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 announcement yesterday that Elizabeth Blackburn has won the Nobel Prize in Physiology or Medicine was no surprise, but surely a much-deserved recognition. Her work on the function of telomerase was a breakthrough in molecular genetics, and she had long been among the informal class of Laureates-in-Waiting.

It cannot but bring to mind, however, the shameful episode in which Blackburn was hounded off the Bush-era President’s Council on Bioethics by its erratic right-wing chair Leon Kass. Blackburn was one of the few voices of sanity on that board (along with ethicist William May, also purged at the same time). She had distinguished herself by filing a “minority opinion” to the Council’s first official position paper; after that, minority opinions were no longer allowed, and eventually she and the other dissenter were replaced by pliable right-wingers (notable for their ravings about “ejecting God from the public square” and the coming wave of “forced abortions”). Kass himself, of course, is well-known for his flamboyantly idiosyncratic reactionism (he’s against, among other things, dating, virtually every form of reproductive technology including ones that don’t exist yet, and, infamously, eating ice cream cones in public*).

As Kass finally fades into his richly-deserved irrelevance, and even with the right-wing anti-science circus still in full cry, it’s refreshing to see one of science’s stars – and, for her forthrightness in the face of the intellectual debacle that was the Kass Council, one of its heroes – acknowledged for pursuit of the truth by means of reason and fact. Whatever distortions the right clings to, and whatever political means they use to deny science’s truths and withhold its benefits from those who choose to make use of them, truth is what it is and science reveals it. Blackburn, in a peculiar and distinctive way, exemplifies both the majesty of the search for truth and the dangers of its repression. Though her prize is based on the scientific importance of her work, her personal story gives it particular salience, and makes her success particularly triumphant, in these darkling times.

* Yes, really.

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).

Just once, I wish we could have a debate over an important political issue that wasn’t entirely shaped and determined by sheer stupidity and ignorance from the right wing. Today will not be that day.

The winger blogs are all a-twitter over a story noting that the Omnibus Budget bill that was (finally) just passed contains a provision – known as the Dickey-Wicker Amendment, which the religious wingers have stuck in every budget since 1996 – prohibiting federal funding for research “in which human embryos are created, destroyed, discarded, or knowingly be subjected to risk of injury or death”. Setting some kind of a record for intellectual incompetence, the right-wing CNSNews mis-reported this as “Obama Signs Law Banning Federal Embryo Research Two Days After Signing Executive Order to OK It” – which, in one single sentence, misrepresents the event (he did not sign a law on embryo research, he signed the budget bill, which contained one small amemendment addressing embryonic research among its reported 3,500 pages of text and appendices), false as to fact (his executive order did not address embryo research), and completely wrong in its implication (the budget amendment does not undo the research policy Obama announced, as this headline implies). Despite this falsity and confusion, the event is viewed as some sort of humiliation for, or hypocrisy by, President Obama, since he had made a point of repealing the Bush ban on stem-cell research funding just two days before signing the budget with its unrelated embryo-research amendment. Much chortling and back-slapping is now underway, among people who know nothing about the issue and are apparently too dumb to read.

(more…)

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:

(more…)

“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!

Man, they are insane over at National Review! I mean it literally – their minds don’t work normally. I usually think that’s just the inherent limitation of being a right-wing second-stringer (you’re already lower than a very low bar), but here I’m not even talking about their developmental team at The Corner – today NRO runs a feature piece by some professional abortion-myth peddler that simply takes a wig-out and keeps on flippin’. The reason Sarah Palin is a laughingstock, you see, is that . . . her critics all feel guilty about abortion.

[Digglah: Forget the baseball tie-ins. The Gibbering Abortion-Rights Exquisite Corpse Dadaesque Word Association Prize has now been retired.]

Here’s Kevin Burke explaining what everyone else pretty much figured needed no explanation:

Some of the very personal and often uncharitable criticism of vice-presidential nominee Sarah Palin and her family may have a relationship to [the country's] collective grief, shame, and guilt from personal involvement in the abortion of an unborn child.

