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There’s More To Women’s Health Than Contraception

If you have been listening to the contraception debate in Washington (sort of hard to avoid, isn’t it?), you may be under the impression that preventive health for women equals contraception. Or contraception equals women’s preventive health. (We’re putting aside, for the purpose of this post, the debate about religion, conscience and the role of government).

The Senate has defeated one bid to overturn the administration rule requiring employers to provide an insurance plan with first-dollar coverage of birth control, and it’s not clear what the House will do. But the issue is likely to percolate in Washington, state legislatures and the courts for some time to come.

The health reform law, and the regulations being developed to implement it, has a far more expansive definition of prevention and what it means for women’s health. Here are more details on the new regulations and a tutorial from Kaiser.edu. According to the new women’s preventive health rule, new health plans must cover, without cost-sharing, a lot more than the pill:

  • well-woman visits;
  • screening for gestational diabetes;
  • human papillomavirus (HPV) DNA testing for women 30 years and older;
  • sexually-transmitted infection counseling;
  • human immunodeficiency virus (HIV) screening and counseling;
  • FDA-approved contraception methods and contraceptive counseling;
  • breastfeeding support, supplies, and counseling; and
  • domestic violence screening and counseling.

These requirements will go into effect in August (with another year allowed to finalize how the religious exemptions will work). Grandfathered plans won’t have to follow the new rule, while they maintain their “grandfather” status. Over time, many health plans will go through changes that will mean that they will no longer be “grandfathered.” Then they too will have to follow the new regulations.

Of course, more women will get these benefits, simply because more women will be insured. Approximately one in five women of reproductive age is currently uninsured. Most of them will get coverage, including preventive services, starting in 2014 whether through Medicaid, through subsidized coverage in the exchanges or by buying coverage. Right now, coverage of maternity benefits is spotty on the individual insurance market, but the plans in the health exchanges will cover it.

The law also requires many other preventive services – some free – for men, women and children. They have not gotten much attention in the polarized birth control debate.

The conversation (and press coverage) about the contraceptive rules have included lots of misinformation about abortion. Politicians who misstate policy don’t help, but reporters need to know what the law does and does not do.

The health law does not mandate abortion coverage and this preventive health rule does not change that. In fact, states under health reform have the explicit ability to limit abortion coverage in policies sold in state exchanges and several have already taken action to do precisely that. Plans that do cover abortion in the exchange will have to wall that off in a way to keep it apart from the federal subsidies.

A few more stray but relevant facts:

According to the Kaiser.edu materials, about two-thirds of women aged 15 to 44 use contraception – and do so for about 30 years.

Most employer-based insurance plans do cover contraception, though there are often co-pays. Among large employers, more than 80 percent cover contraception.

Federal Medicaid dollars do not cover abortion under the Hyde Amendment (except for rape, incest or when the life of the mother is in danger) – although some states use their own money to cover abortion in some circumstances. But Medicaid does cover contraception. In fact, Medicaid pays for more than 70 percent of publicly financed family planning services.

And Title X funds family planning clinics (created in 1970 under the Nixon presidency). According to HHS, about 5 million women and men get family planning services through more than 4,500 community-based clinics. Someone with religious objections to providing contraceptives for employees is indirectly paying for Medicaid birth control coverage – and indirectly for the tax subsidies of employer-sponsored insurance – just as we all pay taxes that fund some things we agree with and some we don’t.

 

By: Joanne Kenen, Association of Health Care Journalists, March 1, 2012

March 2, 2012 Posted by | Women's Health | , , , , , , , , | 1 Comment

“Severe Conservative Syndrome”: An Incurable Malady Detached From Rationality

Mitt Romney has a gift for words — self-destructive words. On Friday he did it again, telling the Conservative Political Action Conference that he was a “severely conservative governor.”

As Molly Ball of The Atlantic pointed out, Mr. Romney “described conservatism as if it were a disease.” Indeed. Mark Liberman, a linguistics professor at the University of Pennsylvania, provided a list of words that most commonly follow the adverb “severely”; the top five, in frequency of use, are disabled, depressed, ill, limited and injured.

