Tuesday, February 23, 2010

"Rationing," "Death Panels," And Other "Pro-Life" Criticisms of Health Care Make a Come Back.

As the health care bill begins to again show sign of life, "pro-life" and anti-reform forces are again raising unfounded concerns about "government-funded abortion," "rationing," "death panels," and "conscience clauses."

Americans United for Life, a Christian group (part of what I call the Legal Right, a collection of "pro-life" "legal" organizations that work to pass religious laws regarding patients' rights) has reposted it's claims against the health care bill.

First, before I go into my debunking of those claims, let me say that I have no great love for this bill as it exists in its many forms. While it may constitute gains for millions of uninsured, it does little to advance the cause for meaningful health care reform unless great changes are made to it. Our health care delivery system, as it exists, is badly broken. This bill will only work as a band-aid on the larger structural problems; it does little to address necessary systemic reform. And it goes a long way to create challenges to that impending reform (changes will have to be made as the system continues to bankrupt us) in the future. Most notably, it damages the cause for meaningful reform by mollifying those who accept that the system is broken but think that government is appropriately addressing the crisis. And it complicates women's access to reproductive rights by compromising women's health needs for the sake of passage. Any support I give this bill is predicated on the un-guaranteed hope that it is a step in the right direction, one that can be expanded on in the very near future.

But back to Americans United for Life. Their claims and my refutations:

Further, the White House proposal dramatically increases funding – by 11 billion dollars – for “community health centers” which will include Planned Parenthood abortion centers. Because the proposal lacks a blanket prohibition on the use of federal funds for abortions, these new funds could be used to directly pay for abortions.

This is a response to Bernie Sanders (Vermont) amendment to the bill that, as Katrina Vanden Heuven explained at The Nation in the second week of December, when it was added:

Without fanfare, the good Senator from Vermont, Bernie Sanders, has continued to work behind the scenes to champion community health centers--something he has done for years (also here). These non-profit, community-based facilities provide primary healthcare, dental care, mental health services, and low-cost prescription drugs on a sliding scale. As amendments were added in recent days to win over the Liebermans and Nelsons of the "greatest [undemocratic]deliberative body" in the world, Sanders made sure that a $10 billion increase in funding for the health centers was included.

"This is not gonna solve all the problems of the world," Senator Sanders told me yesterday. "But expanding access to high quality primary health care, and low-cost prescription drugs, and mental health counseling, and dental care--which is a big issue--this is a very significant step forward. If you walk into a health clinic and you have no insurance at all they will treat you on a sliding scale basis. So, that's affordable healthcare."

AUL's opposition to this sensical amendment is that some of those community centers could be Planned Parenthood Centers, which provide, yes, abortion services, but also other women's reproductive services like birth control, pap smears, exams, treatment for STDs, etc. Laws already exist that prevent Planned Parenthood from using federal funds for abortion services. In other words, AUL is protesting more federal money from being used at PP Centers because in those same centers women are paying for their own abortions. Forget the other needs of women that have been marginalized by our current laws and health care system. The objective is to starve PP out of helping women at all, simply because they perform a legal service (abortion) in their clinics that AUL and others have religious objections to.

I would be very surprised to hear that the Sanders amendment rescinds that segregation of funds at PP centers, but even if it does, "no federal funding for abortion" is a misused and discriminatory term. The Hyde amendment, passed after the legalization of abortion under Roe v. Wade in 1973, only restricts use of Medicaid funds for abortion - not all federal funds. Even as misunderstood and misrepresented by "pro-life" groups, Hyde is basically a discriminatory law that preys on the poorest, most disadvantaged women in our society. If you can pay for an abortion yourself, the bill allows, go ahead. If you can't, you're forced into pregnancy.

First, the amendment provides inadequate conscience protection, because it does not prohibit any government entity or program (federal, state, or local) from discriminating against health care providers that do not want to participate in abortions.

While the current health care bill doesn't include provider refusal laws (so-called "conscience clauses"), other laws at the state and federal level already protect not only doctors and other providers but also institutions (like the 624 Catholic hospitals in the country) from providing abortion (or as with Coats, from teaching abortion at medical schools!) In other words, a web of "conscience" laws allows every denominational health care institution, every provider, doctor, or nurse, from denying you a legal, medically-sound service. And this can be done without informed consent (telling the patient what services are available and allowing the patient to make their decisions according to their own conscience) and without meaning referrals (telling a patient where to get the services they need). The AUL wants to keep the disastrous and discriminatory Bush "conscience clause" in place, the one the Bush administration enacted only weeks before leaving office, that allows virtually anyone in the medical research (lab workers) or delivery network (pharmacists) to deny patients' their right of informed health care decisions and access - without any provision for the patient at all.

