Thoughts on Obama's speech

These are my off-the-cuff, as I read the text, reactions to Obama's health care speech.

"Others are self-employed, and can't afford it, since buying insurance on your own costs you three times as much as the coverage you get from your employer."
If you are lucky. We found that buying coverage on our own was cheaper for at least my husband and daughters, and these days I'm wondering if there might have been a cheaper option for me as well. But I can accept this as an average.

"More and more Americans worry that if you move, lose your job, or change your job, you'll lose your health insurance too. More and more Americans pay their premiums, only to discover that their insurance company has dropped their coverage when they get sick, or won't pay the full cost of care."
Yep, this is what I worry about. Pre-existing conditions and job loss.

"Under this plan, it will be against the law for insurance companies to deny you coverage because of a pre-existing condition. As soon as I sign this bill, it will be against the law for insurance companies to drop your coverage when you get sick or water it down when you need it most."
Okay, this is something I want to see . . . I think. A little clarification might be nice, though. But it sounds like something I think we need.

"We will place a limit on how much you can be charged for out-of-pocket expenses, because in the United States of America, no one should go broke because they get sick."
I think I disagree with this. People should be allowed to take higher deductibles and pay more out of pocket if they choose. A person can reasonably save $20K in their life, and choose to take a $20K deductible to lower their health insurance costs. A person who works hard might be able to save $100K, and some people would rather depend on home equity they've built up than pay for a low-deductible plan. There should not be such a limit, IMO.

"And insurance companies will be required to cover, with no extra charge, routine checkups and preventive care, like mammograms and colonoscopies – because there's no reason we shouldn't be catching diseases like breast cancer and colon cancer before they get worse. That makes sense, it saves money, and it saves lives."
"With no extra charge" worries me. Are they saying that insurance companies shouldn't be reimbursed for this care? That doesn't make sense to me. But I do want to see incentives of SOME kind for people to get preventative care, so this might be something I agree with . . . more clarification is needed.


"the second part of this plan will finally offer you quality, affordable choices. . . . We will do this by creating a new insurance exchange – a marketplace where individuals and small businesses will be able to shop for health insurance at competitive prices."

How is this different from eHealthInsurance.com? That's what we used to shop around for competitively priced insurance. And it worked GREAT for us! I guess I don't see why the government is doing this, what it is adding. Visibility of choice, at least, I guess. There is something to be said for that.

"In the meantime, for those Americans who can't get insurance today because they have pre-existing medical conditions, we will immediately offer low-cost coverage that will protect you against financial ruin if you become seriously ill. This was a good idea when Senator John McCain proposed it in the campaign, it's a good idea now, and we should embrace it."
A public option for catastrophic care? Is that what this is? If so, I support it whole-heartedly. And also if it is just for those w/ pre-existing conditions.

"That's why under my plan, individuals will be required to carry basic health insurance – just as most states require you to carry auto insurance."
I call bullshit. I don't think a single state has this requirement. I know lots of people who don't carry auto-insurance. The consequence, of course, is that they aren't legally allowed to drive - but there is a way to avoid it. I have used this option in the past to save money. I know people who never bothered to get their license. Sorry, the analogy proves your opponents' points.

Also, what is the definiton of "basic" health isurance? Catasrophic + preventative care makes more sense. Anything else should NOT be required for sure - there are ways to handle more normal expenses, like savings. And we need to be careful not to over-cover care so that market forces continue to apply.

"And one more misunderstanding I want to clear up – under our plan, no federal dollars will be used to fund abortions, and federal conscience laws will remain in place."
This had better be true.

"But an additional step we can take to keep insurance companies honest is by making a not-for-profit public option available in the insurance exchange."
I support this, with some misgivings.
"based on Congressional Budget Office estimates, we believe that less than 5% of Americans would sign up."
I find this plausible. I really don't know that a public option would be able to offer anything better than a private option - unless it's subsidized (duh duh duhhhhhh).
"[Insurance companies] argue that these private companies can't fairly compete with the government. And they'd be right if taxpayers were subsidizing this public insurance option. But they won't be. I have insisted that like any private insurance company, the public insurance option would have to be self-sufficient and rely on the premiums it collects."
Yep, I support this. That's my main misgiving.

"And if we are able to slow the growth of health care costs by just one-tenth of one percent each year, it will actually reduce the deficit by $4 trillion over the long term."
Boy, "the long term" - is that ever vague! Ten years? One hundred? Infinity, approaching 4 trillion as an asymptote?

