Health Care Has Passed
November 7, 2009 9:01 PM Subscribe

The House of Representatives just passed the health reform bill in a vote of 220-215.
posted by reenum (388 comments total) 13 users marked this as a favorite

USA! USA! USA! USA!
posted by Senor Cardgage at 9:02 PM on November 7, 2009 [6 favorites]

However, my understanding is that they abortion stuff was all removed. :(
But still this may be a very good first step.
posted by Senor Cardgage at 9:03 PM on November 7, 2009

If in ten years America is a bankrupt failed state ruled by a fascist dictator who lights his cigars with strips of burning Constitution, I'm going to have to do a lot of apologizing to my Republican pals.
posted by Pater Aletheias at 9:04 PM on November 7, 2009 [69 favorites]

Welcome to the mid-twentieth century!
posted by CynicalKnight at 9:05 PM on November 7, 2009 [69 favorites]

Question about the bill: If I am employed, but my employer does not provide health insurance, am I required by this bill to purchase insurance? What if the price of the available insurance (government or private) is too much for me to pay?

Or is the government insurance plan free (ie. paid by taxes)? If not, what are the penalties if I do not purchase insurance if I am employed? Fines? Jail?
posted by jsonic at 9:05 PM on November 7, 2009

Congratulations. To be fair, I wasn't really expecting it to pass.
posted by flippant at 9:05 PM on November 7, 2009

USA! USA! US . . . Wait we couldn't pass the bill without adding an amendment that eliminates insurance coverage for abortions for low-income women? And the amendment was proposed by anti-choice DEMOCRATS? Yeah. USA.
posted by The Bellman at 9:06 PM on November 7, 2009 [9 favorites]

Pater Aletheias, you're worrying without cause. There is nothing in this bill that will make time to run backward.
posted by felix betachat at 9:06 PM on November 7, 2009 [13 favorites]

On the negative side, only one Republican vote--the partisan divide is ridiculous. On the positive side, only one Republican vote--when this turns out to be obviously a good thing for the country, the GOP will be further marginalized. And they don't have a lot of room left to fall.
posted by Pater Aletheias at 9:06 PM on November 7, 2009 [6 favorites]

No too happy about the Stupak amendment but otherwise pretty happy about this.
posted by octothorpe at 9:07 PM on November 7, 2009

Context? Is this a local issue?
posted by mazola at 9:08 PM on November 7, 2009

Guys, this is the undercard. The main event is in the Senate.
posted by Cool Papa Bell at 9:08 PM on November 7, 2009 [11 favorites]

And they don't have a lot of room left to fall.

You may be misunderestimating them.
posted by smcameron at 9:08 PM on November 7, 2009 [6 favorites]

Never doubt the ability of narrow minded and ignorant people to continue deluding themselves.
posted by reenum at 9:08 PM on November 7, 2009 [6 favorites]

On the negative side, only one Republican vote--the partisan divide is ridiculous. On the positive side, only one Republican vote--when this turns out to be obviously a good thing for the country, the GOP will be further marginalized. And they don't have a lot of room left to fall.

Yeah that was our first Vietnamese congressman Joseph Cao

And oh, look....

the right hits Wiki!

but then...

the left hits Wiki!

Good times.
posted by Senor Cardgage at 9:09 PM on November 7, 2009 [15 favorites]

Question about the bill: If I am employed, but my employer does not provide health insurance, am I required by this bill to purchase insurance? What if the price of the available insurance (government or private) is too much for me to pay?

Without reading the link because I'm about to go to bed, that's my question, too. Is it a real "public option" or is it a law that makes you buy it yourself at supposed lower rates in what amounts to a sweetheart deal to insurance companies? What kind of anti-abortion stuff got snuck in there?

I'm (extremely cautiously) optimistic.
posted by dunkadunc at 9:10 PM on November 7, 2009 [1 favorite]

When does the Senate vote?
posted by ThePinkSuperhero at 9:11 PM on November 7, 2009 [1 favorite]

I think it's time for another round of this. Amputation, BOOP!
posted by ThePinkSuperhero at 9:12 PM on November 7, 2009 [4 favorites]

Title should read Health Care has Passed the House ... we've still got one of the wings of congress to push this through.
posted by msbutah at 9:14 PM on November 7, 2009

If I am employed, but my employer does not provide health insurance, am I required by this bill to purchase insurance?

Yes.

What if the price of the available insurance (government or private) is too much for me to pay?

Too bad. You have to buy it anyway. (For some people who's income is low, there will be government subsidies, but it's the government that decides if you can't afford it, not you.)

Or is the government insurance plan free (ie. paid by taxes)?

It'll be partially subsidized by taxes ("on the rich").

If not, what are the penalties if I do not purchase insurance if I am employed? Fines? Jail?

Potentially both of those. If you don't have insurance you get hit with a tax penalty of a magnitude approximately comparable to how much insurance would have cost you. That effectively is a fine, except that there's no court process involved since the IRS will be doing it. There is also the possibility of prosecution and jail.
posted by Chocolate Pickle at 9:15 PM on November 7, 2009 [4 favorites]

-When does the Senate vote?-

It could be weeks actually. There is a lot more room for floor debate, attempts to amend and general procedural wankery to slow down passage. While the House passage is a great thing, it was a walk in the park compared to what will come I fear.
posted by peacay at 9:15 PM on November 7, 2009

The public option is not free and is self financing (i.e. not paid by taxes), If you do not purchase insurance you be fined.

So, instead of providing us with universal health care, this bill basically forces those of us who are employed, but don't have employer provided health care, to purchase health insurance. If we don't, we face fines. Sure hope the government option is affordable.
posted by jsonic at 9:17 PM on November 7, 2009 [6 favorites]

The lone Republican supporter.
posted by peacay at 9:17 PM on November 7, 2009

I might be wrong about some of this as I am not that clear on the differences between the house and the senate bill.

The house bill taxes the wealthy while the senate bill plans on taxing high cost insurance policies.
posted by Brian B. at 9:18 PM on November 7, 2009

As to financing, one of the ways that they're going to finance it is through the FICA tax. This bill massively reduces Medicare and Medicaid funding, but it doesn't reduce the FICA tax rate an equivalent amount. The money will still be collected, but a lot of it will go to subsidizing the "public option".
posted by Chocolate Pickle at 9:18 PM on November 7, 2009

Those wily Democrats... Wait until midnight on a Saturday, when all the College Republicans are out partying (to respectful Christian music and with non-alcoholic punch) and all the rest of the party is fast asleep. They'll wake up tomorrow to find their country a smoldering crater, destroyed by the cruel specter of affordable health care.
posted by mccarty.tim at 9:19 PM on November 7, 2009 [12 favorites]

After all the bullshit pulled on the House floor by the Republicans all day today, I'm glad that not only did the bill still ultimately pass, but one Republican (from Louisiana, yet) actually broke away from the pack and voted for it. However, the devil is in the details -- in this case, whatever the Senate decides it will do to water down/foul up what the House has passed.
posted by blucevalo at 9:20 PM on November 7, 2009

Guys, this is the undercard. The main event is in the Senate.

Yeah, but there were recent questions about whether they could get 218 votes.
posted by krinklyfig at 9:21 PM on November 7, 2009 [2 favorites]

When does the Senate vote?

2010
posted by xorry at 9:21 PM on November 7, 2009 [1 favorite]

This has a very weak public option and effectively outlaws abortion. And given history, the Senate bill will be even more conservative, if it passes at all.
posted by dirigibleman at 9:23 PM on November 7, 2009 [6 favorites]

If the House ran the world we'd all have flying cars by now. Let's wait for the Senate to suck everything good and decent out of the bill in accordance with longstanding tradition before we get too excited here.
posted by enn at 9:23 PM on November 7, 2009 [7 favorites]

I heart Nancy Pelosi.
posted by gsteff at 9:24 PM on November 7, 2009 [1 favorite]

I can't wait for a few days of the usual talking points out of my more right wing friends. They're already going in with the "insure the illegals" and all that. Mind you, there seems to be plenty of actual shit in what was passed to be ooky about, but they always seems to come back to the xenophobia.
posted by Kyol at 9:25 PM on November 7, 2009 [4 favorites]

The Baltimore Sun has more details, including a note that the Dems hope to get the Senate to vote before Christmas, so the legislation can get to Obama's desk before the end of January. Also, the House plan would cover an additional 36 million people by 2019, leaving 4% of the nation without coverage, compared with the estimated 17% who do not have insurance now, according to the nonpartisan Congressional Budget Office.

Not fantastic, but it sounds better than what we have now.
posted by filthy light thief at 9:33 PM on November 7, 2009 [4 favorites]

Suddenly, the Republicans sound awfully petty when they act like winning two governorships is a sign the country hates Obama (and/or health reform). And the Superbowl of Freedom seems to have been a bust. And to think, the teabaggers followed Bachman's advice and broke into Nancy Pelosi's office and shred up the bill!

Let's see Christie try and stop health reform. The people here in New Jersey would eat him alive if he blocked us out of the public option.
posted by mccarty.tim at 9:33 PM on November 7, 2009

However, the devil is in the details -- in this case, whatever the Senate decides it will do to water down/foul up what the House has passed.

The Senate is historically more conservative, so there's that, but the devil is in the details of what happens when it goes to committee, and the two versions have to be reconciled.
posted by krinklyfig at 9:35 PM on November 7, 2009

I can't wait for a few days of the usual talking points out of my more right wing friends.

Don't wait, Chocolate Pickle is all over it for ya.
posted by joe lisboa at 9:37 PM on November 7, 2009 [5 favorites]

Question about the bill: If I am employed, but my employer does not provide health insurance, am I required by this bill to purchase insurance? What if the price of the available insurance (government or private) is too much for me to pay?

You are required to purchase insurance, much like you are required to purchase automobile insurance.

If your employer does not provide health insurance, they will be paying 8% of their payroll in fees. There is a very good chance that your employer will start offering insurance as a result of this plan.

The price will almost certainly not be too much for you to pay. The fee for not purchasing insurance will be 2.5% of your income, generally around the same amount that it would cost for you to buy into the plan. If you make under a certain amount (I don't have the numbers, but "certain amount" is actually fairly high) your cost will be lower and lower, based upon how much you make. In other words, it will be affordable for you.
posted by mark242 at 9:38 PM on November 7, 2009 [9 favorites]

There is also the possibility of prosecution and jail.

This is completely false. No one is going to be sent to jail for not having health insurance. The plan, ironically, is very similar to that huge liberal socialist REPUBLICAN Mitt Romney's plan in Massachusetts, which has overwhelming public support, has increased coverage and has not sent anyone to jail.

The *real* problem is going to be controlling health care costs as people don't like not getting what they want-- even if it doesn't work and is actually harmful-- and they will argue that anything that say, limits mammograms to women over 50, is an evil plot to cut costs and make everyone get cancer and not pay for it.

In fact, however, the data shows that mammograms for women in their 40's do not reduce mortality and produce lots of biopsies and worry and treatment of stuff that would never have progressed to cause harm. Obviously, if someone has a genetic risk, that's a very very different story-- but in that case, the woman would get covered because, guess what, the evidence shows that screening such women *does* reduce mortality.
posted by Maias at 9:40 PM on November 7, 2009 [10 favorites]

Can I just say that the health care industry in this nation is below despicable? And also add that the fact that they managed to buy enough politicians to push through this kind of raving crap demonstrates that they have plenty of money and don't need mine? One would think that "free & equal health care for all" = "mandatory still-costly health care required for all" is a canard of the basest simplicity, and that only the rankest, greediest form of life would try to pull that over on people. And one would be right; it's just more and more obvious that everyone in the house of representatives and everyone in congress is just that type, to be bought by the highest bidder.

Politicians are shit. This is the most idiotic thing I've ever heard of. It's not even a health care bill. It's yet another instance of an entire industry that managed to get congress to force people to give them money.
posted by koeselitz at 9:40 PM on November 7, 2009 [34 favorites]

Unruly Republicans Silence Women Lawmakers With Screams, Shouts, And Delay Tactics. Such a lovely display of civility and goodness. We can all be proud of our Republican brethren. And now we have a mandated insurance system that will pay for viagra, but not birth control, just like most insurance policies. And women...well, you better hope you want that pregnancy, because if you want a policy that covers you in case you don't, well, you can't have one. The Stupak amendment, prohibits women who receive insurance subsidies from purchasing any plan or additional rider that pays for elective abortions. Stay a virgin, breed or die, sisters. We've come such a long way.

What we needed was Health Care Reform. What we got was a giveaway to the insurance companies. This bill forces Americans to carry insurance. Large companies would have to offer coverage to their employees. Both consumers and companies would be slapped with penalties if they defied the government's mandates. There's nothing in the bill that caps what the insurance companies can charge consumers or businesses.

The Stupak amendment is a huge win for the U.S. Conference of Catholic Bishops, which used its power -- especially with conservative Democrats in swing congressional districts -- to help force other Democratic leaders to permit a vote that most of them oppose. The GOP accounted for 174 of the votes in favor of the amendment, with 1 Republican voting "present." On the Democrat's side, 64 voted for the measure, and 194 voted against.

Note that there's no single men's health issue that won't be paid for. But women's health? Well, why would we want to leave that to women and their doctors, when we could play politics with it?

I am so tired of churchs being able to be tax-free lobbyists. Just like I think the Scientologists and the Mormons should have their tax exempt status pulled, I think the Catholics have just lost the right to tax free status too. Fuck this nonsense. Get your damn gods out of my uterus.

But, and this is important...this is just the House Bill. The Senate hasn't even begun debates. Once they pick a plan and vote on it, then the Senate and the House have to create a unified bill.

So, there's still plenty of time for the religious, the powerful and the rich to really screw the poor, the powerless, and the undocumented some more.
posted by dejah420 at 9:40 PM on November 7, 2009 [100 favorites]

As I understood it, employers that have 50+ employees will be required to provide insurance. If they don't they'll face a fine. If you're self-employed or employed by a "small" business (under 50 employees), you're responsible for your own insurance. If you don't get insurance, you're fined a percentage of your income (I heard 2.5% on CNN, but that could be wrong)—I'm not sure if that's levied as a tax penalty (i.e. collected by the IRS) or through the judicial system, but I suspect the former. Also, subsidies will be made available for those who can't afford coverage, the amount of which is needs-based, i.e., based on your financial situation (although it's not clear if those subsidies are locked to the gov't "public option" or can be applied anywhere).

Notably, this bill also makes it illegal for insurers to deny coverage based on "pre-existing conditions."

Anyway, if somebody else has read the document more closely and wants to clarify and correct this, please do. I'd love to have a detailed "executive summary" from a knolwedgable person.
posted by LMGM at 9:40 PM on November 7, 2009 [1 favorite]

mark242: if I do not own a car, I am free to opt out of auto insurance. in the case of health insurance, I am not able to opt out. what am I trying to say here? never, ever use car analogies.
posted by Geckwoistmeinauto at 9:42 PM on November 7, 2009 [5 favorites]

I honestly hope this doesn't pass the senate. This is exactly the reform I did not want.
posted by crataegus at 9:42 PM on November 7, 2009 [3 favorites]

wish it weren't such a close vote but I'm glad it happened. The senate's gonna be tougher, but to put an optimistic spin on it, the right's alredy turned the shrill to 11 and can't scream any louder. And every step towards passage increases the sense of historical inevitability. So those two factors give me hope.
posted by condour75 at 9:42 PM on November 7, 2009

So, instead of providing us with universal health care, this bill basically forces those of us who are employed, but don't have employer provided health care, to purchase health insurance. If we don't, we face fines. Sure hope the government option is affordable.

I do, too, but the system won't work very well if everyone doesn't participate. The economic reality is that everyone must join in to make the pool big enough so that the risk is spread around to subsidize the sick and keep premiums down across the board. If you don't, then only sick people will buy insurance and the system will fall apart.
posted by MegoSteve at 9:43 PM on November 7, 2009 [7 favorites]

This is completely worthless unless I, a fully employed person with existing insurance, can opt out of my employer provided insurance and sign up for the public option instead.

You can opt out of your employer-provided insurance plan and sign up for the public option if you want.
posted by mark242 at 9:44 PM on November 7, 2009

Filthy Light Theif, I admit that it is disappointing that 4% will be left uninsured, but I think this is just the beginning. Once the public starts using the public option and realizes that the world didn't end and that Americans didn't lose their liberty and become parasite-slaves to a welfare state, people will be more willing to improve the plan. In 10 years, people opposed to the public option will look as backward as people who want to get rid of the public library, or Medicare for that matter.

It says a lot that the Republicans talk a big game about how bad "socialized medicine" is, but they promise to do everything possible to save Medicare the Sacred Cow.

Michael Steele wrestles with this existential crisis eternally.
posted by mccarty.tim at 9:44 PM on November 7, 2009 [3 favorites]

Actually, I should have previewed. It's not exactly the reform I did not want. It does include the language about pre-existing conditions, as LMGM mentions. Other than that, it's exactly what I didn't want.
posted by crataegus at 9:44 PM on November 7, 2009

Here are some interesting things!

The Republican alternative bill would have allowed all health insurers to operate nationally under the law of the Northern Marianas, a land which is not officially part of the United States and is not known for fastidious healthcare legislation, but does have an awesome trench.

Republican politicians are asshole babies and bad people, in that order

John Shadegg in particular needs to be punched in the dick, forever, metaphorically speaking
posted by East Manitoba Regional Junior Kabaddi Champion '94 at 9:44 PM on November 7, 2009 [14 favorites]

If your employer does not provide health insurance, they will be paying 8% of their payroll in fees.

Thanks for that. Helps to ease the worry that employers might cut insurance if the government is offering it.

The fee for not purchasing insurance will be 2.5% of your income, generally around the same amount that it would cost for you to buy into the plan.

So this is basically a 2.5% tax increase on employed persons. Post income tax increase, actually, since you'll be paying for this insurance using money you already paid income tax on. Or are health insurance costs tax deductible?
posted by jsonic at 9:46 PM on November 7, 2009

So this is basically a 2.5% tax increase on employed persons. Post income tax increase, actually, since you'll be paying for this insurance using money you already paid income tax on. Or are health insurance costs tax deductible?

This is a 2.5% "tax increase" on employed persons who do not currently have health insurance and are making enough money to afford the 2.5%. In exchange for the "tax increase" you will get health insurance, zero co-pay for preventative care (eg free flu shots, free yearly checkups, etc), and a cap on your out-of-pocket expenses if you get really sick or injured. In other words, if you are wealthy and have never gotten sick nor will ever get sick in your life, this plan may not be the best for you, otherwise, this will be an incredibly attractive option.
posted by mark242 at 9:51 PM on November 7, 2009 [27 favorites]

MegoSteve: “... the system won't work very well if everyone doesn't participate. The economic reality is that everyone must join in to make the pool big enough so that the risk is spread around to subsidize the sick and keep premiums down across the board. If you don't, then only sick people will buy insurance and the system will fall apart.”

Nothing will work correctly until the system falls apart. By setting up a system which requires us all to start paying, this only props up the health insurance industry. That industry needs to be dismantled, not propped up.

I admit I haven't read the bill, and I sincerely hope I'm wrong and that the 'public option' doesn't involve any insurance companies or HMOs or any trappings of the current system. But I doubt it; some of that money is bound to go to perpetuating the system as it is.

Either way, doesn't really matter. Before, I couldn't afford health care. Politicians didn't seem to believe me. This bill says, "okay, so you only have to pay for..." No, fuck off. I can't afford health care. Can't people understand what that means?
posted by koeselitz at 9:51 PM on November 7, 2009 [10 favorites]

So this is basically a 2.5% tax increase on employed persons. Post income tax increase, actually, since you'll be paying for this insurance using money you already paid income tax on. Or are health insurance costs tax deductible?

I actaully wish it were just a straight tax and everybody got single payer it would make the whole system way more efficient.
posted by afu at 9:55 PM on November 7, 2009 [15 favorites]

I admit I haven't read the bill but I won't let that stop me mouthing off like half the rest of the ill-informed commenters in this thread.
posted by peacay at 9:55 PM on November 7, 2009 [7 favorites]

I'm still just a bill.
posted by bigmusic at 9:58 PM on November 7, 2009

This plan is terrible news for people who will never get sick because they are from the planet Krypton or are Jesus. They will have to buy health insurance unnecessarily! I WEEP
posted by East Manitoba Regional Junior Kabaddi Champion '94 at 9:58 PM on November 7, 2009 [29 favorites]

Okay, peacay, that's fair.

Can someone just answer this question for me? Is the so-called "public option" actually a public option, or does it involve health-care providers, HMOs, insurance companies, et cetera?

Now, I will see if I can find the actual text to go over it a bit, since I really should read it.
posted by koeselitz at 9:58 PM on November 7, 2009

Well done USA, now all you have to look forwad to a couple of decades of falrly average healthcare before some little turd with a majorty in both houses guts it saying an American style user pays system would serve us ~~better~~ right.
posted by mattoxic at 10:00 PM on November 7, 2009 [4 favorites]

The Stupak amendment makes this worse than the status quo. Seriously. I hope progressives vote against this. Codifying the Hyde Amendments and giving a handout to the insurance companies is not reform. And to think the Senate will be worse. Any plan that sells out 51% of Americans for pathetic quartersteps towards reforms whil giving handouts to those who have blocked any meaningful change is not progress. Those who voted for this may be worse than those who voted against.l
posted by allen.spaulding at 10:02 PM on November 7, 2009 [6 favorites]

I actaully wish it were just a straight tax and everybody got single payer it would make the whole system way more efficient.

Exactly.
posted by jsonic at 10:03 PM on November 7, 2009 [1 favorite]

Can someone just answer this question for me? Is the so-called "public option" actually a public option, or does it involve health-care providers, HMOs, insurance companies, et cetera?

A summary of the bill, from the committee of Education and Labor.

Does it involve health-care providers? Do you mean doctors? Yes, you will be going to a doctor in order to diagnose your mononucleosis or remove your broken spleen.

It involves HMOs, insurance companies, and "et cetera" in that the plan establishes a national exchange (which-- by the way-- this cannot be emphasized enough, the nationwide exchange will do more to lower costs than anything else, due to regional monopolies that exist today) where you'll get a listing of available plans, whether they're from an HMO or a PPO or a private plan or the public insurance option. It may wind up that some private provider decides that their plan will be cheaper than the plan from the government, and you may want to sign up for that.

In either case, regardless of which plan you sign up for, you will pay no co-pay for preventative care, your total out of pocket expenses will be capped, and your rates cannot go up as a result of whatever illness you get or because of those great words "pre-existing condition". When you change employers, you will not need to change healthcare plans, as the plan is tied to you, not your employer.
posted by mark242 at 10:08 PM on November 7, 2009 [5 favorites]

Can someone just answer this question for me? Is the so-called "public option" actually a public option, or does it involve health-care providers, HMOs, insurance companies, et cetera?

It is a public option. It does not involve any HMO or insurance company because it is an insurance company, just one owned by the Federal Government that doesn't have to give a fuck about making a profit. Health-care providers are involved because that phrase refers to the people actually providing health care, eg, doctors, nurses, et al.
posted by Tomorrowful at 10:08 PM on November 7, 2009

If you have questions and want to see the official line, plenty of documents are on the Speaker's website. now, this is just for the bill that just passed the house. The Senate will be different, and so then will be the reconciled one.
posted by ALongDecember at 10:11 PM on November 7, 2009 [2 favorites]

OK, I went and found the original information regarding peril of being jailed. It isn't quite what I thought it was.

This bill contains tax penalties for a person who doesn't maintain adequate health insurance. The bill itself doesn't mention any criminal penalties.

But if someone doesn't get health insurance, and tries to avoid paying the tax penalty, then they could be prosecuted for tax evasion under existing law.
posted by Chocolate Pickle at 10:14 PM on November 7, 2009

.
posted by blaneyphoto at 10:20 PM on November 7, 2009

My favorite thing ever is people who have cable TV and high speed internet and fancy cell phones complaining that they cannot afford health insurance.
posted by tumbleweedjack at 10:22 PM on November 7, 2009 [19 favorites]

I object!

Maybe my kids' kids will have single payer. fucking republicans.
posted by bottlebrushtree at 10:24 PM on November 7, 2009 [1 favorite]

Stay classy, teabaggers.
posted by Rangeboy at 10:26 PM on November 7, 2009

cable TV and high speed internet and fancy cell phones

I'd love to be able to purchase quality comprehensive health care for around $120 a month.
posted by jsonic at 10:26 PM on November 7, 2009 [29 favorites]

This is completely worthless unless I, a fully employed person with existing insurance, can opt out of my employer provided insurance and sign up for the public option instead. Opening it up to the middle class in this way is the only way to prevent it from becoming another badly initialized government "program" that never achieves it's true function and instead is used primarily to generate kickbacks and as a campaign tool at the expense of the needy of society.

Except it's not worthless, because if this were passed in 1993/1994 instead of the failed attempts that we got from those Democratic leaders, it would've saved many, many, many lives between then and now. It also would've improved the health of many more. And given the history of expansion of government entitlement programs (in the most inefficient way, unfortunately), we'd be even closer to universal health coverage now. It seems worthless to many of the people who really need help but won't get it, but it's extremely important to many others who will, indeed, be helped. And along the way, it benefits insurance companies and politicians far more than it should. All of that can also be said of Medicaid and Medicare, saving lives for decades now. You can argue they were mistaken compromises on the road to purity, but you can't argue they were worthless.
posted by aswego at 10:31 PM on November 7, 2009 [12 favorites]

I've only voted for one republican in my entire voting life, and that was Anh Joseph Cao. You go Cao.
posted by gordie at 10:34 PM on November 7, 2009 [6 favorites]

Maybe Joseph Cao should not be a Republican any more and should join another party!?
posted by East Manitoba Regional Junior Kabaddi Champion '94 at 10:36 PM on November 7, 2009

Y'all, there's no way the Stupak amendment will survive Conference. It was a bone Pelosi tossed to Blue Dogs to allow them to posture for their conservative districts at this stage, in order to whip enough votes for passage tonight.

I don't see any way in hell Pelosi's Conference Committee is going to allow that to stand.
posted by darkstar at 10:37 PM on November 7, 2009 [4 favorites]

I can't afford health care.

That's what insurance is for. If you meant you can't afford health insurance, unfortunately the rest of us can't afford for you to not have insurance. I'm assuming, of course, you get sick like the rest of humanity.
posted by scottreynen at 10:41 PM on November 7, 2009 [8 favorites]

The Senate is historically more conservative, so there's that, but the devil is in the details of what happens when it goes to committee, and the two versions have to be reconciled.