That’s clearly not what Mr. Romney meant to convey. Yet if you look at the race for the G.O.P. presidential nomination, you have to wonder whether it was a Freudian slip. For something has clearly gone very wrong with modern American conservatism.

Start with Rick Santorum, who, according to Public Policy Polling, is the clear current favorite among usual Republican primary voters, running 15 points ahead of Mr. Romney. Anyone with an Internet connection is aware that Mr. Santorum is best known for 2003 remarks about homosexuality, incest and bestiality. But his strangeness runs deeper than that.

For example, last year Mr. Santorum made a point of defending the medieval Crusades against the “American left who hates Christendom.” Historical issues aside (hey, what are a few massacres of infidels and Jews among friends?), what was this doing in a 21st-century campaign?

Nor is this only about sex and religion: he has also declared that climate change is a hoax, part of a “beautifully concocted scheme” on the part of “the left” to provide “an excuse for more government control of your life.” You may say that such conspiracy-theorizing is hardly unique to Mr. Santorum, but that’s the point: tinfoil hats have become a common, if not mandatory, G.O.P. fashion accessory.

Then there’s Ron Paul, who came in a strong second in Maine’s caucuses despite widespread publicity over such matters as the racist (and conspiracy-minded) newsletters published under his name in the 1990s and his declarations that both the Civil War and the Civil Rights Act were mistakes. Clearly, a large segment of his party’s base is comfortable with views one might have thought were on the extreme fringe.

Finally, there’s Mr. Romney, who will probably get the nomination despite his evident failure to make an emotional connection with, well, anyone. The truth, of course, is that he was not a “severely conservative” governor. His signature achievement was a health reform identical in all important respects to the national reform signed into law by President Obama four years later. And in a rational political world, his campaign would be centered on that achievement.

But Mr. Romney is seeking the Republican presidential nomination, and whatever his personal beliefs may really be — if, indeed, he believes anything other than that he should be president — he needs to win over primary voters who really are severely conservative in both his intended and unintended senses.

So he can’t run on his record in office. Nor was he trying very hard to run on his business career even before people began asking hard (and appropriate) questions about the nature of that career.

Instead, his stump speeches rely almost entirely on fantasies and fabrications designed to appeal to the delusions of the conservative base. No, President Obama isn’t someone who “began his presidency by apologizing for America,” as Mr. Romney declared, yet again, a week ago. But this “Four-Pinocchio Falsehood,” as the Washington Post Fact Checker puts it, is at the heart of the Romney campaign.

How did American conservatism end up so detached from, indeed at odds with, facts and rationality? For it was not always thus. After all, that health reform Mr. Romney wants us to forget followed a blueprint originally laid out at the Heritage Foundation!

My short answer is that the long-running con game of economic conservatives and the wealthy supporters they serve finally went bad. For decades the G.O.P. has won elections by appealing to social and racial divisions, only to turn after each victory to deregulation and tax cuts for the wealthy — a process that reached its epitome when George W. Bush won re-election by posing as America’s defender against gay married terrorists, then announced that he had a mandate to privatize Social Security.

Over time, however, this strategy created a base that really believed in all the hokum — and now the party elite has lost control.

The point is that today’s dismal G.O.P. field — is there anyone who doesn’t consider it dismal? — is no accident. Economic conservatives played a cynical game, and now they’re facing the blowback, a party that suffers from “severe” conservatism in the worst way. And the malady may take many years to cure.

 

By: Paul Krugman, Op-Ed Columnist, The New York Times, February 12, 2012

February 14, 2012 Posted by | Election 2012, GOP Presidential Candidates | , , , , , , , | Leave a comment

Mitt Romney, “A Well-Oiled Weathervane”: Character And Core Values May Be His Downfall

More than most elections, the contest for President this fall is likely to be decided less on “wedge issues” — or even candidate positions that are symbolic of who is on whose side — and more on the character and core values of the candidates — and for that matter on the question of the core values of the society we hope to leave to our children.