Second, the amendment fails to address our concerns that under the Mikulski amendment (already accepted in the underlying bill), the Health Resources and services Administration (HRSA) has the power to require private insurance plans to include abortion coverage under the guise of “preventive care.”

Private health insurance policies already provide abortion services. About 85% of them. Preventing those policies from such coverage when included in the federally subsidized "networks" is a further extension of Hyde's original intent and again applies denominational health care discrimination to a pluralistic society. Restricting such coverage would further restrict access to legal, medically-sound service simply because a segment of society doesn't believe in that service. Poor, minority, or rural-living women would be most hurt by it.

Third, the amendment allows insurance plans that cover abortions to receive government subsidies, which is a radical departure from existing law (which is not allowed under the Hyde Amendment and the Federal Employees Health Benefits Program).

It's not radical, as I explained above. And the Weldon amendment, which in 2005 eliminated coverage of abortion in the health care plans for the Labor, Health and Human Services and Education departments of the U.S. government was itself a radical departure from the Establishment clause that should protect society from government endorsement of religious ideology. To be clear, Hyde and Weldon are both amendments that are renewed each year with the budget for their programs; but "pro-life" groups have made such a fuss about them that, as their language alters annually, they have become more restrictive and the question of their removal has become politically challenging. That doesn't mean that they represent good, non-discriminatory medicine. Again, claims that these laws currently prevent any "federal funding for abortion" are grossly exaggerated. There's no "radical departure" here as AUL claims.

Fourth, while the amendment allows states to “opt out” of allowing private plans that include abortion coverage to participate in their exchanges, this “opt out” provision makes abortion coverage normative. In other words, states will have to act to prevent subsidies from going to plans that cover abortions in their state, turning on its head the traditional federal approach to abortion.

Uh, abortion coverage is normative in the private sector. Though conservative groups largely oppose movement from health care coverage from the private sector to the federal government, they're going to fight tooth and nail to make certain that women's access to services they oppose (abortion, sterilization tubal ligation, condom access, fertility services, STD counseling) are as restricted as possible. Egalitarian health care access, they say is a false concept; health care is a commodity, you get what you pay for.

This new state "opt out" simply gives state legislatures yet another tool to impose denominational health care on a pluralistic society - with one quick action. And as to the dramatic defense of the "traditional federal approach" to abortion, Hyde and Weldon are discrimination, plain and simple. Other forms of discrimination could be - and have been - called "traditional." (See pending court case in California regarding Prop 8 where "tradition" is used to discriminate against gays.)

Fifth, the amendment fails to ensure federal funds will not go to assisted suicide and fails to address concerns that Comparative Effectiveness Research will lead to rationing of essential medical care.

Despite the relatively known aspects of the controversies surrounding the health care bill and women's rights, this last point by AUL is perhaps the most damaging. Their effort (abetted by the medical industry) to include elders in their coalition against health care reform (and this bill particularly) have proven that these groups will prey on society's and elders' fears of death without scruple.

In our current medical system, patients are pushed into ineffective, aggressive, futile care at the end of life by a culture that has turned hospice and palliative care into giving up on life. As Tim Cousounis writes:

Misconceptions about hospice and palliative care have abounded well before the latest efforts to refrom the health care system. How else to explain the persistent and continuing reticence to refer to, and accept hospice services, in most US communities. What's different today is that the skeptics of hospice and palliative medicine are more vitriolic than their predecessors, and their talking points (arguments) are more vivid - "death panels, socialized medicine".

Palliative care, making terminal patients comfortable and relieving their pain in the last months of life, is twisted maliciously into "rationing." Elders are fed unfounded fears of doctors and a preying government that want to kill them, infantilized by a paternalistic church and the medical industry into patients who are unable to make their own decisions. Seniors are uninformed about advance directives, living wills, state laws that could protect them, their options for end of life care. Doctors fail to discuss terminal diagnoses because they don't like doing it or because they aren't paid to do it. Seniors, who say they would like to die at home (80%) end up dying in medical facilities (75%). The government is drained by death-prolonging care in their last months (2/3rds of Medicare goes to the last two months of life). Families are bankrupted, emotionally and physically drained by the suffering inflicted through unnecessary services. And still, elder and terminal patients have no choice in how they die.

As to the egregious funding of assisted suicide AUL claims the bill will facilitate: Death with Dignity is legal in two states: Oregon and Washington. On New Years Eve, a third state, Montana, had their Supreme Court rule that the state constitution does not prohibit aid in dying. Laws already exist that prevent federal funds from being used to promote these services (and aid in dying advocates from using federal funds to promote it). This additional fear, compounded by claims of "rationing" and "death panels" works well for health care reform opponents but has little basis in fact. The costs of Death with Dignity are minimal. Those who use it (some few hundred in Oregon since 1998) tend to be wealthy, educated, and white. The AUL's concerns that federal funds will pay for Death with Dignity are grossly exaggerated.

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