Well, technically, it's that the Senate is more moderate, which means when the House is overwhelmingly Democratic (like now), the Senate is more conservative. The Senate bill most definitely will look much, much more pathetic than this bill. Reconciliation in the conference committee will involve compromises between the two, but certain types of compromises work in reconciliation better than others. Odds are the House's "robust" public option will be chipped away some, but subsidies for buying insurance will go up (when in a bind, Congress throws money at problems).

More often than not there's a good faith effort to just go along with the reconciled version of a bill when it goes back to both houses, even though it no longer matches what everyone spent painstaking months negotiating over. This time, though, I'm not so sure. The CBO report can come back VERY negative if the conference committee isn't careful about giving it the appearance of deficit neutrality (especially since the CBO head basically acknowledged that even if they score it deficit neutral it most likely won't end up being so).
posted by aswego at 10:44 PM on November 7, 2009 [1 favorite]

It is a public option. It does not involve any HMO or insurance company because it is an insurance company, just one owned by the Federal Government that doesn't have to give a fuck about making a profit.

Not exactly. It's a self-funded insurance scheme. What they collect in premiums and employer taxes will create a fund that will pay out for health claims. While they're not after profit, they are after breaking even -- otherwise, they'll have to go begging to Congress to keep going. I'm not sure if they can squirrel any money away year to year; they may be required to return it in lower premiums the following year.

The nuts and bolts of claims and service will be provided by a third-party administrator the public option administrators will hire. The TPA will only provide service under contract; they won't actually run the public option. This is how Medicare is in many states, e.g. Blue Cross runs Alabama's Medicare system.

This is what some states and a few large employers already have. Microsoft, for instance, is entirely self-pay.

So, it's less insurance like an HMO and more one giant pool of money run by people trying to keep the pool from drying up before the end of the fiscal year.
posted by dw at 10:47 PM on November 7, 2009 [1 favorite]

Hrm. Does anyone remember the point by point response to the death panel craziness that popped up last August? You know, with the whole:

(craziness) FEDERALLY FUNDED ABORTIONS!
(response) Er, no, actually, section 82, paragraph 5, sentence 3 explicitly says it won't. If you're going to badmouth the bill, could you try and actually read it, Palin?

I have a feeling I'm going to need it. I never actually bookmark anything that might be useful, oh no. It's a wasteland of maneki neko retailers up there.
posted by Kyol at 10:49 PM on November 7, 2009 [3 favorites]

My favourite part about that maddeningly stupid Shadegg video was how baby Maddie kept insistently pushing the microphone away from ol' Grandad as he put those stupid, stupid words into her mouth. It was clearly the only way she could express herself, being unable to speak.

As a Canadian (well, dual citizen) temporarily living in the States and who just received a bill that should have been five $10 copays, but something hiccuped and the bill I got was ONE THOUSAND DOLLARS instead of $50...OH GOD GET ME OUT OF HERE. (Yes, $1k is nothing compared to many things, but I'm a grad student subsisting on loans and unpaid internships.)
posted by ilana at 10:53 PM on November 7, 2009

As for the Stupak Amendment, many states require abortion services be paid for by insurance companies beyond the "endangerment" exception the Hyde Amendment provides. I would expect that will need to get worked out in committee. Right now those same states provide abortion coverage beyond Hyde for people on Medicaid.

I'm less worried about the Stupak Amendment and more worried about whether it covers birth control.
posted by dw at 10:54 PM on November 7, 2009

I'm very worried about the abortion stuff in the bill.
posted by agregoli at 11:03 PM on November 7, 2009

I was happy at first, but the more I read about this, the more it looks like corporate welfare, in the form of handouts to private insurance companies. There is no real public option if one cannot opt out of the employer plans. There is no real public option if one is forced to buy from the local healthcare monopolies. The Catholic Church laundered money through the government to get reproductive heathcare options removed. Insurance companies still have their inefficient monopolies. I'm really understanding the joy about this less and less.

Whatever meagre progressive aspects of this plan will be eliminated once it goes through the Senate. Why are people happy about this seeming disaster?
posted by Blazecock Pileon at 11:07 PM on November 7, 2009 [9 favorites]

I'm in college and living on student loans and part-time employment. I end up with less than a thousand dollars a year or so in funds that don't have to go to food, shelter, and other bills, and that's just cash in hand- I'm accruing debt, too. Does this bill make me get another job to pay for health insurance?
posted by Pope Guilty at 11:08 PM on November 7, 2009 [1 favorite]

scottreynen: “That's what insurance is for. If you meant you can't afford health insurance, unfortunately the rest of us can't afford for you to not have insurance. I'm assuming, of course, you get sick like the rest of humanity.”

I don't know what you're referring to - I get sick, and I usually just stay home and wait it out like everybody else, so you needn't worry about me infecting you. As far as being able to afford insurance: I could, and did, pay for general health and dental coverage.... until I got hit with a $600 dental bill and several other (non-disease) health care bills. When you have to choose between continuing to pay for health insurance and paying your health care bills right now, the smartest thing to do is usually to pay the bills. That's what I did - and what I'm still doing.

The irony is not lost on me.
posted by koeselitz at 11:08 PM on November 7, 2009 [2 favorites]

Why are people happy about this seeming disaster?

Because it's the Affordable Health Care for America Act!^*

* Some restrictions apply. May not be combined with other coupons, offers, or anything that actually works. See Speaker for details.
posted by oaf at 11:12 PM on November 7, 2009 [6 favorites]

If anyone's up for some low-level Facebook activism this good eve,

Here is Joseph Cao's Facebook wall. It's been getting hammered by the knuckedraggers, but The Sensible have entered the fray!

(cmon, its saturday night)
posted by Senor Cardgage at 11:14 PM on November 7, 2009

Does anybody have a link that shows how the wording/policies in the bill about abortion are different in any substantive way to the current policies? My understanding is that this whole thing was about ensuring - in double-double certain language - that no federal funds go to supporting abortion costs; which is the way it is right now. Otherwise, what are the changes??
posted by peacay at 11:22 PM on November 7, 2009

Question: If, as I'm hearing, the odious Stupak amendment will likely be softened (or eliminated) in conference, how in the world will the bill get past the House a second time given the slim margin of error?
posted by Bromius at 11:32 PM on November 7, 2009

koelitz writes "I get sick, and I usually just stay home and wait it out like everybody else, so you needn't worry about me infecting you."

If you get a cold, sure. If you get cancer, other taxpayers pay for your treatment under the current system if you don't have insurance. If you show up at the ER on death's door, they are obligated to give you incredibly expensive treatments that won't save your life (since you went so long without getting your cancer looked at). And who pays for that treatment? Taxpayers.

So yeah, suck it up and deal. This bill isn't perfect, but it's a step in the right direction.

I live in a country where it couldn't be simpler: you get wages garnished every month into the national health care system, and everybody's covered. (FWIW, I pay the equivalent of about 50 USD out of my salary.)

As mentioned up-thread, welcome to the mid-20th century America.
posted by bardic at 11:41 PM on November 7, 2009 [7 favorites]

I admit I haven't read the bill but I won't let that stop me mouthing off like half the rest of the ill-informed commenters in this thread.

Holy god, this.

Either way, doesn't really matter. Before, I couldn't afford health care. Politicians didn't seem to believe me. This bill says, "okay, so you only have to pay for..." No, fuck off. I can't afford health care. Can't people understand what that means?

It means... that the rest of us are going to have to pay for your healthcare? Which I, personally, am okay with.

Can I just say that the health care industry in this nation is below despicable? And also add that the fact that they managed to buy enough politicians to push through this kind of raving crap demonstrates that they have plenty of money and don't need mine?

Enough with the blanket statements about the healthcare industry. I go to med school with a lot of smart, hyper-intense, entirely non-despicable kids whose primary earthly desire is to take care of sick people, NOT to fill swimming pools with cash by stealing bread from the mouths of orphans.

Leave the red-faced shrieking to Republican populists and to six-year-olds fighting over toy ducks.
posted by killdevil at 11:43 PM on November 7, 2009 [9 favorites]

killdevil, IMO doctors are not part of the "healthcare industry." People like their doctors. Their insurance companies? Not so much.
posted by bardic at 11:47 PM on November 7, 2009 [2 favorites]

Thanks XQUZYPHYR. Amy Sullivan at Time has more on the politics [and here]. Interestingly, there's some talk that the Senate is actually less conservative on the topic so there's some hope that it will disappear or be watered down in conference. The other thing may well be that the conservative Democrats have now demonstrated their concerns to placate their constituents but won't actively oppose the legislation once the final bill comes up for a vote, even if the Stupak amendment has been removed/altered.
posted by peacay at 11:59 PM on November 7, 2009

If you get a cold, sure. If you get cancer, other taxpayers pay for your treatment under the current system if you don't have insurance. If you show up at the ER on death's door, they are obligated to give you incredibly expensive treatments that won't save your life (since you went so long without getting your cancer looked at). And who pays for that treatment? Taxpayers.

Or you just die.
posted by afu at 12:00 AM on November 8, 2009

And now, a microcosm of Teabagger reaction to the healthcare bill's passage, as seen through the Twitter feed of one RightBloggerPat.

# Markos Moulitsas is a classless asshole - http://is.gd/4PUqb #TCOT #TLOT #MILITARY #GOP #TEAPARTY #GLENNBECK #P2
about 5 hours ago from TweetDeck

# I want to see a fist fight break out on the senate floor. #tcot #hcr #killbill
about 4 hours ago from TweetDeck

# Eeesh, vote on the thing already.... this is the most CSPAN I've watch since I've been blogging about politics. #tcot #hcr #killbill
about 3 hours ago from TweetDeck

# We're screwed.
about 3 hours ago from TweetDeck

# I'm seriously thinking about closing my blog. fuck this
about 3 hours ago from TweetDeck

# @AnhJosephCao You Bastard piece of shit fuck! GO BACK TO Saigon, South Vietnam where you fucking BELONG GOOK! #GOP #TCOT #TLOT #TEAPARTY
about 3 hours ago from TweetDeck

# Racism.... My ass. @AnhJosephCao is a damn traitor and should be treated as such! Many of our men spilled their blood for his ppl.
about 2 hours ago from TweetDeck

# All so @AnhJosephCao could stab his own damned country in the fucking back.
about 2 hours ago from TweetDeck

# Some of us, have not forgotten what happened on Dec 7, 1941 either! @samuel @levihenry @kerrence @tonyyeung @paparatti @Yeggo @frautoasty
about 2 hours ago from TweetDeck

# I'm really starting to distrust ANYONE of Eastern Descent. 1st it was John Yu, then it was Obama's guy saying we should repay China.
about 2 hours ago from TweetDeck

# I'm head fucking serious... Al-Qaeda is not our Worst Enemy. The East is man. China, Japan, Vietnam, all of 'em. #tcot #hcr #killbill #VTO
about 2 hours ago from TweetDeck

# Remember '41 people, this was their revenge on us. Ceo is a fucking Commie Plant in the G.O.P. #tcot #hcr #killbill #VTO
about 2 hours ago from TweetDeck

# Okay. I will admit it... I fucked up on Japan... They weren't commies. But they did attack America.
about 1 hour ago from TweetDeck

posted by Rhaomi at 12:00 AM on November 8, 2009 [31 favorites]

I count doctors as part of the health care industry. I've spent most of my adult life giving money to doctors. I guess I should be grateful for that fact, even if it has taken food out of my mouth more than once; but understand, killdevil, that I'm probably speaking out of personal bitterness. That probably means that I should hang back and say less, and I'll do that now. But doctors do take home a ridiculous amount of money in this society, and I can't help but feel as though that situation ought to be remedied.

But I'm probably the last person anybody wants to listen to on fiscal policy. I mean, I'm the raving nutter who thinks salaries should be capped at $250,000 society-wide.
posted by koeselitz at 12:02 AM on November 8, 2009 [3 favorites]

I get sick, and I usually just stay home and wait it out like everybody else, so you needn't worry about me infecting you.

Hey poor people, SUCK IT UP and stay home until you're better!

Please tell me that I'm not reading you correctly, man.
posted by secret about box at 12:06 AM on November 8, 2009

"I don't think opinions, (even humble ones, but you didn't choose one of those) work the way you think they do."

I have a great amount of respect for doctors. The ones I know personally tend to be the first people who will tell you that the American system is completely fucked, and that they are prevented from doing their jobs thank to the insurance companies.

What's so hard to understand about this?
posted by bardic at 12:10 AM on November 8, 2009 [1 favorite]

But doctors do take home a ridiculous amount of money in this society,

Yeah, fuck doctors. What did they do for anyone? Bitter nerds need more money.
posted by rodgerd at 12:16 AM on November 8, 2009 [6 favorites]

bardic: “If you get a cold, sure. If you get cancer, other taxpayers pay for your treatment under the current system if you don't have insurance. If you show up at the ER on death's door, they are obligated to give you incredibly expensive treatments that won't save your life (since you went so long without getting your cancer looked at). And who pays for that treatment? Taxpayers.

I live in a country where it couldn't be simpler: you get wages garnished every month into the national health care system, and everybody's covered. (FWIW, I pay the equivalent of about 50 USD out of my salary.)”

Well, lucky you. Please don't misunderstand me; I envy your country's system, and I'd like ours to be like that. I've just lived here too long to believe this is anything like what you seem to think it is. I pay taxes as much as anybody else; and up until a few months ago I paid for insurance, too, even though now looking back I realize that all the health-care bills I was paying on top of the insurance render the insurance itself generally meaningless. Whatever, I threw money away; I don't really mind. But it still pisses me off that people here in the US can act as though this system is "the best in the world" when it's so clearly flawed.

And another thing: please note that most people with health problems aren't close to dying, so the promises that we often get that they'll step in and help if things get really bad mean almost nothing.. And even if you are at death's door, if you're a standard working-class person you have no excuses; they won't give you a dime of government help. They'll let you rot in tens of thousands of dollars of health-care debt. The US isn't exactly jumping at the chance to help people out where health care is concerned. So, if you're trying to say that we're all just fine the way we are right now, and that tazpayers support the sick and the injured in our society: we aren't, and we don't.
posted by koeselitz at 12:20 AM on November 8, 2009 [3 favorites]

[Mikey-San: Argh, no, you're not reading me correctly. I was responding to somebody who seemed to think that I'm putting everybody else at risk by not being able to afford health insurance while I'm paying my medical bills. I'm damned lucky on that count; I'm only 30, and I can handle sickness better than a lot of people. I pity the people with real health troubles in this society; they're the ones that are well and truly fucked.]
posted by koeselitz at 12:25 AM on November 8, 2009

"But it still pisses me off that people here in the US can act as though this system is 'the best in the world' when it's so clearly flawed."

FWIW, I'm definitely not someone who would agree with this.

"most people with health problems aren't close to dying"

Sure. And guess what? Those are the most expensive people to manage from a pubic health standpoint. But I'm not sure what you're angry about. This bill as I understand it (obviously I haven't read the whole thing) would address your concerns. Healthy people have to have an affordable insurance plan and yes, they subsidize fellow citizens who are sick.

IMO the important thing is that people with pre-existing conditions can't be refused coverage, meaning they don't have to go into a debt spiral to cover their cancer or what have you.

But we'll see what we get once the Senate has their way with it.
posted by bardic at 12:29 AM on November 8, 2009 [1 favorite]

I don't know anything about this at all, and I dread to look at it.. but, uh.. if I'm unemployed (and will remain so) and have zero income and absolutely cannot afford to buy ANY health insurance (I've never had health insurance in my adult life), am I screwed? I mean, I CANNOT afford to buy health insurance. And the thought of reading articles wrought with legalese and/or bureaucratic mumbo-jumbo actually turns my stomach. That's why I've never read ANYTHING.

I also stopped going to doctors and dentists (even though I have a serious endocrine condition and am supposed to be on two prescription medications.. neither of which I've taken in years) because I can't afford it.

So, seriously, how screwed am I? How does this actually affect someone in my situation?
posted by Mael Oui at 12:31 AM on November 8, 2009 [2 favorites]

bardic: “But I'm not sure what you're angry about.”

(Maybe it's as simple as: I'm taking this personally. Because it's going to affect me, and my health, over the next few decades. And I'm probably taking it too personally and being a bit irrational because of an accretion of fear and mistrust over a lifetime under this health-care regime. Sorry about my irrationality, then, on this count.)
posted by koeselitz at 12:38 AM on November 8, 2009 [1 favorite]

koselitz, do not forget that you are talking to liberals, for whom being anything other than perfectly polite is a form of transgression.
posted by Pope Guilty at 12:39 AM on November 8, 2009 [4 favorites]

I don't think you people understand. I wasn't being hyperbolic in my last comment. The House Healthcare bill makes abortion effectively illegal in the entire United States of America (yes, yes, for all but the richest women -- which is the situation pre-Roe V. Wade). This is a travesty of a bill. It sets women's rights back three decades. And this is the "pie-in-the-sky Liberal Commie" House bill! The Senate bill, if any passes, will be even worse (literally making abortion illegal somehow, along with birth control).

I don't think you people understand. We. Lost. Healthcare. Utterly. Maybe in another 15 years, after most of us are dead, finally people will wake up. I'm starting to doubt it.

If, as I'm hearing, the odious Stupak amendment will likely be softened (or eliminated) in conference, how in the world will the bill get past the House a second time given the slim margin of error?

Progressives say they will not vote for the final bill. Blue dogs mean it.

I get sick, and I usually just stay home and wait it out like everybody else, so you needn't worry about me infecting you.

You're fired.
posted by dirigibleman at 12:41 AM on November 8, 2009 [3 favorites]

So the solution to tens of millions of Americans who can't afford insurance is to make it illegal to not have it? Am I missing something?
posted by cj_ at 12:43 AM on November 8, 2009 [2 favorites]

I don't know anything about this at all, and I dread to look at it.. but, uh.. if I'm unemployed (and will remain so) and have zero income and absolutely cannot afford to buy ANY health insurance (I've never had health insurance in my adult life), am I screwed? I mean, I CANNOT afford to buy health insurance. And the thought of reading articles wrought with legalese and/or bureaucratic mumbo-jumbo actually turns my stomach. That's why I've never read ANYTHING.

If you are unemployed you should be eligible for Medicaid. Look into it, seriously.
posted by afu at 12:47 AM on November 8, 2009 [1 favorite]

Glad it passed this hurdle, but not digging the anti-choice amendment. Come on, guys, let's go fund the SHIT out of some abortions!
posted by Hollow at 1:03 AM on November 8, 2009 [1 favorite]

I think our next move should be to require everyone to purchase houses. This would solve the homelessness problem lickity-split.
posted by Pope Guilty at 1:06 AM on November 8, 2009 [7 favorites]

I like where you're going with this. Maybe we can pass a law to make hunger illegal and take care of starving children in Africa while we're being so progressive.
posted by cj_ at 1:12 AM on November 8, 2009

One step forward, two steps back.

Except there's no singing, dancing cat involved.

It's sad that a) this process has been so convoluted (and half-assed) and b) It's nearly 2010 and our "leaders" are so cowed by reproductive rights.
posted by cmgonzalez at 1:20 AM on November 8, 2009

Dennis Kucinich Explains Why He Voted No On Affordable Health Care for America Act
posted by catchingsignals at 1:30 AM on November 8, 2009 [9 favorites]

I wish that more members of congress were like Kucinich.
posted by crataegus at 2:24 AM on November 8, 2009 [6 favorites]

"I'd love to be able to purchase quality comprehensive health care for around $120 a month."

If the numbers in this thread (3% after tax) are correct you'd pay less than that for the federal plan until your after tax take home was more than $4000 monthly or $48K annually.

"I don't know anything about this at all, and I dread to look at it.. but, uh.. if I'm unemployed (and will remain so) and have zero income and absolutely cannot afford to buy ANY health insurance"

0 dollars income times 3% is $0 in premiums for the federal plan. Looks like life is about to get immeasurably better.

"The House Healthcare bill makes abortion effectively illegal in the entire United States of America (yes, yes, for all but the richest women -- which is the situation pre-Roe V. Wade). "

Are you being a little hyperbolic here? How much does a privately funded abortion cost down there?
posted by Mitheral at 3:12 AM on November 8, 2009

"The House Healthcare bill makes abortion effectively illegal in the entire United States of America (yes, yes, for all but the richest women -- which is the situation pre-Roe V. Wade)."

Um... no it doesn't.

It means that if you choose to use the national insurance policy -- rather than the one provided by your employers, as most Americans will -- then you will have to pay "retail", basically, for your abortion, if your abortion would otherwise be subsidized by taxpayers.

Abortions could still be obtained by policyholders who pay their entire premiums without government assistance or by individuals receiving federal subsidies in the event of rape, incest or danger to the mother's life.

(This will only effect a rather small percentage of insured Americans, btw.)

Also, please note that we're *ALREADY* in a country where most insurers do not cover the cost of abortions... except in cases of incest, rape or when the life of the mother is in danger..

Most women never get more than one abortion in their entire lives... but if they need an abortion, chances are they can get one for between $350 and $900.

This is already what those who are poor, unemployed, or lack insurance already pay for abortions in this country. The big difference being, now these people won't die or go broke due to lack of access to health care.

So, there ya go. Your ~~ignorance~~ lack of information, corrected by a few Google / Google News searches. (Alternately, you could always just read the legislation.)

(Might I suggest that next time, you stop being so lazy and do the basic research, before showing us how much consideration you *don't* have for the truth, and how okay you are with spreading lies?)

(And no, I do not support this Amendment, as I think it's fundamentally biased against women, while men will still get free viagra. That said, I also don't support intellectually lazy scaremongering, no matter what side of the ideological divide they are on.)
posted by markkraft at 3:40 AM on November 8, 2009 [40 favorites]

This has a very weak public option and effectively outlaws abortion.

Wins for overstatement of the year.
posted by Ironmouth at 4:17 AM on November 8, 2009 [1 favorite]

One other thing. A bill designed to provide universal healthcare has never passed any chamber, ever. This is incredibly historic and puts a lot of pressure on the Senate.
posted by Ironmouth at 4:19 AM on November 8, 2009

Kucinich sounds spot-on here. Dems gave up too much in their race to pass this.
posted by Josh Coe at 4:40 AM on November 8, 2009

Okay.

My life being...my life, I have a particularly unusual situation in play that I can't seem to figure out how this plan would affect it. In practical reality, it'll resolve itself in February, well before this plan - if passed -- would be implemented, so I offer this only as an intellectual challenge.

Now then.

My primary source of income is a temp agency. My temp agency offers a decent health insurance plan -- not the cream of the crop, but for me -- someone with no pre-existing conditions, no kids, generally healthy -- it was fine. It let me get my annual checkups, it was someone I could go to when I got strep throat, my doctor was working with it, it had a decently low co-pay, it was fine.

The problem is, if you do not work for a month through this plan, your coverage lapses -- because, well, you're not paying into it. You can sign up for COBRA, of course.

In early February I stopped getting work. I didn't get work again until April. So, my health insurance lapsed. They sent me the forms for COBRA, but I wasn't getting any work, so I sure as fuck couldn't afford COBRA and so my health insurance lapsed in early March.

In April, I started getting work again -- a day here, a couple days there -- and then got more work through the summer, and still more, until September, when I was finally getting work again fairly consistently, and I called my temp agency and said "okay! I can sign up for health insurance again, right?"

And they said, "No, we only have two times of the year when we have open enrollment -- you just missed the last one in August. You have to wait until February."

So -- my employer offers health insurance, but from February through August I wasn't making enough money TO enroll in it. From September through February, they will not LET me sign up for it.

In that specific situation, would I, under the current health bill, be fined?
posted by EmpressCallipygos at 5:06 AM on November 8, 2009 [3 favorites]

Yea Empress, COBRA's often a sad joke, "You just lost your job but you can buy insurance for only $800 a month!" I had a few co-workers who got laid off this time last year at the same time I did who were the sole income earners in the family and had multiple kids. Trying to afford COBRA for two adults and three kids while living off of un-employment is pretty close to impossible. Luckily, my wife could just put me on her work policy but if it had happened during a different time in our lives when she wasn't employed by a big multi-national company, I'd have been screwed. I'm in good health but I'm forty-five years old.
posted by octothorpe at 5:24 AM on November 8, 2009

Just because the bill passed with 219 Democratic votes doesn't mean there's only 219 Democrats who would vote for it. You line up your votes and take the 218 least vulnerable seats for something big and controversial like this; everyone else gets to prove how centrist they are by voting against it. They did this in the Clinton years too.The margin doesn't prove anything, in other words; a whip count doesn't work like that.

Indeed, the closeness shows how in hand the caucus really is. They had no fear of it not passing. So she sets it up perfectly to ensure that the most vulnerable districts are just fine.

As for Kucinich, I'm glad he feels that he can gamble like that. There's nothing like the granstander who knows he's in a safe seat and who knows he never has to take responsibility for anything. Real leaders make tough decisions. They are the ones who know how hard it really is and are willing to say they will take responsibility to get the actual legislation passed. It is no fun to have to leave in stuff you don't like and take out stuff you do like. But that's what being a leader is all about, making tough decisions that fall on your head. Because the real leader in the House is Nancy Pelosi. Kucinich couldn't even carry her purse.
posted by Ironmouth at 5:39 AM on November 8, 2009 [17 favorites]

If you can't afford private insurance and you can't afford the public option scaled to your income, there should be little to fear from the fine. In this case, you will very likely be below the exemption threshold for the fine. But this is based on what I knew of the bill before last night so I can't be too sure.

One problem I remember from the House bill is that there are no subsidies for the poor (below 150% of federal poverty level) under the assumption that Medicare will be expanded at some undetermined point in the future to include them. Basically, if you're poor, this bill won't affect you at all; it won't get you insured and it won't punish you.
posted by effwerd at 5:41 AM on November 8, 2009 [2 favorites]

As for giving up too much, if people could please give the names of all of the 218 actual reps that were actually going to vote for the better bill you had in mind, I'd love to see it. Like, by their actual names. Because it is Pelosi's actual job to know each and every member who will vote for it. And she does. That's why we actually are going to get healthcare rather than a sorry list of excuses.
posted by Ironmouth at 5:46 AM on November 8, 2009 [3 favorites]

In response to Kucinich's statement:

"“We have been led to believe that we must make our health care choices only within the current structure of a predatory, for-profit insurance system which makes money not providing health care."

Only if you want legislation that brings about some very important changes, opens the door for an expanded federal insurance program, and that saves people from death and bankruptcy. If you try passing legislation that entirely shuts out the private sector, it will not pass.

"Even those with insurance are at risk. The single biggest cause of bankruptcies in the U.S. is health insurance policies that do not cover you when you get sick."

So, you just voted against legislation that mandates that coverage cannot be dropped why, exactly...?

"the health insurance companies are getting quite a deal..."

And so are consumers... and those who are dying for health care. (Literally.)

