The recent federal-court decision invalidating California’s ban on gay marriages was of course welcome and long overdue. And there’s a lot of commentary from across the political spectrum predicting that it will be upheld at the Supreme Court level, given Justice Kennedy’s authorship of both major recent groundbreaking decisions favoring equality for gays (Romer, invalidating an exception to equal-rights statutes in the case of gays, and Lawrence, invalidating the criminalization of gay sex), and his status as inevitable swing vote on discrimination issues. So – while nothing is yet assured – this is a watershed, and very hopeful, moment for the cause of equality.

The question it raises, however, is what kind of backlash this will trigger. One likely possibility is an attempt to push through a Constitutional amendment imposing discrimination nationwide. Although that possibility concerned me greatly, I am – with fingers crossed – hopeful that such a movement would be unavailing. By the time any such plan could gain traction, there will have been several years’ worth of experience with gay marriage, and increasing experience of life under a national-level Supreme Court decision for equality, tending to reduce the panic over the supposed consequences of gay marriages. The political winds have shifted, also; it’s true that the GOP is somewhat resurgent, but the grounds for debate are now dominated by economic issues, and the religious-right/teabag movement is proving more and more of a liability for the GOP. I suspect the homophobic firestorm the GOP deliberately stoked in 1996, which created gay marriage as a political issue for their base, will not be possible in 2012. And, too, Constitutional amendments over controversial issues are hard to pass, and this one is unlikely to have enough momentum to overcome the inevitable decline of the homophobic movement as the reality of gay marriage proves their crazy ranting is just pointless. So I suspect there will be an attempt to pass the first-ever Constitutional amendment creating a new form of discrimination, but it will fizzle out.

However, I just read speculation elsewhere that gay marriage will become “another Roe v. Wade” – that is, a cultural flashpoint issue that will polarize society and give the right wing something to agitate about forever. That is no reason to oppose equality, of course, but it is a daunting prospect nonetheless. And that commenter was surely right that the (presumptive) institution of equality by the Supreme Court, and the failure of legislative or Constitutional processes to maintain discrimination, will energize the right wing and serve as a focus of grievance for them for the forseeable future. And yet, as I think about it, it occurs to me that this outcome may not be as destructive as it would seem, and could even have an upside. I suspect that the wingnuts will indeed agitate interminably over gay equality, and this will have two consequences: (1) it will further marginalize the religious right, and (2) it could conceivably bolster support for abortion rights as well.

The argument for the first possibility above is obvious. As gay marriages become more and more commonplace, and as disinformation about priests being forced to perform gay marriages, or children being “indoctrinated” in schools, are disproven by everyday experience, the disingenuous fearmongering that drives the hate movement will be undermined. The haters will simply serve to highlight the unhinged and bigoted streak that infects the Republican party and, as Sarah Palin is quickly becoming, and Sharron Angle already has become, will be an albatross around the neck that the GOP will eventually be glad to be rid of.

The argument toward a pro-autonomy rebound is less intuitive, but not implausible, I think. The idea that gay marriage will galvanize conservatives like abortion did is likely true. The parallels between the issues are strong: each is a cause celebre’ for the religious right, grounded on religious visions of morality, driven by a deep-seated revulsion to sex, and centering on a despised group whose claims to equality and autonomy the religious right hates and resents.  And the campaigns waged by the right against autonomy and self-determination in both cases are again similar: bizarre predictions of the consequences of allowing people to make their own decisions, Biblical injunctions against equality and non-patriarchal sex, deliberate lies and disinformation about the implications of freedom in each case, hateful moralistic judgmentalism, simply deluded scientific disinformation, and a manipulative pretended concern “for the children”, all of it as grossly distorted and dishonest as it is possible to be. As wingnut hot-button issues, they do have much in common.

It is that close parallel that, I think, spells (indirect, and uncertain) good news for the pro-choice position. The campaign against equality for gays is very similar to the campaign against self-determination for women. The basic idea at the bottom of both campaigns – that one particularly backward and restrictive religious view of how people should live their lives should be made mandatory for everyone, by law – is the same, and the attempt to regulate sexual behavior that they disapprove of is likewise a common central element in both campaigns. The gay-marriage controversy brings this to the fore because that issue is clearly solely driven by sex-based animus, but the same elements are at work in the abortion issue. And so, as the gay marriage controversy is exposed as the panicky, lunatic hatefest that it is, all other attempts to restrict the rights of autonomous adults to make their own decisions in areas reflecting on their sex lives will be simultaneously undercut. To the extent it becomes obvious that “gay marriage” is a wholly invented controversy based on ludicrous and bizarre apprehensions about other people’s sex lives, and the characterizations of its proponents and participants were absurdly false and fantastical, and its presence in the community is not a threat or a curse, and the claims and predictions made about it were false and invented, it will become that much easier to see how those same distortions have driven the anti-choice campaign in the same ways. And, most of all, the more it becomes obvious that the anti-gay-marriage people are simply hateful and barely sane, and that their movement is a product of their religiously-inspired reactionism, and that they are the same people who are driving the anti-choice campaign, the true nature of that project will become more obvious as well.

The bottom line is, letting the wingnuts discredit themselves over gay marriage can only work to the advantage of the pro-choice community (and related progressive movements). It will be an ugly and hateful process, but a necessary cleansing, and possibly a road to a better day in the future.

There’s a lot of blogging today over a sensationalistic post at NRO by Shannen Coffin, a former Bush lawyer who was responsible for anti-choice litigation surrounding the so-called “partial birth” abortion ban. She He notes a 1996 memo from the files of the Clinton administration, predating Clinton’s veto of the anti-choice bill, in which Elena Kagan, then a Clinton legal advisor, recommended a change in language in the policy statement eventually issued by the American College of Gynecologists supporting their opposition to the bill. They originally stated that “in the vast majority of cases, selection of the partial birth procedure is not necessary to avert serious adverse consequences to a woman’s health”, and that they “could identify no circumstances under which intact D&X would be the only option to save the life or preserve the health of the woman”, but – on Kagan’s recommendation – clarified that by also noting that it “may be the best or most appropriate procedure in a particular circumstance to save the life or preserve the health of a woman”. (Note that ACOG explicitly reaffirmed this policy, using the same language, at least three more times, in 1997, 2000, and 2003). That policy statement was later referred to by at least one federal judge, in litigation on the constitutionality of the ban later enacted by Bush.

Quelle horreur!

Coffin’s conclusions are that this is a “distortion of science”, that “language purporting to be the judgment of an independent body of medical experts devoted to the care and treatment of pregnant women and their children was, in the end, nothing more than the political scrawling of a White House appointee”, and that “Miss [sic] Kagan’s decision to override a scientific finding with her own calculated distortion in order to protect access to the most despicable of abortion procedures seriously twisted the judicial process” – naturally she he rolls this up into the ongoing Kagan Supreme Court confirmation hearings as well. The right-wing idiotocracy is all a-Twitter, too, natch: Powerline declares this is a “smoking gun” and “shocking”; Riehl calls it “misrepresenting science” and “dishonest”; the risible Betsy, of Betsy’s Page, reads this and concludes that “there was a doctors’ opinion that said that partial birth abortion was not necessary and she, with no medical background at all, drafted a statement that said the exact opposite”. Yuval Levin, the severely bioethics-challenged former staff manager of Bush’s Presidential Council on Bioethics, declares this to be a “war on science”, “astonishing”, and “easily the most serious and flagrant violation of the boundary between scientific expertise and politics I have ever encountered”.

This sort of nonsense is particularly astounding from Levin, who was a central player in the workings of an “ethics” commission that remains a watchword for right-wing distortion and duplicity, whose major policy statements drew dissenting opinions from its own most scientifically-qualified members, and which then censored, and later fired, those same members. Levin – a political scientist and former Bush White House policy staffmember who has spent his entire career crafting right-wing bioethics policy - also castigates Kagan for her lack of medical expertise and her involvement in healthcare policymaking. You really just can’t make this stuff up.

It’s especially disingenuous for people like Levin and Coffin – political hacks whose entire career consists of trying to influence policy to fit their ideological leanings, from both inside and outside the government – to claim that there’s something untoward in political policy staff conferring with the policy-making boards of professional organizations to shape language on statements issued in clearly political and legal contexts. That sort of thing goes on all the time, and it’s appropriate for such bodies of experts to confer with political authorities to ensure that their statements are effectively written and focused. It would be inappropriate for them to turn themselves over to the political authorities as tools of policy, and to issue statements they did not believe were true, but it’s not inappropriate to get guidance on language and emphasis in order to convey an effective message. (As Coffin herself notes, ACOG already opposed the anti-choice bill. Obviously they would want their policy statement to reflect the reasons why.) To suggest that a policy expert drafting language for a policy statement endorsed by a professional body is somehow scandalous – let alone unusual – is simply stupid. And to suggest, as Coffin and others have recklessly done, that ACOG is somehow compromised or tarnished in doing so, is not merely stupid and dishonest, but libelous.

Aside from the completely manufactured, and fictional, scandal that the right-wing noise machine is busily whipping up over this, there is also the simple fact that the language Kagan suggested does not replace or contradict the language previously present. The statement that there are “no circumstances under which intact D&X would be the only option” is entirely compatible with the claim that it “may be the best or most appropriate procedure in a particular circumstance to save the life or preserve the health of a woman” (emphases added). It’s simple, really: the fact that something is never the only option in no way means that it is a bad option; the revised language not only implicitly acknowledges this but clarifies for the dim-witted (i.e., conservatives) the even more important point that it is in fact sometimes the best option. (Obviously, Intact D&X is never the only option: you can always perform an unnecessary Cesearean section or force the woman to deliver a fetus that may be dying and may possibly kill her - options that are much prefereable, for conservatives, than allowing a woman to choose the safest option on her own authority. ACOG’s point, which Kagan nudged them towards, is that there are often better  options – and that women should have the right to choose them.)

The fight over Intact D&X was particularly nasty because it encapsulates so much of right-wing misogyny, so clearly: it was not a ban on abortion, and it was not a ban on late-term abortions; in fact, it did not ban any abortions under any circumstances. It was only and entirely a ban on one particular procedure for performing abortions. It banned the procedure that was preferable in specific circumstances – leaving abortions entirely legal under those circumstances but forcing women to submit to a procedure that was less safe and more debilitating for them. It was straightforwardly an attempt to punish women by making them accept higher risks and a lower standard of care, as the price for choosing a procedure the right wing disapproved. And ACOG’s policy statement implicitly recognized this: it notes that there are always alternatives to the ID&X procedure, but that in some circumstances those alternatives are worse, and ID&X is, in those circumstances, the best or most appropriate procedure. Kagan’s contribution – appropriate, useful, and highly pro-woman – was to encourage them to clarify that distinction. (Note, again, that ACOG explicitly reiterated this policy, and the important distinction it makes, three times after Kagan supposedly “overrode” their scientific judgment in the matter by forcing them to include language that does not contradict that judgment.)

