Planned Parenthood and Me

Since the Susan G. Komen Foundation lost its reputation for being "apolitical" when its decision to de-fund Planned Parenthood's breast cancer screening program for low-income women came to light last week, I've spent time recalling, with gratitude, my own long-ago personal acquaintance with Planned Parenthood. It began in 1971, during the months that I received food stamps. I was working then as a cleaning woman, and Tom (who had started back to graduate school) and I were living on my earnings cleaning houses and a small student loan that with all the scrimping in the world couldn't be made to cover our living expenses. (We just made it with the food stamps, $54 a month, as I recall.) Since I had dropped out of school, I had no access to the university's student health center. I had never heard of Planned Parenthood until a friend, learning that I couldn't afford to see a gynecologist to get a prescription for oral contraceptives, told me about their clinic-- and that they had a sliding scale.

I remember bicycling to the clinic, in Urbana. It was in the basement of a building and distinctly makeshift-- the person doing reception sat at a card table (and indeed, all the "desks" were folding tables of one sort or another), the examination cubicles had curtains rather than doors, and the amenities were nothing like any doctor's office I had ever been in. But the doctor, a woman with a heavy German accent, astounded me with her deftness and gentleness with the speculuum. (I'd had only a few experiences with pelvic exams before that one, and they had all been painful.) Most astonishing, though, was that she did something that has now become standard practice, but certainly wasn't back then: she told me everything she was going to do before she did it, and what she was doing as she did it. And she explained why. She made me--all of me-- part of the process (unlike the male doctors I'd previously had who talked about the weather or a skiiing trip they'd recently taken or else just breathed hard or grunted as they poked around inside my body). I hadn't yet encountered Our Bodies, Ourselves, but when I later did finally see it in the bookstore and buy it, I recognized the attitude and approach to women's health care. It is an approach that puts the woman herself at the center of the process, and seeks to increase her sense of agency. My experiences in that clinic gave me a different idea of what gynecological examinations could be like. When two years later I resumed my undergraduate course work and had the option of getting my health care from the university's student health center, I never gave doing that a thought. And that's probably a good thing, since it was through my annual exams at Planned Parenthood that I learned that estrogen was raising my blood pressure.  When lowering the dosage, which was the first response to the problem, wasn't sufficient to lower my blood pressure, the doctor discussed other options with me, and then introduced me to my first diaphragm. She did this in a way that countered my dismay and sense of helplessnes at learning that oral contraceptives would be deleterious to my health. The people at the clinic also, of course, taught me self-breast examinations. Back in the 1970s, this was unusual. Certainly it wasn't something that was ever done in an ordinary gynecologist's office. I only stopped going to Planned Parenthood when I moved to another city.

My gratitude for the good care of me taken by the people at that clinic is only part of the reason I've been a long-time monthly supporter of Planned Parenthood. As the attack on women and women's agency has escalated over the last few years, Planned Parenthood has been a primary target. The attitude of those attacking the organization is: How dare they give women options? How dare they educate and care for low-income women? At a time of escalating costs of health care and an ongoing campaign of dis- and misinformation about women's contraception, abortion, and women's health issues generally, Planned Parenthood is a bulwark we cannot afford to lose.

The Komen Foundation has (temporarily at least) restored the funding it had been providing for the breast cancer-screening program at Planned Parenthood. But Planned Parenthood is under attack on other fronts. If you can afford to make a contribution to them, please do. This is no time for Planned Parenthood to be forced to cut back its services. I am fortunate that they were there for me when I needed them.

They "might as well be living in 1927" (Living in the future means thinking like an sf writer, Part 2)

In talking about "living in the future" the other day, I didn't mean to imply that we are all of us living in the future. Or that every aspect of our lives is spent in the future. It's all uneven. As ABC News quoted a doctor at Vanderbilt University a couple of days ago, as far as medical resources go, a lot of people in the US "might as well be living in 1927." 

A 24-year-old Cincinnati father died from a tooth infection this week because he couldn't afford his medication, offering a sobering reminder of the importance of oral health and the number of people without access to dental or health care.

According to NBC affiliate WLWT, Kyle Willis' wisdom tooth started hurting two weeks ago. When dentists told him it needed to be pulled, he decided to forgo the procedure, because he was unemployed and had no health insurance.

When his face started swelling and his head began to ache, Willis went to the emergency room, where he received prescriptions for antibiotics and pain medications. Willis couldn't afford both, so he chose the pain medications.

The tooth infection spread, causing his brain to swell. He died Tuesday.