Right. The massive outpouring of largely political, fact-driven, and entirely reasonable criticism of a complete airhead who consistently offers an unrecognizably garbled version of basic constitutional principles affecting the job she is currently seeking, began her campaign for that job by stating she did not know what it entailed, invariably responds to the simplest substantive questions with idiotic evasions and irrelevancies, cites the most bizarrely tangential facts – often incorrectly – as evidence of her own preparedness for office, conducted personal vendettas in office and attempted to ban library books as mayor, has been cited by her own state’s attorney for abuse of authority as governor and is still under investigation for related transgressions, cannot name any Supreme Court decision other than Roe v. Wade, cannot name any magazine or newspaper she herself reads (while claiming to read “all of them”), constantly infantalizes her office and her own supporters by filling public appearances with childish slogans, jargon, meaningless folksy expressions, and winking in lieu of answers to topical questions, campaigns almost exclusively by vague generalizations and character assassination, denies scientific consensus on environmental protection, global warming, and creationism, and adheres to extremist religious superstitions about witchcraft, “the apocalypse”, and God’s supposed direct intervention in her career and electoral campaign . . . is an expression of everyone’s personal feelings about . . . abortion.

What kind of a nut thinks so? The kind of nut who spends his life promoting the entirely made-up, and repeatedly scientifically disproven, myth of “post-abortion syndrome” – a supposed psychological malady that afflicts women who have had abortions (and now apparently the entire nation). It’s particularly an issue in Palin’s case, you see, because she has a child with Down Syndrome, but the majority of such pregnancies are aborted, so all those women are – he knows this – racked with guilt over the fact that Palin is a better woman and mother than they are. They attack her to assuage their own feelings of guilt and inadequacy. I’m not making this up (though, obviously, Burke is):

Seeing the Palin family, in a very visible public forum, with an uncompromising and public pro life philosophy arouses deeply repressed feelings in post abortive parents, as well as media members, counselors, health care professionals, politicians and others who promote abortion rights, especially the abortion of children with challenges such as Down Syndrome. These powerful repressed feelings of grief, guilt and shame can be deflected from the source of the wound (i.e., abortion) and projected onto an often uncharitable focus upon the trigger of these painful emotions…the Palin family.

Burke, by the way, is a founder of a Catholic anti-choice organization specifically dedicated to promoting the “post-abortion” myth. It’s his job to say nonsense like this. But it’s important to re-emphasize that there is absolutely no evidence whatsoever that any of this is true – this Burke clown, and people like him, made this up and just keep saying it. The “post-abortion syndrome” lie has been disproven again and again, by multiple studies in different settings over a period of almost 30 years – there is simply no general phenomenon of depression or regret following abortion (though individual women have differing reactions, of course), and on average women who have had abortions are happier after having done so than they were before. As to whether people’s reactions to Palin have to do with guilt over abortion, he obviously can’t know that and it’s obviously insane. It makes as much sense as saying they love Obama because of feelings of guilt about suntan lotion. He made it up, and asserts it as fact because it serves his purpose. He’s been doing that for decades, shamelessly, in direct contravention of established evidence proving his statements to be lies, and with no evident regard for that fact.

What strikes me, more and more over the years, is the bizarre lengths the anti-woman crowd goes to to promote their false and absurd view of women, sex, and the world in general. They really do see everything as related to those topics. Archbishop Egan, in the risible and obnoxious essay cited in my last post on this topic, claims to hope for “one day, please God, when the stranglehold on public opinion in the United States has been released by the extremists for whom abortion is the center of their political and moral life”. Can he really be that un-self-aware? Is there anyone who better fits that description than people like him and Burke – for whom the merest mention (or photograph) of a fetus is grist for an unhinged and reality-free rant about abortion, in whose minds the entirely predictable failings of an absurdly unqualified political candidate are actually caused by a fictional product of abortion that they themselves made up out of whole cloth? (I guess Colin Powell, Christopher Buckley, Charles Fried, and Ken Adelman are all suffering from “post-abortion syndrome”.)