Raising this issue is simply another example of the right-wing’s reflexive insanity over sex and abortion, coupled with their inherent inability to read and comprehend basic logical statements. (Note “Betsy”‘s analysis: “there was a doctors’ opinion that said that partial birth abortion was not necessary [no, there simply wasn't] and . . . [Kagan] drafted a statement that said the exact opposite” [no, she didn't].) Honestly, the relationship between “not the only” and “sometimes the best” is really not that tricky. It’s too tricky, of course, for the average right-winger, and for people like Coffin and Levin, whose deficiencies were all too apparent back when they were writing policy for Bush, but to people of normal intelligence and reading comprehension, this entire farce is an obviously groundless, and all-too-familiar, political hackery.

The right wing is also up in arms over this because, as Scott Lemieux at Lawyers, Guns, & Money notes:

the only point of this feeble “smoking gun” is to allow Senate Republicans to mention the phrase “partial birth abortion” a lot [and] I should note once again that for reasons Judge Posner and Justice Stevens have explained the entire issue is a farce. The distinction between D&X abortions and other abortion procedures is wholly arbitrary, and for people who have supported irrational laws making such a distinction to pretend to care about rigorous medical science is nothing but comedy of the lowest form.

Mahablog was fast out of the blocks on this, in a post I wish I’d written:

if you actually understand the issue in question — which leaves out righties, naturally — you’d know there is no “there” there. . . . Somehow, in the fevered imagination of righties, a professional organization representing 90 percent of U.S. board-certified obstetrician-gynecologists was duped by Kagan into telling a lie, or something, and because this wording came from Kagan it must not actually reflect the views of ACOG. . . . no scientific finding was “overridden,” just clarified, and ACOG must have agreed with the statement or they wouldn’t have continued to repeat it in their position papers ever after.

Lemieux gets the content issue exactly right:

There’s no contradiction between the two drafts, because D&X abortions are, in fact, not medically necessary in a majority of cases. But this fact doesn’t mean that they are never medically necessary, and indeed the original statement implies that there are cases where D&X abortions are necessary or preferable for a protecting a woman’s health. Adding a statement to clarify what was implicit in the first draft doesn’t “distort” anything, and of course if ACOG didn’t think the statement was accurate Kagan had no power to get them to change it. There’s nothing here.

UPDATE: Corrected pronouns referring to Coffin; he’s a “he”, not a “she”. My apologies to Coffin for the mistake.

UPDATE: Another right-wing website breathlessly announces that Kagan “pressured a second group” on its wording of its pro-choice policy. That group was the AMA. Their claim: “Kagan discussed with other Clinton administration officials whether the AMA could reverse its policy saying there is not an identified situation in which partial-birth abortion is the only appropriate method of abortion. The AMA also noted ethical concerns with partial-birth abortions and said that it should not be used unless it is absolutely necessary.” Note that this repeats exactly the same mistake all the other commentators made about the first memo: the two positions described are not contradictory, and there is no “reversal” in evidence! And Kagan’s particular crime: she wrote an e-mail saying “We agreed to do a bit of thinking about whether we (in truth, HHS) could contribute to that effort . . . . Chuck and I are meeting with the AG on Tuesday; Donna offered to send over some doctors this week”. They don’t even identify who the e-mail was sent to (obviously it was internal), or whether any such meeting ever took place, let alone had any effect. (Apparently the AMA does the bidding of any government staff lawyer who offers to “contribute” to their policy development.) Truly, the stupid knows no bounds with these people.

Dr. Jack Cassell, in Florida, is getting press today for the cranky, obnoxious note he posted on his office door:

If you voted for Obama . . .
seek Urologic care
elswhere

Changes to your healthcare
begin right now
not in four years

He apparently also fills his waiting room with anti-Obama literature, signs about what “the morons in Washington have done to your healthcare” (NB: nothing has changed about any of his patients’ healthcare; he is the only one who has done anything so far), and explicit instructions on who they should vote for.

In response to concerns that he might be politicizing his care just a tad, he argues “I’m not turning anybody away — that would be unethical. But if they read the sign and turn the other way, so be it.” So of course he’s not actually doing anything to make patients feel uncomfortable by explicitly telling them to leave his practice because he disapproves of their politics; they just happen to choose to seek another doctor for reasons unrelated to his behavior or his treatment of them.

There’s been commentary over whether this infringes any laws or principles of medical ethics. His supporters claim he is justified in behaving this way because doctors, like everyone, have a right of free speech. There’s a lot to be said about that – most notably that the whole point to medical ethics is that professional practice and the professional relationship impose standards more stringent than those  incumbent on ordinary citizens. Simply having a right of free speech does not justify acting like a jerk toward your patients; the treatment relationship is one-sided, predicated upon the doctor’s commitment to service of the patients’ needs, not their approval of the patients’ politics; admission as a professional is predicated upon acceptance of those standards, and a willingness to put one’s personal inclinations aside in the professional arena.

But aside from that, what strikes me about this situation is the general attitude it reveals. Not only does this doctor fail in the face of any of the above standards, but it seems obvious he simply conceives of medical practice as something that does not in fact entail the authority of such standards or commitments. Doctoring is apparently a job, to him – something he can do if and as he chooses, and which does not impose on him any obligations he does not happen to want to meet. He is – to all appearances – essentially the doctor in Ayn Rand’s Atlas Shrugged, who joins with the amoral capitalist runaways to form a free-market society founded on hard money and ethical egoism. Being a doctor does not require him to do anything for anyone if he doesn’t feel like it, and it doesn’t require him to accept as a patient – or even keep as a patient anyone he has already accepted – who does not personally agree with him on any matter of his choosing.

What I fear, but perceive, is that this attitude is becoming more widespread. Doctoring is just a job, it seems, in the minds of more and more doctors, and in the minds of the right-wingers who are so afraid that Obama is going to destroy healthcare by making it less capitalist. (As usual, facts are of no moment to the right-wing panic apparatus: it is this doctor himself who is “changing” healthcare for his patients – his own sign says so  – but he still manages to blame it on Obama. And it is this doctor who has made healthcare hostile and unwelcoming for his own patients – he is, not a death panel exactly, but a one-man jerk panel to his personal caseload – but they deserve it, he seems to think, because they voted wrong.) Whatever the consequences of Obamacare, I fear that it will be simply impossible to destroy medicine in the US because there will be no medical profession left to destroy – just a bunch of entitled, self-absorbed jobsworths whining about how much less they like their jobs now that the glamor and remuneration has started to fade and they’re left with nothing more than providing better care to more people, which is such an imposition.

Democratic Congressmember Alan Grayson, who represents that district, was notorious for (accurately) characterizing the Republicans’ healthcare policy as “Die quickly”. He notes about Dr. Cassell: “Maybe he thinks the Hippocratic Oath says, ‘Do no good.’” That’s about the size of it.

This is staggering:

Health Expenditures vs. Life Expectancy

(See link for larger version.)

The graph is a ranking of industrialized countries by per-capita healthcare expenditures. The average figure is $2,986/year; Finland and Spain come in a little below that, and Australia and Sweden are a little above. Canada spends about $1,000 more per person per year than the major-nations average; free-wheeling Switzerland is about $1,400 above average.

See that lone, single red figure wa-a-a-a-a-y up in the left-hand corner? That’s the US. Our per-capita healthcare expenditures, at $7,290/year (!), are more than 240% of the average of all those nations together (actually, more than 260% of the average of all those nations other than the US, which comes to only $2,771/year if you leave the US out of it). And note that those expenditures, in the US, are for only 85% or less of the population; for every other country on the graph except Mexico, that figure covers every permanent resident of the country without exception.

Now look on the right-hand column: the same nations are ranked by average life expectancy. This is a crude, but still useful, indicator of what we’re getting for our healthcare costs. (Crude, because simple measures like sanitation and nutrition can contribute a great deal more to life expectancy than high-tech medical care. But the whole point is that better medical care produces longer and better lives, at the margin at least, and there is good evidence that this is true. So this is not a bad way to scale things out for quick and easy comprehension.) Implicitly, this graph establishes a relationship: assuming all things are equal, average healthcare expenditures should produce average life expectancies (which you could quantify as a numerical ratio, though that would be taking the thing rather too literally). In fact, that is almost exactly what the UK achieves ($2,992/year for about 79.1 years lifespan). About two-thirds of the countries on the list do better than that: their life expectancies, relative to average, are greater than would be expected given their healthcare costs relative to average. (This is indicated by the lines sloping up to the right on the graph. The slopes are not precisely indicative, because the right-side scale range does not match the left-side scale – the ranges should have been correllated better. But a positive or negative slope indicates an above- or below-average ratio, respectively.) A relatively small number of countries do worse.

Whether above or below average, the deviations tend to fall into a small range – note that most of the lines up, and down, are roughly parallel. All except one, of course: the US, as usual, is completely alone in its breathtakingly negative ratio of cost to life-expectancy benefit. That screaming red line plunging down the graph from off-the-charts high expenses to below-average benefits has no peer among any industrialized country: nowhere in the world does any country get such an incredibly below-average relative return for its healthcare expenses (and in fact below average in absolute terms compared to all other countries). The US, with per-capita healthcare expenses 260% highher than its peers, actually averages a total life expectancy almost 1.5% lower. (Only one other country, Denmark, manages to achieve above-average expenditures and below-average life expectancy; their expenditures are still less than half ours and their life expectancy is higher).

Note finally the width of the lines, which indicates average number of doctors’ visits provided per year by each country: the fat lines are 12 or more; the medium lines are 4 to 8; the US comes in at an average number of visits per year per person that rounds off most closely to . . . zero. (Note also that of the 4 countries that average effectively 0 visits per year, two of them are the only two on the graph that do not provide universal coverage.) Not only does every other country on this list except Mexico manage to provide universal healthcare coverage at vastly lower expense than the US, not only do 2/3 of them achieve greater life expectancies than the US, not only do 2/3 of them achieve an above-average ratio between relative expenditure and relative life expectancy, but over 80% of them provide an average of at least 4, and in some cases 12 or more, covered visits per person per year for their entire populations.

Note in passing, too, that the only other nation that can’t afford to provide universal health coverage is Mexico, which spends less than 30% of the average among these nations on healthcare and is still getting a vastly greater bang for its its bucks than is the US.

The utter, abject failure of the US’s profit-sucking healthcare morass is made as stark here as it has ever been. Basically, we’re spending over $4,300 per year for every covered person for nothing whatsoever, and giving up over a year of average life expectancy as our reward – while leaving tens of millions of people with no coverage whatsoever for most or all of their needs! It would be almost impossible to have a healthcare system worse than this, other than one with even less protections for patients than the US already has.

As Ezra Klein notes:

consider this: If we spent what Canada spends per person, our deficit problem would go away entirely. And Canada’s per-person average is in a country where everybody is fully covered and so has full access to care. America’s is in a country with 47 million uninsured, and so many people skimp on needed care. So the comparison is actually unfair to Canada. . . .

This is serious pitchforks-and-torches stuff, if only people really understood it. I continue to believe, however, that the improbable size of the disparity is a barrier to understanding. People just don’t believe these numbers. America may not be the best, but we’re not supposed to be the worst by such a large margin.

Oh, yes, we are. The system is designed to suck money out and deny care. It’s working perfectly. But why do we have a system designed to do that?

UPDATE:

There are some problems with the above graph, which I somewhat glossed over in the original post. DanM alludes to them in his comment below. It’s just as well to clarify some of these points.