That was just last week. As Carrie Gann notes in the piece, it is not unusual for people in the US to die of simple-to-treat problems:

"People don't realize that dental disease can cause serious illness," said Dr. Irvin Silverstein, a dentist at the University of California at San Diego. "The problems are not just cosmetic. Many people die from dental disease."

. . . .

"When people are unemployed or don't have insurance, where do they go? What do they do?" Silverstein said. "People end up dying, and these are the most treatable, preventable diseases in the world."

This would be a very easy problem to fix, if our elected officials cared to serve anyone but the wealthy. Unlike health insurance, medicaid costs almost nothing to administer. But that's because government-brokered health insurance is a nonprofit undertaking. If Dante were alive now and writing the Inferno, insurance executives (along with proponents of torture and banksters) would no doubt be found in of his choicest circles.

Is this what they mean by "progress"?

Preparing for one of my panels at WisCon, I came across this dismaying news:

Women in the USA have a higher risk of dying of pregnancy-related complications than those in 40 other countries, according to a new report, Deadly Delivery: The Maternal Health Care Crisis in the USA, by Amnesty International. And while countries around the world are fighting to reduce maternal mortality to meet Millennium Development Goal 5, maternal mortality ratios have more than doubled in the US from 1987 to 2006.

The report states: "The USA spends more than any other country on health care, and more on maternal health than any other type of hospital care. Despite this… the likelihood of a woman dying in childbirth in the USA is five times greater than in Greece, four times greater than in Germany, and three times greater than in Spain."

As Sarah Boseley writes in The Guardian, “The damning report comes in a year of unprecedented international effort to reduce the death rate among mothers in developing countries, which will include a major conference called Women Deliver in Washington in the summer. The cause has been taken up by Secretary of State Hillary Clinton as well as Sarah Brown in the UK.”

When it comes to healthcare in the US, the lives of poor, uninsured, African American and Native American women are put at a much higher risk. There are severe obstacles that women in the US face when attempting to get necessary services, including: discrimination; financial, bureaucratic and language barriers to care; lack of information about maternal care and family planning options; lack of active participation in care decisions; inadequate staffing and quality protocols; and a lack of accountability and oversight.

While the report highlight the rise in maternal deaths, it also reveals that severe pregnancy-related complications that nearly cause death – known as near misses – are rising at an alarming rate as well, increasing by 25% since 1998. Currently nearly 34,000 women annually experience a "near miss" during delivery.

Read more here, including Amnesty's suggestions to the US Government for how to address this problem.

Dire Consequences

On the health reform front, according to an article by Jonathan Allen on Politico.com, it looks as though Stupak, the anti-abortion amendment to the US House of Representatives health care bill, goes much, much further than originally supposed:

Stupak and his allies, including every House Republican, a quarter of the chamber’s Democrats and the Vatican, say that it simply extends an existing prohibition on federal funding for abortion — an annually renewed policy called the Hyde amendment — to the health care exchange that would be established for the uninsured under the health care bill making its way through Congress.

But lawmakers who support abortion rights contend that, if the Stupak amendment’s logic is extended to the $250 billion in tax breaks Americans get to buy coverage through employer-based plans, it could strip abortion coverage from tens of millions of women who already have it.

Rep. Diana DeGette (D-Colo.), co-chairwoman of the Congressional Pro-Choice Caucus, said that the next step beyond Stupak for the anti-abortion movement will be to make sure that “if that federal wand has been waved over your insurance, then you don’t get to get abortion coverage.

Many Americans may not know that the money used for their employer-based health plans is untaxed, because it doesn’t show up on their paycheck and they don’t have to worry about it at tax time. But Congress’s bean-counting Joint Tax Committee calls the break “the largest tax subsidy” on the books and reports that it “represents by far the largest portion of total tax expenditures for health.”

This is how it works: The health benefits most Americans get at work are a form of income. But federal law excludes that income from taxation — and lets businesses write its cost off as an expense — providing an incentive to workers to buy health insurance and for employers to offer it as compensation.

For better or for worse, that tax-free foundation of the employer-based system props up the insurance industry. Without it, the government would be about a quarter of a trillion dollars richer each year — enough to pay for the House health care bill twice over the next decade.

More important for the abortion debate, Congress considers the income tax exclusion to be a massive “tax expenditure” — a subsidy — for individuals to buy insurance.

The effects the article discusses might be even farther reaching than that, involving nonprofits (including Planned Parenthood). Women in the US have steadily been losing access to safe, legal abortion. Cunning stealth attack or simply inadvertently sweeping in its consequences, it's obvious the Stupak Amendment would go even further in returning us to the actual, if not the legal, conditions of the pre-Roe vs. Wade days. Think that sounds alarmist? Here's another excerpt from Allen's article:

The combined data of a pair of studies conducted by the Guttmacher Institute and the Kaiser Family Foundation strongly suggest that most women who currently are covered by employer-based insurance plans have abortion coverage.