"Think Progress states “since the President signaled that he is backing away from the public option, health insurance stocks have been on the rise.”

...then it's good that legislation passed the House that contains a public option, right?!

"The “robust public option” which would have offered a modicum of competition to a monopolistic industry was whittled down from an initial potential enrollment of 129 million Americans to 6 million.

Would the "robust public option" have passed, as described? Also note that since the House bill expands Medicaid up to 150% of the federal poverty line, millions of uninsured will gain access to what is, essentially, a single-payer system. You like single-payer, right?!

I suspect that the CBO has rather conservatively underestimated the public option. I intend to purchase it, even though I have other options. Why? Because my doing so will help to expand the program. It's simply the right thing to do if you want to move the country towards single-payer... which I do.

"Looking ahead, we cringe at the prospect of even greater favors for insurance companies."

...which explains why Aetna loves this bill. <>with a simple 50-vote reconciliation bill.

Given the *BIG* leads the Democrats have in both the House and Senate, this makes it quite likely that the Democrats will be able to expand healthcare as they see fit, all the way up to 2014, unless the Republicans get a presidential candidate who is a great deal stronger than their current crop.

"America will someday come to recognize the broad social and economic benefits of a not-for-profit, single-payer health care system"

... and this is how we're going to get there.
posted by markkraft at 5:52 AM on November 8, 2009 [11 favorites]

Reading all of the ignorant and blatantly racist rhetoric from right wingers on Joseph Cao's Facebook wall makes me ashamed to be a conservative.
posted by reenum at 5:54 AM on November 8, 2009 [2 favorites]

if I do not own a car, I am free to opt out of auto insurance. in the case of health insurance, I am not able to opt out. what am I trying to say here? never, ever use car analogies.

It is my understanding that you will be free to opt out once you stop using your body.
posted by milarepa at 6:01 AM on November 8, 2009 [7 favorites]

I have scanned the bill and it looks to me like the govt is not treating the insurance providers like the NRC treats reactor builders or the FCC treats broadcasters (i.e. create a ton of "you musts" or you can't be an insurance provider). I see nothing which is going to really do much to reign them in.

I'm not a proponent of a public option, but the govt really needed to make sure the private insurance providers tempered profits or ensured that huge profits made their way into premium refunds or guaranteed investment in a buffer for claim payouts.

And, lastly, while this will just cause me to be slammed by folks, I find it ironic that there is a desire for a "right to health care" but no conscience for a right to life.
posted by hrbrmstr at 6:07 AM on November 8, 2009 [1 favorite]

So -- my employer offers health insurance, but from February through August I wasn't making enough money TO enroll in it. From September through February, they will not LET me sign up for it.

In that specific situation, would I, under the current health bill, be fined?

No, the whole point is that the bill forces or seriously incentivizes insurers and employers to stop these kinds of shenanigans. If you are unemployed, you aren't going to be fined and if you make below a certain income level, you are going to be subsidized. And presumably, you could choose the public option which wouldn't have these issues anyway-- thereby competing very effectively with private insurers and making them less likely to maintain this kind of nonsense.

If public option stays same price and COBRA is massively unaffordable during periods of unemployment or job switching, who is going to pick COBRA? No one. When consumers won't pay for something, that thing will tend not to continue to be sold or the price with drop... it has something to do with free markets, I believe. ;-)
posted by Maias at 6:08 AM on November 8, 2009

MeFi weirdness. Looks like part of my last comment was cut. It should have said:

"Looking ahead, we cringe at the prospect of even greater favors for insurance companies."

...which explains why Aetna loves this bill.

This bill marks the high-water mark for American health insurers. It's the American people's foot-in-the-door.

If I were Aetna, I would be pretty concerned, as the framework of public insurance will now be there, and, as such, could easily be expanded to cover more Americans with a simple 50-vote reconciliation bill.

Given the *BIG* leads the Democrats have in both the House and Senate, this makes it quite likely that the Democrats will be able to expand healthcare as they see fit, all the way up to 2014, unless the Republicans get a presidential candidate who is a great deal stronger than their current crop.

I fully expect that once it comes close to healthcare kicking in, the media will be doing a lot of stories about how the program isn't inclusive enough, isn't large enough to lower premiums as much as desired, etc. This will actually be a *good* thing, as it will be seen as a crisis in search of a solution, providing justification for changes that will make the plan far more inclusive over time.

Next time around, it will be a lot harder for Republicans and the health industry to scaremonger about a program people are already starting to benefit from, that increases competition and saves money whether you're using the federal program or not... and it will be pretty hard to resist changes if we only need 50 votes in the Senate to make them.
posted by markkraft at 6:10 AM on November 8, 2009 [1 favorite]

Countdown to Joseph Cao switching parties in 5... 4... 3...

SRSLY he will be taking serious shit for this. He only got elected because he was running against disgraced and convicted "Dollar Bill" Jefferson (he of the infamous roll of money in the freezer retrieved after Katrina). LA-2 is heavily Democratic and it's widely assumed that Cao should enjoy his one term while he can because his chances of being re-elected are the stuff are so small they're subject to the Heisenberg Uncertainty Principle.

He is genuinely very conservative but not nearly as insane as the rest of the party, and the Republicans have had to steamroll him before to get him to stay in lockstep. It's veeeeery interesting that he actually defied them on this. It's the first time, but if he's decided he would like another term you can bet it won't be the last.
posted by localroger at 6:24 AM on November 8, 2009 [3 favorites]

AS A WEALTHY MAN WITH NO FAMILY EXCEPT FOR MY KAWII ANIME GIRL PILLOW I AM OUTRAGED THAT MY MONEY IS PAYING FOR MEDICAL CARE FOR THINGS LIKE CHILDREN AND SPOUSES.WHERES THE SUBSIDIES FOR NIPPONOPHILES OBAMA???THIS IS CUTTING INTO MY HENTAI BUDGET WE WILL NOT STAND FOR IT DON'T TREAD ON mE
posted by Optimus Chyme at 6:28 AM on November 8, 2009 [18 favorites]

Congratulations on doing SOMETHING about health-care.

My condolences on what you actually got.
posted by blue_beetle at 6:33 AM on November 8, 2009 [4 favorites]

Re: whip counts, it's my impression that an accurate count was slightly hard to come by on this one, in part because certain members were probably waiting to see how Stupak went down, and it was also hard to get a count on Stupak (plus, there were fears about Republican shenanigans bringing Stupak down for strategic purposes - this ended up not happening). Some very last-minute decisions were definitely made. Also it should be noted that there are several very vulnerable frontline members on the Ayes list - 4 of the 9 Dems on this list voted for the bill, for example - so while cynical calculations about who can afford to vote yes/no are always a huge part of leadership's strategy, I don't think that's entirely what last night boiled down to either.
posted by naoko at 6:35 AM on November 8, 2009

Also note that since the House bill expands Medicaid up to 150% of the federal poverty line, millions of uninsured will gain access to what is, essentially, a single-payer system.

Nice. I was worried they were just going to put that off but they evidently got to it before the final bill.
posted by effwerd at 6:37 AM on November 8, 2009

I believe the bill actually does expand the Medicaid threshold to 150% of the poverty line. That's $16,245 for a single person, or $33,075 for a family of four.
posted by EarBucket at 6:40 AM on November 8, 2009

(And on lack of preview, Markkraft got there first.)
posted by EarBucket at 6:43 AM on November 8, 2009

If not, what are the penalties if I do not purchase insurance if I am employed? Fines? Jail?

Well this gives a new urgency to the same-sex marriage debate, doesn't it? Surely I will not be held to a different standard of health-care-getting than my straight, married counterpart, will I? Will I?
posted by hermitosis at 6:47 AM on November 8, 2009 [1 favorite]

It means that if you choose to use the national insurance policy -- rather than the one provided by your employers, as most Americans will -- then you will have to pay "retail", basically, for your abortion, if your abortion would otherwise be subsidized by taxpayers.

It's not just if you're on the public option; it's also if you're in the exchange and your plan doesn't cover it - and you can only use a plan that does if you aren't receiving any subsidies (and why would you choose to plan for something that is, by definition, unplanned?). Stupak's amendment just shows how the pro-lifers can get what they want by sitting there refusing to budge, while the pro-choice side works their butts off trying to come up with reasonable compromises, which the lifers then refuse to legitimize. It's infuriating.
posted by naoko at 6:47 AM on November 8, 2009 [1 favorite]

From what I remember, if the President does sign a healthcare bill into law, it won't actually go into effect until 2013 or 2014. If that is indeed still the case, it means that we'll all have several years to figure out how to deal with the strange new options we'll be presented.

Everything I've read makes me think that the abortion amendment will probably drop out before all is said and done, so I feel pretty good about this development.
posted by GameDesignerBen at 6:50 AM on November 8, 2009

I wish that our system of government didn't involve team-based politics so much. For example, let's say that you could turn back time about a year and a half. You put all Republican members of the House in their own bubble for a week and give them the health care bill. Have them spend the time reading it over and then have them let you know if they will vote for it. They don't get time to find out what the other Republicans are doing. You would find more than one person voting for it. The bill is not being rejected by Republicans based on ideology as much as it is on team-based politics.

But it is all team-based politics. The Republican powers that be tell the members of the house what the party position is. There is an implied threat that those members will not get the financial support of the national party if they do not vote accordingly. There is even an implied threat that the national party will find someone to run against them in a primary if they don't vote the right way. The Democrats do the same thing. It is disgusting. We like to think that we are voting for individuals who will go to Washington and do what their constituents want them to do. Forget about that -- they don't even do what they want to do. Almost every politician's very top priority is to be re-elected, so they are going to vote the way that is most likely to get them re-elected. Again, satisfying their constituents is not the best way to get re-elected. Raising the most money is the best way to get re-elected. So they vote based on what is likely to raise them the most money. And we are left with giant bills like this that wind up with across the board team votes. It is awful.
posted by flarbuse at 6:58 AM on November 8, 2009 [3 favorites]

"Stupak's amendment just shows how the pro-lifers can get what they want by sitting there refusing to budge..."

The simple fact is that the people who support Stupak's Amendment -- and the Hyde Amendment that it is based upon -- are in the majority.

The Hyde Amendment, which dates back to '76, barring the use of federal funds to pay for abortions. The Democrats wanted to overturn it during the Clinton years, but only succeeded in modifying it, so that there was the exception for the life of the mother, for rape, and for incest.

Since '93, that's been the status quo in our government, with many Democrats who support it.

The reason Stupak's amendment was stuck in the bill was to placate the majority, after there was significant discussion that the Hyde Amendment wouldn't apply to the health insurance legislation, but only to Medicare and the like.

If you want to be infuriated, be infuriated by the fact that around 25% of the Democrats felt the need to vote for it.
posted by markkraft at 7:04 AM on November 8, 2009

if I'm unemployed (and will remain so) and have zero income and absolutely cannot afford to buy ANY health insurance (I've never had health insurance in my adult life), am I screwed? I mean, I CANNOT afford to buy health insurance.

Somebody else upthread said this, but I want to repeat for emphasis: If you actually have zero income (or, typically, make less than around $900 per month), you are right now eligible for gov't subsidized health care (probably Medicaid, may vary due to your state and age). I would advise you to go to your local DHS office on Monday to find out what programs you are eligible for.
posted by anastasiav at 7:04 AM on November 8, 2009 [5 favorites]

And isn't there the likelihood that this ban on abortion will wind up being ruled unconstitutional? If so, the ban will be terrible, but at least it will be temporary.
posted by flarbuse at 7:06 AM on November 8, 2009

The fact is that from Day Fucking One, President Obama hawked the line that "nothing in the health care bill will change the coverage you already have." Millions of women have just been lied to.

Obama didn't write the amendment. He didn't vote on it, either. And it remains to be seen if Obama will suggest (publicly or privately) that he won't sign a bill that contains the amendment in its current form - depends on what the Senate comes up with, I suppose. So ease up on that part of your outrage, yeah? It gets a little tedious seeing people pin on the administration what should in fact be pinned solely on Congress.
posted by schoolgirl report at 7:14 AM on November 8, 2009 [7 favorites]

Mark, I'm familiar with Hyde and I think Stupak's amendment goes beyond it (and I'm not alone in thinking so). There was a conscious effort on the part of pro-life groups to torpedo any efforts at compromise (e.g. Capps, Ellsworth), and their strategy worked.

I'm going to keep reading this thread but I can't comment any more. Have a nice Sunday, everybody.
posted by naoko at 7:25 AM on November 8, 2009

I'm as pro-choice as anyone, but did you honestly think that they would pass a bill to enable knocked up sluts and welfare queens and other immoral degenerates to commit a Holocaust of genocide on unknown millions of legions of unborn baby Americans and pay for this wholesale slaughter with a Marxist Commie redistribution of the wealth, and tax good, upstanding family just to pay for some illegal slut to murder her baby?

As far as I can tell, this is exactly why Planed Parenthood exists; to provide birth control and pregnancy termination options because the nutjobs would pitch a fit if it was handled in a sane way. Personally, if that is the worst thing to come out of this bill, then I will cut a check to Planed Parenthood and be very happy with how everything worked out, all things considered.
posted by paisley henosis at 7:39 AM on November 8, 2009

Christ, after reading the reactions from the liberals here and conservatives elsewhere, I have a newfound respect for politicians and the shit they have to put up with from their constituents.

Health care for some, miniature American flags for others.
posted by Garak at 7:44 AM on November 8, 2009 [2 favorites]

Garak: "Christ, after reading the reactions from the liberals here and conservatives elsewhere, I have a newfound respect for politicians and the shit they have to put up with from their constituents."

I'd have a lot more respect for them if they actually listened to their constituents more than they listened to lobbyists and corporations. We elect them and pay them and it's their job to listen to us.
posted by octothorpe at 7:55 AM on November 8, 2009 [3 favorites]

The Baltimore Sun has more details, including a note that the Dems hope to get the Senate to vote before Christmas, so the legislation can get to Obama's desk before the end of January. Also, the House plan would cover an additional 36 million people by 2019,

2019?!?! I love the whole "This costs too much! I know, we'll delay implementation to reduce the 10 year cost of the bill!" thinking.

That effectively is a fine, except that there's no court process involved since the IRS will be doing it. There is also the possibility of prosecution and jail.

Cite? I don't think the mechanism has even been specified, but would probably just be fines less then the cost of the insurance. Or they might simply apply the fines towards health insurance, meaning there would be no way for an ordinary person to choose not to pay.

You can opt out of your employer-provided insurance plan and sign up for the public option if you want.

That's definitely not the case. If you work for a large company, your employer would be required to provide insurance, and neither you nor they can opt out. And they can't put you on the public option either, since that would just cost the insurance companies too much money.

One other thing. A bill designed to provide universal healthcare has never passed any chamber, ever. This is incredibly historic and puts a lot of pressure on the Senate.

Uh, except this doesn't provide universal healthcare. It still leaves 4% uninsured. (Wtf is up with that?)
posted by delmoi at 7:55 AM on November 8, 2009

You guys have to go to Cao's Facebook page and see all the Glenn Beck sloganeering and Fox News fear mongering going on there.
posted by reenum at 8:01 AM on November 8, 2009

I have tricare prime with the government as a retired Air Force member:I pay a monthly fee for my insurance:How will this new bill affect Tricare? Anyone enlighten please
posted by Upon Further Review at 8:08 AM on November 8, 2009

At this point, all I want is the words "public option" in the final bill. If it's weak, if it's strong, if it just makes people shit blood for a week, who cares. We need those words, because if they aren't in, we'll never be able to bring this up again for the next twenty years.
posted by fungible at 8:08 AM on November 8, 2009 [3 favorites]

Mitheral: Are you being a little hyperbolic here? How much does a privately funded abortion cost down there?"

Between $300 and $5,000, roughly. Here in Dallas, the cost for a first trimester abortion starts at around $500. In areas, and there are many, where there are no abortion providers, women will also have to pay to get somewhere where they can get one, and once there, the prices can vary widely.

Between 1996 and 2000, the number of U.S. abortion providers declined by 11 percent -- from 2,042 to 1,819. As of 2000, 87 percent of U.S. counties did not have an abortion provider.

According to Medical Students For Choice, the number of physicians trained to provide abortion is likely to sharply decrease in coming years, as 57 percent of all ob/gyns who perform abortions are 50 years of age or older and only 5 percent of abortions are performed in hospitals, where most medical students are trained, and according to a study conducted in 1997, only 15 percent of chief residents in family medicine residency programs had clinical experience providing first trimester abortions.
posted by dejah420 at 8:09 AM on November 8, 2009 [5 favorites]

In hindsight, this past year is going to go down as a collossal political failure. It would have far been better for the federal government to buy all of the banks and insurance companies when they were struggling, and then do whatever it wanted, using those companies as the providers and lenders. Think of no lobbyists, and nobody left to say that it wasn't pure American capitalism.
posted by Brian B. at 8:13 AM on November 8, 2009

No one has mentioned yet whether or not insurers will still be able to charge extra for those of us unfortunate enough to have "pre-existing" conditions - a lot is being said about the "insurance you already have" - well, am I still going to have to keep paying HALF MY FUCKING MONTH'S SALARY for insurance because I have the misfortune of a chronic condition? Plz advise.

I read the article, but not the bill. Yes, answer my question with an added soupçon of scorn if you like.
posted by grapefruitmoon at 8:21 AM on November 8, 2009 [2 favorites]

As far as I can tell, this is exactly why Planed Parenthood exists; to provide birth control and pregnancy termination options because the nutjobs would pitch a fit if it was handled in a sane way.

Even if you go there, you'd still have to pay for the abortion. It's not like it's free. They do have payment plans and such for their services, and help you get insurance, but due to Hyde and other politics, most of the time, you're still going to be paying retail for an abortion at a PP clinic. The states can use some of their Medicaid funds to help pay for abortions for the very poor, since Hyde affects federal funds, but under this new bill, the states' hands seem to become effectively tied.
posted by cmgonzalez at 8:22 AM on November 8, 2009

It's in the articles, and in the comments above, grapefruitmoon, but charging more for pre-existing conditions is made illegal in this legislation.
posted by cmgonzalez at 8:23 AM on November 8, 2009

XQUZYPHYR, you really seem bent over a rail there. I'm not saying you're wrong or misinformed but I will ask this question (context included).

From what I understand women who currently are insured by their employers and who have abortion/reproductive coverage will not be forced into the exchange. My intuition tells me that insurance companies who want access to the exchange will provide insurance products tailored for the exchange while maintaining their other existing products. Women who currently receive abortion/reproductive coverage and do not switch from their insurers (which continue to offer extra-exchange insurance products) will continue to have abortion/reproductive coverage.

Yes?
posted by mistersquid at 8:30 AM on November 8, 2009 [1 favorite]

mistersquid: "Yes?"

No. It's not the *people*, it's the insurance companies. If the insurance companies want to be part of the exchange, then they have to drop family planning coverage.
posted by dejah420 at 8:34 AM on November 8, 2009

Reading all of the ignorant and blatantly racist rhetoric from right wingers on Joseph Cao's Facebook wall makes me ashamed to be a conservative

It also gives you some idea of the motives behind the tea partiers and what the opposition to Obama is really based on.

Nobody on the Right called LBJ a Nazi when he passed the Voting Rights Act or the Great Society.
posted by Ironmouth at 8:44 AM on November 8, 2009 [2 favorites]

Unruly Republicans Silence Women Lawmakers With Screams, Shouts, And Delay Tactics.

A video mashup highlighting the GOP's uncivilized tactics.
posted by ericb at 8:55 AM on November 8, 2009 [1 favorite]

I honestly cannot believe the level of insane I-got-mine-ism being paraded around the internet today. People are honestly pissed that they now might have to buy relatively cheap insurance so that poor people can go to the doctor. I'm simultaneously proud of being an American (because the legislation passed) and disgusted that so many of my countrymen can think only of themselves.
posted by Avenger at 8:58 AM on November 8, 2009 [7 favorites]

Ha! Ha!

"At the 'House Call; tea party protest on Capitol Hill this week, House Minority Whip Eric Cantor (R-VA) pledged to the right-wing activists: 'Be assured not one Republican will vote for this bill.' Cao’s vote must have surprised Cantor.

Cao has previously been touted by House Minority Leader John Boehner (R-OH) once as 'the future' of the GOP."

posted by ericb at 9:01 AM on November 8, 2009 [3 favorites]

I was hoping to congratulate the USA on making a big, belated step forward.

However, I think I'm going to offer my condolences. This bill may be better than what you have now, but it does not seem to be anything approaching a modern, first-world solution.
posted by five fresh fish at 9:02 AM on November 8, 2009 [3 favorites]

The plan, ironically, is very similar to that huge liberal socialist REPUBLICAN Mitt Romney's plan in Massachusetts, which has overwhelming public support, has increased coverage and has not sent anyone to jail.

Yeah -- The Massachusetts Mandated Health Insurance Law was enacted and signed into law by Governor Mitt Romney in 2006 and put into effect in 2007.
posted by ericb at 9:09 AM on November 8, 2009

If the insurance companies want to be part of the exchange, then they have to drop family planning coverage.

This is not my understanding of the Amendment. It means that companies who want to offer insurance products on the exchange cannot offer abortion on the insurance exchange products' list of covered items. It does not affect the products they currently offer. So if your plan already covers elective abortions, you are still covered.

I'm wondering if anybody knows how many plans currently cover elective abortions. I was under the impression it was quite low, if only because they usually don't cover elective procedures as a whole.
posted by Ironmouth at 9:12 AM on November 8, 2009 [1 favorite]

As a moderate on the issue of abortion (meaning I don't like the practice, but I do think it should be safe and legal to keep people from getting clandestine procedures done that endanger the life of the patient), I'm wondering: About how much does an abortion usually cost without help from an HMO? And is it usually covered? What's the typical co-pay? I know it varies with time, so what would it be within the first week, 2nd trimester, and late term? And does the Stupak amendment also cut off federal money for Plan B, which is arguably not an abortion, but is politically seen that way?

You can tell I don't know much on this issue. Please don't be upset with me, because I just want to learn more about the issue. I think abortion should be avoided in favor of better birth control, but that the government cannot determine every situation. I see nothing wrong with early abortions, especially once that occur within the first few weeks before the primitive streak (the first neurological tissue) develops. I don't want late term abortions banned for mothers who find out their infant has a fatal condition, and yet those are also the ones that get fought against the hardest by the pro-lifers.
posted by mccarty.tim at 9:14 AM on November 8, 2009

Re: the people saying that the individual mandate is a jail sentence: This is just a rehash of the dumb libertarian argument that any public programs are bad because if you don't pay your taxes "men with guns will come over and initiate force."

Granted, you initiated force by failing to keep up your half of the bargain. By being an American, you agree to live by the laws your elected representatives make. In exchange, you get the services from the government and the ability to vote for or against representatives in order to effect policy change. You have representation, and American citizens are free to leave if they so choose. You can either cooperate and ask for the programs to change so that they are more fair, or you can leave. You cannot be a leach on society and expect the government to roll over. It doesn't matter if you think the IRS employees are "thugs." The fact is you are failing to pay your "rent" for being an American citizen.

It's an awful argument, as it could be expanded against the military or public roads, or other programs libertarians typically think are justified. I know it's a strawman, but the fact that it's the core arguement against the individual mandate says a lot.

The real problem with the individual mandate is that it screws over people who are unemployed, self-employed, or working for small businesses without a public option or some other mechanism for grouping together the un-and-underinsured to subsidize the sick with the healthy. Individual insurance is insanely expensive, and it punishes small businesses and entrepreneurs, as anyone with a pre-existing condition or concern for their health would benefit more from going to a large company that would guarantee they get healthcare at a fair rate.

Republicans can't take that talking point against it, though, as it pretty much says "We need to keep the broken system which will bankrupt the nation, or we need to set up a public option." It's a bit like how they could also rag on Obama for not stopping NSA wiretaps or legalizing gay marriage, but they'd be shooting themselves in the foot. So, they're stuck with socialism and death panels.
posted by mccarty.tim at 9:26 AM on November 8, 2009 [3 favorites]

Newsweek: Why Rep. Cao voted for the health insurance bill.
posted by ericb at 9:28 AM on November 8, 2009

This mandatory insurance thing sounds a lot like what we have in the Netherlands. It's not ideal, but when I read that in the US people either go bankrupt or die because they don't have health insurance and get cancer, I am always so extremely glad to live here.
posted by davar at 9:29 AM on November 8, 2009

Guys, this is the undercard. The main event is in the Senate.

There is a lot more room for floor debate, attempts to amend and general procedural wankery to slow down passage. While the House passage is a great thing, it was a walk in the park compared to what will come I fear.

Yep.

A refresher course: Schoolhouse Rock -- How a Bill Becomes a Law.
posted by ericb at 9:30 AM on November 8, 2009 [1 favorite]

Where does it say that a plan cannot cover abortions and be on the exchange? As I read it, the relevant clause on p109 of the bill says that abortion cannot be required as part of the minimum qualifying benefits, but goes on to say that qualifying plans may include it as they wish, and it may even be covered by the public option. Presumably this is one of the 'extra benefits' that may be included in a Premium Plus plan (p169)

In fact, if you continue reading, then it says that the Commissioner shall ensure that there exists at least one plan that does and one plan that does not cover abortion services. (Although I think there is a typing error in that, because it refers to 'services outlined in 222(d)(4)(A), but 222(d) has no subsections and the abortion specifications are in 222(e)).
posted by jacalata at 9:34 AM on November 8, 2009

Upon further review: having Tricare means you are considered to be covered by health insurance, so you don't have to get another plan and won't be subject to any fines (definition of Acceptable Coverage, section 302, specifically mentions Tricare).
posted by jacalata at 9:37 AM on November 8, 2009

Good news in the bill: Sec. 107. Prohibiting acts of domestic violence from being treated as pre-existing conditions.
posted by jacalata at 9:41 AM on November 8, 2009 [2 favorites]

A refresher course: Schoolhouse Rock -- How a Bill Becomes a Law.