There is a kind of funhouse-mirror aspect to the ways these people’s minds work. Back in 1994, when the Edvard Munch painting The Scream was stolen from the Norwegian National Gallery, an anti-abortion group announced that they could get it returned if anti-abortion propaganda were shown on national television (in fact they had no connection to the incident and were just grandstanding). After 9-11, Jerry Falwell famously declared that “the abortionists have got to bear some burden for this  because God will not be mocked.” (It also turned out that gays, lesbians, feminists, and the ACLU were involved.) In 2006, a panel of Republicans in the Missouri State Legislature investigated the problem of illegal immigration (into Missouri?), and discovered it was the result of “the effects of 30 years of abortion.” It is a commonplace within the crypto-racist right that Western (i.e., white) societies are facing a “demographic bomb”, resulting from the different birthrates of white and non-white population groups, caused by abortion and birth control. Certain Catholic scholars, including John Noonan and Philip Rieff, have declared that abortion is itself the product of the “therapeutic culture” which seeks “wellness” (scare quotes always, please) rather than rule-following – sexual autonomy is for them a mental illness. The latest fad phrase among conservative thinkers is “the culture of death” – our entire society, or at least its progressive faction, is devoted to killing human beings, not because preserving biological life is not always the only goal in the healthcare setting, but as some sort of ideological principle in itself. Another fad phrase is “the contracepting culture” – society that accepts the horrors of sex with contraception (do you really think I’m making this up?). And of course, Sarah Palin declares that William Ayers, who helped bomb a number of government installations during an illegal war while causing no deaths, is a terrorist, but when questioned whether the bombers and shooters who murdered numerous people in legal abortion clinics were terrorists refused repeatedly to address the question.

It appears there simply isn’t any issue or circumstance, however far-fetched, that isn’t relevant to abortion; there isn’t any problem or trend, however dubious, that isn’t caused by abortion; there isn’t any need or difficulty, however unlikely, that can’t be solved by criminalizing sexual freedom. The bizarre obsession that leads to such thinking, and the contortions and delusions it requires to make such leaps while ignoring the glaring contradictions they entail, is difficult to grasp. It is simply very hard for a normal person – one who isn’t terrified by sex and obsessed with controlling and limiting other people’s sexual freedom – to imagine how this kind of thinking originates.

Make no mistake: this has nothing to do with taking a reasoned position on the appropriate balance of moral rights and interests between a pregnant woman and her fetus. This is simple full-gone loony craziness. These people make up absurd factual claims and baldly lie when they are refuted, hypothesize bizarre psychological projections upon those they disagree with, and obsessively posit – with dizzying certainty – the most tenuous and far-fetched links between virtually any event or phenomenon in the world and their consuming misogynist bete noir. They’re nuts. And these are the leaders – the thinkers – in the anti-choice movement. This is what the anti-choice movement is like when it’s not ranting at patients in front of health clinics or shooting doctors. This is what being anti-choice is like at its most subtle, sophisticated, and learned: bat-shit loony.

[NB: Crossposted to the blog Lean Left, where I also contribute. I don't usually cross-post, but Lean Left is picked up by the aggregator Memeorandum, and this blog is not, so on topics where I think it's important to reach a wider audience, or to respond directly to posts from Memeorandum, I sometimes do.]

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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tgirsch of Lean Left (and my own blogfather!) writes:

I’m interested in the issues surrounding animal testing. I’m certainly not a member of the PETA crowd or anything, but at the same time, I’d certainly think we should keep such testing to a minimum, using it only where it’s necessary, useful, and relevant. But I honestly don’t know what all the issues are.

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Michael Gerson, Bush administration tool and terminal sufferer from Conservative Comprehension Disorder, continues his pattern of getting everything exactly backwards in his Washington Post-sponsored campaign of attacks on Barack Obama. The day after April Fool’s Day (he must have missed a deadline), Gerson published another misinformed screed, this one claiming that Obama is an “extremist” on abortion for opposing laws that would have sentenced women to death. As usual with Gerson and the forced-pregnancy crowd generally, almost everything he says is factually false, and a repetition of standard right-wing myths. The column consists of nothing more than Gerson and the Post carrying water for the organized anti-woman crowd by repeating their well-worn talking points verbatim, with no pretense of originality or reportorial integrity. (more…)

“Reproductive Health Reality Check” is running an April Fool’s Day blog carnival against “Crisis Pregnancy Centers” that mislead patients seeking abortion with deliberately deceptive tactics and false information. “CPCs” are medical fraud – there is no other description for it. And they are an increasing problem as abortion services are continually targetted and women have fewer real options; currently they outnumber real, full-service reproductive health clinics 2:1.