Hrm . . . other than mandated health insurance and possibly limits on out-of-pocket expenses, it actually sounds pretty good to me. I really don't like the insurance mandate, unless it's basically catastrophic care and maybe a little preventative care that gets insured, but I do want to see a non-subsidized public option. And I don't believe we're going to get all this for free, either.

We need a right to not murder

I think we need a new right in this country: The right for no person to engage in an act that they reasonably perceive as directly contributing to the death of an innocent human being. Therefore, no doctor could ever be legally required to enact an abortion or prescribe euthenasia medication. No pharmicist could ever be legally required to fill a prescription for abortive medication or legal suicide medication. An argument could be made about whether paying taxes for these purposes is "directly contributing" to these acts, and that would need to be resolved. Birth control (the Pill, specifically) would also be an edge case; I believe medical science defines the start of life as implantation, not conception, but I believe that the numbers of people who believe life begins at conception is enough to clearly demonstrate that concerns about the Pill being an abortifacient fit the "reasonable concern" clause.

This could prevent hundreds of potential horrific human rights abuses involving the deaths of innocent people. Many of the worst-case abuses that pro-life people fear could be mitigated with this clause, as those who don't want to participate in these horrors will have legal grounds to oppose them, at least through non-participation. And don't humans at least have the right to avoid directly participating in the murders of innocent humans?

A quick thought on the FOCA

This post is, by no means, intended to share much of my opinion on abortion. I hope that those who know me IRL have no question as to what my beliefs are: Abortion is killing innocent humans; the only reason I distinguish between it and murder is that I think most women who choose abortion have been misled to believe that the lives they end are not yet human; I believe murder requires intent to unjustly kill.

But I didn't intend to write about my understanding of abortion in this post. I just wanted to point out a couple of lines from the FOCA:
The Freedom of Choice Act

(3) VIABILITY- The term `viability' means that stage of pregnancy when, in the best medical judgment of the attending physician based on the particular medical facts of the case before the physician, there is a reasonable likelihood of the sustained survival of the fetus outside of the woman.

...
(b) Prohibition of Interference- A government may not--
(1) deny or interfere with a woman's right to choose--
. . .
(B) to terminate a pregnancy prior to viability; or
(C) to terminate a pregnancy after viability where termination is necessary to protect the life or health of the woman; . . .

Although I still don't like the FOCA, I am glad to see that it does not confirm a woman's right to a late-term abortion (barring the gigantic loophole of part (c)).

Comments on actions we can take to prevent the FOCA would be appreciated. I was shocked that I-1000 passed. I suspect that it is too late, that the FOCA will pass anyways, but will pray for it to somehow fail. I think people fail to realize that the FOCA (and all laws allowing abortion) are essentially declaring that an entire group of humans beings will be denied their most basic right, their right to life. We simply have not done due diligence here; we have not justified this step down the slippery slope.

However, I think that even if the FOCA does pass, abortions will still drop. I think that 40 DFL and other movements are changing our culture, and that will be far more effective than legal changes in the medium term. Take my words with a grain of salt; I am an optimist, and see hope everywhere. But the FOCA cannot halt the very real change in people's hearts (nor can it halt the information from scientist's research) that is seeing evidence of human life and being starting at conception.

This is a good approach to the environment issues

I love No Impact Man. He's a REAL open-minded liberal. As in, he works to engage people from all parts of the spectrum to support his cause.

More importantly, he thinks in a manner that feels, to me, very Catholic (although I doubt he is even a Christian). He believes strongly in stewardship of environmental resources, in loving our neighbors as ourselves, in forgiveness, and in striving for a greater good. And he believes in working together to achieve this with those who may believe differently in other areas, for the greater good.

He writes this excellent post on what he calls "environmental effectiveness". Basically, this is the idea that we want to get the most good for the least resources. Well-used resources which make people happy and fill their lives with opportunity are "environmentally effective". The beauty of this concept is that it captures many of the issues with environmentalism in a way that "sustainability" does not. It emphasizes the importance of human quality of life in a way that the environmental movement tends to gloss over. How many times have we heard the banal, despairing statement that the Earth would be better off without humanity? And how many times have we felt horror that someone should have such disregard for the virtues of their own species, horror that someone should be so willing to disregard OUR personal value, in favor of animals and pristine vistas? More specifically, in favor of animals unloved by humans and vistas unseen by humans? Humanity does believe, in general, that we are better and different than animals. Environmentalism needs to (and ought to) work with that belief.