On preview -- what bigmusic said!
posted by ericb at 9:45 AM on November 8, 2009

I mean, I just got back from Reddit and everybody is like "HEY MAN I SHOULDNT HAVE TO PAY FOR LITTLE JENNY'S CANCER I MEAN SHIT THATS MY MONEY BRO NOT HERS I'M ALREADY PAYING $$$ FOR MY AUTISM MEDS WHY SHOULD I SUBSIDIZE CANCER LIKE THEY DO IN RUSSIA AND HEY MAN IF YOU DONT PAY UP MEN WITH GUNS WILL SHOW UP AND SEND YOU TO GITMO WELCOME TO AMERIKKA M I RITE DONT TREAD ON ME GOOGLE RON PAUL"

Fucking Reddit.
posted by Avenger at 9:46 AM on November 8, 2009 [7 favorites]

You are not paying attention, deja420.
posted by mistersquid at 9:47 AM on November 8, 2009

grapefruitmoon: should the bill pass in this form, it creates a new insurance group as of January 2010 to cover people who have either been refused coverage or offered more expensive coverage due to pre-existing conditions, as an interim measure until the whole thing gets set up. I think you'd be able to enrol in that immediately, which would presumably bring down your costs. (Immediate Reforms, Section 101: National High Risk Pool Program).
posted by jacalata at 9:49 AM on November 8, 2009

Shorter Republicans to Everyone: Drop Dead

Shorter Democrats to Everyone: Nah, Just Women. The Rest of You Are Good, Bros.
posted by emjaybee at 9:51 AM on November 8, 2009 [5 favorites]

Lieberman Pledges To Filibuster House Bill: The Public Option Is ‘Unnecessary’
posted by homunculus at 9:53 AM on November 8, 2009

He's got Joementum!
posted by oaf at 10:02 AM on November 8, 2009

Thanks jacalata! Good to know. If that really does happen, it'll be fantastic for any number of reasons, not the least of which being that I won't have to get married in order to be able to afford health-insurance long term. Oh! Marrying for love! What a concept!
posted by grapefruitmoon at 10:12 AM on November 8, 2009

Nobody on the Right called LBJ a Nazi when he passed the Voting Rights Act or the Great Society.

Nobody back then had the internet, where any idiot can have an opinion that's heard by millions across the globe.

To suggest that intolerance is higher now than back in LBJ's era is unbelievably insulting to our collective intelligence.
posted by SeizeTheDay at 10:15 AM on November 8, 2009 [2 favorites]

It's kind of lame how "filibuster" doesn't mean "stand there and talk forever" anymore. I'd love to see Lieberman choke on his own desiccated tongue on the floor of the Senate trying to prevent even incremental progress in healthcare.
posted by synaesthetichaze at 10:19 AM on November 8, 2009 [3 favorites]

Note that there's no single men's health issue that won't be paid for. But women's health? Well, why would we want to leave that to women and their doctors, when we could play politics with it?
Typical. I haven't read the whole plan, but I'll bet prostate exams are covered for men over 40 regardless of genetic pre-disposition, while mammograms are just too expensive and sometimes lead to biopsies that show benign tissue, so the whole thing was a waste of money in the first place. Women historically have always gotten the short end of the medical stick - DES, the Dalkon Shield, Thalidomide...all rushed to the market without sufficient testing. Yet the FDA keeps a very watchful eye over products like Viagra.

I used to work for a small company with a very jerk of a boss. He used any excuse he could find to screw his employees. For example, back when gasoline was $4 a gallon, trucking companies (which we used to ship our steel) were adding a fuel surcharge to their bills, so that was why there were no salary increases to be had for us that year. I can just see him now - the government is forcing him to pay for health insurance, so he's either going to cut salaries or reduce staff. I wonder how many other employers will react similarly.
posted by Oriole Adams at 10:21 AM on November 8, 2009

Lieberman Pledges To Filibuster House Bill: The Public Option Is ‘Unnecessary’

I like how he just lies about the public option increasing the deficit. What a huge mistake for the democrats not to support Lamont fully back in 2006.
posted by afu at 10:25 AM on November 8, 2009

Nobody on the Right called LBJ a Nazi when he passed the Voting Rights Act or the Great Society.

Nobody back then had the internet, where any idiot can have an opinion that's heard by millions across the globe.

To suggest that intolerance is higher now than back in LBJ's era is unbelievably insulting to our collective intelligence.

I think the point was that no-one was calling LBJ, a white man, a nazi/socialist/antichrist back then whereas now, with Obama (and Cao) there's a whole new level of intolerant tension.
posted by Think_Long at 10:25 AM on November 8, 2009

If you want to be infuriated, be infuriated by the fact that around 25% of the Democrats felt the need to vote for it.

This comment sounds sort of glib, but I am infuriated, actually; I am so infuriated I am having a hard time typing. It is frustrating to see an amendment which restricts access to abortion receive support. From Planned Parenthood's statement, and apologies for the lengthy quote:

The majority of private health insurance plans currently offer abortion coverage, and the Stupak/Pitts amendment would result in the elimination of private abortion coverage in the ‘exchange,’ the new insurance market created under health care reform, as well as in the public option, if one is created.

The Stupak/Pitts amendment would purportedly allow women who want comprehensive reproductive health care coverage to purchase a separate, single-service rider to cover abortion. But such abortion riders do not exist because women do not plan to have unintended pregnancies or medically complicated pregnancies that require ending the pregnancy. These so-called ‘abortion riders,’ which would be the only insurance policy through which abortion care could be covered in the ‘exchange,’ are discriminatory and illogical.

The assertion that this does not change the policy towards women's access to abortion in the USA is therefore incorrect. Even if it were true that this amendment only reinforced the status quo, I'm not sure why this would comfort anyone who does not want to see women punished for making their own choices about parenthood by being forced to fork out hundreds of dollars.

It's all kinds of frustrating that legislation about healthcare has become not a way of ensuring that the greatest number of people possible have the tools and information to make the choices which are best for them and guarantee them the best possible healthcare outcomes, but a way of foisting the values of one particularly vocal group on everybody else. Even if the Stupak amendment does not make abortion illegal, it does cut the number of options women have to pay for an abortion. This restricts women's access to abortion, and it matters.

I know that this bill has not been through the Senate yet, and for what it's worth I hope that this amendment will not survive the next stage. Sorry that this comment is a bit of a rant; I'm having a head/desk moment with lots of cries of 'WTF??' and my anger is directed at no one in the thread.

On a (barely relevant) aside, I come from a country where abortion law is on paper less liberal than in the US. In the UK, the 1967 Abortion Act stipulates that two doctors must consent to carrying out an abortion, and doctors have the right to refuse to give an abortion if they object to it morally. However in this case refer the woman to a doctor who *will* provide it. It is supposedly extremely rare for women to be actually refused an abortion, however; I would love to know how true this is. Despite this, government provided healthcare does cover the cost of abortions in total or in part for those who want them.
posted by the cat's pyjamas at 10:25 AM on November 8, 2009 [2 favorites]

dejah420: No. It's not the *people*, it's the insurance companies. If the insurance companies want to be part of the exchange, then they have to drop family planning coverage.

I don't think that is correct either. AFAIK, the Stupak amendment refers to "products" which participate in the exchange, not being allowed to offer abortion services. The insurance companies have "products", just like any services industry. For example, a product consists of a network of providers, payment terms (such as co-pay and deductibles) and possibly listed services (i.e. is mental health and vision covered under the same plan?). For instance, at my employer I can choose between an HSA and a PPO, which have similar networks and covered services, but dramatically different payment terms. The HSA blows, but I can't afford the PPO since it is 3x the cost per month.

So this seems to me that the insurance companies would be tailoring new products (something they are already VERY interested in doing as they try to push towards "consumer driven" care) for participation in the exchange. So products offered to the existing employer/group based market would not necessarily be affected by the Stupak amendment, while new products that aim for the exchange would.

It remains to be seen what the result of this all is going to be on the makeup of the products offered by plans. It is possible that maintaining 2 products, that differ only in whether or not they offer abortion services, will actually increase administrative overhead on the plans.

So the distinction Stupak draws seems pretty dumb for everyone involved who isn't running for re-election.
posted by butterstick at 10:30 AM on November 8, 2009

As long as I still get to see
posted by Balisong at 10:32 AM on November 8, 2009

Er... my doctor...
posted by Balisong at 10:33 AM on November 8, 2009

"At the 'House Call; tea party protest on Capitol Hill this week, House Minority Whip Eric Cantor (R-VA) pledged to the right-wing activists: 'Be assured not one Republican will vote for this bill.' Cao’s vote must have surprised Cantor.

Cao has previously been touted by House Minority Leader John Boehner (R-OH) once as 'the future' of the GOP."

The irony is that the Stupak Amendment is the reason Cao voted for the bill. That's actually a huge victory for pro-lifers, yet, he's being vilified by the right-wing base for his vote.

Those people are truly idiots.
posted by delmoi at 10:45 AM on November 8, 2009 [2 favorites]

Let fucking Lieberman filibuster. Let the Republicans show the Unites States, in no uncertain terms, that they are the party of divisiveness, rudeness, the obstacle to progress. They're owned by corporate interests, refuse to pass election reform, and don't give a single shit about ordinary citizens. Using the filibuster to block Health Care for Citizens is a dick move. I'm not at all confident that the American people will recognize just how dick-ish it would be, but let those fuckers just go ahead and show their true colors.

Lieberman is not a Democrat; he's theoretically an independent. He's spiritually a dick/Republican. same thing.

There are Republicans I respect; more in the past than now, but, by and large, the GOP just keeps showing how vile they can be.
posted by theora55 at 10:49 AM on November 8, 2009 [1 favorite]

"Between $300 and $5,000, roughly. Here in Dallas, the cost for a first trimester abortion starts at around $500. In areas, and there are many, where there are no abortion providers, women will also have to pay to get somewhere where they can get one, and once there, the prices can vary widely.

"Between 1996 and 2000, the number of U.S. abortion providers declined by 11 percent -- from 2,042 to 1,819. As of 2000, 87 percent of U.S. counties did not have an abortion provider.

"According to Medical Students For Choice, the number of physicians trained to provide abortion is likely to sharply decrease in coming years, as 57 percent of all ob/gyns who perform abortions are 50 years of age or older and only 5 percent of abortions are performed in hospitals, where most medical students are trained, and according to a study conducted in 1997, only 15 percent of chief residents in family medicine residency programs had clinical experience providing first trimester abortions."

This sounds more like an access issue than a funding issue. Would even a fully funded Federal abortion plan significantly change those access numbers? Afterall $500 is a drop in the bucket of anti-natal and delivery costs. If you can't afford an aborotion you really can't afford to have a baby.
posted by Mitheral at 10:59 AM on November 8, 2009

What I'm not understanding is the issues that usually involve insurance... e.g.
"If you read the fine print, we don't cover the spleen!"
"You had your ear canal irrigated 24 years ago, sorry, that wax is a pre-existing condition, so no payment for your ruptured ear drum!"
"Sorry, with this chemotherapy you've used up $500,000 in benefits... no more money from us!"
Does this legislation do anything to fix these issues? I have insurance myself but am very distrustful it will be usable when I really need it.
posted by crapmatic at 11:00 AM on November 8, 2009 [1 favorite]

Re: Nobody calling LBJ a Communist: Not LBJ, but here's integration in Little Rock, AR getting called communism. That happened under Eisenhower, but it's still social progress. I don't care what you say about Dixiecrats, but the fact is that the conservatives were against integration.

Granted, the motivating factor is race. I get the feeling that a lot of the anger is racially motivated. However, it has no place in the debate. It's near impossible to have an intelligent debate about race and racism in America, especially if one side has racist ideas and won't admit it, or if they think we're in a post-racial society and thus should be able to say whatever they want, even if it is racially insensitive. Further, it's impossible to prove if they are racist.

I hate to take the pragmatic road on such an ugly issue, but it's not going to win any votes unless it's an issue directly pertaining to race. We should stick to rational but effective arguments (like Alan Greyson's number of deaths of the uninsured in Republican districts), rather than accusing the teabaggers of racism. Besides, it's an ad hominem to call them racist and their arguments are easy to disprove on their own merits, considering most of them are conspiracy theories.
posted by mccarty.tim at 11:02 AM on November 8, 2009

Wait, if Joe Lieberman is trying to stand in the way of something, isn't that more Libernertia than Joementum? It's true a cow won't derail the healthcare train, but I imagine that train was not prepared for both a cow and the threat of a filibuster.

They can threaten all they want. It only takes 50 votes to change the senate rules. Filibuster requirements were dropped from 66 votes to 60 in 1975. It can be changed again, at any time, and the republicans nearly did so (specifically for judicial nominees) just a few years ago.

The other option is budget reconciliation. You just attach the bill to a budget bill and then it can't be filibustered.
posted by delmoi at 11:08 AM on November 8, 2009

Nobody on the Right called LBJ a Nazi when he passed the Voting Rights Act or the Great Society.

Maybe not a Nazi, but FDR, LBJ, and MLK were all accused of being socialists and communists. The more things change. . .

As a side note, I was in an historical play earlier this year about desegregation, and one of the scenes featured conservative activists with dialogue drawn directly from actual pamphlets handed out by the Council of Concerned Citizens, an anti-desegregation group active in the South in the 50's and 60's. 75% of it could have been transcribed from the Glenn Beck show--it was all about white Americans losing their country to SOCIALISM!!! It was honestly kind of chilling to read it and realize how little conservative rhetoric has changed since the days of Oxford and Little Rock.
posted by EarBucket at 11:09 AM on November 8, 2009

You can opt out of your employer-provided insurance plan and sign up for the public option if you want.
posted by mark242 at 9:44 PM on November 7 [+] [!]

Hmm, I've read a lot of the bill and the explanation on the committee site and I do not think I can do this if I'm already covered by a large employer. I would LOVE to because 2.5% of my salary is about a fifth of what my employer currently pays for my insurance and I bet I could negotiate a nice salary increase and come out way ahead.
posted by fshgrl at 11:10 AM on November 8, 2009

From Matt Yglesias:

This last group, I think, provided the House leadership with a margin of error on the vote. The leaders want to hold these seats, so are happy to let these folks vote no if their votes aren’t necessary. But it’s far from clear that a Larry Kissell or a John Adler (both from districts Obama won by five percent) actually does need to vote need to vote no in order to stay viable. Arms could be twisted in other words. Given how close the vote was in the end, it’s noteworthy that there was no real sign of nervousness from the House leadership all day—they had this in the bag.

posted by delmoi at 11:11 AM on November 8, 2009

If you actually have zero income (or, typically, make less than around $900 per month), you are right now eligible for gov't subsidized health care (probably Medicaid, may vary due to your state and age).

In Florida, a non-disabled, non-pregnant, non-dialysis-needing person older than 17 and younger than 65 is eligible for charity, emergency rooms, and crappy walk-in clinics that charge on a sliding scale and employ nurses who (hand to God) do not wash their hands.

Florida is more terrible than most states, but still, you'd be amazed.
posted by molybdenumblue at 11:19 AM on November 8, 2009

I would be surprised if most existing insurance plans didn't cover abortion. The procedure costs a lot less than birth. I can't imagine the insurance companies actually give a shit about the ethics/politics of abortion. (Are there Catholic HMOs?)
posted by ryanrs at 11:21 AM on November 8, 2009 [1 favorite]

"please note that we're *ALREADY* in a country where most insurers do not cover the cost of abortions"?

Yeah, umm, you're totally fucking wrong.

Actually, no.

While I agree that a majority of insurers do offer *some* abortion coverage, most either do not fully cover elective abortions, or they cover them with significant restrictions and fees. The article you cited talks only about "medically necessary" abortions.

A more accurate statement of the current situation out there comes from the National Abortion Federation, that says "Almost two-thirds of insurance companies cover elective abortion to some degree." That rate is about 57% for HMOs.

The problem is that much of this coverage is significantly restricted, especially as regards elective abortions. Some do not cover elective abortions. Some allow abortions for the first three months, some for four. Some only one per lifetime. Some are even directly restricted by state laws.

And pretty much all of them charge more than before, either in terms of a co-pay, or a percentage. The fact is that it's the private insurers and their medical centers -- and not the family planning clinics -- that are experiencing the most rapid increase in costs.

Case in point: Here's an article citing data from 2003 that says:
"Women getting an abortion between six and ten weeks' gestation can expect to pay about $350 at an abortion clinic and $500 at a physician's office." That's about a 40+% hike for an insurer's in-system medical offices, as opposed to an abortion clinic -- which means that if you are paying a significant percentage of the cost, your expenses can be as much as paying full-price to get the procedure done in a clinic.

The fact is, things have gotten significantly worse since 2003. Planned Parenthood now states:
"Nationwide, the cost at health centers ranges from about $350 to $900 for abortion in the first trimester. . . Costs vary depending on how long you've been pregnant and where you go. Hospitals generally cost more." That high end cost is born disproportionately by those with private insurance, though a friend of mine who works at a Planned Parenthood recently mentioned that they are closing clinics due to budget cuts, and are referring more patients to physicians offices or hospitals.

I've heard stories of people who were "insured" who went to PP instead because it saved them both time and money. In some cases, they're able to get their insurer to pay a lesser percentage by going out-of-system and save money rather than doing it through the insurer themselves. (Not hard to imagine when you get places charging up to $900 otherwise. )

Here's a good example... This Aetna POS+ policy -- one that I used to have, actually -- pays 40% for out-of-system voluntary abortions. And the thing is, Aetna's POS+ coverage for family planning is pretty damn good, compared to many other insurers. So much so that they get flak for it, and boycotted by religious groups.

It's pretty standard for insurers like Blue Cross to restrict coverage to the first 16 weeks, for example. (The last link also shows insurers offering coverage "only if medically necessary", "only one per lifetime", and "only up to 12 weeks".

There's also a whole class of places that provide very llimited coverage. Current law prohibits any of the over 250 private health plans that participate in the Federal Employees Health Benefits (FEHB) program from paying for elective abortions, because these plans receive federal subsidies. These private plans cover over 8 million federal employees and dependents, including members of Congress.

- Nothing in federal law prohibits states from using their own tax dollars to pay for elective abortions for their various health plans, or for their employees. But of all the various state programs out there, only 17 states pay for elective abortions. Again, millions of employees aren't covered.

So in actuality, most insurers really don't cover the cost of abortions... especially for ones which aren't medically necessary, to the point that even poor recipients of the government insurance plan could get coverage for abortions that is every bit as good as what many people pay for every day.
posted by markkraft at 11:26 AM on November 8, 2009 [1 favorite]

I can't believe the weird hangup with abortion. It seriously makes the liberal side look like idiots, and kinda creepy ones at that. If this ends up wrecking health care reform it'll be our own fault.

I fully support every woman's right to have a safe, legal abortion.

I also fully support every person's right to have safe, legal teeth whitening.

In both of these cases, I don't think it's reasonable to use insurance to cover the procedure unless they're medically necessary (and I would include 'if the pregnancy was the result of rape or incest or something else horrible' in my definition of medically necessary). Getting an abortion just because you feel like it, and/or because you didn't take the most basic family planning steps, is not something that your insurance pool should have to take the hit for, any more than they should have to take the hit because I want a nosejob.
posted by mullingitover at 11:29 AM on November 8, 2009 [3 favorites]

For what it's worth. Both medicare and social security where big disappointments for progressives when those programs first passed, over the years both programs have been modified significantly. I kind of see this whole fight this year as getting the framework in place to allow further changes in the future. If we get even a weak PO in place then changing it and making it stronger in future years is going to be a lot easier than trying to create it whole-cloth. I suspect the Republicans realize this and is why they are fighting the current incremental changes so vociferously. I am also hoping this anti-abortion crap gets stripped out in reconciliation.

I wish three had been as much debate about the creation of the DHS.

And Lieberman needs to be kicked in the nuts.
posted by edgeways at 11:30 AM on November 8, 2009 [4 favorites]

Nobody on the Right called LBJ a Nazi when he passed the Voting Rights Act or the Great Society.Nobody back then had the internet, where any idiot can have an opinion that's heard by millions across the globe.To suggest that intolerance is higher now than back in LBJ's era is unbelievably insulting to our collective intelligence.

Please point out where I said that.

I'm saying that a huge aspect of the opposition to Obama is racial. In the 1960's, they weren't as evilly vehement.
posted by Ironmouth at 11:36 AM on November 8, 2009 [1 favorite]

So, mullingitover should the lady take the hit if the dude's condom breaks, or the "basic family planning" goes awry or she has been pressured into it (not really "rape" but borderline), or..... See the problem is, imo, abortion is LEGAL, and there are plenty of valid circumstances that fall between your "medically necessary" and "because they just feel like it". Unlike a nose job having a baby when you are not ready affects a lot more than your vanity.

How much you want to be Viagra will be covered. Men's stiffies: Yes, woman's reproductive decisions: no.
posted by edgeways at 11:38 AM on November 8, 2009 [4 favorites]

"How much you want to be Viagra will be covered. Men's stiffies: Yes, woman's reproductive decisions: no."

Nice strawman you got there.
posted by mullingitover at 11:41 AM on November 8, 2009

Let the Republicans show the Unites States, in no uncertain terms, that they are the party of divisiveness, rudeness, the obstacle to progress.

"Rep. Ed Markey (D-MA) said the Republican's 'do nothing' alternative means that the GOP now "stands for Grandstand, Oppose, and Pretend.'"*
posted by ericb at 11:47 AM on November 8, 2009

I fully support every woman's right to have a safe, legal abortion.

I also fully support every person's right to have safe, legal teeth whitening.

What breaks in a person to make them think that this is a legitimate comparison? What is damaged in a person that they think assessing these two procedures as equal, as comparable, is reasonable?
posted by Pope Guilty at 11:49 AM on November 8, 2009 [3 favorites]

"What breaks in a person to make them think that this is a legitimate comparison? What is damaged in a person that they think assessing these two procedures as equal, as comparable, is reasonable?"

Next up: ad hominem.
posted by mullingitover at 11:54 AM on November 8, 2009 [1 favorite]

>> Part of the economic stimulus (the Obama half, not the Bush half) says that you only have to pay for about 30% of your COBRA premium. It reduced our premiums from $900 to about $300. Ask your HR person, local congressperson, or maybe legal aid about it.

> I'm on it now. Don't bother, it expires at the end of the year.

WRONG. That's not the cutoff date for the subsidy, that's the cutoff date for eligible layoffs. People laid off on or before Dec 31 2009 can sign up and get nine months of benefits. The date of the layoff is what matters.
posted by ryanrs at 12:00 PM on November 8, 2009

"I fully support every woman's right to have a safe, legal abortion.

I also fully support every person's right to have safe, legal teeth whitening."

What breaks in a person to make them think that this is a legitimate comparison? What is damaged in a person that they think assessing these two procedures as equal, as comparable, is reasonable?

I think one of the reasons why this is such a controversial issue is because there aren't really any valid comparisons one can make.

To some people, abortions seem like things that can be easily be prevented by condoms and other forms of birth control. To these people, they believe that if abortion is covered under insurance then people will just be lazy and everyone will have to pay for them because girls are too lazy to use birth control.

But to other people, not having abortion covered under a government health care plan seems awful because girls will be left in awful positions, and kids will be born into unhealthy situations.

I think I can see both sides (though I'm sure I've missed some major points), and they both have good points. I don't think all abortions should be completely covered by government sponsored insurance, but I do think that there needs to be options available to make abortions attainable for women in bad circumstances. I can't think of a solution for this, and I can only hope that our politicians in congress can.
posted by kylej at 12:04 PM on November 8, 2009

I'm saying that a huge aspect of the opposition to Obama is racial. In the 1960's, they weren't as evilly vehement.

You don't think people who opposed desegregation and civil rights weren't "radical" in their opposition?
posted by delmoi at 12:04 PM on November 8, 2009

Did I miss the part in the bill about eliminating recission?
posted by rr at 12:06 PM on November 8, 2009

How much you want to be Viagra will be covered. Men's stiffies: Yes, woman's reproductive decisions: no.

Just curious. This meme crops up on metafilter a lot. It is quite obviously not a valid analogy or complaint, yet it shows up over and over again. Is the idea that it sounds clever and witty, or does anyone actually believe that correcting erectile dysfunction is somehow equivalent to getting an elective procedure?
posted by rr at 12:08 PM on November 8, 2009

kathrineg: "Part of the economic stimulus (the Obama half, not the Bush half) says that you only have to pay for about 30% of your COBRA premium. It reduced our premiums from $900 to about $300. Ask your HR person, local congressperson, or maybe legal aid about it."

I didn't phrase my message very well, I'm not on COBRA, an ex-co-worker was. He's the one with three kids. But it's nice to hear about the reduction in cost.
posted by octothorpe at 12:12 PM on November 8, 2009

Whoops, forgot about the special asterisk for abortion versus, let's say, every other legal medical procedure in existence. Funny, I could go to my insurance-covered doctor for a checkup or prescription "because I felt like it" without needing you to sign a permission slip.

Insurance does not cover all legal medical procedures or even the same procedure depending on the context.

There is a huge difference between, say, insurance covering breast implants for women who are getting reconstructive surgery following cancer and covering them for cosmetic reasons. Or a nose reconstruction following cancer or violence vs. a cosmetic nose job?

Should it be required by law that insurance cover the latter just because it covers the former?

There are many games played around abortion -- the late term abortion discussions of the 90s were a farce because the definition of "medically necessary" was stretched to include things like emotional state thereby guaranteeing that pretty much that the procedure would always be available except where there are no practitioners (which is a real issue).

And it's not like the less consistent parts of the pro-choice crowd aren't pretty weird about it themselves -- in general, there is fairly strong opposition to abortion for sex selection, for example.

The "punish the sluts" strawman is simply that. [Note: I support abortion under _all_ conditions for _any_ purpose, so don't bother with the pro-life-whackjob approach]
posted by rr at 12:16 PM on November 8, 2009 [2 favorites]

rr: Did I miss the part in the bill about eliminating recission?

I don't know, did you? H.R. 3962 Sec. 103. Ending health insurance rescission abuse:

`(f) Rescission- A health insurance issuer may rescind group health insurance coverage only upon clear and convincing evidence of fraud described in subsection (b)(2), under procedures that provide for independent, external third-party review.'.

Sec. 212. Guaranteed issue and renewal for insured plans and prohibiting rescissions:

The requirements of sections [...] of the Public Health Service Act, relating to guaranteed availability and renewability of health insurance coverage, shall apply to individuals and employers in all individual and group health insurance coverage, whether offered to individuals or employers through the Health Insurance Exchange, through any employment-based health plan, or otherwise, in the same manner as such sections apply to employers and health insurance coverage offered in the small group market, except that such section 2712(b)(1) shall apply only if, before nonrenewal or discontinuation of coverage, the issuer has provided the enrollee with notice of nonpayment of premiums and there is a grace period during which the enrollee has an opportunity to correct such nonpayment. Rescissions of such coverage shall be prohibited except in cases of fraud as defined in section 2712(b)(2) of such Act.

(emphasis mine)
posted by teraflop at 12:21 PM on November 8, 2009 [1 favorite]

or does anyone actually believe that correcting erectile dysfunction is somehow equivalent to getting an elective procedure?