First, the graph is somewhat misleading because it seems to position life expectancy as a direct function of healthcare spending: a certain amount of money buys you a certain number of years of life, and the slope of the line from one axis to the other describes the mathematical relationship between them. That is the inevitable broad-brush interpretation of the data, that is true (the whole point is that there is a link between the two factors, otherwise there’d be no point graphing them – and indeed the relation is clearly non-random as even a casual inspection of the graph shows) – but the line-graph format makes it much too literal.

Second, the scales of the axes are distorted. There is most obviously the fact that neither the expenditures axis, on the left, nor the lifespan axis, on the right, start at zero. The actual spread between high and low values on both axes is thus exaggerated, especially for lifespan. Also, the data ranges shown for each bear a very different relationship to the total range for data of each type: the top and bottom entries for healthcare expenditures span about 90% of the value of the top end of the scale, or about 80% if you exclude the US; the top and bottom entries for life expectancy span only about 12% of that range. If the two axes were scaled similarly, the right-hand values would all cluster into a tight knot and the blue lines would converge from high and low on the left into that small range, diminishing the impression of a clear correlation between the two values which is created by spreading the lifespan values out so much.

In addition, setting the average values of the two scales at the same vertical level is an arbitrary decision that reinforces the implicit message that the two are correlated. (A ratio between healthcare spending and lifespan that matches the dollars/years ratio of those average values will be a horizontal line at any level on the graph – thus those countries doing better on a dollars/years basis will have lines that slope up, and others will have lines that slope down.) Again, this is not unreasonable as a way of displaying this data, but it requires as an organizing assumption that the implicit correlation illustrated by the graph is in fact true – which puts the cart before the horse.

Finally, as Dan notes, there are other factors influencing lifespan, and implying that it is a direct function of healthcare expenditure, as this graph seems to do, is much too crude.

Nate Silver, brilliant statistical interpreter at “538“, recasts the same data in this fashion (click graph for larger version):

Healthcare Expenditure vs. Life Expectancy Scatterplot

This graph is much fairer in certain ways. By removing the horizontal lines, it removes the visual implication of a direct mathematical function linking the two data sets. By graphing the data as a scatterplot on two orthogonal axes, it allows the viewer to draw their own conclusions without dictating a relationship in the design of the graph. Silver also takes the obvious steps of scaling the axes fairly and accurately, starting a zero for each.

However, this graph also supports the basic point made in the original version: there is an obvious trendline through the data set, and the US is an extreme outlier that falls insanely far below that trend. (To see how far, hold a ruler against your screen, paralleling the slope roughly marked out from the origin through the data cluster running up to the right – about where Canada falls out. Continue that line up to the right until it is directly above the red “USA” below. It should run off the graph up to somewhere in the third paragraph above the graph. That’s where the US should be, given what we spend (on only a fraction of our population). If you want it in numerical terms (and again taking the implied correlation rather too literally), US citizens who actually have access to healthcare should live more than 193 years, on average, if we were spending that money as effectively as most other countries do. From the reverse perspective, given the below-average life expectancy we get for our healthcare dollars, we could spend at least $4,000 per person per year less than we do  and still achieve our current quality outcome, if we were merely as efficient in our expenditures as, say, Denmark. That $4,000 – more than the average amount other industrialized nations spend per person in total – is the amount we are throwing away on our for-profit healthcare system, for no benefit whatsoever to ourselves.

It must be acknowledged that that correlation has not been subjected to statistical analysis, but the basic point is that the original graph, though its designers made some questionable choices, was not as bad as all that.

Hat Tip: to Andrew Gelman at Columbia, who did the original re-analysis from which Silver took his own version.

The latest entry in the “creepy personified fetus” category: the “Feti” – weird/cutesy Christmas-tree ornaments shaped like tiny embryos at about the 6-8 week stage (bulbous head, no digits, visible tail). As is usual with this genre, they sport adult-appropriate personal characteristics, including clothes, personal possessions, and in one case a moustache. You can buy Santa fetuses, “happy” fetuses, candy-cane-carrying fetuses, and an “Adam Lambert” fetus displaying a punk hairdo and clutching a Star of David – a cultural mishmash that I refuse to attempt to understand.

Happy Fetus

Feto Incognito

Adam Lambert Embryo

The purveyor of the site insists that “Feti is just for fun, no political statements being made here.” I’m tempted to believe that in her case, but the thing still strikes me as weird,  and indicative of a mindset that is worth noting.

The vendor suggests these are intended as gifts for expectant parents, as appropriate additions to the “Baby’s First _____” category of remembrances. (Exactly how, I’m not sure: “Baby’s First Disembodied Hanging on a Christmas Tree”?) In that vein, they play off the very common and understandable practice of many expectant parents in personifying their fetus as it develops – talking to it, playing music, naming it before it is born, and so on. They also seem to accept as a cultural commonplace the fetishizing – literally, in this case! – and personifying of the fetus that is a mainstay of anti-choice propaganda. (Anti-choicers often wear gold-plated fetal-footprint jewelry, and they are forever trying to force abortion patients to look at pictures or sonograms of the fetus.)

I don’t know if the anti-choice movement has so far succeeded in turning the fetus into a fetish object that you can now literally market them to the general public as holiday ornaments, or if the common desire to see fetuses as sort of reverse-extensions of babies simply makes this a natural marketing move, like Cabbage Patch dolls or those weird Anne Geddes photographs of babies in flower petals, and the right wing has merely piggybacked off that common emotional trope for their own purposes. The former would scare me a bit, the latter is merely infuriating. Either way, this sort of thing leaves me with a creepy feeling.

I’m happy for people to be happy about their pregnancies, and to embue their future offspring with emotional valence or even a somewhat overgrandiose sense of promise or accomplishment. In the same way that all parents think their kids are smart and talented, and I wouldn’t quarrel with that, expectant parents can and should go ga-ga over the cute little buns in their respective ovens. There is no point, in the case of people’s emotional experience of the events in their lives, to go around insisting to them “you know it has no functional higher nervous system, right?” . . . “that’s not a ‘person’ you’re carrying, in any meaningful sense of the term – just wanted to let you know” . . . “don’t get too close to it – there’s about a 1-in-12 chance you’ll lose the pregnancy”. But when it comes to law and policy-making, clear distinctions do have to be made – and at that point, the conflict between stark reality and parents’ expectations may be uncomfortable.

Regardless of parental beliefs, not all kids are smart or talented, and thus some won’t make it into selective academic or sports or art programs. And regardless of the fervent, desperately dishonest myth-making of the anti-choice right, the early fetus is not a person and does not make moral claims on a woman’s body and life sufficient to override her autonomy. It is unfortunate to have to disappoint people emotionally invested in believing otherwise, but it is far worse to make policy based on wishful thinking in defiance of the truth.

By all means, have yourself a merry little Christmas, and hang a smiling Adam Lambert Jewish punk fetus upon the highest bough. But let’s keep the “personified fetus” myth firmly in its place when we go to making important decisions about real issues in real people’s lives.

So, much has been made this week of the fact that the Republican National Committee, throughout its longstanding berserker campaign against women seeking control of their own bodies, has in fact been providing comprehensive healthcare insurance to its own employees – including female employees – for almost 20 years. Many fingers were pointed over the hypocrisy of attempting to prohibit abortion access for all women in America by every means possible, while covering abortion care for its own employees under their internal health insurance plan. (This in fact is in keeping with right-wing approaches to the issue generally: their values legendarily evaporate when it’s their personal interests at stake, and stories of women’s clinics providing abortion care to the same women who were picketing those clinics before and after the procedure are legion.)

Predictably, Michael Steele, the hapless RNC head, announced less than 24 hours after the story broke that that coverage provision had been rescinded unilaterally. The usual right-wing hysteria has erupted, with demands that people be fired and angry denunciations that donors to the RNC had not been allowed to deny healthcare to its female employees as they wanted to do. As Ben Smith rightly points out, not one female employee of the RNC – the ones whose coverage has now been stripped without their consultation (and presumably without any reduction in their premium contributions) – has been quoted or consulted in this move.

I note also that pro-choice ideology within the Republican party has run at about a steady 35-38% for most of a decade (a recent poll shows it down somewhat among Republicans, but is widely regarded as an outlier). I presume the large majority of those are women. Assuming further that women are half the GOP membership, that would mean that roughly two-thirds of GOP women are pro-choice (I suspect they’re actually less than half the membership, which would push the prevalence of pro-choice ideology even higher within that smaller female group). Now, I don’t know if the RNC employee base is representative of the Republican Party generally, but if it is, that would mean that about a third of its staff, and about two-thirds of all its female staff, are in favor of abortion rights. There are other factors to be considered, for which we don’t have data (what percentage favor having abortion covered in their health plan, as opposed to its just being legal; to what degree the RNC staff skew even crazier on abortion than the rank and file; what percentage of the staff are female; and so on), but any way you slice it it seems inevitable that there is at least some considerable degree of support for abortion services among the RNC’s staff, to say nothing of the GOP generally. Yet the RNC leadership revoked their own staff’s coverage without consultation, and without the slightest apparent consideration for that staff’s wishes, needs, or rights.

The message is clear enough, and, I suppose, fair and consistent in that peculiar GOP way: for Republicans, hurting women is more important than anything else – certainly more important than providing real healthcare for an entire nation, but more important also than seeing to the needs of their own membership. The Republican National Committee – a body that exists solely to cater to the interests and welfare of registered Republicans – stripped healthcare services that had been available for almost 20 years away from Republican women employed in the service of that body and their party, without the slightest hesitation or apparently without even talking to them.  Within the highest levels of the Republican Party itself, your lack of status as a woman trumps your preferential status as a Republican.

Michael Steele could have just made it much more simple and direct:

Goldman Sachs has just issued a helpful report for the insurance industry, identifying the profit potential for them in various likely outcomes of the current healthcare access reform initiative. Their conclusion: the best thing for the insurance companies is no reform at all, followed by the weakest possible reform; the worst thing for them is real reform with universal access and a publicly-backed plan option.

In other words: the current disaster of a system is the one that provides the greatest possible profit potential to the insurance industry; any effort at increasing access to care is against that industry’s interests, and a robust and successful reform effort is the worst possible thing from an industry whose profits are entirely dependent on charging the highest possible premiums and delivering the least possible care.

The Senate Finance Committee bill, which Goldman’s analysts conclude is the version most likely to survive the legislative process, is described as the “base” scenario. Under that legislation (which did not include a public plan) the earnings per share for the top five insurers would grow an estimated five percent from 2010 through 2019. And yet, the “variance with current valuation” — essentially, what the value of the stock is on the market — is projected to drop four percent.

Things are much worse, Goldman estimates, for legislation that resembles what was considered and (to a certain extent) passed by the House of Representatives. This is, the firm deems, the “bear case” scenario — in which earnings per share for the top five insurers would decline an estimated one percent from 2010 through 2019 and the variance with current valuation is projected to be negative 36 percent.

What the firm sees as the best path forward for the private insurance industry’s bottom line is, to be blunt, inaction.

The study’s authors advise that if no reform is passed, earnings per share would grow an estimated ten percent from 2010 through 2019, and the value of the stock would rise an estimated 59 percent during that time period.