College women are specifically targeted by these charlatans – sometimes with official support from the colleges themselves. Shockingly, not only does Georgetown University – a Catholic school – refuse to provide any form of contraception or abortion referral through its campus healthcare center or hospital, they apparently have also been blanketing the campus with anti-abortion stickers whose only pregnancy-care referral number is to a CPC, not a real health clinic. (Full disclosure: I have an MA from GU, from the early 90s, and their behavior in this regard was even more reprehensible then.) UNC Chapel Hill students have had to create their own sex-ed programs for fellow students, who mostly come from local high schools with “abstinence only” programs and literally don’t know anything about reproductive health, and then are targeted for lurid propaganda by a CPC located just off campus. Students at other schools have had to do the same.

CPCs are a threat to the larger patient population as well. Vicki Saporta of the National Abortion Federation documents many of the problems they represent, including their deceptive tactics, medical fraud, and the support they receive from the anti-choice right (including over $30 million in taxpayers’ money from the Bush administration, and more from state legislatures). Allyson Kirk reports her experience with a CPC that had deliberately located itself along the entranceway to a real health clinic; after receiving an appointment at the real clinic, she mistakenly entered the wrong door, deliberately made up to look like a pro-choice facility, and was treated as if she was the expected patient, then subjected to invasive questioning and fraudulent misinformation.

This kind of behavior would be criminal in a real health clinic. CPCs present themselves in a deliberately fraudulent manner, impersonating real clinics with trained personnel (almost invariably, nobody at a CPC is a licensed healthcare practitioner) offering appropriate healthcare services, for the deliberate purpose of manipulating patients’ decisions and foreclosing their options; they then defend themselves legally by denying that they are subject to the professional obligations of real healthcare providers. The more this is known, and the more their tactics are exposed, the safer women will be.

I don’t usually write link-only posts, but this is worthwhile and the stories some contributors have to share are appalling. Go take a look.

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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There is a terrible tension in healthcare – medicine, especially – between the use of expert knowledge to serve and heal those in need, and its use to aggrandize those with the knowledge and to control, mold, dictate to or torture those who fall into their hands. Knowing what can help another can easily be mistaken for “knowing what is best for them”, and historically has been so mistaken throughout the entire history of medicine as a profession. Today, it’s hard to hear the phrase “Doctor knows best” without an ironic smirk – the same smirk we conjure up for the parallel slogans of wrongheaded patriarchal oppression “Father knows best” and “Trust your government”. But it was not long ago that that slogan was the entirely literal creed of the most respected profession in Western society, and the work of challenging that creed and establishing the primacy of patient values and autonomy was lengthy and hard-fought. Its path was marked by the graves – quite literally the graves – of too many martyrs.

The most entrenched redoubt of medical power (though least well-grounded in research and knowledge) was psychiatry. Not only did the head-shrinkers lay claim to the most occult knowledge of human functioning and health, but they stood against a patient population that was inherently and societally almost unable to defend itself. Members of, possibly, the most severely and unsympathetically stigmatized stratum of society, mental patients were given no credence, and often had no recognized legal standing, to assert their own values and choices in treatment. And it is true that in many cases, patients with mental illness could not in fact act for their own interests or competently manage their own treatment and caretaking. But the presumption that no such patient could have a valid opinion about their own care, coupled with the prejudice that they were unfit for “normal” society, and likely dangerous, meant that virtually anything could be done to anyone, if advocated by a doctor armed with a diagnosis of mental illness. The things that were done were in many cases almost unthinkable.

Howard Dully spent over 40 years thinking about what was done to him. It took him a full life of hardship and failure to finally understand his own fate, and to come to terms with it. That anyone could have survived, let alone found peace and stability, after having lived his story, is an amazement in itself.

