Why Health Exceptions Aren’t Enough

I made the mistake once again of arguing about abortion on Facebook. I pointed out that SB5, if passed, would harm or kill women who have unhealthy pregnancies. (And gave a couple examples of issues that can occur.) The guy I was arguing with waved that off because he’s talked to more than one doctor who says he’s never seen any reason a woman would need an abortion to save her life, and that it’s just an “excuse.” (I’m sure he’s operating with *no* personal biases whatsoever.)

Well, there you have it. These two medical professionals (and no, he didn’t say that they were even OBs) said it, that must settle it. I’m glad I never have to worry about having an ectopic pregnancy, or pre-eclampsia or hyperemesis gravidarum (extremely severe morning sickness that causes malnutrition, dehydration, and weight loss) because they apparently don’t exist. Though, I’d love to know what Savita Halappanavar actually died of, since it totally couldn’t be the pregnancy.

This is why, even if you think that abortion is immoral if the pregnancy isn’t going to kill or seriously injure the mother, abortion for any and all reasons still needs to be legal. (That’s not my position, but for this particular post, I’m going to focus on health only.) Because if you just have a health exception, those same doctors will be the expert witnesses testifying at some woman’s trial when she ends her pregnancy so she can have chemo. Or speaking to Congress about how those exceptions should be worded.

Not to mention, limiting abortion to only “medical necessity” does not mean that every woman whose pregnancy is likely to kill or cripple her will have an abortion. What it means is that you need to:

  1. Find a doctor willing to bet his medical license and his freedom that not only are you really at that much risk, but that a court of law will back his decision. (That’s a much higher bar than just a doctor’s opinion that it’s necessary.)
  2. Jump through all the hoops set up by a legal system that doesn’t want you to get an abortion—maybe a waiting period, maybe multiple doctors’ sign-off, maybe a court order.
  3. Get all that done and actually have the procedure while there’s still actually time, before the condition that made an abortion necessary in the first place worsens.

I bring up Savita very deliberately, because it was supposed to be legal, even in Ireland, for doctors to complete her miscarriage and save her life. And yet, that didn’t happen, and she died unnecessarily. Just the fact that something is technically legal is not enough to mean that it really is available when it’s needed.

Edit: I added a couple more examples of fatal pregnancy complications, because putting “ectopic pregnancy” and Savita in the same sentence made it sound like that was the condition she had, when in fact it was septicemia that resulted from the hospital’s refusal to complete her miscarriage.

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The Boundaries of Religious Freedom

So, when the GOP and the Catholic bishops started screaming that Obama had “declared war on religion,” he announced that if employers had religious objections to birth control, insurance companies would pay for it directly instead. Sounds good to me. And yet, for many, that still wasn’t good enough. “What about the insurance company’s freedom of religion?” I’m sorry, if paying for health care is against your religion, methinks you should not be in the insurance business. (Plus, pretty much every health insurance company out there has finally figured out that BC is cheaper than abortions or pregnancy and would much rather insure a woman who has access to contraception than one who doesn’t.)

I’m a really strong supporter of religious freedom, but I don’t think it means the freedom to force your beliefs on other people, or the freedom to not do your job and continue to be paid. I mean, I have every right to convert to Quakerism tomorrow and decide I don’t want to support the military anymore, but I don’t have a right to expect a defense contracting company to keep paying me while I sit around playing Solitaire or rearrange my job so I don’t have to participate in the company’s main business.

My big argument with the outrage about requiring Catholic schools and hospitals to cover contraception is that if a religious organization wants to be an employer, they should be held to similar standards as secular employers. There are already *lots* of concessions to religious freedom for religious employers. Like the church school that got to ignore the ADA and fire a teacher for having a medical condition. Because it was a religious position, they don’t even have to pretend with a straight face that they had religious reasons for firing her.

But secular employees should be treated like…secular employees. If the church doesn’t require someone to be of the same faith to serve in a particular role, that role should be subject to all the rules of employment law.

Let’s not even get into the fact that what the President mandated has already been required by the EEOC for any employer that offers prescription coverage, on the basis of equal treatment of the sexes. Lots of Catholic schools and hospitals already comply with this rule, but it’s convenient to ignore that for political purposes.

Another issue with the whole idea is that there are Catholic-approved uses of hormonal birth control. Have PCOS and take the pill so that you don’t get cysts, or so you actually have periods? That’s not considered a sin. Similarly, as I understand it, married Catholic women who have severe health risks from pregnancy can generally talk to their priest and have him okay contraception. (The second is according to my Catholic sister-in-law.)