The next best thing for the insurance industry would be if the legislation passed by the Senate Finance Committee is watered down significantly.

Coincidentally, no doubt, the report arrives from Goldman Sachs – recipient of uncountable billions in public bailout dollars for their executives’ bonuses, from the Obama administration – just as the healthcare access reform plan being pursued right now by that same administration is nearing its final legislative conflict. Goldman helpfully notes in a disclaimer that the firm “does and seeks to do business with companies covered in its research reports.”

All you have to do to see how utterly repulsive the healthcare insurance industry is is to simply watch how they talk about their own business. It is impossible to be disgusted enough by an industry that – uniquely in the industrialized world – treats people’s bodies, health, and lives as saleable commodities in a free market in misery.

The AP reports that Scott Roeder, the terrorist who killed Dr. George Tiller, publicly and in cold blood, last May, has openly confessed to the crime and justified it with the usual religious-radical gibberish about “unborn children”. In the article, he explicitly equates fetuses with independently-living persons and claims that killing to prevent abortion is justified if at least one forced pregnancy results; he encourages others to perform similar terroristic murders, and states he intends to base his legal defense on an argument for a religious-political justification for murder. None of this is new, except possibly that he has stated all this on record now.  It confirms what we knew about him, anyway.

The real question is whether those who are so agitated about real or imagined terrorism of other kinds (especially by Muslims), and who have been so complacently accepting of anti-woman terrorism in the US for decades, will condemn or even acknowledge an open statement of Christian religious-terrorist ideology in the case of yet another anti-choice fanatic.

Just this week we’ve seen a terrible mass murder committed by a Muslim military officer who was apparently distraught over the war in Afghanistan and his possible deployment. Literally before the bodies were cool, various right-wingers jumped in to denounce “Muslim terrorism” and to cite vague links between the suspect and Al Qaeda (he visited a mosque which was also visited by someone who knew someone who was connected with Al Qaeda); however, it is not clear that the apparent perpetrator’s motives were intended for a political end at all – as opposed to merely an outburst of personal anxiety – and there is little to suggest that it was terrorism in any reasonable sense. The murders of doctors by anti-choicers, beyond any question, are defined by the features of terrorism found in most of the commonly-used definitions: they are acts of violence committed against civilians for the purpose of inciting fear in other, third-party individuals, to promote a particular political end. We heard nothing of this at the time of Dr. Tiller’s death (nor of any of the previous murders and other acts of violence); will we hear it acknowledged now that the terrorist has so openly proclaimed his murderous religious ideology?

Anti-choice terrorism is intended to prevent women from exercising a legal and moral right involving their bodily health and autonomy, by terrorizing those women and their healthcare providers – it is violence intended not merely against its chosen (often random) targets, but to terrorize and thus paralyze a larger group, to further the religious and political ideology of the perpetrators and their vast army of supporters and admirers within the religious right. Yet it has never been acknowledged as such, and the large subculture on the right wing who have made a profession of terrorism scare-mongering have never acknowledged the persistent anti-choice terrorism ongoing in the US. (Nor has the FBI: fake anthrax attacks had been staged on almost 700 abortion clinics in the US in the days before 9/11 – not one of them resulted in an arrest, or any obvious urgency about the issue, and they were not treated as domestic terrorism. One person was charged with terrorism for fake anthrax attacks on clinics in the wake of 9/11 and the Congress anthrax mail attacks – the first and only such charge in the entire history of anti-choice terrorism. None of the anti-choice murderers, including Roeder, have been charged as terrorists.)

Now we have an admitted terrorist openly advocating further political killings to promote his religious obsessions. If Roeder were a Muslim and his targets were not women and their healthcare providers, the shrieking loons of the right would be off their heads screaming about his crime, his religious beliefs, his unrepentant stance, his advocacy and rationalization of violence, and his links to other extremists with similar religious and political beliefs. Will we see even the slightest acknowledgment of Christian anti-choice religious terrorism and its dangers in this blatant case?

At this moment, debate is proceeding on the House votes on the landmark healthcare bill. I haven’t blogged about it, because, frankly, it was overwhelming and I didn’t know what I could say that would help. (The Democrats’ stealth approach to bill-crafting, while possibly politically astute, made it hard to get a clear handle on the thing, too.) This will be, without question, one of the most important legislative events of my lifetime; if the bill passes the Senate and is finally voted into law in a reasonably intact form, it will be the most significant development in American history that I will see. More importantly, it will be – largely, though not entirely – an end to crippling insecurity and lifelong anxiety for hundreds of millions, and of irremediable pain and suffering for tens of millions who now live in the only affluent country that permits its business class to sell life itself for profit.

The bill on offer is far from optimal. It locks in the profiteering on death and misery that the vast majority of the country is burdened with, and is needlessly complicated and limited in what it offers to the rest. It deliberately cripples its own modest offering by restricting it only to those whom the profiteers have absolutely refused to serve at any price, prohibiting the rest of the country from accessing healthcare organized on any saner and more humane basis. But worst of all, the bill is being held hostage by the insane and vicious anti-choice army that infests the right wing and has wholly captured the Republican party. And, too predictably, the omnipresent contingent of grandstanding asshole Democrats is giving them exactly what they want, as they always do.

Right now, the “Stupak amendment” is being debated: an amendment that will prohibit any person enrolling in the government-backed “healthcare exchange” – which is to say, the poorest and most desperate, who are the only ones eligibel to enroll in that plan – from being offered a full range of healthcare services in cases of unwanted pregnancy. For those people, the “public options” will be forced pregnancy, death in childbirth, or an abortion that she likely can’t afford and the right-wing terrorists have likely made unavailable anyway. The Republican House caucus has already stated explicitly that they will refuse to vote for the healthcare bill in any form. But they – with their unconscionable Democratic allies – are holding up the bill to demand the anti-choice amendment in a bill they will not support even if they get it. And enough Democrats are equally indifferent to women’s lives and women’s needs to help them do it.

Democratic women are putting up a good fight – and their male allies deserve thanks, too. The Republicans have shrunk from merely legislative misogyny to outright thuggery, as they so commonly do. Michele Bachman led crowds of right wingers through the Congressional office buildings earlier today, invading offices and screaming at people to, in her words, “scare” them away from supporting women and healthcare for all. House Republicans staged an organized disruption on the floor today, systematically interrupting Democratic women as they spoke in favor of women’s interests and full healthcare coverage. The healthcare debate is being conducted the same way the Florida recount was in 2000: in the face of Republican assaults and intimidation, and without regard for the truth or significance of the actual substantive issue.

I have little to say about the whole thing. I feel helpless – particularly frustrating in the face of an issue so central to my personal and professional concerns – and am waiting as on election night for the outcome of votes that will – with great good luck – mean so much to so many, and move American one huge step closer to the decency and commitment to humanity that has been so sadly lacking in so much of our history. I can only wait and hope, like everyone else. In the meantime, there is an organized, vicious, and relentless minority that is fiercely dedicated to their own hostility to any notion of a decent regard for others, and to the freedom of others to live their own lives unconstrained by that minority’s backward and reactionary values. They are fighting – in the most literal sense – right now to keep tens of millions of people at the mercy of any illness they may suffer, to keep hundreds of millions at the mercy of an insurance system that rivals only those reactionaries themselves in its hostility to the needs of the people they nominally serve, and to keep every woman in America at the mercy of the nasty and bitter men who despise them and their bodies.

I can’t stand watching this unfold. And I can’t say, can’t express even fractionally, how much, how gut-wrenchingly much, I hate and revile these disgusting creeps.

UPDATE: Rayne at Firedoglake reports “Stupak Amendment Passes: 64 Dems Ask for Primary Opponents“. That’s exactly how I feel about it. I had already promised myself that I would contribute to the primary opponents of any misogynist Democrats; I’m saddened, and shocked, that there are so many of them. I will certainly target all that I can afford to. Read the rest of the post; it’s exactly right.

UPDATE: The final bill has passed, 220 – 215. Exactly one Republican voted in favor – 39 Democrats voted to withhold healthcare from over 40 million Americans. This is a great – but very partial – victory. There still remains the Senate bill – which will be a far tougher fight, with looser rules and a larger percentage of heartless and misogynist Democrats in the mix – followed by the conference committee and the final vote. The Republicans and reactionaries will do everything they can to destroy other people’s hopes for a decent life, and their control over their own bodies and life plans – the rioting, disruption, demagoguery and thuggery seen today are just a taste of what is coming. And this step, momentous as it is, comes bitterly. The discussion in the followup post at Firedoglake captures it perfectly; as one commenter put it: “It’s like winning a huge battle, but half of your friends were killed or wounded.”

UPDATE: I’ve added the reference to Democrats in the headline. I didn’t make it clear above that Bart Stupak, who led the charge to destroy healthcare reform for over 300 million Americans if they didn’t let him destroy autonomy for 150 million female Americans, is a Democrat. Along with 63 other misogynist traitors, he put the people’s party against 51% of the people, to indulge their personal medieval religious obsessions. Fuck him and all of them.

UPDATE: Scott Lemieux at Lawyers, Guns, and Money gets the power dynamic exactly right: “Certainly, there are many potential criticisms of how Democratic leadership has dealt with health care, although when you actually care about expanding access to health care it’s hard to negotiate with the Stupaks of the world who don’t, but want to use other people’s progressive impulses to attack women.”

A former healthcare clinic administrator in Texas today announced that she had quit her job, joined a far-right anti-healthcare group, and dedicated herself to harassing other women to prevent them from receiving surgery and other forms of “icky” healthcare, after seeing a video of an appendectomy that she didn’t like.

I just thought I can’t do this anymore, and it was just like a flash that hit me and I thought that’s it,” said Jonhson. . . .

Johnson said she was told to bring in more women who wanted [icky procedures], something the Episcopalian church goer recently became convicted about.

“I feel so pure in heart (since leaving). I don’t have this guilt, I don’t have this burden on me anymore that’s how I know this conversion was a spiritual conversion.”

Johnson reports that she is likewise convicted about gall bladder removals, most forms of cancer surgery, and liposuction, although she does not criticize the decisions several of her friends have made to have such procedures, because “that’s different”. She is semi-convicted about breast implants, believing they are the work of the Whore of Babylon but also something you could understand that a woman needs sometimes. She justifies these distinctions with random Bible quotes and references to her own idiosyncratic feelings, which she cannot coherently articulate but is happy to impose on others by law.

This otherwise trivial story about one small-town individual’s weird religious hangups was trumpeted by the religious right as a stunning victory over the right of other people to make healthcare choices they don’t like, claiming other people’s healthcare was now “in meltdown mode” and “total disarray”. Every healthcare clinic in the country, including the one that has now hired a new director, went about its business as usual.

Today is National Coming-Out Day (one day after President Obama promised yet again to repeal the “Don’t Ask Don’t Tell” policy and work toward fuller equality for all people, and yet again did nothing tangible about it).

I don’t have much to say about that, except to offer support and the wish that the homophobia that infects our society, among other lingering forms of discrimination and prejudice, will soon fade, and “coming out” can be the act of celebration and affirmation that it should be, rather than an act of courage and risk-taking in the face of dangers that should not be allowed  to exist.