Um, and correcting erectile dysfunction is NOT elective how.....? IANAD, but I don't believe that the inability to achieve an erection could threaten a male's life or impact the quality of his family's life in the same way as an unexpected pregnancy. To amplify, say a woman's method of birth control fails, or she is raped, and she has been advised against getting pregnant by her physician due to health concerns. Or she can't afford another child (both the medical costs, even after what Medicaid covers, and the clothes and food) without cutting back on the food and clothing of her existing children. Oh well, too bad, if you can't afford an abortion then your tough luck because insurance surely isn't going to pay for it. However, if a man has problems in the boudoir department and he has adequate insurance coverage, that's another story. He can get a prescription for Viagra for a few bucks and restore his precious manhood. Not that that's elective or anything...not that his existing children might have to subsist on government cheese because Dad can't get a stiffy....
posted by Oriole Adams at 12:23 PM on November 8, 2009 [2 favorites]

rr- because no one gets on the floor of Congress or an internet message board and says "how DARE men demand that insurance pay for giving them more erections! What if someone gets PREGNANT? Why aren't MEN making the appropriate decisions about family planning?"

I repeat: it's about shaming women. "You should make better decisions" means "I don't want to pay because you fuck too much." And no one ever says that about medical issues for men who, quite frankly, want a certain medication to do only and just that.

Like I said in a previous comment, there's really no other medical condition that can be related to abortion. This includes erectile dysfunction. They are not related at all except that they are both related to sex.

So can we please stop comparing them and being outraged that one is provided by insurance and one isn't.
posted by kylej at 12:24 PM on November 8, 2009

rr- because no one gets on the floor of Congress or an internet message board and says "how DARE men demand that insurance pay for giving them more erections! What if someone gets PREGNANT? Why aren't MEN making the appropriate decisions about family planning?"

If the proposal was to pay for viagra for use as a party drug for people who do not otherwise have ED, people would be doing exactly that.

You know what is closely analogous to viagra for me? Women with orgasmic dysfunction and age-related mood issues. Like HRT, despite recent issues, which has been covered by insurance FOR EVER.

The abortion thing may or may not be about shaming women (though perhaps they _should_ be making better decisions, if you're actually opposed to that I find it insane since that is the basis of all sex education) but it has zero to do with viagra.
posted by rr at 12:24 PM on November 8, 2009 [1 favorite]

XQUZYPHYR: "I repeat: it's about shaming women."

So if our shiny new universal coverage is being used to fund an abortion because the mother wanted a boy and not a girl, and we're think maybe it's not a good thing, it's because we're all about shaming women?

This is why we can't have nice things.
posted by mullingitover at 12:25 PM on November 8, 2009 [1 favorite]

I fully support every woman's right to have a safe, legal abortion.

I also fully support every person's right to have safe, legal teeth whitening.

That's a pretty ridiculous comment, right there.
posted by Blazecock Pileon at 12:27 PM on November 8, 2009

Getting an abortion just because you feel like it [..] is not something that your insurance pool should have to take the hit for

NEWSFLASH: Abortion is cheaper than childbirth.
posted by ryanrs at 12:28 PM on November 8, 2009 [9 favorites]

This was brought up farther upthread, but isn't the real threat to abortion not the Stupak amendment (which may or may not make it to any final bill that may or may not cross Obama's desk), but simple access to abortion providers in the first place?

Currently, Mississippi has the dubious honor of being the state with the lowest median per capita income and the lowest median household income. In 2000, Mississippi had fewer than 5 abortion providers state-wide. I don't imagine that number has swelled since then since more restrictive laws have been passed since 2000 and abortion providers are decreasing across the nation as a whole. Further, other low income states such as West Virginia (#49) and Kentucky (#47) have no abortion providers at all. So it seems, while cost may be prohibitive, the main issue is not cost but availability of providers.

Admittedly, this bill does nothing to improve that availability, but does it do anything to explicitly make it worse? Given low average incomes, it doesn't seem too far of a conceptual leap to assume that states like Mississippi and Kentucky will be where the most demand for the public option will arise. Women in these states already face prohibitive hurdles to obtaining abortions, so will Stupak really change this game any?

Given that it seems incredibly mean spirited, but it also seems like elective rhinoplasty to say this bill is made of fail because of Stupak. In fact, if states like Mississippi and South Dakota get their way, they'll find legal workarounds to Roe v Wade and once again criminalize abortions. Criminalized abortions leads to illegal underground abortions which leads to women dying or becoming sterile. At least with this health care bill, women in those states could get affordable "follow-up" care which could save lives and fertility. Not saying this is the best we can get, but at least that's something and it seems to be an improvement on the situation on the field.
posted by quakerjono at 12:29 PM on November 8, 2009 [1 favorite]

Um, and correcting erectile dysfunction is NOT elective how.....?

By your definition, so is correcting an inability to walk. Think it though.

I am curious though -- if the bill allowed for a maximum lifetime number of covered abortions and the limit was a small number (say, one), would you still be in opposition?

If so, what number would be acceptable to you?
posted by rr at 12:30 PM on November 8, 2009

rr- because no one gets on the floor of Congress or an internet message board and says "how DARE men demand that insurance pay for giving them more erections! What if someone gets PREGNANT? Why aren't MEN making the appropriate decisions about family planning?"

You're a smart guy, XQUZYPHYR, but sometimes, you really make me wonder... How much of Viagra's ability to get covered by insurance has to do with "men ruling the world and punishing sluts" and how much has to do with big PHARMA being a HUGE contributor to various politicians' campaigns?

I don't think you know the answer to that question, and yet you have no trouble trotting out this strawman, which undermines any credibility you have. Abortions don't make drug companies rich - and are far more a political landmine than just giving dudes stiffies. I think your passion regarding this issue really prevents you from questioning some basic assumptions.
posted by SeizeTheDay at 12:30 PM on November 8, 2009 [2 favorites]

@teraflop, thanks for the pointer. I appear to be having PDF searching issues. I suspect the insurance companies will find a way around this, because they are scum, but it's good that it is there.
posted by rr at 12:32 PM on November 8, 2009

""Nice strawman you got there."
posted by mullingitover at 2:41 PM
posted by XQUZYPHYR at 12:30 PM on November 8 [+] [!] "

What strawman? Did you abandon your support for coverage of elective abortions sometime in the past couple minutes?
posted by mullingitover at 12:34 PM on November 8, 2009

Stupak/Smith at al will likely be watered down in conference. All three committee heads in the House refused to a dare by Boehner to support Stupak in committee.
I'm pro-choice and against public funding of abortions. *BUT* politicians should not fuck with affordability credits in the exchange, nor should they exclude private plans that offer abortion coverage in the exchange. Don't waste your time italicizing people in your carefully crafted ripostes; instead get on your senator's case (ex DC you have two) and push hard for your convictions.
posted by nj_subgenius at 12:36 PM on November 8, 2009 [2 favorites]

I would certainly hope you are right and I'm wrong on the COBRA issue, but right now my invoices switch to full payment in January and your interpretation is contrary to that of my (former) HR rep.

Ok, I just re-read my COBRA documents. I thought the wording was clear, but now I see there's some ambiguity. Fuck.
posted by ryanrs at 12:38 PM on November 8, 2009

...support Stupak in conference...sorry
posted by nj_subgenius at 12:40 PM on November 8, 2009

Don't waste your time italicizing people in your carefully crafted ripostes; instead get on your senator's case (ex DC you have two) and push hard for your convictions.

This times a thousand.
posted by kylej at 12:41 PM on November 8, 2009 [4 favorites]

Stupak/Smith at al will likely be watered down in conference. All three committee heads in the House refused to a dare by Boehner to support Stupak in committee.

It seems very unlikely that the coverage will exceed that of Medicaid.

(Aside: I am quite surprised how expensive mifepristone is, it is comparable to a surgical abortion.)
posted by rr at 12:41 PM on November 8, 2009

Supporters of gay rights have long been trying to change the tax treatment of health benefits provided by employers to the domestic partners of their employees. In effect, such benefits are now treated as taxable income for the employee, and the employer may owe payroll taxes on their fair-market value.

Under the bill, such benefits would be tax-free, just like health benefits provided to the family of an employee married to a person of the opposite sex.

Representative Jim McDermott, Democrat of Washington, who proposed the change, said it would “correct a longstanding injustice, end a blatant inequity in the tax code and help make health care coverage more affordable for more Americans.”
posted by Blazecock Pileon at 12:43 PM on November 8, 2009

ryanrs: "NEWSFLASH: Abortion is cheaper than childbirth."

I said I supported every woman's right to have one. I did not say I thought it was a good idea to get them just because it'll save an insurance pool a few bucks. I guess this might be the line between pro-choice and actual pro-abortion.
posted by mullingitover at 12:44 PM on November 8, 2009 [2 favorites]

So if our shiny new universal coverage is being used to fund an abortion because the mother wanted a boy and not a girl...

I heard on the radio that married gays will take turns indoctrinating children with the homosexual lifestyle in public schools.
posted by Blazecock Pileon at 12:45 PM on November 8, 2009

rr: Did I miss the part in the bill about eliminating recission?

Yes you did. From SEC. 103. ENDING HEALTH INSURANCE RESCISSION ABUSE.

"A health insurance issuer may rescind group health insurance coverage only upon clear and
convincing evidence of fraud described in subsection (b)(2), under procedures that provide for independent, external third-party review.’’

Just open H.R 3962, search for "rescission." It really isn't that hard (although it helps if you spell it correctly). You should try it. It takes all of about 30 seconds.
posted by JackFlash at 12:45 PM on November 8, 2009 [1 favorite]

To some people, abortions seem like things that can be easily be prevented by condoms and other forms of birth control.

That might be because 45% of those getting abortions were non-coerced and simply not using contraception: cite (yes, crappy site, but Alan Guttmacher Institute is not anti-abortion). It's not an entirely wrong position.
posted by rr at 12:45 PM on November 8, 2009 [1 favorite]

You want to start an argument on the difference between the ease of approval for Viagra and the ease of approval for contraceptive and abortive medication in the United States? Be my guest.

But it has nothing to do with erections or Viagra. How about abortive medication X vs. some random painkiller?

The fixation on viagra is truly bizarre.
posted by rr at 12:48 PM on November 8, 2009 [2 favorites]

BP: "I heard on the radio that married gays will take turns indoctrinating children with the homosexual lifestyle in public schools."

Oh snap. You got me there. Sex selection abortions couldn't possibly happen here.
posted by mullingitover at 12:53 PM on November 8, 2009 [1 favorite]

Sex selection abortions couldn't possibly happen here.

Asian communities have a well-known cultural bias towards male offspring, so that paper's conclusions are not too surprising. but the implication that federal funding of abortion procedures would lead primarily to sex selection is wrong, or certainly nothing that this paper is implying, in any case.
posted by Blazecock Pileon at 1:00 PM on November 8, 2009

American Spectator writer defends Joseph Cao.

And promptly gets attacked in the comments by teabaggers.

American political discourse: It's angry-mob-tastic!
posted by dw at 1:03 PM on November 8, 2009 [1 favorite]

Representative Jim McDermott, Democrat of Washington, who proposed the change, said it would “correct a longstanding injustice, end a blatant inequity in the tax code and help make health care coverage more affordable for more Americans.”

About time McDermott was useful for SOMETHING in the other Washington. Guy's been mailing it in for the last decade.
posted by dw at 1:04 PM on November 8, 2009

Interesting... I got an email from Pres. Obama / Organizing for America, signed by the President, specifically geared towards fundraising in order to help get health care passed.

(Yeah, I know, this sounds obvious... but the thing is, rarely do they ever have the President make the "ask" for fundraising, so this is a bit of a rarity.)

The basic spiel is that the money is needed for resisting insurance company FUD and funding grassroots efforts. (People can donate at
https://donate.barackobama.com/History, btw.)

And the thing is, I'm tempted to donate, as the Democrats did something really major and really could use more $$, given the relative fundraising successes by the Republicans in comparison.

... on the other hand, I have to ask myself, "What the hell has the Obama people / the DNC been doing?"

They *NEVER* put a visible fundraising goal in front of the people anymore, they never seek to raise money from X many people, and they never really use video to effectively "compelete the sale" like they used to. After such a dynamic campaign with the most campaign donors in history, it pains me to see their static, lifeless, uninspired fundraising efforts lately.

It's almost like they forgot what populism meant. Perhaps they should dump Tim Kaine and bring Dean back. At least he knew how to motivate people and raise money. I really do not know what Tim Kaine does. Does he think it's a part-time job or something? I see Howard Dean more than him... and Dean is a complete outsider nowadays.

I certainly appreciate the need -- especially now -- to do *something* to break the obvious Senate filibuster threat... and yet I see nothing. Nobody is providing a clear plan... a window of hope... anything that would really inspire Americans to hope that there's a solution to the gridlock.

If anyone is going to donate/buy influence, I would certainly rather see it be the voters than the healthcare lobbyists. Really, if anything could win over Lieberman's votes, it would be promises of a big pile of DNC money. Likewise, if you wanted one of the Maine Republican Senators to defect, it might help to have a big wad of money to bribe them with... combined with Joe Lieberman's committee seats.

So I can see the strong rationale; I just don't see the heart.

Don't they want our money anymore?!
posted by markkraft at 1:05 PM on November 8, 2009 [1 favorite]

>> NEWSFLASH: Abortion is cheaper than childbirth.

> I said I supported every woman's right to have one. I did not say I thought it was a good idea to get them just because it'll save an insurance pool a few bucks. I guess this might be the line between pro-choice and actual pro-abortion.

Uh-huh. You argued that abortions shouldn't be covered because they cost you money. But abortions yield a net savings for the insurance pool. Therefore you cannot oppose abortion coverage for financial cost-saving reasons. I'm afraid you'll have to think up some other reason to block access to abortion.
posted by ryanrs at 1:07 PM on November 8, 2009 [9 favorites]

BP: "but the implication that federal funding of abortion procedures would lead primarily to sex selection is wrong, or certainly nothing that this paper is implying, in any case."

The paper wasn't really related to the health care debate, it's just an analysis based on census numbers. But regardless, you're right, the public funding would be used for so much more than just sex selection abortions. Many more, as cited above, would be cases of willful negligence where the couple simply did absolutely no family planning whatsoever.
posted by mullingitover at 1:10 PM on November 8, 2009

I'm afraid you'll have to think up some other reason to block access to abortion.

On non-preview, I see you already have: sex-selective abortions of girls. Points for novelty, I guess.
posted by ryanrs at 1:14 PM on November 8, 2009 [1 favorite]

ryanrs: "Uh-huh. You argued that abortions shouldn't be covered because they cost you money. But abortions yield a net savings for the insurance pool. Therefore you cannot oppose abortion coverage for financial cost-saving reasons. I'm afraid you'll have to think up some other reason to block access to abortion."

Actually, I don't personally mind if elective abortions are covered. Heck, you guys can even abort for sex selection if that's what you want. I just don't want progress over real health care reform to be derailed because we're demanding (what the opposition can easily convince their side is) free abortions for all.
posted by mullingitover at 1:16 PM on November 8, 2009

Uh-huh. You argued that abortions shouldn't be covered because they cost you money. But abortions yield a net savings for the insurance pool. Therefore you cannot oppose abortion coverage for financial cost-saving reasons. I'm afraid you'll have to think up some other reason to block access to abortion.

One could argue that if the government provided funds for abortion, then people would be lazier in their use of contraception, causing abortions that would not have been previously necessary.
posted by kylej at 1:17 PM on November 8, 2009

Many more, as cited above, would be cases of willful negligence where the couple simply did absolutely no family planning whatsoever.

I don't get the idea behind withholding health care (such as an abortion procedure) as punishment. The Calvinist approach to health care seems fairly barbaric, to me, bordering on superstitious and irrational.

We don't withhold care from people who eat poor diets, for example. Do you also propose eliminating coverage for people who are obese from overeating? That seems like a good punishment for willfully poor decision making, right?
posted by Blazecock Pileon at 1:18 PM on November 8, 2009 [3 favorites]

One could argue that if the government provided funds for abortion, then people would be lazier in their use of contraception, causing abortions that would not have been previously necessary.

I guess we'd better cover birth control pills and vasectomies, too. Ta-daa, problem solved!
posted by ryanrs at 1:24 PM on November 8, 2009

BP: "I don't get the idea behind withholding health care (such as an abortion procedure) as punishment."

I don't get the idea behind withholding health care (such as my rhinoplasty and teeth whitening, for my large nose and stained teeth have caused me such emotional distress) as punishment either.

See what I did there?

Folks, I don't have a problem with elective coverage for abortions in the bill, but so help me god if this is what kills health care reform we should all be ashamed. I don't believe in the argument above, but that's what the opposition can use against us, and worse. Taking a hard line in this debate is not helpful.
posted by mullingitover at 1:29 PM on November 8, 2009

See what I did there?

I did. You turned abortion into cosmetic surgery. Which, again, is a ridiculous thing to say.
posted by Blazecock Pileon at 1:32 PM on November 8, 2009 [1 favorite]

Concern trolling isn't helpful either, mullingitover.
posted by ryanrs at 1:33 PM on November 8, 2009 [1 favorite]

One could argue that if the government provided funds for abortion, then people would be lazier in their use of contraception, causing abortions that would not have been previously necessary.

One could also craft any argument they like, too. Watch: "If the government provided funds for abortion, OB/GYN specialization will skyrocket in med school." See, it's fun!

That is seriously some unfounded logic that implies the deterrent to abortion is monetary cost, not the general ickiness of the subject. Not to mention wildly speculative. You are making a basic welfare queen argument, straight outta 1986.
posted by butterstick at 1:35 PM on November 8, 2009

One could also craft any argument they like, too. Watch: "If the government provided funds for abortion, OB/GYN specialization will skyrocket in med school." See, it's fun!

That is seriously some unfounded logic that implies the deterrent to abortion is monetary cost, not the general ickiness of the subject. Not to mention wildly speculative. You are making a basic welfare queen argument, straight outta 1986.

I was just playing devil's advocate.
posted by kylej at 1:41 PM on November 8, 2009

BP: "You turned abortion into cosmetic surgery."

That's true, in some cases (eg the sex selection abortions) it does a disservice to cosmetic surgery. It's equally ridiculous to put elective abortions in the same class as 'health care,' which implies they're needed for good health, when in so many cases they're for convenience or vanity. I already stated that for cases of medical or psychiatric necessity, of course they should be funded, and I don't think the other side has any ground to stand on there.

Everything's not black and white. Concern trolling? I'm concerned with health care reform. If you're less concerned with health care reform than with guaranteeing taxpayer-funded abortions for anyone with a whim to terminate their pregnancy, maybe start a new thread on this topic?
posted by mullingitover at 1:43 PM on November 8, 2009

The opposition to abortions on a cost basis is ridiculous. Abortions and birth control are a huge cost savings — why is why the majority private health insurance plans cover them, except where it's been legally prohibited. (The 12 states which prohibit private coverage of abortions except under a separate rider bring the overall private coverage of abortion services down to just under half the covered population.)

Birth control, even for a long period, or an abortion (with the exception of very late term ones) are staggeringly cheap compared to covering a pregnancy, and birth control or an abortion doesn't lead to another insured on the same plan.

Unfortunately, the side effect of pushing healthcare into the government domain is that while an insurance company can pretty much be expected to act in whatever way — good or bad — benefits the bottom line the most, Congress doesn't have to. And per Maher v. Roe, they are free to make "a value judgment favoring childbirth over abortion," no matter how much that may cost everyone else, or how negative the consequences may be for the women involved.

The entire thing is shameful and I think it will turn out to be a hugely regrettable Faustian bargain.
posted by Kadin2048 at 1:45 PM on November 8, 2009

when in so many cases they're for convenience or vanity

Vanity? I have never heard of anyone getting an abortion out of vanity. Are you for real?
posted by Blazecock Pileon at 1:47 PM on November 8, 2009 [1 favorite]

I don't get the idea behind withholding health care (such as an abortion procedure) as punishment.

The idea is not punishment. That is a very shallow, unfair reading that is the product of the typical knee jerk response (the same one that gives rise to VIAGRA!! STIFFIES!!).

The general problem is that creating an obligation to pay for something [i.e., subsidizing a behavior] without creating a disincentive for it is a bad practice.

I do not want to sign up to pay for X unless one of two things happens -- either X is a significant savings over the current situation (which is why I support universal care -- real universal care, not this payola-to-the-health-insurance-industry) or people are motivated to not to expand their use of X in response to the subsidy.

I don't think abortion is even remotely the biggest issue of this sort. There are many things which are much larger problems -- coverage of anti-depressants (which have been shown repeatedly to be a rather ineffective, expensive and polluting placebo for most people after the use during an initial crisis), for example is by itself a much larger cost than if every single abortion was paid for by the USG.

(Despite being a participant, far more pro-abortion) I think the discussion on abortion is a distraction -- my guess is that it is primarily faux outrage [on both sides].
posted by rr at 1:53 PM on November 8, 2009

lalex: "a whim? really? Are you under the impression that a significant number of women give abortions the same level of thought they might give an impulse shoe purchase?"

No, I'm under the impression that a number of terminated pregnancies happen because people whimsically fail to use any birth control at all, a level of impulse control much lower than tending toward a whimsical shoe purchase.

BP: "Vanity? I have never heard of anyone getting an abortion out of vanity. Are you for real?"

Maybe we live in different worlds, but in my world not every pregnancy is greeted with enthusiasm and support from friends and family. The vanity motivator is one of maintaining one's social standing.
posted by mullingitover at 2:08 PM on November 8, 2009

I just don't want progress over real health care reform to be derailed because we're demanding (what the opposition can easily convince their side is) free abortions for all.

No one is demanding free abortions. We just want our INSURANCE companies to cover them. Doctors would still charge for them, no matter what....

And anyway, the "sex selection" you're talking about would be illegal under existing state laws anyway, no matter whether they're paid for by insurance or out of the family's own pocket. Currently, nearly every state only provides abortion on demand without restriction during the first trimester. During the second trimester, abortion is only legal in most states if the mother's or unborn child's health is at risk -- and most states are very, very specific when it comes to what "health at risk" actually means.

The unborn child's sex is indiscernible until the second trimester. So I can't see how anyone would legally be able to obtain a "sex selection" abortion legally under any state as it is, much less pay for it.

By the same token: personally, when contemplating the morality of abortion, I was struck by an observation someone made once: we legally determine the definition of "death" as "the cessation of brain activity," so therefore, why not define the beginning of "life" as "the beginning of brain activity". This too happens at the beginning of the second trimester -- after which there are already legal restrictions on abortion already in place in most states.

So most of the on-demand abortions in this country are being performed during the first trimester, when the unborn child has no brain activity yet -- at a time when many pregnancies also fail anyway.

Your concerns are noted, but much of what you are concerned about is already illegal, and wouldn't be affected by permitting abortion under the public insurance policy.
posted by EmpressCallipygos at 2:10 PM on November 8, 2009

No, I'm under the impression that a number of terminated pregnancies happen because people whimsically fail to use any birth control at all, a level of impulse control much lower than tending toward a whimsical shoe purchase.

OMG SHOES!

Geez, I wish I had a libido that was as easy to control as my shoe shopping.
posted by butterstick at 2:12 PM on November 8, 2009 [1 favorite]

It's equally ridiculous to put elective abortions in the same class as 'health care,' which implies they're needed for good health

It is good to know that pregnancy and childbirth never, ever have any negative health consequences that one might want to have an abortion to avoid.
posted by ROU_Xenophobe at 2:16 PM on November 8, 2009 [3 favorites]

On the local level, you can still push your own legislatures to install medical price commissions like the one in Maryland. This is the kind of thing that can actually rein in the crazy prices that make American health care so expensive.
posted by Jimmy Havok at 2:17 PM on November 8, 2009

Many more, as cited above, would be cases of willful negligence where the couple simply did absolutely no family planning whatsoever.

Why does this matter? Seriously, why does it matter? It's not the responsibility of the healthcare provider to enforce responsible behavior, it's their job to provide healthcare. There is no other medical procedure where coverage is only provided if you can prove that it's not your fault. If I break my leg, the doctor doesn't say "Welll now, this had better have been an accident, otherwise this will be very expensive for you!" No, he performs the fucking procedure. Maybe he chastises me for being stupid on my bike, but he performs the procedure and my health insurance (if I had it) covers it.

One could argue that if the government provided funds for abortion, then people would be lazier in their use of contraception, causing abortions that would not have been previously necessary.

This kind of bullshit "One could argue...." thing has no place in this debate. You're trying to make an argument without taking responsibility for it, because you know the argument makes absolutely no sense.

The notion that people have sex with the intent to "just" get an abortion (which is a very unpleasant and relatively expensive medical procedure) is utterly ridiculous. People who get pregnant accidentally do it because they weren't thinking, or because it was the heat of the moment and they were out of condoms, or because they live in a state that makes it difficult to get contraceptives, or because they received little to no sex education (abstinence-only sex-education, IOW).

It's equally ridiculous to put elective abortions in the same class as 'health care,' which implies they're needed for good health, when in so many cases they're for convenience or vanity.

Vanity? As in "Gee, if I'm pregnant, I won't look good in my bikini"? Like that? Cite.Fucking.Source.

Convenience? Being unable to afford to raise a child isn't "inconvenient", it's tragic. Being unable to provide for the child is bad for the mother and bad for the child. Being emotionally ill-equipped to raise a child is tragic, and again, is bad for both parties. You know who knows whether the woman is in one of these situations? Hint: IT ISN'T YOU!
posted by !Jim at 2:21 PM on November 8, 2009 [17 favorites]

rr, I can see the point you make here. From my perspective, withholding abortion coverage seems like punishment because abortions are a significant savings over childbirth.

It is not really apparent that withholding coverage is going to matter at all. Abortion is fairly cheap as far as things go. If coverage is a serious issue, then you are basically stating indirectly exactly what the anti-choice people are: adding coverage will increase abortions. I don't think this is an argument that the pro-choice side should be making.

IMHO "punishment" is chosen as the interpretation because it plays into the narrative about how this is all about men wanting to "punish the sluts" which makes people feel morally superior.

Do you really think that people who are opposed to abortion on moral grounds are universally about punishing women? There is a nasty undercurrent of misogyny in the anti-abortion crowd, but it is not universal. Using framing to create a virtual strawman is not an honest approach.

@floam:

People may choose to skip birth control on a whim, that doesn't mean they decided then and there to have an abortion

Really? Seriously? Because the legal interpretation of this right now if you're male is that you're consenting to have a child. Seems pretty inconsistent to not use this same reasoning when it comes to abortion when the people who are making the (pro-)abortion argument are generally the same people who are make the "don't want kids? keep it in your pants" argument in other circumstances.
posted by rr at 2:23 PM on November 8, 2009 [1 favorite]

One could also craft any argument they like, too. Watch: "If the government provided funds for abortion, OB/GYN specialization will skyrocket in med school." See, it's fun!