Last Friday, speaking to the Democratic Caucus Policy Conference, Vice-President Joe Biden told a story that speaks volumes about the character of Barack Obama.

According to Biden, the day before he ordered the raid that finally stopped Osama Bin Laden, President Obama met with his top national security advisers in the Situation Room.  At the close of the meeting, he went around the room asking each person for his or her recommendation on whether to launch the risky nighttime mission.

As it went around the table, Leon Panetta recommended that the President proceed.  Most of the others expressed reservations and handicapped the odds of success as only fair.  Finally, the President got to Biden who said he recommended not proceeding until two additional steps were taken to enhance the odds.

Then the President stood and told his advisers he would let them know of his decision in the morning.

The next day, as Obama stepped onto his helicopter to leave on a day trip, he turned to his National Security Adviser, Tom Donilan, and issued a simple order: “let’s go.”

Much more was at stake in the Bin Laden mission than success or failure killing or capturing the most wanted fugitive of modern times.  In some respects Obama’s Presidency itself was at stake.

To quote Biden, “The President has a backbone like a ramrod.”

Whether or not you like all of his policies — or all of his decisions — it’s hard to argue that Barack Obama is not a tough, decisive guy — a guy who is guided by solid core principles and has a disciplined, laser-focused will. This is not a President that flip-flops in the political wind or is swayed by the last person who talks to him.  Above all, Barack Obama is centered.  He has a solid core built around strong core values.

America — and the rest of the world — have seen those character traits over and over again during the last four years.

They saw them when he announced his candidacy to become the first African American president of the United States — and then organized the highly disciplined, leave-no-stone-unturned campaign that elected him 2008.

They saw that same inner toughness in his — at the time unpopular — decision that saved the American auto industry.

In early 2009, Obama simply refused to throw in the towel on health care reform, when the election of Senator Scott Brown made it appear impossible to succeed — and he won.

Later that year, Obama’s force of will guaranteed the passage of Wall Street reform and the creation of a Consumer Financial Protection Bureau.  And his willingness to just say no to Republican obstructionism last month by making a recess appointment of Richard Cordray, guaranteed that American financial institutions — for the first time — have a regulator dedicated solely to looking out for the interests of everyday consumers.

Obama has remained determined and unflappable in the face of the toughest economic and political environment in sixty years and has emerged from three years of battle ready to wage a highly organized, focused campaign this fall that will center on most fundamental question facing our society: whether we will have a nation where we look out for each other, and have each other’s back — or a society where we are all in this alone.

Obama intends to make this campaign a battle over core values — a choice between a society where we are all responsible for our future, and for each other — or a society where selfishness is our highest value — where “greed is good.” His campaign will frame the choice before America as whether we have a government dedicated to defending privilege — or one whose mission is giving everyone a fair shot, a fair share, and a guarantee that we all have to play by the same set of rules.  His campaign will be about reigniting the values that underlie the American Dream and the hopes of the middle class and all of those who aspire to it.  It will be about restoring fairness and opportunity and hope.

Contrast that kind of President — and that kind of campaign — with Obama’s likely opponent, Mitt Romney.

Right after the 2004 election I was riding in a New Jersey taxicab. The driver was a typical male New Jersey cabbie.  “So what do you think of Corzine?” I asked.” “Oh, Corzine, tough guy.  Like him,” he replied about the then-Senator.

“What do you think of Bush?”  I said.  “Like him too.  Tough guy.  Stands up for what he believes,” came the answer.

“How about Hillary Clinton?”  I asked.  “Tough gal.  Like her,” he said.

“What about Kerry?”  I asked.  “Kerry?  Can’t stand him.  Flip-flopper–a phony.”

Ideology, policy positions — none of that mattered to this cabdriver who liked Corzine, Clinton and Bush.  He wanted a tough, committed leader.  But the Republicans had convinced him of its central message — “John Kerry is a flip-flopper–a phony.”