I’ll note, by way of parochial hyper-focus, that the pressures and threats that impede coming out and living openly in one’s chosen orientation have health consequences as well as many other harmful impacts; they cause stress and depression, create barriers to healthcare access, often result in abusive or discriminatory treatment in emergency care, and not infrequently result in violence. And of course the pervasive legal discrimination LGBTQ people face, in particular regarding health insurance, visitation and decision-making rights for gay couples, and barriers to assisted fertility and adoption, are also health and family-rearing issues as well as being rank discrimination in the basic sense.

Ending homophobia for reasons of good health is an odd and circumlocutory approach to the problem, but it’s one reason among many. Simple moral necessity is a better one. It’s long past time.

The Huffington Post today breaks an original story on a long-running scandal at Columbia University Hospital, in New York, regarding lack of informed consent on a risky blood-volume-expander study. Heart-surgery patients were recruited into a study involving a new formulation of a volume expander that had been known to cause severe bleeding in its existing form; minimal information was provided in the consent form, some patients did not speak English, some were recruited in the ER under stressful circumstances, and the hospital IRB apparently did not adequately review the existing literature indicating the level of risk potentially involved. (Frustratingly, the story does not say what stage this experiment was conducted at, but it appears to have been a Phase I trial.)

The consequences:

At least two patients in the study died shortly after receiving the fluid and more than two dozen others required transfusions, according to documents submitted to the federal government by the hospital and obtained by the Huffington Post Investigative Fund.

There were attempts to rein in the problem as it developed:

In November 2000, two Columbia anesthesiologists – Marc Dickstein and Mark Heath- sought out the head of the institutional review board, Paul Papagni, a lawyer. They told Papagni that they had been in the operating room when a number of patients had hemorrhaged. They feared the study’s design virtually guaranteed that there would be more who would suffer hemorrhaging

However, their objections were derailed by internal politics. Columbia did later act decisively to crack down on the lead investigator, Dr. Elliott Bennett-Guerrero and report the breaches of protocol to the HHS, but they also downplayed the severity of the consequences, in part by reporting only a narrow range of outcomes from selected patients, not including the most severe adverse outcome, the bleeding that was the most important known side effect. The hospital also ignored advice from the HHS that it contact patients from the study and apprise them of the truth. Dr. Bennett-Guerrero has now been dismissed from the hospital (he landed in a Directorship and medical-school professorship at Duke – guess they’re OK with all this). Columbia has now been ordered by HHS to contact its former patients.

So, all in all, a serious problem plagued by misbehavior at every level, and an apparent partial coverup.

That’s all very worrisome, but it is the investigator’s attempted defense that particularly caught my attention:

Bennett-Guerrero . . . said in e-mails: “It is hard to imagine that an unbiased expert in cardiac surgery clinical trials could conclude that subjects were harmed in this study, since with only 50 patients per group the study was not designed or powered to prove any differences in major complications including death.”

What he’s saying is that because the sample size was so small, the statistical error in the results is necessarily mathematically too large to be able to show that the deaths or other events that resulted are clearly more numerous that would be expected by chance in such a group of patients.

There are a couple of real problems with this.

First, with a sample size of 50 and, as the article notes, varying dosages of the expander given, up to “three times the level recommended by the manufacturers”, this appears to have been a Phase I Ascending Dose trial. Phase I trials are conducted expressly for the purpose of monitoring safety and adverse side effects of the experimental treatment – they are intended to weed out unsafe treatments before they are tried on large groups of patients. In such trials, safety monitoring is paramount; the first sign of harm to patients should bring the trial to a halt. It’s true that such trial sizes are often too small for statistical significance, but the whole point is to gain confidence before exposing a larger sample size – so empirical monitoring is vital. In this trial, two patients died and numerous others suffered serious hemorrhaging – severe-enough outcomes that experienced clinicians complained directly to the IRB – but the lead investigator never reported a problem or stopped the trial.

(It is possible this was a Phase II or combined Phase I/II trial – though again the facts still seem to suggest Phase I. But if so, the sample size should have been large enough to be likely to return statistically significant results. The trial would be worthless without them.)

Another concern is that no early-Phase trial is supposed to be conducted on patients receiving conventional therapy or in lieu of conventional therapy, where such therapy exists. They are conducted on healthy volunteers. Partly this is to ensure that participation is truly voluntary (i.e., that patients are not being enticed into trials because they see it as a requirement for receiving other therapy), partly precisely to avoid this problem of contaminating apparent adverse consequences of the experiment with the patients’ underlying pathologies.

So it is difficult to see how this trial could have been appropriately designed, aside from the question of informed consent. Either it was a safety trial conducted on patients whose health was already compromised to the point that adverse effects could not be identified as the results of the experimental medication, or it was a dosage-efficacy trial conducted on a sample size too small to provide reliable results, either positive or negative. And in either case, clinical judgment seems to have been dispensed with as patients died but – because of the built-in lack of confirmatory mathematics – no suspicion was entertained about a possible link to the experiment they were participating in.

That raises questions of the investigator’s intent. At this point, I want to step away from this particular incident, and make it clear I am not making insinuations about Dr. Bennett-Guerrero or others from the Columbia trial. Clearly things went badly there but I don’t know what was going through his mind or what his intentions were. I want to use this situation to illustrate ways in which clinical trial design can be (again, I am saying nothing about this particular case) manipulated to  evade ethical protections for subjects.

If a trial is deliberately designed with a sample size too small to return significant results, then by definition no negative results can ever be discerned (nor can any positive results, either, of course). At the Phase I level, where harm is the only reported result, lack of positive results is not a problem, but the impossibility of negative results means that the candidate drug will automatically pass the screening. (Since you can’t find any statistically significant negative results, there will be no statistically significant negative results to report, thus the drug can never be proven to have failed the test. And since, at Phase I, “not failing” is a good-enough result to justify further research, the lack of a robust experimental design can, paradoxically, be a very useful feature.) With a lax IRB focusing only on the mechanics of the informed consent procedure, and not the possible pathways for harm or the mathematical intricacies of the results testing, one can easily get permission to conduct a “drug test” that no drug can possibly fail.

Doing so, of course, requires that you suspend judgment as to the empirical/clinical course demonstrated by the subjects. With no mathematical test for success/failure, an ethical researcher must rely on careful clinical monitoring to detect problems with individual patients or the trial as a whole. Starting with healthy subjects makes such problems obvious, since they aren’t supposed to die at all, but conducting the trial on subjects already sick (or, in fact, pulled directly out of the ER into heart surgery) creates a ready explanation why some of them may die, if in fact they do. So, again, there is an incentive to conduct the trial in what would otherwise be a scientifically invalid manner, essentially building in negative outcomes from the beginning (if the patients already have life-threatening illnesses, you’re going to get some bad outcomes no matter what) as a screen for the negative outcomes that may arise from the experimental procedure. This makes it difficult to honestly answer the question whether the procedure harmed the subjects, but makes it easy to argue that it did not provably harm them.

Thus, for an unscrupulous researcher (and again, this part of the discussion is hypothetical; it is not aimed at a particular individual), it may be possible to design a trial that cannot deliver honest and reliable results, but which also cannot fail to provide the preferred result from the point of view of a drug manufacturer or funding source. Doing so requires conducting a trial that is both scientifically non-decisive by intention and which lacks the ability to identify clear harms to subjects. It may also require deliberately enticing patients into the trial for whom better and safer therapies are available, precisely to use their pathologies as a ready excuse for adverse clinical outcomes which the trial may produce in them. And, it necessarily requires vacating the professional obligation to use vigilance and judgment to monitor and protect patients in all circumstances, and especially the experimental environment – and to instead rationalize patients’ outcomes away in order to avoid public knowledge, and possibly self-knowledge, of the harms inflicted upon them.

Convenient rationalizations are not an acceptable mindset for those who take vulnerable others into their care. The fact that a trial design cannot determine whether its subjects have been harmed is not an acceptable exculpation of those whose obligation was to watch for, detect, and ameliorate such harms. It is a reason why such trials must not be conducted in the first place.

There is a considerable component of right-wing blather, on healthcare and other topics, that is not seriously intended from the outset. To be sure, actual right-wing policy proposals are often offensive and addle-headed – withholding healthcare from women for religious reasons, or prohibiting factual information on contraception for teens are too-familiar examples – but often enough the most outrageous statements the wingnuts make are intended only to generate controversy. The ensuing agitation inflames the right-wing base constituency and feeds their self-aggrandizing notion of themselves as “under siege”, while the attention the controversy gins up raises the wingers’ profile and generates book sales and speaking fees. Rush Limbaugh, Ann Coulter, Michael Savage, and their cretinous ilk have made a profession of making factual claims that are indefensible in morals or truth, then evading responsibility by claiming they were joking; nominally more respectable right-wing pundits are not above the tactic, either. (George Will’s incompetent blundering into the issue of global warming continued long after his lack of knowledge had been thoroughly exposed in his own paper; the incident did him no harm among his target readership, for whom truth is an incidental feature of their reading material.)

For this reason, I felt less shock than merely tired recognition at this week’s reports from the right-wing “Value Voters” conference, in particular the much-remarked insanity of anti-choice provocateur Lila Rose’s demand that abortions be “done in the public square” (“maybe then we might hear angels singing as we ponder the glory of conception”*). Of course it’s idiotic, outrageous, and unhinged; of course it’s meaningless as a serious policy proposal. But it was never intended to be otherwise. It was intended to do exactly what it did – get more attention for a serial attention-seeker whose stock in trade is saying provocative things on video so she can enjoy the reaction, as well as create yet another controversy to make anti-choice theater seem important by generating press.

But it’s worth taking a moment, not to combat this nonsense as if it was to be taken seriously, nor even to condemn the continual offensiveness and provocation of the anti-choice movement (a singularly unlikely complaint, since without that the anti-choice movement wouldn’t even exist), but to note the ways in which anti-choicers choose to offend.

What does it mean to imagine – even if only to create offense – that women should be forced to have their abortions in public? As crazed as the suggestion is, it is not as extreme, from the right-wing perspective, as it would seem from any decent point of view. Mandatory public display of intimate gynecological procedures in order to diminish the legal availability of those procedures is nothing more than the literal instantiation of the basic presuppositions of the anti-choice movement in general:

• that women seeking abortion, uniquely, must be denied any presumption of privacy (in the sense either of autonomous choice or of confidentiality);
• that women’s sexuality is fodder for public observation, examination, and commentary;
• that women’s sexuality, women’s bodies, and women’s needs are so inherently disgusting that merely observing them will create the same visceral hostility among the general public that they already receive from the right wing (and that the general level of support for abortion that has always existed is due merely to the fact that supporters haven’t yet seen women’s bodies and healthcare up close yet);
• that women’s choices, preferences, and comfort in their own bodily autonomy and healthcare count for nothing against the demands by those who hate them that they expose themselves to hostile scrutiny for those others’ political goals;
• that policy regarding women’s autonomy and health is appropriately decided by deliberately-manipulated public emotions – in which tactic the women may be forced to participate to their own detriment – and not any considered defense of the women’s moral agency and interests, or the objective absence of moral agency in the fetus.