Wouldn't happen; the abortion provider shortage obviously isn't about funding or lack thereof. Operation Rescue and its ilk have very effectively turned the provision of abortion services into a defiant, dangerous political act. Given this, you can't blame young doctors for avoiding it; who really wants to sign up for continual harrassment of every nominally-legal sort, including the publication and re-publication of personal details (which has the not-so-implicit aim of making it convenient for lone nutjobs to carry out attacks while providing plausible deniability to the right-to-life organizations).

Until the religious extremists tire of protecting the unborn, abortions will continue to be difficult to get in this country, due to problems on the supply side (not enough doctors who want to get screamed at and wear bulletproof vests all the time) AND the demand side (lower-income women unable to access services due to non-covered costs, minors unable to access services due to notification requirements, etc).
posted by killdevil at 2:24 PM on November 8, 2009

the people who are making the (pro-)abortion argument are generally the same people who are make the "don't want kids? keep it in your pants" argument in other circumstances.

I don't believe this is the case. Usually pro-choice people are FOR better sex education, while people who are anti-abortion are for abstinence-only sex education.

Really? Seriously? Because the legal interpretation of this right now if you're male is that you're consenting to have a child

Who in this thread is arguing that this interpretation is something they agree with?
posted by !Jim at 2:28 PM on November 8, 2009

Can someone explain the 4% to me?

I mean, if you can't to afford insurance, the government will (effectively) buy you some.
If you are covered by your employer, you continue to be covered by your employer.
If you are over 65, Medicare is your friend.

So who is the 4%? Are they expecting that many people to pay the "no health care tax"?
posted by madajb at 2:33 PM on November 8, 2009

mccarty.tim As a moderate on the issue of abortion (meaning I don't like the practice, but I do think it should be safe and legal to keep people from getting clandestine procedures done that endanger the life of the patient)

That describes the pro-choice position perfectly.

floam I'm not only for free abortions for all, I think we should pay people to have them. Or best, pay for them to get their tubes tied and vasectomies.

The Idiocracy Principle doesn't actually work. Heritability of IQ (and IQ is only one measure of intelligence, itself controversial) isn't high, and generationally intelligence (and all other characteristics) will tend towards the group mean. In any case there really isn't a huge difference between "dumb human" and "smart human" in terms of mental processing speed, mental processing power, memory capacity and reliability, etc. The overwhelming majority of people who are stupid, are stupid for environmental and cultural reasons. They've simply never needed to learn to not be stupid. It's not required for them to live vaguely successful lives.

mullingitover It's equally ridiculous to put elective abortions in the same class as 'health care,' which implies they're needed for good health, when in so many cases they're for convenience or vanity.

There isn't a bright dividing line between "elective" and "required" except in the case of life-or-death procedures. In theory anything that you could live without, however horrible your life (a somewhat subjective judgment itself), is "elective". Only we as patients know for sure and we're quite capable of deceiving ourselves as to our motives. The greyness of the area should, in my opinion, reflect the level of subsidy, and very few things are so completely elective as to deserve no subsidy at all: and in those cases I would question whether they ought to be allowed at all, if they in any way deprive other people of more essential treatment and do nothing to advance medical knowledge.

Impotence, for example, isn't very darkly grey. It strongly aggravates depression and anxiety. I believe that pervasive depression and anxiety are far, far more of a problem to the US society and economy than obesity and smoking together (which interrelate with depression and anxiety; reduce those, and obesity and smoking rates would drop). I'm fine with Viagra being subsidized in the same way and for the same reason as any other anti-depressant or social-functionality-improving medication: anything that so directly improves human happiness and productivity ought to be subsidized very highly. I would argue 80-100%, the higher end to younger men. On the other hand, a genuine medical diagnosis of impotence, and psychotherapeutic treatment, should be required to get that subsidy.

Abortion really isn't comparable and "electivity" is a barely applicable concept to it. The normal outcome of a pregnancy, as others have pointed out, is a new human being. Making that human being into a productive, happy member of society, and useful participant in the economy and other forms of social discourse ought to be a high priority. The concept of abortion (or pregnancy and childbirth) as in any way "elective" comes from social rejection of pervasive responsibility for children, the pushing off of responsibility for children as completely as possible onto their parents alone, in particular onto their mother.

I don't like abortion any more than the most vehement pro-life protesters do; unlike them, I recognize it as necessary in an environment where, in order to raise a child, that child's individual parents (and in particular the mother) must personally go to enormous trouble with minimal social support. The problem isn't that an abortion is necessary to preserve the potential mother's "place in the world" (her schooling, career, relationship, etc), the problem is that the potential mother's place in the world is in danger because of her pregancy.
posted by aeschenkarnos at 2:36 PM on November 8, 2009 [2 favorites]

Some of that 4% is probably illegal immigrants.
posted by oaf at 2:38 PM on November 8, 2009

Basic question about how a bill is made into a law. I'm not finding the answer anywhere:

Let's say the Senate overcomes the filibuster and gets their 60 votes. Then it goes to committee, and the bill is modified.

When it goes back to the House and Senate for a vote, does the Senate need 51 votes, or do they have to invoke cloture by wrangling 60 votes?

Because if they just need 51 votes, I'm hopeful. If they need to get back to 60 votes, I'm not. At all.
posted by jragon at 2:39 PM on November 8, 2009

Many more, as cited above, would be cases of willful negligence where the couple simply did absolutely no family planning whatsoever.

Do you also favor withholding coverage of heart bypass operations for patients who simply did not eat a healthy diet or do any exercise whatsoever?
posted by EmpressCallipygos at 2:40 PM on November 8, 2009 [5 favorites]

Back during the campaign, there was an article in Time that compared Obama's style of gambling with McCain's style. Obama is a slow cautious poker player who doesn't win big, but he wins consistently. He looks at his cards and his opponents and decides what can be done and does it. McCain, on the other hand is a craps player who regularly goes to Vegas and drops big money on the table. He bets big and stupid because he likes the thrill of winning a long shot, even if it means losing more than he wins.

Obama is playing the legislative game exactly the same way he plays poker. He's racking up a steady stream of small wins. But that makes people who want a big spectacular win impatient, even if losing that bet could hurt us all badly, as happened with Clinton's big bet on health care. This bill is a potential small win that can be leveraged into larger wins down the line.

For example, there are things that can be done now to extend the effect of this version of universal care. One is to extend Medicare to cover children and students. We could also reduce the age of eligibility. These are things that the insurance companies would be glad to sign on to, since they would take high-cost cohorts out of their arena of responsibility. A gradual stripping away of customers could slowly boil the frog until we no longer have to give 30% of our health care dollars to a parasitic bureaucracy.
posted by Jimmy Havok at 2:40 PM on November 8, 2009 [11 favorites]

Do you also favor withholding coverage of heart bypass operations for patients who simply did not eat a healthy diet or do any exercise whatsoever?

We do withhold liver transplants for not dissimilar reasons.
posted by rr at 2:48 PM on November 8, 2009

Do you also favor withholding coverage of heart bypass operations for patients who simply did not eat a healthy diet or do any exercise whatsoever?

We do withhold liver transplants for not dissimilar reasons.

That's an issue of resource allocation. If there are 20 livers available for 200 people, you want to give them to the 20 people most likely to have the best outcomes. Withholding the liver is not punishment for bad behavior, nor a way to enforce someone's moral values. Abortions are heart bypass operations are not finite resources.
posted by !Jim at 2:53 PM on November 8, 2009 [4 favorites]

Who in this thread is arguing that this interpretation is something they agree with?

You've been around metafilter long enough to have encountered at least one thread where the consensus answer to men on contraceptive failure is "he consented to have kids when he had sex."
posted by rr at 2:53 PM on November 8, 2009

That's an issue of resource allocation

ALL health care -- ALL of it -- is a resource allocation issue.
posted by rr at 2:54 PM on November 8, 2009

I don't get the idea behind withholding health care (such as an abortion procedure) as punishment. The Calvinist approach to health care seems fairly barbaric, to me, bordering on superstitious and irrational.

It's not Calvinist. It's a moral hazard approach. That is, elective abortions provide a certain level of insurance against the unwanted pregnancy, giving women (and men) a willingness to engage in riskier sexual behavior than they would without abortion. Same would go for contraception.

The problem with this, of course, is that it assumes that a) people are universally rational, b) people will always know the most economically correct choice, and c) people can always choose to enter into sexual intercourse willingly (vs. being coerced into it).

Now, you can extend it outward and frame it up as religious, but at the heart what we're talking about here is if people are shielded from the consequences of their actions they will make "wrong" choices.

Funny thing is, the same people in middle America who are anti-abortion are also anti-TARP for the same reason -- the bankers who got us in this mess are shielded from the consequences of their actions, and society as a whole suffers from it.

As for abortion being cheaper than childbirth, this is true -- in the short term. In the long term, too low a birth rate puts insurance companies in the unsustainable position where very few healthy younger people are paying for the care of many sick older people. Or, what Italy and Japan are dealing with right now.
posted by dw at 2:58 PM on November 8, 2009 [1 favorite]

and society as a whole suffers from it

Let me clarify this before I get torn apart by the wolves: I mean THEY BELIEVE society as a whole suffers from it, and that goes for abortion as well. I don't agree with them on this; I think in both cases the consequences of refusing on grounds of moral hazard are worse.
posted by dw at 3:10 PM on November 8, 2009

the late term abortion discussions of the 90s were a farce because the definition of "medically necessary" was stretched to include things like emotional state thereby guaranteeing that pretty much that the procedure would always be available

WTF? FUD. Documentation, please.
posted by five fresh fish at 3:12 PM on November 8, 2009

The people in middle America who are anti-abortion believe that it is infanticide. It's not about the cost, its not about moral hazard: it's that the procedure itself is considered immoral. That does not seem hard to understand, and yet we seem to really be struggling to get that.

That's why people who are against covering elective abortions are fine with heart bypasses for obese people and all the other examples given in this thread of procedures made necessary, at least in part, by irresponsible choices. There's nothing morally problematic about heart surgery qua heart surgery, but they do feel that the abortion procedure itself is immoral. Accordingly, they are troubled by the possibility of their tax dollars going to fund murder.

I get that. I don't agree, but I get it. I feel the same way about our current military operations.

I know, this is where you all start arguing that it's really all about "punish the sluts," but you're going to have a hard time convincing me of that. I have a lot of close friends who are deeply anti-abortion, and I've never heard any reasoning from them other than that abortion is murder.
posted by Pater Aletheias at 3:16 PM on November 8, 2009 [6 favorites]

Can we please slowly raise the heat of the water around that frog metaphor until it goes away? It's starting to become the new "WAKE UP, SHEEPLE!" when it's used to describe politics or sociology. It was okay in An Inconvenient Truth, as the metaphor fit. The temperature of the Earth is rising at a rate that feels slow from the human perspective, but which is going at the rate that it will hurt the ecosystems, as life on the species scale is used to change happening on the scale of 10,000 years or so.
posted by mccarty.tim at 3:20 PM on November 8, 2009

The people in middle America who are anti-abortion believe that it is infanticide.

No, they really don't because if they did they would all be busting down the door of the local women's clinic with guns a'blazin and prepared to accept whatever consequences came their way. At least, that's what a rational human being would do if there was a local building wherein newborns were being legally butchered.

Anyway, we've had that discussion about 80,000 times here on the Blue so enough of that...
posted by Avenger at 3:21 PM on November 8, 2009 [3 favorites]

I have to agree with Pater. Most people I speak with who are pro-life strongly believe that a fetus has the same qualities as an infant, at least as far as legal rights and spiritual status are concerned. They're convinced a fetus has a soul, and develops thoughts relatively soon after gestation (think first trimester).

They consider it to be murder, which is why passions run so hot. It's not that they think people should suffer for their sinful lifestyle. That may be how some of the leaders of the pro-life movements think, but it doesn't seem to be the sentiment among the typical pro-lifer.

Granted, if you look into the neurology, it tells a different story. It's about 15 days to develop the first signs of a nervous system, and about 15 weeks for the brain to begin to function. As for the first conscious thought, some neurologists think that occurs a few weeks after birth. If you believe that the soul is first granted to a human when they have a nervous system, then there should be no controversy over Plan B. If you believe that humanity exists down to the zygote, that's a big issue, too. An embryo can split into twins and then reform into one embryo again, or two distinct embryos can combine to form a chimera. That raises theological issues if each embryo has its own soul, as souls would thus be created and destroyed/removed. And if you argue the only difference between a person and an embryo is time, that raises issues, as any copy of a person's DNA has potential to be cloned, so that interpretation could mean most cells in your body has a soul just waiting to be matured into a distinct person.

My stance is that it's wrong to kill a fetus with a well developed nervous system (think after 15 weeks), but that it should not be up to the government to decide that. The medicine and philosophy frankly aren't definitive enough IMHO to justify any certain cut off point.
posted by mccarty.tim at 3:35 PM on November 8, 2009

Now, you can extend it outward and frame it up as religious, but at the heart what we're talking about here is if people are shielded from the consequences of their actions they will make "wrong" choices.

That is the crux of the issue, but the disagreement is about what action is the 'wrong' one.

Pro-lifers seem to be more concerned about sex; pro-choice people, myself included, tend to be more concerned about unintended pregnancies.

I don't much care how much sex anyone has, as long as it doesn't result in an unintended pregnancy. If they do get pregnant, I'd much rather they get an abortion than have a child they don't want out of some misplaced sense of duty or obligation.

If restricting abortions actually resulted in fewer unintended pregnancies by making people more careful, the anti-choicers would at least have an argument. But—and I'm setting aside the many other ways in which that stance is offensive—reality doesn't work that way. We've had ample opportunity to test this hypothesis and it just doesn't pan out. The net effect of restricting abortions isn't preventing people from having unsafe sex, it's just an increase in unintended births.
posted by Kadin2048 at 3:36 PM on November 8, 2009 [2 favorites]

WTF? FUD. Documentation, please.

Come now. NARAL's stated official position is that a health exception must accompany any legislation about later term abortions. This exception must explicltly include an exception that includes any mental health problems that may occur in pregnancy.

http://www.naral.org/assets/files/Abortion-Abortion-Bans-Protecting-Womens-Health.pdf

Surely you are not going to pretend that getting a psychologist or psychiatrist to produce a conditional diagnosis of depression is going to represent a significant challenge.
posted by rr at 3:37 PM on November 8, 2009

The ones I know personally tend to be the first people who will tell you that the American system is completely fucked, and that they are prevented from doing their jobs thank to the insurance companies.

Nine years ago PBS | Frontline did a program about this with my primary care physician : Dr. Solomon's Dilemma.

"This one-hour Frontline special examines how physicians are battling over the soul of medicine. Some have regained control of managing their patients' care from HMOs and are now saddled with the very problem against which they rebelled: cutting costs by controlling care. Daily, doctors find themselves faced with the responsibility of balancing quality care against their own bottom line. The program focuses ethical dilemmas of doctors at a Harvard Medical School teaching hospital as they weigh the bottom line pressures of HMOs with their commitment to quality patient care."*

posted by ericb at 3:40 PM on November 8, 2009

No, they really don't because if they did they would all be busting down the door of the local women's clinic with guns a'blazin and prepared to accept whatever consequences came their way. At least, that's what a rational human being would do if there was a local building wherein newborns were being legally butchered.

You're right, violence is the only option if you oppose something heinous (like our involvement in Iraq, or for that matter, our support of oppressive regimes).
posted by rr at 3:42 PM on November 8, 2009 [3 favorites]

> Why are people happy about this seeming disaster?

Remember the story of the camel's nose and the tent? Even if this bill turns out to be way less than what's needed and have all sorts of other defects (more of these, one predicts, after it's reconciled with the Senate version) it's entirely reasonable to hope that it represents the camel's nose as regards public health care in the US. And that, all by itself, is worth a couple hits of happy.
posted by jfuller at 3:44 PM on November 8, 2009 [1 favorite]

Avenger, that has happened, and some fringe churches have praised people who have done it. And it's a common thing for pro-lifers to call it genocide on a larger scale than the Holocaust. Granted, that sounds awfully ignorant and disrespectful to someone who is pro-choice on many levels, but some of them actually believe that.

Of course, even though many people think (or at least say) that abortion is murder, it's clear not all of them have thought the implications through. It says a lot that they aren't saying "death penalty," "mandatory stay at a mental facility" or "life sentence at a hard minimum of 40 years with parole" or something like that. Those are what strike me as the rational answers for murder penalties.
posted by mccarty.tim at 3:52 PM on November 8, 2009 [1 favorite]

Surely you are not going to pretend that a link to NARAL's policy satisifies, in any way, fff's request for documentation

OK.

http://www.guttmacher.org/statecenter/spibs/spib_PLTA.pdf lays it out state by state. Only one state requires an independent psychiatric certification when the "mental health" exception is used.
posted by rr at 3:56 PM on November 8, 2009

I know, this is where you all start arguing that it's really all about "punish the sluts," but you're going to have a hard time convincing me of that. I have a lot of close friends who are deeply anti-abortion, and I've never heard any reasoning from them other than that abortion is murder.

But it's not as simple as "abortion is murder," or at least many people and groups who are strongly anti-abortion do not behave as if their own beliefs are as simple as "abortion is murder."

The thing is, preventing abortion is pretty much a solved problem. If you make abortion legal and safe, give your adolescents thorough and accurate sex education, and make contraceptives cheap and easy to obtain, then abortion becomes much rarer than in the US.

But yet many people and groups who strongly oppose abortion also strongly oppose thorough and accurate sex education and easy access to cheap contraception.

Which doesn't necessarily mean that they're all about PUNISH THE SLUTS, but it does and must mean any of several things, all of which have in common that their behavior is inconsistent with the simple motivation they have stated and must be something else or something more complex.

(A) They are simply ignorant about the connections between sex education, contraception, and abortion. At which point, you know that however much they say they care about preventing abortion, they do not care enough to learn what actually, empirically, really does prevent abortion in the real world.

(B) They are aware of the connection and are willing at some level to accept that their preferred scheme for sex education and contraception regulation means that more abortions will occur than otherwise because they are unwilling to accept that accurate sex education and easy access to cheap contraception might lead to higher rates of adolescents or other unmarried people having sex. In this case, you know that at best they believe teenage sex to be worse than abortion, because they are willing to live with an increase in abortion rates to "prevent" teenage sex. This does mean, though, that their claim that abortion is murder is hard to accept at face value -- if they hold to that, and are not irrational, than it must follow that they believe that teenage sex is worse than murder.

(C) They are aware of the connection and are willing at some level to accept that their preferred scheme for sex education and contraception regulation means that more abortions will occur than otherwise because it is more important to them that abortion be illegal than that it be prevented. Which would be an awfully strange way to think about something you believe is murder.

There are problems with "abortion = murder" as the actual motivation for antiabortion people and groups that go beyond their commonplace treatment of sex education and contraception. Most prominently, no prominent antiabortion activists or groups that I am aware of propose treating abortion as a hired murder. Indeed, they are usually quick to assure listeners that they do not want to punish the mother, which makes no sense at all if they believe the mother to be morally equivalent to someone who hired an assassin to kill someone.
posted by ROU_Xenophobe at 3:58 PM on November 8, 2009 [13 favorites]

Remember the story of the camel's nose and the tent?

For those not familiar: The Camel's Nose.
posted by ericb at 4:03 PM on November 8, 2009

No, they really don't because if they did they would all be busting down the door of the local women's clinic with guns a'blazin and prepared to accept whatever consequences came their way.

That's a really ridiculous argument. It's entirely possible to believe something is immoral, even equivalent to murder without wanting being compelled or willing to break the law to stop it. You don't see anti-war types out there blowing things up, does that mean they don't seriously think war is murder?

On the other hand, if they really thought abortion was murder, they would support contraception access and real sex education so that women could avoid getting pregnant. I think there's a little of both types on the anti-abortion side.
posted by delmoi at 4:07 PM on November 8, 2009 [2 favorites]

There are problems with "abortion = murder" as the actual motivation for antiabortion people and groups that go beyond their commonplace treatment of sex education and contraception. Most prominently, no prominent antiabortion activists or groups that I am aware of propose treating abortion as a hired murder. Indeed, they are usually quick to assure listeners that they do not want to punish the mother, which makes no sense at all if they believe the mother to be morally equivalent to someone who hired an assassin to kill someone.

This is a pretty good rebuttal, but you are treating the pragmatic actions being taken by these groups as bounding and defining their actual position, which is not valid.

[At least for the groups that are absolutely opposed to abortion on all grounds -- life of the mother or not -- it is morally equivalent to making seeking an abortion a capital offense.]

One other point on your reasoning is that you are assuming that they cannot simultaneously believe that contraception is wrong and and abortion is wrong. You are correct that these are somewhat in conflict, but they also (and IMHO independently) believe that pre-marital sex is wrong. To them, the conflict is resolved by this (independent) belief.

You do reason that in practice all being opposed to contraception means more abortions (since teenage pregnancy would be expected to increase) but that is not outside the bounds of their consideration: they believe pre-marital [and extra-marital, and ...] sex is wrong, their answer is that we should arrive at an _effective_ way to discourage such activity. Abstinence-only education is observably ineffective, but that's not their goal, it is a[n ineffective] vehicle.

Reality has never stopped anyone, left, right or middle from holding a position on the basis of principle.
posted by rr at 4:14 PM on November 8, 2009

I still don't see your point. Are you arguing that late-term abortions are widely available, or just theoretically possible?

I am arguing that the big debate about restricting late term abortions was a political show with zero real world consequence other than possibly adding to the shame burden. They are still obtainable and practiced in the United States and the rate doesn't seem to have changed at all, which is not surprising given that the number per year (about a thousand) represented 0.08% of all abortions in the US at the time of all the political hubbub.

(In that sense, it is not unlike the "rape or incest" argument, since those represent about 1% of abortions.)
posted by rr at 4:21 PM on November 8, 2009

But surely they can't believe that contraception is equal to murder. An argument that both contraception and abortion are equally immoral is identical to a "punish the sluts" argument.

You are drawing a false conclusion to create a strawman. There is nothing about the following two beliefs --

1. contraception is wrong

2. abortion is wrong

-- which has as its only explanation "punish the sluts." That's like saying the only explanation for being opposed to extremely high executive pay while at the same time being in favor of estate taxes is because one wants to "punish the rich."
posted by rr at 4:26 PM on November 8, 2009

Hi, anyone know where the discussion on this bill went? Cause all I can find in here is the same tired arguments about abortion.

The abortion rider is brilliant, in a way. Want to derail national discussion of the meat of the bill?Said rider pretty much guarantees it.
posted by maxwelton at 4:40 PM on November 8, 2009 [7 favorites]

The abortion rider is brilliant, in a way. Want to derail national discussion of the meat of the bill?Said rider pretty much guarantees it.

The whole abortion discussion arose because of a rant about Viagra [and getting back to that, I'm pretty sure the appeal of using viagra in these arguments comes from a sort of shaming tactic against male sexuality more than anything else -- no matter how weak the analogy is, it is appealing because it lets one poke fun at men and specifically at men who can't "get it up."]
posted by rr at 4:49 PM on November 8, 2009 [1 favorite]

I have a lot of close friends who are deeply anti-abortion, and I've never heard any reasoning from them other than that abortion is murder.

And yet do they promote actions that act to increase abortion rates?

The fact is that in countries where abortion is legal and easy to obtain, abortion rates stay about the same. The sole factor that does make a difference is access to disease and pregnancy prophylactics of one form of another and an honest, forthright education about the need to use them each and every time.

Yet do the people who want to reduce the number of "murdered" proto-people typically support full and open education? No. They typically do not support education and access to prophylactics.

They are not concerned about reducing the number of conceptions — i.e. the only factor that is shown to significantly reduce abortion rates. They reject what actually works. They go to any lengths to reject what is proven to get the results they want.

They are solely about making women bear the result of a conception to term. It has nothing to do with actually reducing abortion rates.

It's a pretty sick mindset.
posted by five fresh fish at 5:12 PM on November 8, 2009 [3 favorites]

Surely you are not going to pretend that getting a psychologist or psychiatrist to produce a conditional diagnosis of depression is going to represent a significant challenge.

Surely you know late-term abortions are no laughing matter.

So while it may be possible to do what you say, is there anyone actually doing it? Is there a real problem with women seeking to make casual use of a late term abortion operation?

Or is it about as common as the number of people who compulsively seek out tonsillectomies?

I'm thinking it probably trends very, very strongly to the latter: a problem that exists only in fevered imaginations.
posted by five fresh fish at 5:16 PM on November 8, 2009 [1 favorite]

One could argue that if the government provided funds for abortion, then people would be lazier in their use of contraception, causing abortions that would not have been previously necessary.

Only a person who has never had an abortion. It's not exactly a pleasant or painfree procedure and the recovery time is long (4-6 weeks for full functionality); little facts that seems to escape most men.
posted by fshgrl at 5:19 PM on November 8, 2009

So while it may be possible to do what you say, is there anyone actually doing it? Is there a real problem with women seeking to make casual use of a late term abortion operation?

I'm not claiming otherwise -- my whole point from the first mention of the farce around late term abortions is that they are completely rare and a distraction.
posted by rr at 5:23 PM on November 8, 2009

Okey-dokey. I must have read you wrong.
posted by five fresh fish at 5:26 PM on November 8, 2009

Only a person who has never had an abortion. It's not exactly a pleasant or painfree procedure and the recovery time is long (4-6 weeks for full functionality); little facts that seems to escape most men.

So .. they're willing to plan ahead and consider recovery time, pain from the the procedure and so on but not enough to use contraception in the first place?

I agree with you, though, if only because it would apparently be hard for people to be lazier in their use of contraception than they are today.
posted by rr at 5:35 PM on November 8, 2009

the people who are making the (pro-)abortion argument are generally the same people who are make the "don't want kids? keep it in your pants" argument in other circumstances.
I don't believe this is the case. Usually pro-choice people are FOR better sex education, while people who are anti-abortion are for abstinence-only sex education.

That's often (if unfortunately) true, but it's completely tangential to rr's argument, which I believe is that the legal standard for paternal responsibility is basically involvement in conception. This is also the cultural standard in the pro-life circles I'm familiar with.

But surely they can't believe that contraception is equal to murder.

I've never understood the idea of contraception as a moral wrong, but after reading dozens of metafilter threads on abortion, I'm coming to believe that it does create at least one problem: it leads people to expect that they have some deep right to have sex without giving any serious weight to the ethical consequences of conception.