Here is the link: http://www.worldchanging.com/archives/008905.html

Response to Linda Hirschman

This is an email I wrote in response to this article by Linda Hirschman.


What I like:
- [I fel the s]ame as [another wife of a SAHD]about the glass ceiling at home, although I haven’t been taking this for granted :-) but there’s been a lot of resistance when I ask for help in getting through it. This is the negative attitude that has been chaffing me so much, I think – the social reinforcement of that glass ceiling, even from those who should be most interested in breaking through it.
- Hirschman’s really trying to change things. That’s good. And she’s thinking outside the box. We need new thoughts on feminism.
- Hirschman focuses on how the path to being shouldered out starts early – college choices, marriage choices, etc. My husband made all the choices made by the young women she describes, for different reasons, but with the same results (but like many of these women, he’s happy with that).

What I don’t like:
- She dismisses the idea that women generally have authentically different values than men as conservative brainwashing, and then dismisses any woman who has those different values or believes women are fundamentally different as being brainwashed / socially pressured.
- She measures women according to traditional measures for men, and dismisses traditional measures for women as being without value. I think this is tragic - we need to apply traditional measures for women more broadly, to men *and* women, not throw them out – just as we applied more broadly the traditional measures for men when women entered the workplace (showing we valued men’s goals and ambitions).
- She has a very dismal (and in my experience, inaccurate) view of staying home. Maybe she doesn’t enjoy changing diapers, but my work as a SAHP was the most challenging, engaging work I’ve ever done. And I do have a challenging, engaging job, too – something many women don’t have.
- I find her description of SAHP work as being “lower caste” insulting to my husband, who does it, and even more insulting to me, because I asked him to do it (I am not an oppressor!). If we don’t value SAHP’s work, then the problem is in our values – not the work. And Linda Hirschman exemplifies these demeaning values, the real problem.
- She is insulting a large group of women, who would rather stay home, and makes no attempt to understand them. She simply dismisses them as a lesser group of people, unworthy of full consideration.
- She implies that there must be equal numbers of women in the work force working equal hours for feminism to succeed. Even if this is actually not what most women want.
- I don’t like her claim that women should only have one baby. This will distance her from any woman who wants two children more than she wants a career, and encourage “opting out” by implying that the two goals – multiple kids and career – are incompatible.

What I felt was missing:
- Debate about if career being equal to power and status is a good thing, something bad that can be changed, or something bad that cannot be changed. She seems to just accept that it IS.
- Mention of the wrong done to men because they are incapable. I know many men who are interested in staying home, but don’t see it happening because most women are more capable at home and their wife will already stay home to recover from birth and initiate breastfeeding.
- The obvious (albeit long-term) solution: Teach our boys to do housework. Make them as capable as our women. Give them the opportunities (and responsibilities) that we have.
- Discussion of the power or influence that women (and men) can wield inside the home, even to show that it is less than the power and influence of the workplace. She only points out the negatives.
- Discussion of social changes (like flexible workplaces, childcare subsidies) that could help. For someone complaining about how women lack power, she is slow to suggest working for broad change.


I think this premise is strongly applied, but poorly supported: “. . . what they do is bad for them, is certainly bad for society . . .” And this line, several paragraphs later, is ironic: “Good psychological data show that the more women are treated with respect, the more ambition they have”. It makes me want to yell at her, “Geesh, Linda! Then RESPECT women already, all of them! Don’t limit your respect to just those women who believe as you do and hold your values.”
I think Linda Hirschman needs to look at the group MomsRising, which is a way SAHMs can have political power – working moms too, but since many events are during the day, their ability to help is limited. I think she needs to think outside the cubicle to see how SAHMs (and SAHDs) can influence the world around them in ways working parents just . . . can’t, or not as well.



Other thoughts, from my experience:
I actually did “marry down” – not exactly intentionally, but it happened because I didn’t care about “marrying up” and, since I knew I could breadwin, I was more interested in a good father than a breadwinner. Which is exactly what I got  I’d like to know how many other SAHD wives *did* marry down, intentionally or otherwise. I get the impression that the man’s lower income is often a significant factor in him staying home instead of the wife. I rarely hear of a situation where the man was equally capable of bringing in a high income and still opted out (although it’s out there).

