Half Changed World

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I listened to the health care debate in Congress on and off today while driving around to soccer fields and the mass flu vaccination site, and for the last hour I've had c-span on while sorting my clothes.  Although I know that there's still a long while to go before we actually get a law, and this bill is truly an act of sausage making, I'm still fascinated by the process.

Wow, the margin is a lot closer than I would have guessed– they've got exactly the 218 votes needed, with only one D not yet recorded.  I'll be interested to see how many of the Dems voting no are on the left.

Ok, here's the roll call results.  I'm not an expert on all members of Congress, but the only nos that jump out at me as being from the left are Kucinich, and maybe Artur Davis.

So, the big news of the evening was probably the passage of the Stupak amendment, which says that any insurance plan purchased through the "exchange" can't cover abortion.  My understanding is that this would NOT affect coverage under employer-provided insurance.   When I looked into this last year, I found out that about half of employer-provided plans do cover abortions. 

I think this is bad policy, for precisely the same reason that I think the Hyde amendment, which bans coverage of abortion under Medicaid, is bad policy.  It pushes abortions into the second trimester, which is more dangerous and more expensive.  But I'm not particularly surprised by it.  Fundamentally, I'd rather health insurance reform that didn't cover abortion than no health insurance reform.  And with such a thin margin, I'm not sure Pelosi had a choice.

The cynic in me wonders if maybe more of the public will holler when it's their insurance that is affected, not just poor women's coverage.

Update:  I listened to this NPR story on the Stupak amendment on my way home tonight, and now I'm even more confused.  They say that it doesn't prevent the exchange from including plans that cover abortion (although insurers would have to offer plans that were otherwise identical but didn't cover abortion) as long as you're paying with only your own money and don't receive a tax subsidy for the insurance.

So what I'm confused about is what are the rules for employer-provided insurance, which is also tax-subsidized.   Is it covered by the Stupak amendment?  Or are they pretending that employer-provided insurance isn't subsidized by taxpayers?

Update 2: Nice analysis of the D's who voted no from the NY Times.

Becca at Not Quite Sure poses an interesting pair of questions:

I have no doubt that 40 years from now, when my hypothetical grandchildren learn about this period in history, the collapse of the US auto industry will feature prominently.  And my guess is that Dr. Tiller won't be mentioned, although the culture wars more broadly will.

That said, I'm not really upset about GM going into bankruptcy.  A bit sad, but not really upset.  Both because it's been coming for so long that it's not shocking, and because the good union jobs in the auto industry were going away whether or not GM managed to avoid bankruptcy.  And I'm going to blog about Tiller, not GM, because I don't have anything particularly original to say about GM.  (If you want to read about GM, go re-read Gladwell's article about why GM should be understood as a health insurance company that finances itself by selling cars.)

So, back to Tiller.  With Obama nominating Sotomayor to the Supreme Court, and presumably getting make at least one more and possibly several nominations, I think abortion is likely to remain legal for the foreseeable future.  But Tiller's murder drives home the degree to which the question of whether abortion is legal has become almost completely separate from the question of whether women who want an abortion can get one.  According to Planned Parenthood, more than 85 percent of counties in the US do not have a single abortion provider.  Tiller was one of only a few doctors in the whole country who do late-term abortions.

I can't blame doctors who decide that they're not up to facing the screaming protestors, the constant threats on their lives and their families.  And there's a selection issue — because so many doctors don't do abortions at all, it's easy for a doctor who is willing to serve women in this way to find that they're spending most of their time doing abortions.  But it's pretty hollow to have a legal right to an abortion if you can't actually find someone to do it.  Wealthy women will always be able to travel to providers (at least, if they don't need the abortion because of an immediate crisis) but poor women won't.

I have to admit, I sort of rolled my eyes when I read the plea in my inbox today from NOW with the claim that "Roe is still under attack."  Obama is expected to repeal the global gag rule although apparently not today.  And at the inauguration, we joked that after Justice Stevens swore Biden in, he was saying "thank god, I can finally retire."

But then I read Cecily's posts today.  First, she reminded me of the problem of the lack of availability of doctors who will perform abortions.  And then she notified me that Virginia is once again considering making it a crime to fail to report a miscarriage to the police.

We've defeated this bullshit before.  Let's do it again.  If you live in Virginia, here's the link for finding out who your state senator is.

Update: For the record, here is Senator Obenshain's response to comments, where he acknowledges that the bill is far too broadly drafted for his intent, which he claims was to eliminate the "it was born dead" defense for infanticide.  However, given the history of a very similar bill four years ago, either Obenshain is lying or he didn't even bother to do cursory research before introducing the bill.