I think it's great that we've got methods of contraception that do the job at statistically effective rates when used properly, and I think public education about this is not only vital public health issue but also vital ethically as well (as I believe delmoi implied it should be in an earlier). I think, though, that the high success rate has kindof the same effect that loosely enforced speed limits do: people begin to act as if the effective speed limit (10-15 over the legal limit) is the real limit. And they begin to calibrate their expectations that way. But the legal limit is unchanged, and the biological facts are still that sex is a mechanism for conception. If you have it with someone who is capable of conception, it is possible that your actions will cause a conception, and you are ethically responsible for a range of issues at that point, no matter what other measures you've taken to prevent it.

I recognize some of these ethical issues are subtle enough that I believe that shouldn't be the end of any choices for women who find themselves there, and in that sense, I'm pro-choice, but I'm also pro-life enough that I think even early-stage human life deserves weighty consideration and at least some measure of legal respect, and choosing not to publicly fund abortions (except for the usual exceptions) federally strikes me as a one of a number balances that respect both things.

Never wins you a lot of friends, though. I expect the CWA and others will be on about the fact that OBAMACARE FUNDS BABBY MURDER because the of the usual exceptions, while on the other hand, there will be people who are unhappy because we aren't forcing every last medical professional in the country to perform abortion free of charge, regardless of personal feelings, in the name of choice.

I wasn't being hyperbolic in my last comment. The House Healthcare bill makes abortion effectively illegal in the entire United States of America

It makes publicly-funded insurance for abortion illegal, which has been the state of things for quite some time.

The mixing of the private system and public funding that's going to come because of this only makes abortion inaccessible to the extent that it's expensive, that no one forms any kind of insurance outside the federal system specifically to cover it, or that no one who feels strongly about abortion as a choice starts a private funding initiative. My guess is that instead, there will be private insurance, there will be private initiatives, there will be some measure of people either just bearing the cost themselves, and there will be some measure of people moving away from abortion as a post-hoc method of contraception.
posted by weston at 5:36 PM on November 8, 2009 [3 favorites]

One other point on your reasoning is that you are assuming that they cannot simultaneously believe that contraception is wrong and and abortion is wrong. You are correct that these are somewhat in conflict, but they also (and IMHO independently) believe that pre-marital sex is wrong. To them, the conflict is resolved by this (independent) belief.

You're misreading my point there. Their stated preferences are cheap talk; their preferences as revealed by their behavior and choices indicate what motivations truly drive their actions.

We know that many antiabortion people and groups believe abortion is wrong, and also believe that premarital and especially teenage premarital sex is wrong.

My point is that in their actions, they reveal that they are willing to trade more abortions for, at least arguably, less teenage sex. There are a few possible ways this can be true.

One is that they are literally irrational; they take actions and make choices that they believe will fail to accomplish the goals that they hold.

Another is if they believe premarital and especially teenage premarital sex is worse than abortion.

Another is if they simply refuse to admit the connection between sex education and abortion rates, or simply insist that they prefer none of either with no known causal mechanism to achieve that goal. This last, however, is really pretty childish, and I didn't want to ascribe this to them; in the real world, there is this tradeoff, and refusing to deal with it means that they are refusing to take the subjects of abortion and sex seriously.
posted by ROU_Xenophobe at 5:49 PM on November 8, 2009 [2 favorites]

While I'm sure there are some who rant about Viagra because of the shaming tactic you mention, I think the Viagra argument is appealing to most because it's an example of men's reproductive health being given a lot of societal support while women's reproductive health is open to perpetual angry moralizing.

Totally right. Like, no insurance covers the HPV vaccine, for instance, or HRT, or pap smears, or ... Women's reproductive health is the third rail, no support for it at all.
posted by rr at 7:22 PM on November 8

I'm not saying there's no support - I'm saying it's open for moral debate in a way that men's reproductive health never seems to be. I see people saying that getting HPV vaccine will encourage promiscuity, and I've never heard anybody say that about Viagra (at least, not as a negative). It's not that there's no support for women's reproductive health - it's that we have to argue about it all the damn time.

Anyway I agree the Viagra comparison is kind of dumb and tired. I'm just saying I think it comes out of a real and justified frustration.
posted by joannemerriam at 6:17 PM on November 8, 2009 [2 favorites]

One is that they are literally irrational; they take actions and make choices that they believe will fail to accomplish the goals that they hold.

They run their lives in by some of the rules given to them by an invisible guy who lives in a sky, some of which they were released from by a talking dead guy who was his own father.
posted by rr at 6:28 PM on November 8, 2009

Anyway I agree the Viagra comparison is kind of dumb and tired.

Agreed.
posted by rr at 6:29 PM on November 8, 2009

"note the importance of the Gutmacher Institute's graf about how "current health care proposals do not affect status quo of abortion coverage-" that was, of course, before an amendment was added to the bill that essentially makes all these providers drop coverage to be in the public exchange"

Not necessarily the case at all. Insurers have many different types and variations of coverage, varying widely by state and location. It seems odd to suppose that they'd change their existing contractual obligations with employers, in order to move all of their policies onto the exchange. Rather, they'd create a couple specialized policies specifically for the exchange.

"Low income Americans tend to have higher medical costs and are less profitable, less desirable customers. Offering abortion coverage would be a simple way for an insurance company to keep them out of their risk pool."

Or, alternately, they could merely not participate in the exchange. The truth, though, is that this is capitalism... someone will go after those customers, with a product that is priced appropriately relative to the risk involved. Will the insurers want that expanded marketplace? Sure they will, if there's any money to be made.

"The "better" option is merely the aforementioned act of almost every major private insurer dropping abortion coverage to compete in the exchange."

Again, you seem to be viewing things as if these companies didn't already have a couple hundred variations of their product on the market, all adjusted for a certain niche. What's one more niche to them, so long as the product is designed to be profitable?!

"you're praising the idea that women who formerly had this service available to them"

i.e. Only those previously insured through their employer...

". . . will "merely" now have to face the same burden of poor and unemployed ones?"

No. They will have the same policy that they had before, through their employer.

If for some reason, they become unemployed, then they might find themselves with a subsidized policy that didn't cover non-medically necessary abortions, true... but that's better than paying through the nose for Cobra, which is ultimately just a temporary fix.

The bigger issue, perhaps, is whether having federal programs that don't provide full abortion benefits, encourages private insurers to cut their policies to match that offered through the govt. Medicare/Medicade kind of suggests not, however... and according to the CBO, these programs cover far more people than the new legislation.

"Bravo for delicately skipping around the point that this bill will remove abortion coverage from millions of women that previously had it."

I skipped around it, because, well... it doesn't do it.

"I'm really sick of people making the nitpick contrarian whinge about how "you're overreacting! It's not a BAN on abortion!"

Hm. I'm sorry you're tired of hearing the truth, I guess...

"Regardless of your personal opinion on what this "technically" means, the reality of Stupak's amendment is that it would effectively remove access to abortion services, by a reduction in coverage. . . "

So, it's your argument that when you give *some* abortion coverage to those who couldn't afford *any* coverage before, that's removing access?!

". . . and/or a massive increase in cost, to millions of women.

Except, of course, that the new legislation would reduce cost increases for existing plans substantially.

"The fact is that from Day Fucking One, President Obama hawked the line that "nothing in the health care bill will change the coverage you already have."

... and yet, you still haven't demonstrated that this statement is in any ways a false one.

"Millions of women have just been lied to."

You flatter yourself. Not that many people read your comments.
posted by markkraft at 6:51 PM on November 8, 2009 [1 favorite]

I leave for a few hours and this thread turns into a more civilized version of the chaos on Joseph Cao's Facebook wall.

I've never understood the passions that abortion inflames, and it is sad that this issue has the ability to derail legislation that could, on the whole, help a lot of people.
posted by reenum at 7:05 PM on November 8, 2009 [1 favorite]

Oh, and as a response to the idea that federal programs with fewer benefits might encourage private policies to follow suit, it occurs to me that there are several strong economic arguments against this idea:

1> The British example. Most of the private insurers offer policies specifically designed to expand upon the coverage levels of widespread public coverage. They get customers because they offer more.... and offering their employees more, in the way of benefits, is a good way to attract talent and increase company loyalty. This implies that the more widespread public coverage is, the more private insurers will target their services to offer more than public options, even at a higher price point.

2> The Medicare example. There are many complementary insurance programs to designed to work side-by-side with Medicare, filling in gaps and expanding coverage.... and this appears to happen pretty predictably, even for a less widespread level of coverage.

3> The "inflation drives policy cuts" model. Rapidly increasing healthcare costs have *already* led insurers to offer less coverage for more money, with increased copays, percentages paid by the consumer, or exemptions. So, when a programs comes forth which increases competition and lowers costs, decreasing the rate of inflation for healthcare, this *should* decrease the pull towards offering lowest-common-denominator levels of coverage.

Perhaps someone could suggest other factors that might tend to point the other way, but these, to me, seem to be the dominant ones. As the Democrats find ways to expand coverage over the years, more and more private insurance plans will likely find it's more feasible -- and more profitable, per customer -- to compete by offering more coverage, not less. This trend might actually help encourage public insurance policies to follow suit, as we have seen in Britain, where public plans have adopted privatized elements to improve access to service / service levels.
posted by markkraft at 7:30 PM on November 8, 2009

They run their lives in by some of the rules given to them by an invisible guy who lives in a sky, some of which they were released from by a talking dead guy who was his own father.

That might be because 45% of those getting abortions were non-coerced and simply not using contraception

How many of the later group are part of the former group? How many of the later group received the kind of education in contraceptive use that most pro-lifers support?
posted by Green With You at 7:41 PM on November 8, 2009

How many of the later group are part of the former group? How many of the later group received the kind of education in contraceptive use that most pro-lifers support?

No idea, but contraceptive use isn't exactly rocket science.
posted by rr at 7:47 PM on November 8, 2009

"contraceptive use isn't exactly rocket science."
*ahem!*
posted by markkraft at 8:01 PM on November 8, 2009

markkraft, yeah, I'm getting the impression a lot of my right wing friends believe that whatever we end up with will ultimately be used to explain even further service reductions from the private sector, ignoring that that has been the status quo for the past decade or so.

I have this theory that my fellow Americans are so very used to being bent over the barrel by their health care interactions, that the notion of changing it is scary and couldn't possibly be an improvement. Better the devil you know and all that. Every last one of them points to how much of a pain it is to deal with the citizen-facing aspects of government ("have you been to the DMV, man?"), but to be honest, in day-to-day life, my health insurer is 100 times worse.

I mean, just this past summer, my wife and I had to deal with a situation where Doctor A couldn't prescribe medical technology B because they weren't set up to order it for patients and bill for it, but Doctor Q can, how about you schedule an appointment with him and order the device (after a round of unnecessary tests that Doctor A had already performed) and we'll see if your insurer will cover it and and and 6 months later we finally have the resolution for something that would've been an afternoon's work in any sane system. (We were a couple of weeks away from just buying it outright. A simple INR home testing machine - $10 strips versus $100 hospital visits, and our insurer had to be COAXED into it. It would amortize in just about 2 years, to borrow financial lingo. It makes my head hurt.)

Preaching to the choir, I know, but how do you bridge the gap to people who have the notion that there's no way our civic organizations could possibly manage something so complex? Or even get them to ponder some of their knee jerk reactions to consider them from other angles?
posted by Kyol at 8:28 PM on November 8, 2009

(And, to answer my own hypothetical parenthetical, I actually sort of like going to the DMV here in SE Wisconsin. They're sort of scary how well they've got queue management down to an art. Dynamic window management, disparate queues by function so you (with your simple renewal) don't get stuck behind the person trying to arrange a 12 way title swap with limited documentation and a hazy recollection of everyone's name, reasonably comfortable seating, and an endless array of people to watch. And most of the annual type stuff that doesn't require a physical presence can be done online these days! We live in the future and all that. I don't seek out trips to the DMV, but it's not the nightmare some people try to make it out to be. It used to be pretty lousy in the single queue days, but we've moved on since then.)
posted by Kyol at 8:41 PM on November 8, 2009

Some thoughts:

I have heard that some insurance companies force psychotherapists to provide notes about supposedly confidential therapy sessions, so that the insurance company can decide whether or not to continue covering that round of therapy. Does the bill ban this offensive practice or will it be allowed to continue? For that matter, are insurance allowed to limit coverage on mental healthcare the way they currently do? Would, for example, only cognitive-behavioral therapy be covered? Can they limit the length of treatment?

What about dental coverage? I haven't been to a frigging dentist since the twentieth century and while I am not aware of any dental problems, it would be nice to be able to visit one and confirm that, in fact, everything is OK, and treat whatever isn't.
posted by jason's_planet at 8:48 PM on November 8, 2009

--..but how do you bridge the gap to people who have the notion that there's no way our civic organizations could possibly manage something so complex?--

Ask them what they think of Medicare perhaps.
posted by peacay at 8:57 PM on November 8, 2009

There are many things which are much larger problems -- coverage of anti-depressants (which have been shown repeatedly to be a rather ineffective, expensive and polluting placebo for most people after the use during an initial crisis)

Generic anti-depressives (zoloft, prozac generics, e.g.) are really cheap, and several with non-expired rights are no more expensive than certain widely used allergy sprays. You have no idea what you're talking about.
posted by raysmj at 8:57 PM on November 8, 2009

See, I think the Viagra vs abortion is not entirely dissimilar, despite all the omg how could you compare the two. Imo they are both about controlling aspects of sexuality and/or reproductive health. We are all very concerned about ED, Bob Dole tells us so, and without Viagra think of all those men who wouldn't be able to lead normal healthy sex lives. Yet, the procedure that gives women a high level of control over the result of healthy sex lives is so friggen controversial.

Hell, we use the same word for terminating pregnancies weather it is 2 weeks or 7 months. Up to a given point I think abortions should absolutely be unfettered and on-demand, what is the BFD about removing a few clusters of cells. As the pregnancy matures it should be more and more difficult, with increasing barriers to be overcome.
posted by edgeways at 9:05 PM on November 8, 2009

jason's_planet, I was without dental coverage for the past few years and investigated the options. It seems as though you can buy private dental insurance for reasonable prices that more or less end up costing as much per year as you would pay the dentist for a 6 month checkup/cleaning and annual x-rays anyway, but with the benefit of having some additional coverage for caps, fillings, root canals and similar less planned things. I can't speak for how much of that is smoke the marketing branch blows up your ass, though. (And if you're really in a tight place, I don't know how much 50% off a $1500 cap helps. But there's always the comfort of the pliers, I guess.)

I haven't heard anything about the currently discussed plan that would indicate it includes dental coverage, but fundamental dentistry is pretty cheap stuff to start with. (Whitening and orthodontics and stuff is a whole other ball of wax, of course..)

peacay, I don't think any of them tries to think of Medicare, to be honest. They're all (reasonably) young and (reasonably) invulnerable. To them the federales are: Cops pulling them over for speeding. Schools churning out 18 year olds who can't read. The pothole down the street that damn near took off their wheel. Etc etc etc. They don't see the broader society and all the stuff that gets taken for granted.
posted by Kyol at 9:10 PM on November 8, 2009 [2 favorites]

No idea, but contraceptive use isn't exactly rocket science.

In college, I met people who were so unaware of their own biology that they didn't think it was possible for a woman to urinate while she had in a tampon. "Why wouldn't you be able to pee with a tampon?" I asked.

"Doesn't the tampon plug up the hole?"

"....Women have TWO holes there."

"....They do?"

A lot of people do not get the "birds and bees" talk from their parents because their parents are too ashamed, too paranoid, too uncomfortable, too...something. For these people, contraceptive use IS rocket science.
posted by EmpressCallipygos at 9:13 PM on November 8, 2009 [4 favorites]

Obama is playing the legislative game exactly the same way he plays poker.

This does explain why he pissed away all the advantage he had by getting a decent majority - because politics is nothing at all like poker. In poker, the cards have no memory - it's better to make tiny wins consistently. In politics, you have "momentum" - that's there are huge movements, like Bush II and Reagan, and then long periods where not much happens.

This explains an awful lot about why Obama was such a good candidate and has so far been such a mediocre President.
posted by lupus_yonderboy at 10:04 PM on November 8, 2009 [3 favorites]

coverage of anti-depressants (which have been shown repeatedly to be a rather ineffective, expensive and polluting placebo for most people after the use during an initial crisis)

Wow, I missed this earlier, but you're way off. The new, sexy drugs are very expensive, but older drugs are now off-patent and extremely cheap. Paxil has been off-patent since 2006; Target and Wal-Mart offer it as a $4 generic. The only major depression/anxiety drugs that aren't generic are Lexapro (patent will expire in 2012) and Cymbalta (either 2010 or 2013, depending on how the courts and FDA rule). Prozac, Zoloft, and Wellbutrin are all off patent.

Bipolar prescriptions, though, are dominated by Abilify and Seroquel, and they'll be under patent through 2014 and 2011, respectively.
posted by dw at 10:27 PM on November 8, 2009

"Isn't rocket science" sounds like "ignorant people should suffer" to me. Lord knows there are many people who are not only morally opposed to informing their children fully of things sexual, they're incapable of doing it; and when the public school system also fails to inform them — it seems you feel they should be punished for those failures.

That's a pretty harsh view of the world. Real dog-eat-dog quality to it. Why would you have society not support those things that do the most to reduce harm?

By the way, your original words from our earlier exchange were

There are many games played around abortion -- the late term abortion discussions of the 90s were a farce because the definition of "medically necessary" was stretched to include things like emotional state thereby guaranteeing that pretty much that the procedure would always be available except where there are no practitioners (which is a real issue).

Which reads to me like you think medically necessary third-term/late abortions were performed for "stretched" "emotional" "games." I think my initial interpretation was indeed right, and you have not addressed my request: documentation, please. Show that this was one of "many games."
posted by five fresh fish at 10:36 PM on November 8, 2009 [2 favorites]

Oh god, seroquel the zombie drug.
posted by Justinian at 10:39 PM on November 8, 2009

This does explain why he pissed away all the advantage he had by getting a decent majority - because politics is nothing at all like poker. In poker, the cards have no memory - it's better to make tiny wins consistently.

The cards don't have a memory, but the other players certainly do. If you think you can play without keeping that in mind you're not going to do very well. Cards are important in poker but they're not the only thing. It's fundamentally a game of deception.
posted by delmoi at 11:09 PM on November 8, 2009 [2 favorites]

This explains an awful lot about why Obama was such a good candidate and has so far been such a mediocre President.

Has he been?

I mean, take away everything post-9/11 and Dubya's first year was three things: the $300 refund checks, No Child Left Behind, and Jim Jeffords handing control of the Senate to the Democrats. Until 9/11 people seriously thought he would be gone in 2004 because he was as bumbling as his father.

Clinton's first year was Somalia, the health care debacle, Zoe Baird, Don't Ask Don't Tell, and Travelgate. On the upside, though, FMLA became law (though very watered down).

George HW Bush's first year was... mostly watching everything else happen. He did manage to honor his "read my lips: no new taxes" pledge in '89, at least.

Reagan's first year: He got shot. Volcker's anti-inflation tactics at the Fed triggered the 1981-82 recession. He busted the air traffic controllers union. On the plus side, he got his tax cut plan through Congress.

Carter: The Sweater Speech. His battles with Congress began early and continued throughout '77.

Nixon figured out Vietnam in a hurry (to the chagrin of protestors), got a moon landing he didn't plan or pay for, struggled a bit with inflation, but generally had a pretty decent opening year.

JFK had the Bay of Pigs; Eisenhower had a recession six months in.

Obama so far has pushed through ARRA, which is quickly helping us identify every freakin' inefficiency in the government by not getting the money out. He's signed an expansion of SCHIP and the Matthew Shepard law. He's got a health care reform bill farther than it's ever been, even if it is a 1990 page book of compromises. Most everything else seems stalled by some combination of government inertia, White House inertia, and generally not understanding how this whole system works. Afghanistan is stalled, but Iraq seems to finally be getting its legs under itself, or at least the one leg it still has.

I'd say, all things considered, he's par for the course. I mean, the two presidents that did have good first years, Bush I and Nixon, were defeated in re-election and had to resign, respectively. The guy with the worst opening year, Clinton, ended with immense approval ratings despite the scandals around him.

I think the problem is that in the minds of progressives, Obama was going to be better than FDR, an idealist superhero. He's not. He's a Chicago-style politician, who will horse trade like crazy to get what he wants. His main problem is leaning too hard on a timid Congress to worried about re-election to work for change. Couple that with an inexperienced staff used to using Facebook and Twitter working in a government where data transparency means someone wrote some numbers on an overhead, and you end up with a president that's not doing nothing as much as fighting just to be able to do anything.

So, I don't think this year is all that terrible. It could definitely be better, but I wouldn't say mediocre. We knew this was going to be a difficult opening year, and the administration has done a good job dealing with it. They haven't performed to expectations, of course.

If this administration is performing this way in year 2, I'm still not sure it's the end of the world. Reagan bottomed out in '82 and then steamrolled in '84. Clinton was thrown into opposition by the '94 elections, then won a decisive victory in '96.

Still, though, it's been a disappointing year. Hopefully, the White House will learn its lessons. If not, it'll be on to whomever the Republicans can manage to muster for 2012.
posted by dw at 11:13 PM on November 8, 2009 [9 favorites]

If you are unemployed you should be eligible for Medicaid. Look into it, seriously.

Medicaid, okay. I STILL dread the bureaucratic mumbo-jumbo. I think I'm getting a stomach ulcer just looking at this post, let alone reading a 1000+ page bill that will make no sense to me. But, I will look into Medicaid because I think I won't have a choice (?). Thank you very much for the information, afu and anastasiav (I'm a 28 y/o female in PA, fwiw)! I'm apparently the only female in the US who doesn't care about abortion coverage one way or the other. I have congenital health problems that I have no choice but to deal with -- or not, but that should be my prerogative, not the government's -- every day for the rest of my life. Just to say, I didn't mean that as a political statement, I have no problem with pro-life or pro-choice, and I refuse to argue about it. I just meant that I'm more worried/confused/panicked about what this means for unemployed/low-income people who have unavoidable health issues that go beyond anything related to reproductive health, specifically abortions and pregnancies that will be carried to term (but not including something ostensibly unavoidable like cancer, for instance). Okay, that's it.
posted by Mael Oui at 11:25 PM on November 8, 2009

Cards are important in poker but they're not the only thing. It's fundamentally a game of deception.

Just like politics!
posted by Jimmy Havok at 1:00 AM on November 9, 2009

Viagra is a cosmetic drug, for vanity purposes. An erection or lack thereof, does not result in health issues.

It is entirely reasonable to question why viagra would be covered by any healthy insurance package. If one were to make the argument that Big Scary Pharma just wants to make money selling pills, then why wouldn't BSP also want birth control bills and RU486 to be covered?
posted by bravelittletoaster at 1:38 AM on November 9, 2009

weston I'm pro-choice, but I'm also pro-life enough that I think even early-stage human life deserves weighty consideration and at least some measure of legal respect, and choosing not to publicly fund abortions (except for the usual exceptions) federally strikes me as a one of a number balances that respect both things.

No it does not. Not funding it is a cop-out: at best it's defaulting on taking a moral stance at all, at worst it is endorsing a view that abortion is a moral and right thing for the wealthy to do, but immoral and wrong for the poor. Money is a means of exchange for goods and services, not a measure of the rectitude of actions, and has no business being used that way.
posted by aeschenkarnos at 1:58 AM on November 9, 2009 [5 favorites]

Do you also favor withholding coverage of heart bypass operations for patients who simply did not eat a healthy diet or do any exercise whatsoever?

We do withhold liver transplants for not dissimilar reasons.
That's an issue of resource allocation. If there are 20 livers available for 200 people, you want to give them to the 20 people most likely to have the best outcomes. Withholding the liver is not punishment for bad behavior, nor a way to enforce someone's moral values. Abortions are heart bypass operations are not finite resources.

You're trying to compare a female's ability to have dozens of abortions, with a precedure which is inherently likely to occur only once. Abortion isn't like anything else, so analogies aren't applicable.

Also, analogies are always the pro-lifer's preferred method of argumentation, as they can't argue principles. Because as soon as they argue principles, the concept of bodily autonomy takes center stage and they can't really defend the idea of forced pregnancy. Which is why they always try to change the subject to a flawed analogy. Take it back. Make them argue the principle.
posted by bravelittletoaster at 1:59 AM on November 9, 2009 [1 favorite]

"(Aside: I am quite surprised how expensive mifepristone is, it is comparable to a surgical abortion.)"

Are you talking about the drug itself or the entire procedure? Surgical abortions aren't really that complicated and mifepristone administration requires two clinical visits.

"No idea, but contraceptive use isn't exactly rocket science."

No, but there are a lot of ignorant people out there. People who the system has intentionally kept ignorant via side effects of extreme abstinence only policies.
posted by Mitheral at 5:10 AM on November 9, 2009

My question is what about those providers who refuse insurance (cash only)? Many therapists refuse insurance and make the patient go through hoops.
posted by stormpooper at 7:06 AM on November 9, 2009

He's a Chicago-style politician, who will horse trade like crazy to get what he wants.

This is not how Chicago-style politics works at all. It is, however, how little-D democratic politics work in every democracy on the planet. The problem is when people expect it to work like an authoritarian system with everyone happy. The only way any of this gets done, ever, is through horse-trading.

FDR was a unique situation that has never been replicated, before or since, due to the intensity of the economic problems of the time.
posted by Ironmouth at 7:21 AM on November 9, 2009 [1 favorite]

Over at Feministing, a few good things about the House health reform bill, in spite of the Stupak amendment tripe. The bill:

-- Expands Medicaid "to reach a wider range of poor households up to 150% of the federal poverty level. 36M additional Americans will now be eligible for Medicaid."

-- Bars discrimination in health care on the basis of gender identity or sexual orientation.

-- Acknowledges LGBTQ Americans are a population likely to "experience significant gaps in disease, health outcomes, or access to health care." This will hopefully ensure that LGBTQ people are included in future data collection, and that grant programs will focus on their specific health needs.

-- Ends the "unfair practice of taxing employer-provided domestic partner health benefits, allowing thousands upon thousands of LGBT people to obtain domestic partner health benefits for their partners and families without having to pay a tax penalty through the nose."

-- Allows states to cover early HIV treatment under their Medicaid programs. (Currently, states are only allowed to use Medicaid money for patients with full-blown AIDS.)

-- Funds comprehensive sex-ed programs.
posted by the cat's pyjamas at 7:49 AM on November 9, 2009 [3 favorites]

Medicaid, okay. I STILL dread the bureaucratic mumbo-jumbo. I think I'm getting a stomach ulcer just looking at this post, let alone reading a 1000+ page bill that will make no sense to me. But, I will look into Medicaid because I think I won't have a choice

Mael Oui, you should really look into finding a health advocate in your area. Are you hooked up with any nonprofit groups, especially ones that are related to your illnesses? There are professionals who are much better at reading the 1000+ page bill than you are, and there are professionals who work with those other professionals to make sure you will get the best coverage you can afford. Seriously, look into it – or post an AskMefi and see if the hive can find you some resources.
posted by Think_Long at 8:24 AM on November 9, 2009

FDR was a unique situation that has never been replicated, before or since, due to the intensity of the economic problems of the time.

