetus is the product of incest though, they may need to compare DNA to potential fathers. If that's the case, the pregnant woman would have to admit to the incest and ID the man involved. While there are also other circumstances of incest, it's often a subset of rape. Do you think a 13-year-old girl would be willing to admit to being raped by her uncle? Do you think she'd even necessarily understand that it's rape?

I don't know how quick the turnaround is on this sort of DNA testing, I'm guessing faster than Down syndrome screening and that can be done before the baby is born, but I'm not sure.

It may be possible to do routine incest screening on all women seeking abortions, but doing so would solve the problem of "how do we enforce the incest exception and prevent non-incestuous abortions?" it wouldn't solve the problem of "how do we provide access for rape victims?"

I'm still thinking about your other comments. Thank you for your thoughtful and respectful responses.

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In the case of a 13 year old girl, I don't think she has to admit to anything. By definition, if she is pregnant, she has been raped, incest or not. It just gets more difficult after the age of consent. So the only option is to cover all abortions because the burden of proof is often too difficult to ascertain. I totally understand your argument. It's just in my personal opinion, I have a hard time justifying all cases. But if it must be done because it's the only way to cover legitimate reasons, then it's something that I'll just have to swallow.

However, I do understand why the provisions are in the bills. This reform is an extremely difficult thing to pass. The question is if it's worth not passing because not everything you like is in it. The country is split down the middle on abortion, so you will not be pleasing half the people if you go all the way to one side. My belief is that this bill should not have been one bill. It should have been a series of bills that were voted on individually. This all or nothing approach seems too risky and overreaching. If it doesn't pass, a lot of good things don't get implemented. If it does pass, some bad things will get implemented. They should have created a bill with all the things both sides of the aisle agree on and just passed that right away. Then they could have created additional bills to deal with the more controversial stuff like abortion, public option, and immigration that they could have argued about without affecting the core of the reform.

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The Stupak/Pitts amendment did not provide an exception for the health of the pregnant woman, only for her life (or for pregnancies caused by rape or incest). Leaving out an exception for health is huge, and probably unConstitutional, since Roe requires health exceptions.

The George Washington University School of Public Health and Health Services did a study on the likely outcome if the Stupak/Pitts amendment stayed in the final bill, and their conclusions are pretty grim - they concluded that the amendment would lead to no private insurers offering abortion coverage, period. Since the Senate has already gotten rid of Stupak/Pitts in favor of something closer to the status quo, I am hoping that is how the final bill will be (well, to be honest, I'd like them to ditch the fucking Hyde amendment, but we all have unrealistic hopes).

Consequences for "just accidentally getting pregnant" are one or more of the following:

-pregnancy
-miscarriage
-labor or c-section
-death
-potentially any/all of [a long list of non-fatal health problems]
-permanent changes to your body
-abortion
-giving up child for adoption
-raising child

None of those aren't consequences. Probably the least of them would be a very, very early miscarriage that requires no medical intervention.

It is much less expensive to provide an abortion than pay for the medical costs of pregnancy, delivery, and the child's medical expenses, some of which -are- mandatory for insurers to cover.

The issue with pelvic exams and contraception are that some health services are explicitly listed as "must be covered" by insurers, like certain health services for children, and those things (as well as screening for domestic violence) were not listed. Therefore, insurers can cover them or not, it's up to the insurer. FanTASTic.

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Yes, there should be a stipulation for the woman's health. If the Senate bill holds, it should be better on that front.

Rather than repeat myself, see my comments above on abortion. I just wanted to address this:

It is much less expensive to provide an abortion than pay for the medical costs of pregnancy, delivery, and the child's medical expenses, some of which -are- mandatory for insurers to cover.

Part of me believes that expense shouldn't be such a big factor in the decision to have an abortion. It's kind of implying that the less costly an a abortion is, the more likely the woman is going to have one. You could also argue that it's cheaper to execute a prisoner than it is to keep him or her in prison for life or rehabilitate them. Should these decisions be driven by cost? It's a tricky line. For those who need abortions, it shouldn't bankrupt them. On the other hand, the woman shouldn't have an abortion if she would have carried the baby to term without issue if she couldn't afford the abortion.