So, we aren’t even talking about something that automatically violates their religion, just something that can. Meaning they want to not only deny employees something because it violates their employer’s religion, but that they’re okay with denying it to good Catholics* who need it for other reasons (either that or they think you should have to reveal private health issues to your employer to get insurance coverage).

I think that if an employer has decided to provide insurance to its employees, what they do with that coverage is between them, their doctor, and the insurance company. It’s a benefit that belongs to the employee in exchange for work performed, and the employer has no more right to tell you what to do with it than they do to tell you how to spend your paycheck.

And if we can’t have a public option for health coverage because “oh no, socialism!” then it’s reasonable that the government set some standards on what actually counts as insurance in order to get the crazy costs and lack of care under control. Requiring all insurance to provide cost-saving preventive care free of charge (as part of the coverage that the employee and employer are paying for) is reasonable based on that. While insurance companies save money from birth control, that doesn’t mean they won’t charge for it too if they’re allowed because, hey, they can.

I like the proposed solution; I just don’t think it should have been necessary. I also don’t think it will be enough to satisfy people who think their freedom of religion means that no one should get to have contraception.

*I’m neither Catholic nor opposed to birth control, so please don’t take that as my saying that the ninety-some percent of Catholic women who use birth control are bad Catholics.

Insurance Companies are Evil

A friend of mine just got a letter from her insurance company that their independent review board has decided she’s not actually married to her husband and isn’t eligible for coverage. Coincidentally, this comes the night before she has an appointment (finally!) at a highly regarded diabetes center. The documentation they require for the re-review is also insane. Not only a marriage certificate and her social security, but two years tax returns and utilities with both their names. I’ve been married for near five years and I don’t think we have utilities in both our names. (It’s sort of a weird mishmash–some in mine, some in his, based only on who called to set stuff up.) And married couples are allowed to file taxes separately if they want.

I believe that this was the legitimate result of an independent review–and not a decision that a diabetic who needs a knee replacement is too expensive and making up a reason not to pay for her care would be cost-effective–about as much as I believe in Santa Claus.

But isn’t it great that we don’t have that awful socialized medicine?

Healthcare Crisis…Culture Crisis…More Like a Severe Shortage of Empathy

This has been making its way around Facebook. It’s an ER doctor talking about how horrified he is that a woman “whose smile revealed an expensive shiny gold tooth, whose body was adorned with a wide assortment of elaborate and costly tattoos, who wore a very expensive brand of tennis shoes and who chatted on a new cellular telephone equipped with a popular R&B ringtone” is on Medicare. He also brought in her smoking and commented on her eating nothing but fast food, but still having money for beer and pretzels.

And he is outraged that someone like him, a white male virtuous and hardworking individual, has to contribute to the healthcare of someone who’s obviously a minority a lower social class lazy and stupid.

First off, the R&B ringtone? It’s a nice racist dog whistle, but you lose points for a complete and utter lack of subtlety. If you want to get away with that sort of thing, you need to at least get some plausible deniability in there.

Second, I love how the tattoos, the cell phone with–gasp–a *ringtone*, and the tennis shoes are all signs that she has plenty of money and can afford her own medical care. Ringtones cost, what, a couple bucks? Wow, big spender. That’ll totally cover, like, a tenth of one copay. I’ll admit to having no idea how much tattoos cost, but I also doubt she got them all last week. The sneakers, the same. Were they a gift, were they bought on sale, saved for? You have no idea, and by the way, it’s none of your business. Besides that, has she been on Medicare forever, or did she or her husband have financial troubles recently…you know, like most of the country.

Even if all this stuff was bought full-price, it doesn’t translate to “She doesn’t need Medicare.” Hundred-dollar sneakers and a hundred dollar cellphone would pay for the portion of my husband’s health insurance that he pays to cover both of us…for a single month. So, arguing that someone whose job, if she has one, probably covers exactly nothing toward health insurance, should easily be able to afford it because she has a couple hundred-dollar “luxuries” is BS. (Even leaving aside the idea that good sneakers and a cell phone are outrageous luxuries.)

But what strikes me as the worst part of this is that this is coming from a *doctor* in an ER. The venom and condescension he uses to describe his patient–someone who came to him for help in an emergency–is a little chilling. From the way he writes her off, I’d bet money she didn’t get good care from him. Maybe the good doctor needs to spend a little less time getting judgmental or worrying about what his patients should spend their money on and a little more time actually helping them.