This is very true, it is also worth noting that even FDR had a lot of people who absolutely hated him, for a long long time.
posted by edgeways at 9:48 AM on November 9, 2009 [1 favorite]

Amy Goodman talks to Dennis Kucinich and Jane Hamsher about the health care bill.
posted by homunculus at 10:09 AM on November 9, 2009 [1 favorite]

Funny, I thought this was a post about the health care reform bill passed in the house. I was looking forward to some good information and discussion about the bill, but it seems like 4 or 5 of you have decided to commandeer the whole thread and make it 100% about abortion.

Do the rest of us a favor, please, and get a freaking room...
posted by syzygy at 12:14 PM on November 9, 2009

So anyway!

years ago I told a story about how I was in a situation where I have been uninsured because I was underemployed for several months, and then when I finally could enroll in my company's plan again, I was too late and had to wait another few months for the "open enrollment period." So even though I'm working, and my employer offers insurance, I can't partake.

Someone said that I would only be fined if I didn't choose the public option instead. But here's what I'm not understanding: does the fact that my company offers me a plan PREVENT me from taking the public option in any way? I actually looked into a couple of other low-cost insurance plans offered by New York State -- but I am ineligible for them because I work for someone that offers insurance. So I'm in a catch-22.

Actually, that's a good question -- does the new bill eliminate those ridiculous "open enrollment" hoops, so as to allow someone to make changes to their plan at any time rather than waiting for pre-arranged 3 month windows?
posted by EmpressCallipygos at 12:57 PM on November 9, 2009

does the fact that my company offers me a plan PREVENT me from taking the public option in any way?

Someone more knowledgeable than me will answer this question, but I’m pretty sure that the point of the public option is that it is an option. You will have the choice between your employer’s plan and the public plan, hence the ‘competition’ part.
posted by Think_Long at 1:09 PM on November 9, 2009

Personally, I'd also love it if the bill addresses that "you can only enroll for your company's plan on X, Y., and Z dates" problem as well. Because the one and only reason why I can't re-enroll in my company's plan is, simply, that they won't let me do that until February. I'm working now, I can pay into it now, but it's not February. So I'm SOL.

That kind of sucks.
posted by EmpressCallipygos at 1:16 PM on November 9, 2009

does the new bill eliminate those ridiculous "open enrollment" hoops, so as to allow someone to make changes to their plan at any time rather than waiting for pre-arranged 3 month windows?

Nope; as much as open enrollment periods suck, there's a decent reason that companies keep them in place, to prevent people from gaming the system. It's actually the exact same principle behind the guaranteed issue / individual mandate underlying the national health care reform proposals: if your employer offers health insurance coverage, it cannot deny it to any employee [basically guaranteed issue], but of course this creates a situation where it would be possible for people to hold off on buying insurance until they became seriously ill. This adverse selection causes premiums to skyrocket, since only sick people buy insurance, until the risk pool eventually collapses and no one has insurance. The only way to make this work is (1) to require everyone to have coverage before they get sick [either by making it law or by only allowing people to sign up at certain times] or (2) to allow insurance companies or employers to decline coverage to those who waited until they were ill to buy insurance. Option #1 can result in some unintended negative side effects, like what happened to you, with locking people out of insurance for an entire year if they forget to file a single piece of paper; however on balance I think option #2 (which is where we've been nationally) is a lot worse.
posted by iminurmefi at 1:53 PM on November 9, 2009

I don't seek out trips to the DMV, but it's not the nightmare some people try to make it out to be.

We have a tiny DMV here in Taos, and it would be fine except for the people who work there, who seem determined to stick on matters of procedure over common sense. The office was actually torched last year in an act of vandalism - I'm inclined to believe someone was upset at their treatment. Luckily, I can drive 45 minutes to Questa, which has an even smaller DMV, but at least they're nice and get me out of there in a hurry.
posted by krinklyfig at 2:16 PM on November 9, 2009

does the fact that my company offers me a plan PREVENT me from taking the public option in any way?

It depends on how much money you make, but for most people, yes, they would be prevented from choosing the public option--this is the flip side of Obama being very strong on the principle of "if you like your current insurance, you can keep it." Allowing people to jump out of their employer-based plan and into the insurance exchanges was seen as too potentially disruptive, running the risk of "blowing up the system" of employer-based insurance that 80% of the country uses, so it was for the most part disallowed.

The lack of choice for people who are offered employer insurance is a big negative in the current bill, and one that Ron Wyden has been really hammering on (to the great displeasure of other Dems) for months. It's unclear how possible it is to change this at this point in the process, but it looks like there's a decent possibility on the Senate side that a modified Wyden amendment will be included, that would let certain employees take their employer match and go to the exchanges:

Under the Finance bill's terms, people can already opt out of employer policies and use the exchanges--taking advantage of the government subsidies available there--if they can demonstrate that paying their share of premiums for an employer policy would cost more than 10 percent of their household income. At the same time, people who can demonstrate that paying for insurance would cost more than 8 percent of their household income are exempt from the individual mandate--that is, the requirement to buy insurance altogether.

As you can see, there's a gap there. If you work for a company that offers insurance, but the premiums would take between 8 and 10 percent of your income, then you would not be required to pay for that coverage--but, simultaneously, you wouldn't have access to the subsidies that might help you buy a different policy even if you wanted. (from here)

posted by iminurmefi at 2:20 PM on November 9, 2009

Note that there's no single men's health issue that won't be paid for.

As a guy, with 'good' insurance, who ended up over $400 out of pocket for a mammogram, let me assure you that is not true.
posted by No1UKnow at 2:25 PM on November 9, 2009

It depends on how much money you make, but for most people, yes, they would be prevented from choosing the public option--this is the flip side of Obama being very strong on the principle of "if you like your current insurance, you can keep it." Allowing people to jump out of their employer-based plan and into the insurance exchanges was seen as too potentially disruptive, running the risk of "blowing up the system" of employer-based insurance that 80% of the country uses, so it was for the most part disallowed.

See, that right there was my concern -- for six months, through no fault of my own, I am uninsured despite the fact that my employer offers coverage. However, I also cannot BUY my own insurance via the public option-- because my employer offers coverage. And, even though my employer offers coverage, I cannot enroll back in it for another few months, because my employer will not let me.

So: back to my original question -- that being the case (my employer offers insurance, so I can't take the public option, but I also can't sign up for my employer's insurance plan), would I be fined for being uninsured during that period?
posted by EmpressCallipygos at 2:29 PM on November 9, 2009

EmpressCallipygos, just to be clear, there's two different things here: the insurance exchanges, which are the special marketplaces where all carriers have to sell insurance policies with identical benefits and transparent pricing to any individual who asks; and the public option, which would be a government-run nonprofit insurance plan offered within the exchange.

In Massachusetts, which is what the national reform is modeled after, there are actually two exchanges: one where subsidy-eligible plans are offered, and one where non-subsidy-eligible plans are offered. I *believe,* although it's damn hard to find details on this, that it would be the same set-up nationally. In the subsidy-eligible exchange, you'd have the public option (and if Stupak's amendment stays, none of the plans would offer abortion services), and only people with no employer insurance or no affordable employer option could buy a policy in that specific exchange. In the non-subsidy-eligible exchanges, anyone could buy a policy.

So, in the same way that you could theoretically turn down your employer's plan and go buy an insurance policy in the open market today, you could do the same after reform, in the non-subsidy-eligible exchange. That's how you'd avoid the penalty.

Also, not to get too personal, but I'm surprised you weren't able to sign up for your employer insurance if you originally lost it due to your hours being reduced. Once your hours came back up high enough to qualify you to participate in the employer-based plan, that should have been a "qualifying event" and I think your HR mighta fucked up if they didn't let you enroll then. After all, people who have babies or get married when they're on employer-based insurance don't have to wait an arbirtrary number of months to get their new family members on insurance--that's exactly why there are "qualifying events" that let you get around open enrollment periods.
posted by iminurmefi at 2:46 PM on November 9, 2009

Funny, I thought this was a post about the health care reform bill passed in the house. I was looking forward to some good information and discussion about the bill, but it seems like 4 or 5 of you have decided to commandeer the whole thread and make it 100% about abortion.

This is a Health Care bill, not an Abortion bill.
posted by ericb at 3:43 PM on November 9, 2009

iminurmefi: other countries have solved the problem in different ways. In Australia, you can get health insurance at any time you like. You can't (I'm pretty sure) be refused insurance for a pre-existing condition, but they can refuse to cover related treatment for the first 12 months (no waiting periods apply if you are transferring from a similar policy in another insurer: pdf).

I'm biased, but it seems like a much better system.

Empress Callipygos: It looks like the 'open enrolment' system would remain, but the status quo will change to being enrolled in the employer plan, and so you would be automatically enrolled in your employer's plan and have to make them let you opt out to a different one (ie the public option/any on the open exchange).

I haven't seen anything indicating two exchanges would be available in what I've read so far, it looks like one exchange to me?
posted by jacalata at 8:38 PM on November 9, 2009

"Amy Goodman talks to Dennis Kucinich and Jane Hamsher about the health care bill."

Because if I wanted to know about health care, I want hear from the guy who just voted against it, and the woman who co-produced Natural Born Killers.

Hamsher has been blogging for what... five years, maybe?! Oh... and she helped get Lieberman elected, with her stupid, racist "blackface" stunt?

Progressive... without the progress.
posted by markkraft at 6:51 AM on November 10, 2009

"It's just great seeing the president defending his principles like that. I'm just not sure what the principle actually is. It certainly isn't that a woman has a fundamental right to make her own reproductive decisions."

Women certainly have the right to their own reproductive decisions, as the President has said. They just don't have the right to force other taxpayers -- some of whom are staunchly against abortion -- to subsidize their reproductive decisions.

"the truth is that she doesn't have the votes without the pro-choice caucus either. Why isn't it just as reasonable to say that Stupak and his crowd should compromise?"

Because those who are morally opposed to abortion tend not to compromise much? Because a *VERY* substantial bloc of the House Democrats demanded Stepak's amendment? Because simple math tells you that if this amendment hadn't passed, then the greater good of guaranteed access to healthcare would be dead-on-arrival?!

The simple fact is, Digby has her heart in the right place, but isn't being rational or realistic on this issue, even if she has a cute pseudonym that people like to cite.

"But, but... Digby says...!"

Sorry mac, but your Digby is just this woman named Heather Parton, who studied theatre down the hall from where I deejayed, over at San Jose State.

Nowadays, she lives in Santa Monica... and last time I heard, unelected women from Santa Monica do not get to decide what US domestic policy should be. They aren't generally considered experienced in the vagaries of politics or public policy. They most certainly aren't considered representative of anything in particular, with the possible exception of Santa Monica., even if you personally tend to agree with them.

It's one thing to agree with someone's policies, in principle. It's another thing entirely to strictly push those policies without compromise -- and fail miserably as a result -- as opposed to being as effective as possible and getting what you can reasonably get.

And the last time I heard, the President's primary goal was to be effective, not ideologically pure. If purity was so important to you, there were several other candidates you could've chosen. This President was just the most pure *electable* candidate. He's got his heart mostly in the right place, even if he usually can't act upon it.

Perhaps you should encourage your nearest unelected woman from Santa Monica to run for office next time?!
posted by markkraft at 8:09 AM on November 10, 2009

"Huh, interesting... that's 2 in a row.

...and Dennis Kucinich.

Apparently, your idea of a "personal attack" is pointing out someone's complete and total inexperience in creating public policy might tend to make them a bit naive and unrealistic about what actually can be accomplished legislatively, on a national level.

As for Dennis Kucinich, who *DOES* have the experience, well... I think he's essentially just grandstanding to his followers for contributions... which goes a long way to explain why I got an email from him on Nov. 7th, saying "Please know the struggle for real health care reform will continue. Contribute, we can make a difference", and similar ones on the 5th, 4th, 3rd, 2nd, Oct. 31st, 30th, and 29th.

(Yes, it may surprise you, but I am on his email list, despite my reservations about the man and his tactics.)

The thing about Dennis is that he gets most of his private donations from outside his district, which is a real rarity in Congress. It seems like he does more fundraising over here in the S.F. Bay Area than he does in Ohio. Basically, he's the Ron Paul of the Democratic Party, which isn't really a complement. The good thing, however, is he does tend to keep Democratic candidates more honest. I appreciate his ideals. I just don't think he's realistic. In this recent case, I don't think he was helpful. He narrowly avoided being the deciding vote against healthcare.

"But, but... Digby says..."
Why did you write this like a quote?"

Perhaps because you can't shake a progressive blog without shaking off a whole bunch of "Digby says..."

My obvious response is "Who cares?! Digby is a fine blogger who can turn a phrase, but politically, she's a naif.

Why should we care about Digby's -- erroneous, inexperienced, naive -- opinion about how we should *merely* get the quarter of the House Democrats who are strongly opposed to federally subsidizing abortions to change their minds, especially when almost all of them are from conservative districts and will face a lot of heat as a result?

Really, any congressional staffer with a year of experience could tell you that it just wasn't going to happen that way... and that losing the vote could've killed healthcare for another generation.

"They just don't have the right to force other taxpayers -- some of whom are staunchly against abortion -- to subsidize their reproductive decisions.

Ahhhhhh. There we go."

So, you *do* believe that women should have the right to expect deeply religious people to help pay for elective abortions?

Please note... I am pro-choice. I have even gone to my local Planned Parenthood before when they've been surrounded by protesters to serve as an escort.

That said, I also have friends with chronic medical conditions that can't get health care, and that need it, badly. If they don't get it, they could die.

If you want to say that there are too many adherents of Christian dogma out there who are altogether too willing to tell women what they can do with their bodies, I will certainly agree with you. There are so many out there that Democratic politicians are terrified of them, especially in conservative districts.

This is unfortunate. This, however, is also the reality of the situation.

However, I also believe there are too many followers of "progressive" dogma who are approaching politics from a very naive place, and who are more concerned about being ideologically pure than being effective or bringing about real change.
posted by markkraft at 10:19 AM on November 10, 2009

Why did you write this like a quote? No one actually said this.

This must be those "summary quotes" I've heard so much about.
posted by Pope Guilty at 10:21 AM on November 10, 2009

What does "Digby", whoever he is, say about my employer not letting me sign back up for health insurance until February?

she said, trying to get the conversation back on track somehow
posted by EmpressCallipygos at 10:26 AM on November 10, 2009

"__________ certainly have the right to their own ________ , as the President has said. They just don't have the right to force other taxpayers -- some of whom are staunchly against __________ -- to subsidize their __________ ."

I wonder how many ways we could fill in those blanks where the result would be completely counterintuitive.

How about this: First Amendment champions; freedom of expression; their views; being able to meet in public parks.

Or how about this one: Intellectuals; books; new ideas; public libraries.

This would make a great Mad Lib, is all I'm saying.
posted by darkstar at 10:39 AM on November 10, 2009 [1 favorite]

Darkstar: The idea isn't that anything that costs a dissenting minority of taxpayers $$ should be forbidden.

The problem in this case, unfortunately, is that the dissenting minority is damn near a majority, and they are being asked to pay for the single most divisive, emotionally loaded issue in politics today.

Quite possibly, the only thing that has trumped it in the past has been slavery, and in order to keep the peace, it's pussyfooted around like slavery too, with an uneasy truce.

Given the percentage of Americans identifying as pro-life, I'm actually pretty okay with the government paying for health insurance that does cover abortions, so long as they are medically necessary.

Oh, and one thing I think that Digby was right about in the past, when asked about what would be the single biggest victory for Democrats...

"Universal health care. It will restore people's faith in government by tangibly improving their lives. That's exactly why the Right is so afraid of it."

So, when I hear her say that we should play a Rebel-Without-a-Causeian game of chicken with health care in order to make sure that elective abortions are subsidized, it makes me wonder whether she's all that serious about the issue.

Let's get healthcare passed, by all means. Let's tangibly improve people's lives. And then, once people can see the benefits, let's make it better.
posted by markkraft at 11:14 AM on November 10, 2009

So...what I'm hearing you say...is that you really don't like Mad Libs.
posted by darkstar at 12:06 PM on November 10, 2009

So, you *do* believe that women should have the right to expect deeply religious people to help pay for elective abortions?

Yes. Because if they do not, women will die.

FFS, I do not understand how people do not get this. Every fucking study out there indicates that access to safe, elective abortions makes all aspects of the abortion debate better. Abortion rates do not go up and the amount of harm goes down.

At this point, fuck the religious: they do not know what they are doing, so they do not get a voice in this. STFU, religionuts, and let sensible, fact-using, thoughtful people decide the policy.
posted by five fresh fish at 1:09 PM on November 10, 2009 [2 favorites]

I'm against MadLib moral equivalency, to be precise.

But hey... as for all this kerfuffle? Sen. Boxer says it's probably a moot issue.

"If someone wants to offer this very radical amendment, which would really tear apart [a decades-long] compromise, then I think at that point they would need to have 60 votes to do it. And I believe in our Senate we can hold it. It is a much more pro-choice Senate than it has been in a long time, and it is much more pro-choice than the House."

Even Baucus says it's a compromise too far... and that's coming from the Midwestern, red state guy who was prepared to give away the ship.
posted by markkraft at 1:14 PM on November 10, 2009

Pelosi's explanation in her Seattle new conference yesterday was that at some point the abortion issue would come up, and shunting it into an amendment that will get addressed in committee is the least unappetizing way of dealing with it.

That said, it's clear the Right knew abortion was the Left's Achilles Heel. Force the Dems to make a choice and piss off one group or the other. Piss off the moderates and their constituents, risk losing Congress in 2010. Piss off the liberals and their constituents, risk a civil war within the party. And so pushing the moderates and Blue Dogs into making this a referendum on abortion is an instant win-win for them.

And now all the left can talk about is abortion. It's no longer about health care. Heck, you've seen the screaming and handwringing here with people wanting to outright kill the bill. They chomped on the hook, and now the Right is just reeling them right on in. Lack of party discipline again dooms a Democratic reform.

As Will Rogers may have once said, "I am not a member of any organized political party. I am a Democrat."
posted by dw at 1:55 PM on November 10, 2009 [1 favorite]

"Yes. Because if they do not, women will die."

Approximately 1000 women die in the US every year during childbirth. The amount who would've opted for an elective abortion but couldn't afford one isn't known, but both the NAF and Planned Parenthood have special programs designed to help with this, either in total, or through a loan. Most abortion providers also provide similar services, or information on things such as the NAF's loan program.

The bigger issue is lack of affordable access to health services in the first place.

The first New York Safe Motherhood of 2005 found that of those who died in childbirth, 43% were already at high risk -- for example, due to obesity and heart disease -- and that mothers could benefit from knowing their risk sooner. These women would benefit greatly from the health care plan the House approved, and would be eligible for abortions for medical reasons.

It was also determined that of those who died, only 37% received adequate prenatal care. These women would also benefit from access to public insurance and an expansion of Medicaid coverage.

So, while I agree with your concerns, the larger issues to me are:
1> The health care plan would save a great many lives, even amongst those going through childbirth.
2> It would substantially expand prenatal and medically necessary abortion services to the poor.
3> The legislation would not have passed the House without a compromise.
4> There's still an excellent chance that this amendment will be dropped or watered down in the final House/Senate compromise.
posted by markkraft at 2:17 PM on November 10, 2009

Look, I want women to have health care. But I'm not comfortable with doing it at the expense of a right that women are supposed to have, and have access to - abortion. The thing that amazes me over and over again is that abortion is supposed to be LEGAL. You'd never know it.
posted by agregoli at 2:20 PM on November 10, 2009

There's a big difference between "legal" and "paid for by someone else".

Perhaps there should be an organization where all of us who support the right to choose could create a charitable fund to guarantee affordable access to abortions?
posted by markkraft at 2:30 PM on November 10, 2009

Everyone who is against the whole bill because of the abortion clause is reminding me of the saying 'the perfect is the enemy of the good'.

Maybe all the money philanthropists currently donate to funding services for the uninsured can be redirected to Planned Parenthood or The Local Hospital Abortion Fund. Or an ob/gyn scholarship to increase availability. Or maybe everyone should just give up because you're never going to have a perfect system and let's just nuke the country already. Tough choice, really.
posted by jacalata at 3:20 PM on November 10, 2009

Just a reminder: there's virtually no way the Stupak amendment will still be in the bill when it comes out of conference. It was a way for the abortion issue to be dealt with in as harmless a way possible, giving conservadems cover for their constituency. So I don't think we need to get too worked up about it.
posted by darkstar at 3:50 PM on November 10, 2009

Everyone who is against the whole bill because of the abortion clause is reminding me of the saying 'the perfect is the enemy of the good'.

I totally agree.

Hey! I'm not going to be paying half my salary for health insurance if this gets signed into law! I know that disabled rights isn't as sexy a cause as abortion advocacy - but REALLY GUYS! I AM SO PSYCHED! I CAN PAY OFF MY STUDENT LOANS AND BUY MY MEDS AND NOT JUST EITHER OR!

Really, any legislation that closes the "Oh, yeah, you have a pre-existing condition? Just leave your left arm on the table." loophole is a huge step forward. I can barely afford to have insurance right now and yet... I can't afford *not* to because I have a chronic condition. This Catch-22 is one of the most fundamentally EVIL ways of kicking someone when ze is already down.

Could the bill be better? Absolutely. Is it at least a good START? Fuck yeah.

If abortion rights specifically are important to you and you are somehow saving money on this deal, put some of that money into Planned Parenthood. Lobby your congresspeople and tell them that they're wienies for cutting out funding for abortions. But don't damn the WHOLE BILL, which is an imperfect piece of legislation - but is at least a hell of a lot better than the system that we currently have.

I've often said that I would vote for Satan himself if he would promise single payer healthcare. Problem is, he's the one who created the private insurance system that the US currently uses.
posted by grapefruitmoon at 3:57 PM on November 10, 2009 [3 favorites]

(People are responding to my comment as if I'm against the health care bill, abortion problems or not. I'm not against the health care bill.)
posted by agregoli at 3:58 PM on November 10, 2009

Someone said that I would only be fined if I didn't choose the public option instead. But here's what I'm not understanding: does the fact that my company offers me a plan PREVENT me from taking the public option in any way? I actually looked into a couple of other low-cost insurance plans offered by New York State -- but I am ineligible for them because I work for someone that offers insurance. So I'm in a catch-22.

Most companies don't force people to wait until open enrollment to get healthcare, and the law will mandate that all employers will have to offer their employees health care. If your company doesn't offer healthcare right away they will be fined. So the short answer is that the waiting period you're currently in will be illegal.

Sorry mac, but your Digby is just this woman named Heather Parton, who studied theatre down the hall from where I deejayed, over at San Jose State.

Oh no, Digby is a woman? I had no idea! I guess we better ignore everything she has to say. Can't trust those lady-brains!

Besides, I heard she was anti-bush back when he was popular. Obviously we should only listen to bloggers when they promote the majority opinion.
posted by delmoi at 12:54 PM on November 11, 2009 [1 favorite]

Oh, this is too rich: The RNC Healthcare Plan for Employees — pays for abortions!
posted by five fresh fish at 6:03 PM on November 12, 2009 [1 favorite]

Today it doesn't, fff. The story got caught in the spotlight, so the RNC decided yesterday they had to nix abortion coverage to avoid looking any more like the hypocrites they are. But it is pretty intersting how, for decades, they provided this coverage to their members and how donations went to paying for this coverage.

No telling how many RNCers used the coverage over the years.
posted by darkstar at 9:35 AM on November 13, 2009

If only there was some kind of law that would say that an insurance company couldn't offer any abortion services whatsoever to prevent such indirect claims of funding.

Oh, right. The Democrats just did that. Good job guys.

No, they didn't. Insurance companies would still be able to offer plans that cover abortion except for any plans that would be on the exchange, and anyone buying insurance with affordablity credits or government assistance could not buy a plan that covers abortion.

Throughout all the handwaving I have seen over the last few days about this, two questions come to mind:

Has anyone actually read the text of the amendment?

And how many abortions does a woman have to anticipate having during the course of the fertile period of her life to make paying an insurance company extra every month to cover the costs? As far as life-crisis, unexpected expenditures go, they are relatively inexpensive, and statistically, the majority of women have two or less (mostly less).

Seriously, even when I was dirt poor and living on friends' couches, coming up with the money for an abortion wouldn't have been the problem. Finding a clinic would have been the problem and still is --worse now, perhaps in some areas.
posted by Orb at 2:09 PM on November 13, 2009 [1 favorite]

Insurance companies would still be able to offer plans that cover abortion except for any plans that would be on the exchange, and anyone buying insurance with affordablity credits or government assistance could not buy a plan that covers abortion.

That's not quite right. The restriction isn't on people with affordability credits; it's on plans who have people with affordability credits buy their product. In a world where carriers could refuse to sell products to people who qualified for government subsidies, this would be a meaningless distinction--carriers would create one "with abortion" plan and one "without abortion" plan and only allow those with affordability credits to buy into the non-abortion plan--but one of the key reforms in the exchange is that insurers cannot refuse to sell a policy to anyone. In essence, that means that if a carrier had a plan with abortion coverage, and even one person who qualified for $1 worth of subsidies signed up, they'd have to drop their abortion coverage for everyone in the plan.

That's why the Stupak amendment is significantly more far-reaching than the current Hyde amendment. The big worry is that you'd see more and more of the insurance market pulled into the exchange--that is, 10 or 15 years down the road, reformers are hoping that the exchange is opened to large employers, so that eventually everyone is buying within the exchange--and under those circumstances, what this amendment would in effect do is wipe insurance coverage of abortion off the map for everyone.

Of course, it now looks like some Senators are signaling that that the new exchange(s) will not replace the individual market, but rather operate alongside. So on the one hand, maybe this fear is overblown, as any plan offered outside the exchange can offer abortion coverage. On the other hand, HOLY SHIT that is literally the worst thing I've heard in weeks about the prospect for health care reform. New fear: we spend months and months on health reform, putting other key issues like cap and trade on the back burner to deal with it, and the end product has a fatal flaw that insurance companies and young healthy people game to the extent that the exchanges collapse in a death spiral of adverse selection. Poof! The very modest start at reform we worked so hard for disappears, and we're just as badly off as before.

Lovely. I think I need a drink.
posted by iminurmefi at 2:57 PM on November 13, 2009

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