It's already up to insurers whether or not to cover pelvic exams and contraception. My argument is not that the bill makes things better. It's just that I don't see how it makes things worse as the open letter states.

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Re:costs - one of the reasons given to leave contraception out of the list of things that must be covered was cost. As in, "if we have to pay for X amount, that will increase the total cost of the bill too much," ignoring the fact that -not- covering contraception will lead to a variety of more expensive results, including things that the bill said must be covered, like costs for some children's health coverage.

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sildra.livejournal.com

On the other hand, the woman shouldn't have an abortion if she would have carried the baby to term without issue if she couldn't afford the abortion.

How would she even know if she could have carried a baby to term without issue? I say this because a good friend of mine nearly bled to death during childbirth--despite being at a first-rate hospital--and ended up with sufficiently severe permanent brain damage due to the loss of blood that she had to quit her job. Now, three years later, she still collapses if she tries to walk too far or go up more than a small flight of stairs. In her case it was a wanted pregnancy. But in the case of an unwanted pregnancy, the risks--including ones like this that can't be predicted--seem sufficiently high that a woman shouldn't be coerced into going through with it.

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Of course you can't predict what will happen in childbirth. You can't even get an abortion after a certain point, so whether or not you're covered has no bearing. In the case of your friend, I'm sure there was no reason up until childbirth to abort. All indicators probably pointed to a successful pregnancy. That's the situation I'm referring to. If you have warnings about the health of the woman or the baby, then that changes things.

My point is that if the deciding factor for terminating a pregnancy is affordability, I believe that's the wrong criteria. While I'm certainly not saying that's the case with most women, I have known at least two women who had abortions because having the baby would have been an inconvenience. There was no medical reason for the abortions. They were not forced or coerced into having sex. They were not uneducated about the potential consequences of unprotected sex. They just neglected to use birth control while in a long-term relationship. They were not rich by any means, but they were not financially strapped. I don't know if they paid out of pocket or were covered, but they could afford the abortions. If they couldn't, they probably would have had the babies and figured something out. In these cases, money seemed to be the deciding factor between aborting or having a child. I'm not saying it was an easy decision for them because it wasn't, but the fact that the abortion was affordable made it easier for them to decide. It also gave their partners a get out of jail free card, as they had as much responsibility as the women.

Honestly, I don't know what the best solution for coverage is. If you cover everyone, abortions resulting simply out of carelessness will get covered when there are other options. If you put restrictions on coverage, some women who really need them will be denied. I guess the lesser of the two evils would probably be covering abortions for careless pregnancies.

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It's funny. My impression is that your views are deeply offensive to one or more of the people you're communicating with, and yet instead of shouting you down, they're arguing within your selected framework. I've always found that to be kind of a liberal failing. If this conversation were happening in my space, you'd be castigated roundly.

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It's a failing to argue within a framework rather than engage in shouting matches? How exactly are shouting matches helpful? Look, I'm expressing my opinion. If there are reasonable arguments to the contrary, I will listen. If I'm just denigrated, then no, I will not listen. Personally, I'm not offended if someone disagrees with me if they can tell me their reasons. If they just yell at me and say they're right and I'm wrong, then that accomplishes nothing for either side.

Abortion is a very touchy subject. I realize that, and I don't expect my views to be embraced by everyone. I happen to think that careless pregnancies do exist, and I also think there are some women who view them as inconveniences rather than a complicated matter. I don't feel this is an overgeneralization because I made it clear that it was some women. Not all women are saints just like not all men are. However, it's not up to the insurance companies or the government to make a moral judgment, so I don't think these situations can or should be prevented by laws. They can only be prevented through education.

I know some of my wording didn't get my point across correctly and could be construed as offensive. Perhaps the point is offensive, but I won't pretend to think otherwise. I view coverage of abortions like many other programs. There will always be instances of using the system incorrectly, but for the greater good, they must be endured, and hopefully with better education, they will be reduced. It doesn't mean I'm happy with them. My taxpayer money goes to a lot of things I don't use or agree with, but that's the price I pay for all the good things it does go toward.