Also, I actually do want to opt out, and am making plans to do so despite being the sole income. I want to cut back to part-time and live on ½ income for our entire family in ten years (the earliest I think we can afford it). DH and I are really excited about this plan – part-time at 35, retired at 55. I think there are a lot of families where both parents would rather stay home than work, but creating a family where both parents are primarily homemakers / parents is tough and unconventional. However, if we can pull it off it will be really, really cool. And we can have a big family  Something I’ve always wanted.

I wonder what Linda Hirschman would think of our “half-income family” plans. A step in the right direction, because it’s more equal and challenges common assumptions about gender? Or a step back, because another woman is opting out?

MomsRising slogan

Right now MomsRising is having a slogan contest. I entered :-)

I think MomsRising is a great group, trying to do something very tough and very important. They are working to break down all the arguments in the media that have divided mothers lately and make progress on motherhood's common ground. There are a lot of suggestions, including some I like and some I don't (and one I hate).

The ones I like:
- Unite mothers
- Focus on common ground only
- Focus on the main issue and not a pet issue
- Sound good to the ear
- Are simple
- Are clearly calling for action

The ones I don't like:
- Express one side of a debate that moms are split on (MomsRising is trying to avoid this)
- Only represent working moms, probably the most easily targeted parts of the MomsRising audience - we need to target those who aren't as easily involved. We need SAHMs to say where they stand.
- Are too domistic-y and might put off working moms, who are probably the majority of the MomsRising audience (although I did like, "Good Bread, and Good Moms . . . Rise Up!" - I'd rather err on this side, especially if there will be more than one slogan used)
- Are too wordy
- Don't explain what MomsRising is
- Focus on one problem, when MomsRising is addressing many problems and policies.
- Aren't clearly political (often of the "Moms Rock" form - we need to do good, not feel good)

The one I hate is a pro-choice message. Errr (buzzer sound), wrong, MomsRising is not pro-choice.

In fact, I think the greatest issue MomsRising faces is in avoiding the following stereotypes:
- Partisan, Democratic (they try to be non-partisan, but many of the solutions are changes to federal laws - hence, best led by Democrats)
- Working-moms only (MomsRising wants to represent all moms, but the workplace is the place where moms are most clearly discriminated against - fair solutions for SAHMs are harder to recognize)
- Pro-abortion rights (I really think MomsRising as an organization wants to avoid this issue, but there is tension from the membership with the desire to follow feminism)

MomsRising is feminist in that it represents a group of women. However, this isn't the anti-man, all-moms-must-work feminism that so many women hate. This is political feminism, seeking through political action to give women realistic options. This group is ACKNOWLEDGING that women are NOT the same as men. We have different values. We have different goals. Whether this is cultural or biological doesn't matter. Feminism doesn't have a right to dismiss the views of women who come from a different culture than "approved" feminists as being lesser. If you believe all women are equal to men, you can't follow it up by saying that some women are more equal than others.

MomsRising is NOT feminism itself; it does not claim to represent ALL women. It is a branch of feminism. A natural result of women being empowered is that groups of women with something in common - like motherhood - can now seek to have their needs met through political processes. Without including all other women. If only the female pro-choice groups would do the same, instead of co-opting the "feminist" title and dragging it through the mud. But I digress.

I also took the time to create my own idea. My suggestion?
"When politics divide
MOTHERS UNITE!"

WHO on health care - the US ranks 37th, but why?

The WHO assessed the world's health systems and found that the US ranked 37th. This number has been bandied about a great deal, and my fellow blogger at "What the Hey", after hearing this number on "Sicko", followed her curiosity to find out where it came from. The result is a thought-provoking post that I hope will be followed by a post of her own thoughts on the WHO assessment.

Please read the WHO article on the assessment for yourself. Once you do, read on to hear my own thoughts on the article.

The main thing I want to draw attention to is this paragraph:
"In designing the framework for health system performance, WHO broke new methodological ground, employing a technique not previously used for health systems. It compares each country's system to what the experts estimate to be the upper limit of what can be done with the level of resources available in that country. It also measures what each country's system has accomplished in comparison with those of other countries." (emphasis mine)

The bolded part is confusing and inappropriate, unless this explanation of the measurement gets passed along every time someone quotes the ranking of a country from this report. When we hear that the US is ranked 37th, we expect that the US is being ranked against only the other countries, not also against the level of resources available in that country. We automatically say, "With our resources, why aren't we #1?" The answer is, it is because of our resources that we are so very low. Because we have much, much is being expected of us. This fact needs to be made clearer when people pass these facts along. Even better, the WHO should focus on a ranking based on just the italicized (by me) portion, and give the other ranking as a supplementary statistic.