As with so much anti-choice agitation, women simply disappear from this invasive and offensive scheme as persons to be taken seriously in their own right. Healthcare is granted near-sacrosanct status as regards privacy, discretion, and the centrality of the needs and interests of the patient, but a woman seeking abortion must expose herself, legs splayed in stirrups, vagina dilated, instruments inserted, “in the public square” – her needs and interests, in fact her basic humanity as a person deserving of consideration and dignity, carry no weight against the creepy, invasive perversions of the sex-obsessive misogynists. The abortion debate is structured, logically, as a conflict between women’s autonomy and the religious imperatives of the anti-choice right wing, but here there is no recognition of autonomy interests at play in any way – women not only may not control their bodies or reproductive options, but may even be forced into invasive and degrading displays deliberately intended to undermine their own autonomy, as a condition of (temporarily) accessing such options. As always, women simply don’t count. Whatever protections and privileges the typical moral person might command in undertaking their own purposes in their own life simply vanish if that person is a woman seeking control over her reproduction.

But this familiar moral blindness is not accidental, and it is not merely the hyperbolic implication of a deliberately provocative suggestion. Stupid, crazy, and nasty as they may be, the right wing is not completely incapable of recognizing moral humanity, even in those they despise. The right wing gradually learned not to use racial slurs; today it would unthinkable for them to suggest that people of color should be paraded “in the public square” even as a tactic to undermine their rights, and wingers fall over themselves denying the racism in their racist policies. The gay-rights movement, embattled as it was, made remarkable progress in the space of about 35 years; today, the conservative position on gay rights extols accommodations (“Don’t Ask, Don’t Tell”; civil unions) that would have been grand liberal victories just a few years previously. Yet after thousands of years of patriarchy, women command no such deference. Even as a joke or a provocation, there are things that are not said about minorities and gays – things the public would reject in disgust. There seems to be nothing the right wing won’t say about women – there seem to be no abuses or humiliations that are beyond the pale, no degradations or invasions that are unthinkable, whether or not they seem likely as policy.

Vacating medical confidentiality to publicize abortions for the explicit purpose of humiliating women by generating disgust at their bodies, healthcare, and reproductive choices?  The only part of that scenario the right wing objects to is the abortion. All the rest is merely the rights, interests, and choices of women. Nothing at all, really.

* I am not making this up.

Apparently, tea-baggers protesting healthcare reform have adopted the slogan “Keep your laws off my body”. This is what passes for wit on the right-wing: people who are presumably largely anti-choice have appropriated a pro-choice slogan for their own purposes.

Mind-bogglingly, they claim they are not merely poking fun by making progressive symbols retrogressive, but are adopting the tools and techniques of left-wing activism for purposes that they regard as similar in motivation and intention. Adam Brandon, press secretary for the tea-bagger organization, claimed:

If we had been alive back in the 1960s, we would have been on the freedom bus rides. It was an issue of individual liberty. We’re trying to borrow some from the civil rights movement.

Right. Freedom Riders:

But that wasn’t my main point. I wanted to note just that one slogan: “Keep your laws off my body”.

It seems undeniable that the vast majority of tea-baggers would strongly oppose the liberty that slogan advocates. Surely their Congressional enablers do. But with the characteristic ignorance and lack of shame that makes it possible for right-wingers to say any of the things they say, they’ve co-opted words they don’t believe in into a context in which they don’t even make sense.

Unlike the issue of abortion rights – wherein the same noisy faction that opposes healthcare for others also aggressively campaigns to prohibit women from controlling their own bodies, and to force them to undergo pregnancy and childbirth against their will – the proposed plan for universal healthcare access doesn’t impose any unwanted procedure on anyone’s body. The access plan incorporates no specific treatments at all – it is a funding mechanism, not a treatment regimen, still less a mandatory one.

Naturally, of course, the wingers who oppose both abortion and healthcare in general, while demanding “keep your laws off my body”, also oppose abortion funding under any healthcare plan that is passed: that’s right, they insist that the healthcare plan they oppose because it would impose laws on their body must also be crafted so as to assist them in imposing laws on other people’s bodies. But more fundamentally, it is the characteristic right-wing solipsism and sheer imperviousness to fact that makes this absurdity possible: their aversion to healthcare means other people can’t have any, and their valorization of unplanned pregnancy means other women must have them; laws that have nothing to do with actually imposing upon people’s bodies are opposed with liberal slogans regarding bodily freedom, while the liberal demand for bodily freedom is opposed by people who spout that same slogan.

As always, the interpretive question here is whether these people are simply mind-bogglingly stupid, or deliberately dishonest. And as always, it’s hard to tell the difference in their cases.

So there’s a lot of commentary, and no doubt there will be more, about the just-released Gallup poll showing that people self-identifying as “pro-life” outnumber those calling themselves “pro-choice”, for the first time on record, and by a considerable margin. No doubt the wingers will be beside themselves, given the moral significance they attach to slogans and labels. There are a few things to be said about this, however.

First off, it doesn’t matter who call themselves what – bodily autonomy is a fundamental part of women’s freedom and moral independence, and must be protected regardless of public opinion. Laws trampling women’s freedom are unjustified no matter how many people support them. To the extent that the political balance shifts – or is even seen to shift – the legislative practicalities of safeguarding women’s status as citizens and full moral persons becomes complicated, but that is only a measure of the misogyny of a political system that puts some citizens’ freedom at the hazard of other citizens’ whims and prejudices.

Second, it’s interesting to note that, while the supposed balance between self-identifying pro- and anti-choicers has shifted, the same poll of the very same respondents shows almost no change in opinion on the broad spectrum of options regarding the legality of abortion. (It does show that those holding the extreme anti-freedom position – no abortions ever for anyone – slightly outnumber those holding a full pro-freedom position – abortion legal under all circumstances – also for the first time, and that in general attitudes toward women’s freedom have harshened slightly across each category, but those shifts are only a few percentage points.) So, what has changed is the labels people apply to themselves, not so much what they actually think in practical terms.

Regarding that shift in labels, it strikes me as odd. Gallup is a reputable pollster, and this is a periodical survey they have been doing at intervals for some time. I would normally accept their findings, but this one is clearly anomalous. A shift from 50% pro-choice/44% anti-choice to a balance of 42/51 the other way is a relative shift of 16% in just one year (i.e., the pro-choice position went from up by 7% to down by 9%). It dwarfs the year-to-year shifts at any other point since at least 1995 (the range shown on their graph), and probably longer. That requires an explanation.

The situation becomes more intriguing when you note that, as Gallup discovered:

The percentage of Republicans (including independents who lean Republican) calling themselves “pro-life” rose by 10 points over the past year, from 60% to 70%, while there has been essentially no change in the views of Democrats and Democratic leaners. . . . [A]ll of the increase in pro-life sentiment is seen among self-identified conservatives and moderates; the abortion views of political liberals have not changed.

So: right-wingers have not greatly changed their views on abortion in practical terms, but have shifted considerably toward explicitly identifying themselves as anti-choice. Hmmm . . .

I’ll tentatively float two hypotheses:

First, this is part of the winger backlash. The same sort of thing that is driving gun nuts to stockpile firearms and ammunition so they’ll have something Obama can pry from their cold dead hands, and which is driving anti-government morons to protest the fact that Obama is giving them a tax cut, is also driving anti-sex misogynists to stake out seemingly more-extreme positions on women’s rights: they’re terrified that they’re about to lose the thing that defines them politically, and they are ratcheting up their rhetoric both out of fear and in order to remain relevant. With right-wing and religious groups in a panic over the Republicans’ loss of Congress and the White House, and responding with ever-more-extremist rhetoric on abortion, the public has become superficially polarized. (In a country where you can get thousands of low-tax advocates to join a protest against their own tax cut just by giving it an idiotic name, it’s not surprising you can get misogynists to call themselves “pro-life” if you scream it at them enough.)

Second, this is also part of long-standing winger hypocrisy on abortion. They want to be morally righteous hardliners, but they don’t want major changes in abortion rights because they also avail themselves of that service in considerable (for Catholics, greater than average) numbers. As with many other public policy issues, conservatives retain their far-right rhetoric while gradually accommodating themselves to modern reality. (Remember when “civil unions” was the progressive option for gay rights?*) Now, apparently, among the group that say they are anti-choice, more than half favor legal abortion “under certain circumstances”.

This is not to minimize the importance of these kinds of data, or of shifts, even if only nominal (in the literal sense), between the two broad categories of opinion on women’s freedom. It matters not only that women have a legal right to abortion, but also that it is not constantly under siege by disingenuous and insidious restrictions, and that women are supported in choosing and exercising the options that are right for them. Public opinion is important to all those issues. And this reported shift in opinion, even if it is more superficial than it seems, is evidence both of the continuing right-wing backlash and of the continuing negligible status of women and their moral and civil liberties. The “certain circumstances” the pro-choice misogynists deign to approve are likely only the most restrictive cases, and the ones they find politically untenable.

Continuing to engage the fight for women’s true freedom, and a reasonable understanding of moral personhood and the assignment of legal rights, is more vital than ever as the backlash grows. I remain optimistic in the long term – reality cannot be evaded forever – but this is not good news in the immediate term, there’s no question about that. Fundamentally, and especially given how thin the poll results are on practical issues, I think little has changed. Given where things stood already, though, that’s hardly reason to be satisfied.

* Obama certainly does!

NB: Crossposted to Lean Left, the politics blog I contribute to.

Among the many distortions and intellectual dishonesties that plague right-wing pontificating about healthcare ethics and  policy is the constant pointing to (often hypothetical) drawbacks of policies they oppose as proof that those policies are unworkable or immoral, while exactly the same problem exists with the policies they do approve. In particular, opposition to universal healthcare often takes the form of nit-picking any possible barrier or difficulty that such programs would encounter without the slightest acknowledgment that the market-rationed for-profit system the US now has simply ignores its own gross deficiencies as if they didn’t exist – as if simply leaving people out of the system is not a problem, while having trouble treating everybody within a larger system is a fatal flaw.

The most egregious example of such falsehoods is the claim that universal healthcare will be “rationed” (meaning that no such system will pay for every imaginable treatment); for market fetishists, denying care outright to tens of millions of people is not rationing, and forcing hundreds of millions into overpriced insurance plans that ban entire categories of patients from enrollment, prohibit vast swaths of basic treatments, and then deny reimbursement for treatments they have actually contracted to cover is also not rationing, but creating a system that serves vastly larger numbers of patients more completely is rationing. But that’s just one well-worn delusion. They are nothing if not creative in coming up with new ones.

Today’s meme is that old bugaboo, the “doctor shortage“. (Some of us can remember times – more than one – when it was a “doctor glut“, and the right-wing economists who feared that, as well.) The right wing is just beside itself with worry that, under a scheme of universal healthcare, there simply won’t be enough doctors to go around. (Leading, of course, to . . . healthcare rationing!) Instapundit is convinced the problem is we don’t pay them enough. David Bernstein at Volokh thinks we should educate them less, so they’d have less school debt. Dr. Helen is convinced that the administrative hassles of healthcare are “going to get a whole lot worse with more government intervention” – apparently she believes that reducing the 30% overhead of for-profit insurance company administration would be offset by providing more and better healthcare to hundreds of millions of people, and figures that’s a bad thing. (It goes without saying that none of them thinks we should just subsidize doctors’ education and let them pay it back with service, so as to attract more people who actually care about practicing medicine and aren’t in it for the highest dollar. As Instapundit would say, “Naah, that wouldn’t make sense!”)