Bush strategist Karl Rove had sold that version of Kerry — a Senator who in fact has strong core values — largely because of his tendency to “Senate-speak.” He also realized that Kerry’s vote for the Iraq War, and then against continued funding in 2004, could be portrayed as the symbolically powerful flip-flop.  The icing on the cake was Kerry’s explanation of the 2004 vote: “I voted for it before I voted against it.”  Rove illustrated his flip-flop message with an iconic commercial that featured pictures of Kerry windsurfing and tacking one way and then another.

Kerry’s perceived lack of core values was the factor that, more than any other, led to George Bush’s second term as president.

Voters want leaders who believe in something other than their own election.  Quite correctly they want leaders with a strong moral center. They want leaders who make and keep commitments to their principles and to other people. And they want to know that the candidates they support are the leaders they will get after the election — not, as John Huntsman said of Romney, “a well-oiled weathervane”.

Romney has never seen a position he couldn’t change if he determined it would be to his advantage to do so.   He thinks of politics as a business marketing project, where you say what you think you need to in order to maximize sales. Romney doesn’t think of voters as citizens to be engaged — he thinks of them as customers to be manipulated.

As Massachusetts Governor, Romney was pro-choice — now he is anti-choice.

Romney was the author of the Massachusetts health care plan that in many respects served as the model for Obama’s own health care plan.  Now he wants to repeal “Obamacare.”

Romney once refused to sign the “no new tax pledge.”  Now he has signed the “no new tax pledge.”

Romney favored extension of the assault weapons ban.  Now he opposes extension of the assault weapon ban.

Once he said the TARP “was the right thing to do.”  Now he says he opposed it.

Right after the economy collapsed he said he favored an economic stimulus program; now he says he opposed the stimulus bill.

Once Romney said he believed that human activity contributed to global warming; now he says he doesn’t think we know what causes global warming.

One day he was emphatically neutral on Ohio Governor Kasich’s union-busting legislation — that was ultimately “vetoed” by the Ohio voters.  The next day he one hundred percent supported that legislation.

Romney is a guy who, when called on his flip-flops and inconsistencies, said: “I’m running for office, for Pete’s sake.”

The reason Romney is having such a difficult time making the sale in the Republican primary contest is that many Republicans don’t think he has strong core beliefs, don’t trust him and think he’s a phony.

Wait until he has to convince swing voters that he’s anything more than a “vulture capitalist” who will say anything and do anything to make the biggest deal of his life — the “acquisition” of the government of the United States of America.

But, you say, maybe he will flip-flop back into a more “moderate” Mitt Romney if he becomes President.  Don’t bet on it.  People who have no core values will sell their services to the highest bidder.  Romney’s Presidency has already been sold lock, stock and barrel to the big Wall Street banks, the CEO class, the multi-millionaires who are behind his super PAC and the Republican Establishment that have financed his campaign.

In fact, throughout his career, Mitt Romney has demonstrated that his only “core value” is his own financial and political success. In Romney’s view, both in politics and in business, every other belief or commitment can be thrown overboard if it weighs him down in his quest for success.  And that goes for the people and communities that were impacted by the “creative destruction” of his corporate takeovers and leveraged buyouts at Bain Capital.  To him, they were apparently nothing more than “collateral damage.”

In the end, it is likely that the ultimate irony of the Romney campaign will be that his own willingness to toss aside positions and values that might at one time or another have appeared inconvenient, will ultimately weigh him down more than anything else.