My other issue is that there was no mention of weighting the indicators. Overall health and distribution of health were only two of five indicators - were they also only 2/5ths of the weight? In my opinion, these indicators are far more important than the others. These indicators represent the goal of a health care system: healthy people. The other indicators - responsiveness, distribution of responsiveness, and distribution of cost - seem to me to be fundamentally different, more ways to reach both overall health and a good distribution of health than actual ends in and of themselves. I also do not think distribution of cost should be included, but rather that the WHO should measure people's ability to attain healthcare at all after meeting their other necessities. Otherwise, they are measuring not the health care system itself, but people's access to luxeries after buying health care - which is not the sole perogative of the health care system.

I thought this statement was a bit strange: Dr. Frank said, "What we are seeing is that in many countries, the poor pay a higher percentage of their income on health care than the rich." Why is this, specifically, a problem? The poor also pay a greater portion of their income on food and on housing, I would guess. It is no surprise to me that the poor spend a higher portion of their money any given necessity than the rich. As long as the combination of necessities (including taxes) does not exceed 100% of the amount of money a person / family can reasonably earn, I think that there is no moral obligation to fix the situation. While I would be thrilled to support a national policy that seeks to free up, say, a minimum 5% of EVERYONE's income for luxeries after necessities like health care, food, utilities, and shelter (assuming the person is making a reasonable effort to earn the cost of necessities + 5%) - I don't feel we have a moral obligation to do so.

I guess that my question is, why does health care get preferential treatment over food and shelter, such that all *should* pay a flat portion of their income? Why don't we tax to provide all with basic food, as well? And shelter? How many countries give tax-supported food and shelter universally? I'm skipping the standard discussion of socialism here. My point is that, while I support universal health care in the US, I do not think that a health care system that results in the poor paying a higher portion of their income to health care is innately less fair - and therefore, the WHO should not be measuring this "indicator". I believe that universal health care is better, but that is more because I believe that improving quality of life for the poor in general benefits all of society greatly. There are many ways we can spend money improve the quality of life for the poor to get closer to achieving the maximum net benefit for society; universal health care simply seems to be the easiest at the moment. However, we could instead provide universal food and housing vouchers, freeing up money to be spent on healthcare instead - just as one example, I'm not seriously proposing we do this.

I am also suspicious about other hidden values (beyond the clear bias towards universal health care / evenly portioned health care costs), although this one article doesn't have the information I need to assess this. I want to know what "respect for persons (including dignity, confidentiality and autonomy of individuals and families to decide about their own health)" includes, for example, under responsiveness. I want to know if that includes things like easy-access abortion "rights" for women (at the expense of the fetus' right to live, and the doctor's right to keep his job without performing what he may believe is murder, etc.) - as just one example of a possible innapropriate attempt to measure healthcare quality that might fall under this bucket, but is based on a set of health values that is not universally shared. I personally would argue that enabling abortion decreases health, since it ends many human lives that could have lived, if only there were a better support system for the woman's pregnancy and the child's care after birth. The WHO assessment may not include such non-universal ideas of health under responsiveness; however, I want to find the time to track the information down so I can know for sure.

Health care

I love having good health care. It's an unspeakable luxury, and yet it is such a basic necessity as well. Because of my employer's policy of providing employees and their families with great care for no cost to the employee, we've been able to visit the doctor as much as we needed without a second thought - and haven't paid a single cent yet. After years of having no health care, limited care, or expensive care - well, not even having a second thought about receiving good care is a major relief.

But you know what? After spending years with no health care, I would gladly lose some of the quality of my current health care to have universal health care in this country. What good is quality when so many people receive little care at all?

I would settle for good, free care for all people under the age of 18 (or 21 - to give young folks a chance to get their feet on the ground). I understand that some people hate giving others a free ride for even the most basic necessities, and don't agree with me that the benefits outweigh the costs. But seriously, people, give the kids health care at least. Don't make someone choose between taking her child to the doctor for a check-up or paying the electric bill, and don't make a child's health suffer for their parent's poverty. I'd like to see people covered through age 21 - buying healthcare in college was a joke for me, even at the low rate of about $550 a quarter.