But, aside from the complete inability of of market worshippers to care or consider whether not rationing healthcare by profit margin would in any way improve the ability of people to actually get healthcare, there is in this case the gross hypocrisy of simply ignoring the entire question how this issue plays out in the market-rationed system these people all favor. (Remember that the problems the market doesn’t care about are not problems for the market; they’re only problems for systems that actually care about people’s needs, and thus are uniquely guilty for failing to solve problems that marketeers just don’t bother with in the first place.)

How is it the near-term supply of doctors is insufficient for a national healthcare system, but not insufficient for the market-rationed system we currently have? We’re talking about essentially the same number of doctors and the same number of potential patients – so if there aren’t enough doctors to go around under a system in which everybody has equal access to care, why is that not a problem now? Why haven’t the right-wingers who are so very, very (sincerely, no doubt) concerned that not everybody will be able to see a doctor immediately, when they actually have a right to do so, not concerned that not everybody can see a doctor at all, now, when they simply can’t afford to?

The answer, of course, is that they don’t care in the slightest whether or not people get the healthcare they need (especially those who have proven themselves unworthy by being unable to afford it). And they don’t really care whether there are enough doctors to staff a universal-access system, except to the extent that a potential shortage can be used as an argument against initiating such a system. If the actual impact of a supply/demand imbalance – the fact that some people can’t get access to a healthcare provider – mattered to them as a problem in itself, it would matter much more now, where some people have no access at all and most people are trapped in the hugely oppressive and constraining for-profit health insurance morass, than it would within some hypothetical future system which provides access to everybody, possibly with longer waiting times. But, again, the complete refusal of the market-rationed system to even attempt to do anything about the most helpless and desperate people trapped under it is of no consequence whatsoever, because if you’re ideologically wedded to profit-maximization for healthcare providers, you’re ideologically indifferent to actual healthcare for patients as a goal in its own right. But the idea of the great unwashed flooding your for-profit system and taking up the time and attention of the doctors you paid for, dammit, is both a real inconvenience (to you) and a moral offense (to the principle of purchased entitlement in a market environment).

Yuval Levin was a staff manager of the Bush-era “President’s Council on Bioethics”, a body widely derided for its almost comically right-wing leanings and gross intellectual malfeasance. Today he steps in it trying to say something all clever and sophisticated about the new authorization for stem-cell research. I got as far as the second paragraph before the crankery blew me away:

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“Choice” – the exercise of the fundamental value of autonomy as it affects the most distinctive, and most embattled, aspects of women’s lives – is always under siege by the right wing and its religious foot soldiers, as much so today as at almost any time. And today, “Blog For Choice Day, 2009″, the anniversary of the Roe v. Wade decision and nearly coincident with the the New Year and the Obama Inauguration as well, it is worth taking stock, and seeing just how encroached and relentless that battle has grown, and what hope of progress arises at this time of new beginnings.

The manifold horrors of the Bush years are finally behind us, and President Obama is already taking steps to end their ravages and wipe away the stains they have left upon the United States. In the area of reproductive autonomy, he has sent encouraging signals that he will repeal the odious “Gag Rule” and “Conscience Clauses” and oppose legislative attempts to further intrude upon women’s freedom. Hopefully the discriminatory Hyde Amendment will finally bite the dust as well. But that those are salient issues is only evidence of how much has been lost in a short time.

That we have to beat back absolute absurdities, such as that hospital personnel may refuse to treat patients in need out of personal prejudice alone, or that any yahoo with an ideological grudge, down to and including pharmacy clerks and cash register tellers, can withhold products and prescription medications on the same whim, means that the first promise of the unfolding Obama administration is simply to undo some of the trespasses of recent years, restoring what, under Clinton, nobody imagined could be lost. Actual progress will have to be a follow-on goal.

So it is not merely “choice” – reproductive autonomy in the area of birth control and abortion – that is under siege, but the entire range of choices women may make regarding their healthcare, sexual and reproductive lives, and liberty in general. Not only the right to abortion has been restricted, but, as part of their war on women’s sexual health, women’s rights to make factually informed choices about their own health and treatment options, to choose, purchase, and receive medicine and healthcare products prescribed or recommended for them, to choose how to balance their sexual and healthcare needs without interference, to choose their own goals and methods in family planning without prohibition on extremist religious grounds, to choose to use scientific medical advances without arbitrary religious restriction, and to make any number of other choices regarding their health and bodily autonomy, have systematically been assaulted, hamstrung, and denied by legions of religious-extremist obstructionists inside and outside the Bush administration. The first item on the “choice” agenda must now be restoring the basic set of choices that existed before the whackos got loose; only then can we begin to extend and refine the range and accessibility of those choices.

There is good reason to be hopeful, as, barely days into the Obama Presidency, a new sense of decency emanates from Washington and the most egregious crimes of the recent past are repudiated and undone. There is little reason to be ecstatic, however - and those who value women’s autonomy know too well that women are always the first to be thrown overboard for political expediency, and that women’s bodies and lives are of little weight in the traditional political balance. It would be foolhardy to expect President Obama to be too radical a departure from business as usual in that respect, though he has been generally good on choice, and on scientific, vs. religious, policymaking. Sadly, I expect that “Blog for Choice Day” will be an annual tradition that outlasts even this administration. But this is certainly the beginning of better things to come, and the victory has never been out of sight, however hatefully it has been contested. Good days ahead!

Cardinal Egan, supremely obnoxious Catholic Archbishop of New York, has an essay up on some Web site, complete with the standard handwringing condescension and heart-tugging photos, declaiming how desperately we need to take control of women’s bodies and impose forced pregnancy as a matter of law and culture. Its contents are typical of this well-worn genre: a lame argument about whether a human fetus is a “human being”, willful elision of the difference between biological identity and moral status, sweeping moral declarations grounded on nothing but his unreflective certainty, and of course obligatory references to Hitler, Stalin, and Dred Scott.

The heart of this superficial and nonsensical (or perhaps it could be said: “a-sensical”) piece is a photograph of a 20-week fetus – a photograph which, Egan declares, proves by itself that abortion is wrong and it is utterly worthless to even consider the actual moral issues raised by the question.

Why, you might inquire, have I not delved into the opinion of philosophers and theologians about the matter? And even worse: Why have I not raised the usual questions about what a “human being” is, what a “person” is, what it means to be “living,” and such? People who write books and articles about abortion always concern themselves with these kinds of things. Even the justices of the Supreme Court who gave us “Roe v. Wade” address them. Why do I neglect philosophers and theologians? Why do I not get into defining “human being,” defining “person,” defining “living,” and the rest? Because, I respond, I am sound of mind and endowed with a fine set of eyes, into which I do not believe it is well to cast sand. I looked at the photograph, and I have no doubt about what I saw and what are the duties of a civilized society if what I saw is in danger of being killed by someone who wishes to kill it or, if you prefer, someone who “chooses” to kill it. In brief: I looked, and I know what I saw.

Why it is that the moral attack dogs of the right wing are always so eager to proclaim their own lack of comprehension I don’t know, but it is no longer surprising as a practical fact, and still less in light of the product of their “reasoning”. But ask yourself: who would take such idiocy seriously in any other context? On what moral issue would anyone seriously say “I saw a picture of an organism affected by this subject that moves me in some way, so I refuse to think about it carefully or read what the best thinkers on the subject have said, and that justifies both my unsupported, idiosyncratic religious beliefs about it and my intention to impose them on everyone else in the country!”? Who would seriously claim that not thinking about, reading about, or analyzing a serious problem could possibly produce a correct answer, or was a proper ground for imposing a solution to it as a matter of law and policy? Well, who but a religious right-winger?

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The Sarah Palin nomination is so ludicrous it’s hard to grasp. People are still trying to get a handle on what it means, and what the relevant aspects of her tissue-thin background are. There’s been a lot of good commentary so far, including her relatively minor political experience, all of it in (literally) bush-league environs, and the obvious pandering – to pro-Hillary defectors and religious-right goons – that constitutes the only justification for her nomination. There is also her utter lack of background or preparation for assuming the Presidency without warning – as is her most important, and almost sole, Constitutional responsibility. And there is her apparent penchant for using her office and state agencies for personal vendettas. No doubt all of this will get more thoroughly aired, as it should. (My only fear is that McCain will come to his senses before the official nomination and force her to “reluctantly withdraw” to “spend more time with her family” – I want her on the GOP ticket!)

But there has been some other stuff entering into the discussion that I think is very ugly and ill-advised. Of course there have been some idiotic sexist remarks (and some equally idiotic attempted defenses of her “women’s work” as a qualification for President that are just as sexist in their condescension); that’s bad enough. And it’s hard to know just how to evaluate her “life story”, since much of her qualification for office – according to those who support her – is that she hunts moose and has a passle of kids. If they really think those are qualifications*, then it’s fair game to point out that they are not.

But there are other personal issues that are not fair game.

I hardly like to even bring the subject up, but it should be confronted. There are all kinds of weird rumors going around about Palin and her kids. Many people have suggested that her last child, born when Palin was 44 years old and not known to have been pregnant at the time, was actually the child of Palin’s oldest teenage daughter, who had dropped out of school claiming illness for over 6 months leading up to the birth. In addition, that child was born with Down Syndrome, and some other clown is now posting suggesting that that condition was the result of Sarah Palin’s behavior during the pregnancy. Alan Colmes has suggested Palin could have endangered the fetus by traveling more than 9 hours to a rural Alaskan hospital, rather than go to any of the many larger and closer hospitals, while supposedly in labor. (Note that the two rumors conflict with one another.)

Aside from this being a highly personal issue (and, if the rumor about the teenage mother is true, then apparently something the family does not want to acknowledge), it’s hard to see what legitimate relevance it has. Once, this would have been a career-killing scandal; thankfully, as the result of progressive social activism and the victories for women’s reproductive freedom that Palin herself opposes, there are now many options for forming families, and one’s personal choices in that regard are granted much more respect. Ironically, it is only Palin’s own base that would find anything scandalous in this. But it can certainly be used to create discomfort for the candidate and her family, and, again, among all the irrelevant lightweight issues Palin brings to the campaign, this seems to bear no relation to the question of her fitness for office.

To deliberately pick on an uncomfortable and private issue for the purpose of embarrassing or harassing a candidate is despicable. And to use women’s reproductive choices as weapons against them only involves us in the worst abuses of the right wing. This is absolutely the sort of thing we – decent progressives who support women’s freedom to choose their reproductive pathway – must not be doing. Yet highly-visible blogs like DailyKos and Andrew Sullivan (not a defender of choice, it’s true) are pushing the issue, and others are spreading it with their concern-trolling.**

There is perhaps one argument that makes the issue sound relevant, and that is the question of hypocrisy. The religious right and the GOP are on hair-trigger to judge other people’s lifestyles, family structures, and reproductive choices, so when one of them finds themselves enmeshed in a “non-traditional family” saga, perhaps we are entitled to some schadenfreude? And perhaps we are, but the only decent response is to welcome that family to the community of freedom of choice and freedom from condemnation. Palin, as far as I know, has not been one of the overt persecutors of others in that respect, and does not deserve to be persecuted in return.