Dully is the author (with a professional co-writer) of My Lobotomy: A Memoir. The subject of the book is exactly what the title suggests. The story it contains is heartbreaking.

Dully’s life is difficult to summarize, except to say that it was unremittingly harsh almost from birth. Dully was born in California in 1948; his father was a hard and unemotional man who was driven to work excruciating hours, sometimes at as many as 4 or 5 low-skill physical labor jobs at the same time, partly by the need to support his family, partly by his own obsessive work ethic. Howard grew up a big kid (he’s now 6′7″, 350 lbs) who picked on his younger brother; when he was 4 his mother died after giving birth to a baby brother with a severe neurological deformation – the baby was placed with relatives and never spoken of again within the family. Howard and his family bounced around various friends’ and relatives’ homes as his father struggled to earn a living, and Howard suffered constantly both from missing his mother and from the severe discipline he suffered in some of these homes. Things really got bad when his father married again, to a woman with two sons of her own. Dully claims that she simply resented and hated him; from reading both his own stories of his home life, and some of his doctors’ notes, it is easy to believe he is correct. Howard, in the meantime, was legitimately a handful for any parent: he was apparently flightly and unreliable to an extreme degree, was aversive to school work, discipline, and hygiene, and often fought with his brothers, though they had a generally good relationship. As he got older he began doing stupid kid pranks – shoplifting and stealing items from cars, and playing hooky. As a huge and growing boy, he was constantly hungry, but was not allowed to eat between meals and was beaten for taking snacks. His step-mother also had some sort of obsession with her furniture and household trinkets, and would beat Howard for touching anything in the house, sitting on the parlor furniture, or using the front door. His step-mother would beat him for any infraction, and for things that weren’t infractions; later his brothers confirmed that she did indeed beat him for things she did not mind when done by her own sons, and would rave at him for no reason at all. When his father got home, he would get another beating – his father made him choose a piece of firewood to be beaten with, and Howard developed the skill of picking ones that were flexible enough to hurt less but strong enough not to break (which would encourage his father to continue the beating with his bare hand). Between his actual behavioral problems, his pre-adolescent awkwardness, the fact that his step-mother did seem to truly want him dead, and his father’s absence and emotionally and physically violent treatment, Howard seemed doomed to a life of misery no matter what might have happened. What actually did happen is unbelievable.

Howard’s step-mother apparently conceived the idea that she could get rid of Howard if she got the weight of professional opinion on her side. She began visiting a series of psychiatrists to complain about her son’s behavior, but none of them would agree he had to be institutionalized or removed from the home. Several wrote consulting notes to the effect that they were convinced her harsh treatment was the problem and that she should moderate her behavior toward the boy. She moved from doctor to doctor trying to find one that would agree with her. Finally she stumbled onto Dr. Walter Freeman.

Freeman was the pioneer, in the US, of the new treatment of psycho-surgery. He actually coined the word “lobotomy”, and popularized the use of that treatment in this country. He was the first US physician to see the procedure, after it was developed in Europe just before WWII; Freeman brought it back to the States and traveled the country in specially-modified vans or station wagons that he called his “Lobotomobiles”, giving demonstrations of both electro-convulsive therapy (using a machine he built himself; when it broke down, he simply held the bare wires against the patient’s head for as long as he felt was appropriate, with no mechanism for monitoring voltage or current) and lobotomy. According to the Dully, relating reports of academic researchers who studied Freeman’s career, Freeman was a constant self-promoter and showman: he would perform several lobotomies in a day, every day, in front of medical audiences, liked to demonstrate how easy it was by sometimes using ordinary household implements rather than surgical tools, and developed a signature two-handed bilateral technique in which he would insert “leucotomes” (the lobtomy knife) into both lobes of a patient’s brain and then simultaneously jerk them both through the tissue with a flourish. At times, his death rate ranged upward of 20%. Nobody seemed to think this was cause for alarm. Patients were operated on without their own knowledge or consent, and authorization was freely obtained from courts or patient guardians after reassurances from Freeman that the procedure would solve all the patients’ problems. Often, no precise psychiatric diagnosis was attempted before the lobotomy was performed; lobotomies were used for conditions ranging from headaches to schizophrenia. More than a few were performed on minors, even pre-teens; there were questions about such cases, but little organized opposition. Freeman was profiled in popular magazines, and sometimes hailed as a god, delivering sufferers from their misery. There were many detractors in the medical community, but the great benefit of lobotomy was that it often made patients docile enough to live with their families without monitoring, meaning they could be discharged from the large state mental institutions that were commonplace then. This made the procedure wildly popular with the managers of those institutions, whose patients had no effective representation to oppose the treatment plans made for them by others.