 

By: Robert Creamer, The Huffington Post, January 29, 2012

February 1, 2012 Posted by | Election 2012, GOP Presidential Candidates | , , , , , , , | Leave a comment

GOP: Incoherent Party, Incoherent Candidates

Republicans are clearly not too enthused about Mitt Romney. Nor are they wild for any of the alternatives. This week Ross Douthat wrote a column arguing that it’s no surprise the current crop of Republican presidential candidates is no great shakes since, well, great presidential candidates are pretty rare animals. He then wrote a blog post arguing that the whole problem could have been avoided if the better Republican candidates, particularly Mitch Daniels, hadn’t decided not to run this year. Daniel Larison ridicules this notion; the fantasy candidates, he says, look strong because they haven’t been subjected to the withering attacks real candidates have to face. The ones Mr Douthat touts “don’t have the qualifications that Romney has, they all have their own weaknesses with conservatives and/or with the general electorate, and all of them decided for various reasons to save themselves the trouble, toil, and humiliation that a presidential bid would have entailed.”

Jonathan Bernstein takes Mr Larison’s point a step further and imagines what it would have taken to give Republicans a candidate they could get enthusiastic about.

What Republicans could have used both this cycle and last is a candidate who raised no suspicion from any important party faction and also had conventional credentials. Rick Perry, Tim Pawlenty, and perhaps Fred Thompson all came close, but none of them really achieved that. Given the GOP’s wild pivots on so many issues over the last decade, perhaps no one can, and someone like Romney — who holds orthodox views on all issues right now, but hasn’t for long enough to build long-term trust — is the best they can do.

This is an extremely important point to keep in mind. Mitt Romney looks like a weak phony in this election campaign because he has to pretend to believe with all his heart in orthodox tea-party conservative positions that he transparently doesn’t really believe in. We know this because in the past, Mr Romney supported health-care reform including an individual mandate along the lines of the system he instituted in Massachusetts, essentially the same system as Obamacare. And in the past, he supported a cap-and-trade system for limiting greenhouse-gas emissions to address climate change. But at the time, both of those were orthodox Republican Party positions. The fact that they are anathema today is a legacy of the reactionary fury that has driven the party for the past three years. Conservative voters responded to their epic loss in 2008 with a partisan kulturkampf that labeled every major initiative launched by the Obama administration socialism, and declared the very existence of global warming to be some kind of Communist-scientist hoax. There were very few established Republican politicians who hadn’t taken positions in the George W. Bush era (or the Newt Gingrich era!) that pose ideological problems for them in the tea-party era. Mr Gingrich himself can fleetingly outrun the problem because, like most voters, he has the long-term intellectual consistency of a goldfish. But YouTube never forgets.

Republicans’ disenchantment with their current presidential candidates is not an incidental characteristic of this crop of candidates. It’s a structural feature of a contemporary Republican Party whose pieces don’t hang together. Pro-Iraq-war neoconservative Republicans cannot actually live with Ron Paul Republicans. Wall Street-hating anti-bail-out Republicans cannot actually live with Wall Street-working bail-out-receiving Republicans. Evangelical-conservative Republicans cannot actually live with libertarian, socially liberal Republicans. Deficit-slashing Republicans cannot live with tax-slashing Republicans. Medicare-cutting Republicans cannot live with Medicare-defending Republicans. These factions have been glued together over the past three years by the intensity of their partisan hatred for Barack Obama, and all of the underlying resentments that antipathy masks. Republicans have buried their differences by assaulting everything Mr Obama supports, and because Mr Obama is a pretty middle-of-the-road politician, that includes a whole lot of things that many Republicans used to support. They are disenchanted with their candidates because their candidates are incoherent, but their candidates are incoherent because the base is incoherent. If the GOP wins this election, the party’s leaders are going to be confronted with that incoherence pretty quickly. Unfortunately, so will the rest of us.

 

By: M.S., Democracy in America, The Economist, January 24, 2012

January 26, 2012 Posted by | Election 2012, GOP Presidential Candidates | , , , , , , , | Leave a comment

“Breathtaking Dishonesty”: Romney Revives The Big Republican Lie

As Mitt Romney and the GOP’s merry band of private-equity foes take their delicious war over “good” vs. “bad” capitalism to South Carolina, don’t expect Romney’s triumphalist New Hampshire victory speech to shut his rivals down. With the slugfest heading south, the real shocker is that Romney’s chipper “I like being able to fire people” line — which will now become permanent background noise in our world, like the hum of the air conditioning — is actually much worse in context than it was when taken out.