Lee Stranahan, of the Huffington Post, offers this odd defense:

The whole story is based on an insulting view of fundamentalist Christians; that they’d be so freaked out by a teenage pregnancy that they’d have the Governor — the most highly visible and public women in the small fishbowl of Alaska — fake a pregnancy to cover up the sins her of daughter Bristol.

Actually, I find that perfectly possible to believe. But it’s just as much none of our business as it is none of theirs. We’ve got to stop making political fodder out of people’s health and reproduction, out of their attempts to just live their lives as best they can by their own lights, without interfering with anyone else. I have little hope that this story – whatever is behind it – will have any such effect on the GOP; in fact I have little hope that it will even encourage Sarah Palin to think that women who make different reproductive choices from hers might deserve the kind of privacy and respect that she wants for herself. But if we’re going to see a future in which people have the freedom and security to live their own lives and make their own choices, we have to let everyone do so, even those who oppose that freedom for others. We can’t let ourselves be the thing we oppose and expect anything good to come of it.

Update: Palin herself has just announced that the rumors her 17-year-old daughter had the baby (Trig) in May are false, because . . .  the daughter is pregnant now.

ST. PAUL (Reuters) –  The 17-year-old daughter of Republican  vice presidential candidate Sarah Palin is pregnant, Palin said  on Monday in an announcement intended to knock down rumors by  liberal bloggers that Palin faked her own pregnancy to cover up  for her child.

That would seem to lay the other rumor to rest. It also explains why the daughter was seen wearing an engagement ring – she’s marrying the father of her expected baby (yes, 17 years old, with a baby and a husband, neither of which she planned for). Palin has requested privacy for her family over that issue, and again it seems to me they ought to have it. This does raise the tantalizing question of how her insane fundie supporters are going to react, but I think we know the answer to that already: they would be screaming and howling at any Democrat who made the same announcement, but nothing matters if you’re a Republican, so it’ll be just fine.

* I’m highly suspicious that any of her supporters actually believe she is qualified for this office, or that they really mean the things they say in claiming so.
** I hope that’s not what I’m doing here, also. That’s not my intent, at least.

[Crossposted from my group political blog, Lean Left.]

Update: Revised description of one of the rumors; my original explanation was wrong.

Michelle Malkin now takes on the cause, and the rhetoric, of the misogynist anti-autonomy movement and its efforts to eliminate accessible reproductive healthcare.

Planned Parenthood is the largest single provider of prenatal, contraceptive, and abortion care in the US. In a country in which over 85% of all counties have no abortion services provider at all, in which health insurance plans are not required to provide contraception, and in which government-provided health programs for the poor are prohibited from providing abortion or, at times, even information about abortion, Planned Parenthood is often the only reproductive health provider available in many communities, and usually the only one available at reduced cost.

This drives the anti-woman brigade screaming crazy. There has been an organized campaign against Planned Parenthood by the sex-negative right wing for years, using a combination of smear tactics, lies, distortions, and political lobbying. Attacks range across everything from Margaret Sanger’s racism (don’t believe what you hear from hypocritical liars), Planned Parenthood’s practices of murder, malpractice, and coverup (don’t believe what you hear from anti-woman liars), and the – in Malkin’s terms – “obscene profits” Planned Parenthood makes from the lucrative business of providing subsidized healthcare to uninsured patients in poor communities (don’t believe what you hear from financially illiterate liars). The reason, of course, is that Planned Parenthood is doing what they are dead set on wiping out: making reproductive autonomy real for the most vulnerable women in America.

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I have posted elsewhere on my reaction to Obama’s speech on race, and conservative reactions to it. But yesterday’s column by Michael Gerson of the Washington Post moves me to comment here specifically on the provocative remarks about AIDS that have been quoted in this controversy, and their implications for the larger questions that must be faced by this country.

As most people will be aware, the right wing has been Swift-boating Barack Obama for the past few weeks over controversial statements made at various times over several decades by the pastor of the black-identified Baptist church Obama attends in Chicago. Yeserday Obama responded with a speech on the history and role of race and racial discrimination in America – a speech that will stand within the highest ranks of American political oratory, and, I am convinced, be seen in the future as the watershed moment in race relations in this country (certainly so if Obama wins the presidency; likely so even if he does not). There is almost nothing in the speech about healthcare, and only a little about the particular statements of the Rev. Jeremiah Wright that the right wing has picked out to whip up into controversy. Rightly, Obama placed the entire controversy in the larger context of racial history; many conservative commentators, angry at seeing their manufactured controversy dismissed in favor of more important and more substantive issues, responded with criticisms that Obama did not explicitly repudiate Wright and specific statements he had made, as they had demanded. Michael Gerson, in particular, focuses on Wright’s endorsement of the far-fetched conspiracy theory about AIDS that has been circulating in the black community.

Obama’s excellent and important speech on race in America did little to address his strange tolerance for the anti-Americanism of his spiritual mentor.

Take an issue that Obama did not specifically confront yesterday. In a 2003 sermon, Wright claimed, “The government lied about inventing the HIV virus as a means of genocide against people of color.”

This accusation does not make Wright, as Obama would have it, an “occasionally fierce critic of American domestic and foreign policy.” It makes Wright a dangerous man. He has casually accused America of one of the most monstrous crimes in history, perpetrated by a conspiracy of medical Mengeles. If Wright believes what he said, he should urge the overthrow of the U.S. government, which he views as guilty of unspeakable evil. If I believed Wright were correct, I would join him in that cause.

But Wright’s accusation is batty, reflecting a sputtering, incoherent hatred for America. And his pastoral teaching may put lives at risk because the virus that causes AIDS spreads more readily in an atmosphere of denial, quack science and conspiracy theories.

Obama’s speech implied that these toxic views are somehow parallel to the stereotyping of black men by Obama’s grandmother, which Obama said made him “cringe” — both are the foibles of family. But while Grandma may have had some issues to work through, Wright is accusing the American government of trying to kill every member of a race. There is a difference.

Gerson regards holding such an opinion as beyond the pale – and anyone who would believe such things as deranged. (“This accusation . . . makes Wright a dangerous man. . . . Wright’s accusation is batty, reflecting a sputtering, incoherent hatred for America . . . .”) Gerson is obviously grossly ignorant of the history and substance of these rumors, and the historical context in which they arise. And – like other conservatives dismissive of blacks’ reactions to America’s racial history – he seems to have no sense of what that context means to the people it most closely affects.

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I met Robert Rummel-Hudson last night at his New York book party, celebrating the release of Schuyler’s Monster, his memoir of his daughter’s struggle to meet the challenges of having been born with polymicrogyria – a neurodevelopmental disease that prevents her from developing spoken language – and his own struggle to meet the challenges of parenthood and the demands imposed by his daughter’s condition. The book grew out of Rob’s gripping, heart-rending blog, Fighting Monsters with Rubber Swords.

Robert has been documenting, step-by-step, the pathway he, his equally-admirable wife Julie, and Schuyler (pr. “SKY-ler”) herself have followed, first coming to terms with Schuyler’s developmental difficulties, then battling the public schools’ broken and indifferent system for educating special-needs children until finally moving to a city (Plano, TX, of all places) that offered what Schuyler needed. At the urging of his growing base of enthralled fans and well-wishers, he turned the blog into a book that hit the market just this week. It has already received considerable word of mouth and small-market press attention even before release; I am convinced it is just about to explode into a real sensation, and deservedly so.

Robert has an ability to communicate the pathos and humor of his family’s situation, and even more strongly Schuyler’s unbelievably spunky and winning personality, and her brilliantly unique triumph over the multiple dirty tricks life has played her. Schuyler is without question the star of his blog (which, he says, she still has not read, nor has she the book, either, though she is fully aware that she is a media queen). It is impossible to read their story without falling in love with Schuyler (and indeed she is regularly showered with largesse by fans, often anonymous, who have visited the family’s Amazon wish-lists). “Schuyler has a posse!”, I told Rob, and he agreed that one of the most satisfying side-effects of blogging about her condition is that she has garnered such a wide-spread support base. That is due to Rob’s ability to make her come alive through his words – though it’s obvious Schuyler is giving him a lot of great material to work with.

In person, Rob comes across just as you’d imagine from his blog: funny, personable, thoughtful, fiercely dedicated to Schuyler and her needs, worried about her future, and laceratingly honest about his own uncertainties and shortcomings (which I think he overestimates). It was great fun meeting him, and I was glad to see the St. Martin’s Press staff just as enthused about the book as were the many fans who turned out to meet the author.

I mention all this simply to add this plug for a book that deserves to be read, and will break your heart and change your viewpoint when you have done so. I can’t communicate the impact of Rob’s blog or the book it gave rise to, but I urge everyone to experience them for themselves.

(1) Go buy this book:

(2) Go read this blog.

You can thank me later.

UPDATE: Fixed an editing mistake.

Making with the sorely overdue link-love: two months ago, Amanda Marcotte (of Pandagon, and the best thing that ever happened to John Edwards) linked my prior post on right-wing propaganda about Margaret Sanger (as a way of attacking Planned Parenthood). She points out the fact that, in Sanger’s day, PP was actually anti-abortion (largely for reasons of the relative safety of the procedure, much lower then than now), and that the wingers seem to have no conception of the irony of their slanders.

The article generated a fascinating discussion thread, however (with minimal, but nonzero, trollage) - one that I only stumbled across today by following a visitor link (thanks!). I’m sorry to be so late on this but I encourage everyone to run over there; the discussion is interesting and, collectively, it includes a fascinating list of resources on the history of abortion, abortion and race, and sexual autonomy as seen from a variety of times and places, and presented in a variety of media (the rock-opera version of a 19th-century German play about the link between lack of sex ed and unplanned pregnancy sounds . . . wild – and I had no idea there was a whole list of early silent movies on the same topic!). Now I’ve got a lot more reading to do! So do you.

“Wendi Aarons” contributes an open letter to the McSweeney’s collection:

AN OPEN LETTER TO
MR. JAMES THATCHER,
BRAND MANAGER,
PROCTER & GAMBLE.

February 6, 2007

Dear Mr. Thatcher,

I have been a loyal user of your Always maxi pads for over 20 years, and I appreciate many of their features. Why, without the LeakGuard Core™ or Dri-Weave™ absorbency, I’d probably never go horseback riding or salsa dancing, and I’d certainly steer clear of running up and down the beach in tight, white shorts. But my favorite feature has to be your revolutionary Flexi-Wings. Kudos on being the only company smart enough to realize how crucial it is that maxi pads be aerodynamic. I can’t tell you how safe and secure I feel each month knowing there’s a little F-16 in my pants. . .

Have you ever had a menstrual period, Mr. Thatcher? Ever suffered from “the curse”? I’m guessing you haven’t. . . .

Last month, while in the throes of cramping so painful I wanted to reach inside my body and yank out my uterus, I opened an Always maxi pad, and there, printed on the adhesive backing, were these words: “Have a Happy Period.”

Are you fucking kidding me? . . .

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