I do apologize for hijacking the post and turning it into a debate on abortion. That was not my intent. My initial reply was simply to find out where in the bills the claims in the open letter were referring to because I couldn't find them. I should not have injected my opinion on federally funded abortions.

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Thank you for your civil reply. I'm okay with this turning into a discussion about funding abortions. I'm not okay with other people cursing at anyone in my space, and thank you for keeping your response civil rather than stooping to his level.

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Thank you for deleting the first comment before I could, however I would have preferred if you hadn't posted it in the first place. While anger and vituperation do have their place in these sorts of arguments, MY journal is not that place. My rules are that people should be convinced, not yelled at.

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I hadn't considered the triggering aspect. I'm genuinely sorry, and will be sensitive of triggers not just in this space, but in others as well.

That said, using: "I find what you believe repugnant, however let me tell you how your own (terrible) framework suggests..." is fine, as long as you frame it that way. If you just work within someone's framework without circumspection, you're abdicating moral authority and perhaps being a little dishonest.

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Ah yes, disgust is perfectly fine, or channeling your anger into a logically persuasive argument. (It's the control that makes it tolerable to me.)

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(It's the control that makes it tolerable to me.)
It's kind of a trap, though, isn't it? We're wired so that being engaged serves as a form of validation, even if the other party isn't actually using explicitly validating language. I believe in well-deserved shame, which requires touchstones. And I don't think the word "stooping" is appropriate. The word "stooping" is appropriate when you address someone with terrible views on women's rights as if they don't.

Please understand that, in my life, it was very, very hard for me to get to the point where I felt like my views matter. Seeing people sell themselves down the river is very much a personal trigger for me. And I don't mean that as a clever and snarky "huh, huh, I have triggers too." It's a real problem for me. I've got a lot of baggage.

I should be clear though - I recognize that verbal assault is a place where reasonable people can agree to disagree. But I think there's a powerful pragmatic point to be made about actual (as opposed to semantic) validation.

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If a tone has been set to NOT flame people, I try very hard to respect that, and so I am sometimes very grateful that tone is hard to convey/interpret via text. I also find shouting matches stressful, especially when there's no chance of any kind of conversation changing someone's mind, even if I really really really want to flame someone to the waterline and then nuke them from orbit.

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I appreciate this. IMO "not flaming" isn't the same as "accepting their framework". I think you're doing a good job of expressing your frustration with the other person's viewpoint without getting into the flaming. :)

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IMO "not flaming" isn't the same as "accepting their framework"

I tend to agree, and wish I better knew how to get other people to argue within -my- framework.

And thanks - I'm usually so steaming angry when I engage in these topics that I can't always tell if the results, when read, come across as angrily as I hear them in my own head.

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I think it's clear that some of the claims about the health reform bill are being exaggerated for political effect. I won't be happy, though, until the federal-monies-abortion language gets watered down to the point where insurers put federal money and private money in separate accounts, and abortion claims are simply paid out of the private account. That won't address the concerns of the Right, but the whole "subsidies can't fund a tainted plan" scenario seems really harmful.

I guess I could live with private riders on plans, as long as those riders were legislated as opt-out.

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Oh, hey -- my wish was granted a couple days ago. The current Senate version has the Lois Capp version of the abortion funding language. Separate accounts.

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Ah, maybe that's where the concern that anti-abortion language would affect privately funded insurance plans comes from. If the monies for privately funded insurance plans and for publicly funded plans were co-mingled, then that would "taint" private plans with public funding, requiring the private plans to follow the same rules as for publicly funded plans.

(Amusing that I view it as public funds tainting private plans, rather than private plan coverage tainting public funds.)

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Sorry if it wasn't obvious, but I was using the word "taint" subversively. =)

But yeah, it sounds like Reid championed the pro-life language for the bill. Now we just have to fight to get the damned thing passed. =)

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