Aficionados of this Romney gaffe know by now that Romney was referring to being able to “fire” health insurance companies that aren’t providing adequate care and coverage. But the terrible fraud in his explanation hasn’t gotten the attention it deserves.

“I don’t want to live in a world where we have Obamacare telling us which insurance we have to have, which doctor we can have, which hospital we go to,” Romney said in a rare news conference Monday afternoon to clarify his remarks. “I believe in the setting as I described this morning, where people are able to choose their own doctor, choose their own insurance company. If they don’t like their insurance company or their provider, they can get rid of it.”

On Tuesday he added: “I was talking about, as you know, insurance companies. We’d all like to get rid of our insurance companies — don’t want Obama to tell us we can’t.”

Romney’s dishonesty here is breathtaking. I used to think Republicans had taken chutzpah to unsurpassable new heights when they refused on principle to lift the debt ceiling last summer – despite having passed the Paul Ryan budget, which added more than $5 trillion in debt over the next decade.

But Romney may have topped that. He’s saying that President Obama’s Affordable Care Act — which offers people precisely the choice among competing private insurers that Romney’s own health-care reform did in Massachusetts — is instead some cartoon version of socialized medicine.

It’s a blatant falsehood. The Big Republican Lie.

Now, if Rick Perry had said this, you might say that the man just doesn’t know whereof he speaks. When Rush Limbaugh makes such bogus claims, you put it down to the ravings of an entertainer and propagandist. But Romney is a smart man. He’s also supposed to be a serious man, not a huckster. He knows better. Yet he’s made these outrageous false claims repeatedly. So this is a conscious, premeditated Big Lie.

What should we make of all this?

Let’s review. A candidate makes an obviously insensitive, unattractive remark that makes him sound like a callous, coldhearted boss, but the remark has been taken out of context. That “fire” sound bite will nonetheless become a staple of rivals’ ads and part of the Democratic onslaught if Romney is the nominee. (Look for it to be paired with Mike Huckabee’s perfect quip from 2008 that Romney “looks like the guy who fired you.”)

A fairminded citizen might feel a pang of sympathy for a politician who has to watch every word, lest it be taken out of context and turned against him. That’s why we get such robotic candidates and officials, after all.

But such sympathy dries up when it turns out that Romney’s actual meaning involves the Big Republican Lie on health care. When, in fact, Obama’s law offers exactly the same choices, via exactly the same kind of insurance exchanges, that Romney brought to Massachusetts.

Here’s another wrinkle. Romney’s passage of that health-care law – the one he’s mischaracterizing when he’s not busy running away from it – was a landmark achievement. He was the only governor who passed a bipartisan universal health-care bill. Facts are facts.

So what are we supposed to think of this man?

Here’s what we know. Romney will very casually tell the Big Lie if he thinks it will help him win. He’ll also work to enact universal health coverage if he thinks it’s a sensible path for his constituents and serves his own political ambitions once in office. Does this make him shameless and untrustworthy? A problem-solver? Both? Is belief in his own claim on power the only core conviction we can count on from Mitt Romney? Is any other presidential contender — or president — any different?

Just some questions to mull as you microwave the popcorn and settle down to watch the 30-minute video on Romney’s time at Bain in the days ahead. In the meantime, if the dictionary defines “misfire” as “to fail to ignite when expected,” and “spitfire” means “a quick tempered or highly emotional person,” I’m betting that by the time South Carolina votes, we’ll be looking at a “Mittfire” — a candidate whose loose talk on firing means he hasn’t wrapped things up when he’d hoped and who’s hopping mad about it. There’s a twist or turn left in the Grand Old Party yet.

 

By: Matt Miller, Opinion Writer, The Washington Post, January 11, 2012

January 13, 2012 Posted by | Affordable Care Act, Election 2012 | , , , , , , | Leave a comment

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