They would be in danger of losing abortion coverage if the Stupak principle is ever applied to the existing health care system, according to abortion-rights advocates.

“The next step after that will be to say that anybody who gets a plan purchased by an employer that gets tax relief can’t have abortion coverage,” DeGette said.

Sen. Tom Harkin (D-Iowa) sees the argument bleeding into federal subsidies in other policy arenas, according to the Iowa Independent.

“You can take this on down. You could just say that anybody that got a federal loan for housing could not get an abortion,” Harkin said. “You can take this and just keep going on and on and on with no end in sight.”

Reasonable? Who Decides?

Today's online Seattle Times has a link to "Million-Dollar Doctors," an article by John Ryan, posted on local NPR affiliate KUOW's site, revealing astonishing levels of compensation paid by "nonprofit" hospitals to their top executives and certain physicians. Interestingly, one of the newspaper's headline stories reports steep (double-digit) hikes in health insurance rates by the state's largest health insurers, utterly slamming "consumers" at a time when many people have lost their jobs or are taking mandatory cuts in pay (aka "furloughs"). The Times reports that Washington State's insurance regulators have ruled the rate hikes justified and left them "virtually untouched." I infer that the editors of the Times were loath to make a direct connection between the KUOW report it links to and their article on rate hikes: it would probably have pissed off corporate interests if they had. But I'm glad the link was there, lower down on the page. Presumably the regulators know all about these multimillion-dollar salaries. I guess they think people who routinely rake in 2 mill a year need $4 million dollar going-away presents.

Back in the late 1980s, I worked as a secretary for a couple of docs at one of these very hospitals. I would often come home acutely nauseated by what I had no choice to learn about the relations between drug companies and doctors, and technology companies and doctors, and asbestos manufacturers and doctors-- and by my being required to participate in it. I kept wondering: are these things legal? Ought I to be writing these letters and these bills and these reports on University time? I just couldn't tell, because the corruption was so thoroughly normalized. "I'm not a bad guy, Timmi," one of the docs told me. (Apparently my control over my eyebrows had slipped, betraying my dismay when he told me to charge the asbestos company he was testifying for in court $200 an hour for his travel time, plus, of course, expenses and the fee for deposing the patient who was going to get screwed by his testimony.) (That $200 an hour would probably be a lot more now.) "This is just how we do business, he said," eager to justify himself to me. (One day, telling me about his passion for Ferraris, he told me he'd already put away the money needed to send his five children to Princeton-- which was when, he said, he decided he deserved to spend his money on Ferraris and other treats, given his sober diligence as a breadwinner.) In short, I learned then, from the back end, the real reason health care is so expensive in the US. Which is why, of course, the routine denial of health care to millions of people and the industry's ability to stave off government-mandated universal health care is particularly enraging: it's so totally unnecessary and is the best illustration I know of for what is wrong with the current state of politics in the US.

After reading these two pieces, I found myself wondering how any reasonable person could conclude that the people running hospitals that can't be taxed-- because they're "nonprofit"-- can get away with paying themselves millions a year plus "golden handcuffs." The KUOW article noted that one of these hospitals has as its motto "We seek simplicity in our lives and in our work." (Its CEO was paid $2.1 million in 2007.) It notes, too, that another of these hospitals laid off 200 employees this year. And I also recall reading some time ago that many of these hospitals' employees don't receive health insurance with their wages. (Is that still the case? I'd be surprised if it wasn't.) According to Ryan,

The IRS can impose tax penalties or even revoke a charity's nonprofit status if it deems compensation to be unreasonable.

An IRS report this year on the nation's tax–exempt hospitals found almost no executive compensation violating the federal standard for reasonable pay. But the agency says it has a hard time enforcing the law because the notion of what is reasonable is so imprecise.

Reasonable? I suppose if you assume that bosses need to be paid 200 times as much (or more) as most of their employees, millions in salary a year for the so-called "employees" of a so-called "nonprofit" is "reasonable." But I wonder why someone holding such an attitude gets to decide what is reasonable in the first place. (What are such people doing, working for the IRS?) Why not put some ordinary people in charge of deciding what "reasonable" is. We could ask the surviving relatives of people who die from curable conditions because they can't afford or are denied health insurance and thus health care what reasonable is. Or perhaps we could ask some of the people just laid off by these hospitals: they might have a more informed notion of what reasonable is. "Reasonable," obviously, in this case doesn't mean reasonable to the ordinary person on the street, but something else entirely.