I went to the homeowner’s association meeting tonight and, as is their custom, a number of politicians and their representatives were invited to speak.  Connolly and Fimian were both at a previously scheduled event, but they both sent people to speak on their behalf.  Connolly’s representative did a generally solid job, though he went on for too long.  Fimian’s representative was a young man, perhaps 20 years old, who began his speech by admitting that he usually spoke to groups of high school student and this was a step up for him.  It was pretty painful listening to him, as basically the entire pitch was that Fimian’s not a Washington insider and he knows what it’s like to be us.  Since we had just recognized Tom Davis for his years of service to the district, this was perhaps not the best note to hit.

At the question and answer period, one of my neighbors tossed him a bit of a softball, asking about the mailings that she’d been getting about Fimian, and weren’t they just accusing him of being Catholic?  (Note that Connally is also Catholic.)  He responded with a long answer about how they were making these accusations based on links on the Legatus website, even though the webpage includes a disclaimer that they didn’t constitute an endorsement.

Well, this ticked me off, because it sounded to me like Fimian was trying to hide his strong social conservative positions.  So I asked him about the info from Left of the Hill, that Fimian’s company amended its health insurance plan to exclude coverage of abortion, even in cases where the health or life of the mother was at risk.  (I found this via Anonymous is a Woman.)  The speaker had no idea, and so we moved on, but I found myself arguing with my neighbor about how common this is.

When I got home, I started googling, and I found this 2003 Kaiser Family Foundation survey that found that 46 percent of firms that provided health insurance included abortion coverage.  (I checked, and while KFF conducts this survey every year, they seem to have dropped the question about abortion coverage.)  Large employers were far more likely to provide abortion coverage than small ones.  Interestingly, 26% percent of employers did not know whether their insurance plan covered abortion, which makes me think that this is usually a cost-cutting provision rather than an ideological one.

What I can’t tell from this is whether plans that don’t cover abortion generally have life and health of the mother exceptions.  I can’t find this online — anyone have a source?  Or, if your plan doesn’t cover abortion, can you look it up in your benefits handbook?

In honor of the Roe v. Wade anniversary, I’m highlighting the Hyde- 30 Years is Enough campaign to lift the restrictions on Federal funding of abortion services to poor women who receive health insurance through Medicaid.  Here are some of the reasons I oppose the Hyde amendment restrictions:

• I believe that the ability to control one’s reproduction should not be limited on the basis of income.  NNAF says it better than I can:

"We call for full public funding of abortion as a
part of comprehensive health care for all, and support for low-income
women to care for their children with dignity.  We stand for
reproductive justice, a world in which all women have the power and
resources necessary to make healthy decisions about their bodies and
their families."

• One of the main effects of the Hyde restrictions is to push abortions from the first trimester into the second.  This increases the health risks to the woman, raises the cost of the procedure, and pushes closer to the viability line.

• The logic of the Hyde amendment — and the related laws that prohibit coverage of abortion for federal employers, military personnel, and their dependents — is fundamentally flawed.  Supporters argue that even though abortion is legal, people should be able to avoid having their tax dollars support something that they consider immoral.  Well, I can think of a number of things that my tax dollars support that I consider immoral, and I don’t get to opt out. 

If you’re not poor, a federal employee, or a member of the armed services, these bans don’t affect you.  Now.  But if you hope to someday be covered by a public health insurance system, you should be paying attention.

As I explained in the first ever post on this blog, the name "Half Changed World" comes from the subtitle of Peggy Orenstein’s book, Flux.  Before I started the blog, I googled Orenstein’s email address, and wrote her to ask if she minded my using the name.  She responded with a very gracious note, pointing out that you can’t copyright a title, but  wishing me well.  Thus, when I received an email a few weeks ago from Orenstein announcing the publications of her new book, Waiting for Daisy, and offering me a review copy, I was happy to take her up on the offer. 

In Flux, Orenstein examined the changing expectations and experiences of women in their 20s, 30s and 40s, especially focusing on their choices whether to have children and whether to work for pay.  The not very hidden subtext of the book was her own attempt to decide whether to have a child, what it would do to her career, and whether she would regret it down the road if she didn’t.  Waiting for Daisy is explicitly about Orenstein and her husband’s decision to have a child, and how almost everything that could have gone wrong did go wrong (cancer, a molar pregnancy, miscarriages, failed IVF, a failed donor egg cycle) and the ultimate improbable conception of their daughter Daisy.  Or, as the subtitle puts it "A Tale of Two Continents, Three Religions, Five Infertility Doctors, an Oscar, an Atomic Bomb, a Romantic Night, and One Woman’s Quest to Become a Mother."

I have been fortunate enough not to have personal experience with the world of fertility treatment.  But I’ve read enough fertility blogs that little in Waiting for Daisy was a surprise to me, not the callousness of the doctors, not the way that the couple was sucked into more and more involved procedures, in spite of their initial ambivalence.  If anything, it seems like Orenstein may have had the ironic blessing of responding sufficiently poorly to medication that she and her husband weren’t tempted into cycle after cycle of trying.