After a few years, Freeman heard about, and again pioneered, a variation of the lobotomy procedure called “trans-orbital lobotomy”, often referred to as “ice-pick lobotomy”. In that procedure, a long, sharp, thin instrument was pushed along the eyeball parallel to the nose, and through the back of the eye socket (“orbit”) into the skull, and into the frontal lobe of the brain. The instrument could then be levered back and forth, and up and down, to tear through the frontal lobes and disrupt their neural circuitry. There was no method for visualizing the exact placement of the instrument in the brain, or the location, depth, or extent of the lesions created; the method was simply to stick the metal rod in through the eye socket and wiggle it back and forth to tear the brain tissue randomly. The effect was almost as dramatic as an open-skull lobotomy, but there was no external wound, and it could be performed under mild anaesthesia. The procedure could be done in an ordinary doctor’s office, and took about ten minutes. In many cases, the surgical instrument used was, in fact, an ice pick. (Freeman’s personal lobotomy instrument was labled “Uline Ice Company”.) Patients were sometimes sent home afterward in a taxi cab.

Freeman began popularizing the trans-orbital lobotomy, sometimes performing as many as two dozen procedures a day on patients in mental institutions and hospitals. In some cases, patients were operated on against their consent; after the procedure, they lacked the drive and wherewithal to sue. After some years traveling the country in his Lobotomobile, he finally settled in the South San Francisco Bay Area, near where Howard Dully’s family were living. Eventually, Dully’s step-mother asked to see him.

Freeman met with her a number of times over a period of two months, duly recording her wild stories of Howard’s unmanageable behavior (some of which later turned out to be pure fabrications – such as the story that he had beaten his brain-damaged baby brother almost to death). From the beginning the step-mother openly solicited some kind of dramatic professional intervention. Freeman hesitated at first, insisting he would have to meet the patient and interview the other family members before coming to any conclusion. (What seems incredible is that he began formulating treatment plans with the mother for weeks before ever once meeting Howard.) He interviewed Howard’s father one time; the father gave a much more balanced report of Howard’s behavior, but Freeman didn’t pick up on the clue. He began to meet with Howard himself, and found him reasonably normal though somewhat uncommunicative (who wouldn’t be?). But he kept meeting with Howard’s step-mother, who still filled him with tales of how afraid she was of Howard, how her other sons were afraid of him and were constantly beaten up by him (they deny this), and finally how Howard had beaten up his baby brother in infancy (his entire family denies this – and note that the step-mother was not part of the family at that time). Freeman seems to have accepted everything she said, and viewed Howard’s truancy and other bad behavior through this fictionalized and delusional lens. After four meetings with the step-mother, only one meeting (ever) with Howard’s father, and four visits with Howard himself, Freeman recommended that they should attempt to “change his personality” with a trans-orbital lobotomy. Howard’s step-mother immediately agreed, and took the papers home for his father to sign, which he did without ever speaking to the doctor again. Freeman cautioned the parents not to tell Howard what would happen – only that he would be admitted to the hospital for “tests”. Howard excitedly looked forward to his night in the hospital, because he had heard they gave you Jell-O there. And they did. It was two weeks after his 12th birthday.

Freeman lobotomized Howard the next day. Howard has no memory of any of the events of that day. He contracted a fever and an apparent infection (Freeman was infamous for not sterilizing his instruments before surgery; you can see, in the actual photograph of Howard’s procedure, [see photo at end, below the jump] that he is not wearing gloves), but recovered soon enough.

The rest of his life was a disaster.

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