The part of the book that moved me most is probably the description of Orenstein’s encounter with the Japanese ritual for mourning miscarried or aborted fetuses.  (This is a revised version of an article that appeared in the NYTimes Magazine several years ago.)  I also really liked the way that Orenstein writes about her anger at Sylvia Ann Hewlett’s "chicken little natalism" even as she feels herself turning into the "poster child" for Hewlett’s thesis.  She’s clear-headed enough to see both the big picture and her individual reality at the same time, and neither to believe that her life is prototypical nor to deny her own reality because it’s inconsistent with her story about the world.  So, yes, she did ultimately get pregnant with her daughter without medical intervention, but no, that doesn’t mean that infertile women will conceive if they "just relax."

This is a quick read — I read it over the course of a weekend.  While she covers some serious topics, Orenstein writes about them lightly.  I enjoyed the time in her company.

I’m happy to report that contraception is still legal in the commonwealth of Virginia, in spite of Bob Marshall’s efforts to the contrary.

• Planned Parenthood of Virginia explains the issue.

• And Not Larry Sabato discusses the political ramifications of the Democrats’ move to force a roll call vote on the bill.

Given how close this bill came to passing, sorry Bitch, but I’m not laughing.

I’m not in the mood to write tonight, so I’ll just share some links:

1) I really liked Rowan Crisp’s comment on the sHillary post at Pandagon:

"I was told recently that “as a feminist” I had a duty to vote for her. I stopped laughing long enough to ask if I had to vote for Condi Rice if she ran, too. Funnily enough, I never got an answer on that one.

"I want someone who will fight for national healthcare. I want someone who will stop wrapping themselves in the flag and the bible to justify horrors. I want someone who will obliterate the movement towards a constitutional amendment to ban gay marriage. I want someone who will ridicule DOMA for what it is: a limitation on the right of legal, consenting adults to contract freely.

"I’d also like a pony. 🙁 "

Hillary isn’t my first choice for the Democratic nominee.  She’s not even my second.  But I feel like there’s a level of vitriol against her on the left that is totally out of proportion to the compromises that she’s actually made. 

2)  Blogging for Choice posts from Cecily and Bitch, PhD.  And Wealhtheow writes about Virginia’s "controversial" bill to ensure that anti-abortion laws don’t ban contraception as well.

3)  And via Funds for Writers: Small Markets, I thought some of my readers might be interested in this call for submissions of speculative fiction about futuristic motherhood. 

What do you imagine the function of motherhood to be? How do you think the image of motherhood will change? How do you think the image of motherhood will stay the same? What possible customs, norms or laws will be in place in the future that would have an impact on changing or affecting mothers? How will science and technology affect pregnancy, birth, and child rearing? How might full social equality affect childcare in the home and workplace? How does a lack of social equality in a highly technological society affect pregnancy, birth, and childcare? How about in a future culture with a highly evolved social order but low technology?

The Washington Post ran a bunch of articles yesterday about different kinds of parent-child relationships in this era of assisted reproduction:

• Liza Mundy, who is apparently writing a book about assisted reproduction, writes an overview article, with the obligatory Mary Cheney references.
• Katrina Clark writes about having been conceived by anonymous sperm donation.  She also answered questions on line today.  She writes with passion and pain about having been stripped of the "right" to know who her father is.
• Mike Livingston writes about being a known sperm donor, or maybe occasional father to the child of a lesbian couple.

And, in a completely unrelated article, part of their Being a Black Man series, Neely Tucker writes about Tim Wagoner and how he is navigating what it means to be a father when he’s not married to the child’s mother.

It’s an interesting, provocative set of articles.  One of the points that Mundy makes is that until recently, sperm donation was mostly the province of married couples, as it was essentially the only option that doctors could offer to "treat" male-factor infertility.  Such donation was societally invisible and, in many cases, hidden even from the children.  These children may have been denied access to their genetic heritage, but had social fathers, so face different issues than Clark.

My one complaint is with Mundy’s blithe statement "There aren’t enough adoptable children in the United States to meet people’s desire for kids and family life."  Setting aside the blithe labelling of over 100,000 kids as "unadoptable," I think it’s wrong to suggest that the majority of people using reproductive technologies would choose to adopt if there were suddenly a huge number of healthy infants available for adoption.  What makes the use of donor eggs and sperm so fascinating is that some of the people who go that route are largely doing so because they want a genetic connection to at least one of the social parents, even as they minimize the social connection to one of the genetic parents.

Update:

1)  The comments made me realize that I hadn’t included enough modifiers in the last sentence — so I added the "some of" and took out the "largely."   I apologize if I offended with my carelessness.

2) Family Scholars blog is doing a round up of blog-reactions to the Clark essay, and included a link to this post.  Can anyone point me to something I wrote that makes Elizabeth Marquardt think that I’m a "donor insemination mom"?  The link may be getting a different assortment of commenters than usual.  It’s worth restating my policy that I don’t censor comments for opinions that I disagree with, but I reserve the right to delete comments that I think cross the line into personal attacks.