Life or Death – The Real Choices in the Abortion Wars

sleeping baby

The Planned Parenthood videos have brought a difficult subject into broad daylight for discussion – nothing less than life and death. As medicine has advanced, we’ve had many debates over what “natural” death is, and they all start with figuring out what is life. Breathing? A heartbeat? Brain activity? An implanted embryo? Unique DNA in a developing blastocyst?

The question of abortion is not about “does a woman have a right to choose” what happens to new life growing inside her body. She has a responsibility for her choices at every stage of that new life, and a responsibility and a right to choose within parameters agreed to by culture and sometimes expressed through government rule. It is an appropriate role of government to set guidelines in areas where two lives come into conflict. Which brings us always back to the question – when are there two lives involved? Without agreeing on exactly when, let’s assume that there are two lives at some point before first breath of air.

When approached from a utilitarian view of life, killing a life before it emerges from the womb is justifiable if the mother and society determine that the life has no utility – whether because it’s untimely, unwanted, imperfect or may potentially ¬have a miserable life for some other reason. From a utilitarian standpoint, there is no reason to bother trying to save the life of victim of trauma exhibiting all the signs of a serious brain injury. Just shoot him and put him out of his misery like a dog that’s been hit by a car. From a utilitarian standpoint , why stop someone from jumping off a bridge – clearly he’s miserable. From a utilitarian standpoint, why not abort a baby with the bad luck to be created as a result of rape, try and pretend it never happened by adding one more act of violence to a violent act. From a utilitarian standpoint, why bother to staff expensive Neo Natal Intensive Care Units to save babies that could have been aborted much more cheaply? How disabled is too disabled to deserve to live?

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Because of the siren song of utilitarianism, I cannot support a ban on abortion. A government with the power to ban abortion has the power to command abortion. The responsibility for the decision cannot be taken away from the mother, but the context for her decision is society’s responsibility. Are we a culture of life or of death?

If we respect life enough to cherish it, to give life a chance, to recognize our limitations in foreseeing the future, then we as a society set different sideboards to the mother’s decision. Our responsibility is to err on the side of life, unless it really and truly comes down to the mother’s life or the baby’s – a Sophie’s Choice. Such cases are extremely rare and heart wrenching and clearly the mother’s responsibility to make the decision. We owe it to women to empower them to choose life, and to support that choice. We owe it to our humanity to reject abortion as anything other than an end of life decision, to be made with the same seriousness as at any stage of life.

To condone abortion for any other reason than a difficult resolution between two lives in mortal danger is to operate from a set of assumptions that creates a culture of death. The culture of death says some lives aren’t worth living and the worth of an individual is based on their utility to society in the eyes of Woman and Man. The culture of life says yes, life is often unfair and difficult but it has inherent worth in the eyes of the Creator.
I don’t assume everyone believes the same as I do. I do assume that we have to discuss difficult subjects and express our points of view, and the foundation for those points of view. I believe there is inherent value in human life, from creation of a new and unique string of DNA to natural death. There are plenty of nuances to debate over the exact beginning and ending, even among those who agree life has inherent value and especially to protect the most vulnerable lives among us.

The alternative is a utilitarian view of human life – external value based on potential worth or worthiness. If utility is your standard, there are no nuances. Life belongs to those with the power, whether a police officer holding a gun to the head of a young man on the wrong track in life or an abortion doctor at Planned Parenthood holding a forceps to crush the body of that same young man’s baby before it even has a chance. Where there’s life, there’s hope.

I choose hope. I choose life.

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Unaffordable Health Care – Muriel’s Story

Before the Affordable Care Act (ACA) and in the subsequent partisan battles over Obamacare, there has been one constant point of agreement between Republicans and Democrats. We all want a healthcare system that supports families hit with a catastrophic medical diagnosis.

Last Thursday I interviewed a representative of that class, Muriel Tingley-Turner, for my Better Health podcast at SpokaneTalksOnline.com. It was one of our best interviews ever. Unfortunately, we lost the recording due to technical difficulties. Like technology, sometimes our health is not under our control. That’s where we started the interview.

Muriel is a former classroom teacher, mother of five daughters, active in a home schooling cooperative, and works in a small business. She is grateful to have had private health insurance at the time of her diagnosis with a rare cancer, a condition that has roots in a genetic anomaly and not anything she could have controlled with diet and exercise. There are no fingers to point here. Muriel’s is the classic worst case scenario, the kind where we expect health insurance to protect us. But does it?

After the diagnosis, Muriel started cancer treatments. She was one of those who found her health insurance policy and access to her doctors impacted by the changes mandated under the ACA. It took many hours on the phone with the insurance company and her healthcare providers to keep her treatment on track even when she couldn’t keep her doctor, an additional stress at a critical time for a healthy outcome. Thankfully, the cancer is in remission at this time and now attention turns to keeping it that way.

The new insurance system agreed a second opinion was in order after the first round of treatment. Most qualified health plans will cover the cost of a second opinion. Not only does it benefit the patient by leading to better outcomes, it often benefits the insurer by reducing costs. In Muriel’s case, the specialists for her condition were located at the University of Texas in Houston. They recommended a stem cell transplant as the next step, to be performed by specialists in Seattle. The cost of travel was on her. Travel is just one of the costs of healthcare that we often overlook.

This is a common dilemma for patients with an uncommon or difficult condition. Every hospital, every clinic, cannot be a specialist in every condition. It makes sense to centralize some kinds of services where doctors can see enough patients with the same problem in order to get really good at diagnosis and treatment. In medicine as in so many endeavors, practice makes perfect. Many times these specialists are out of network, although insurance companies can be persuaded to cover at least some of the costs.

When we talk about healthcare costs, we often focus on the insurance premium. Savvy consumers dig into the deductibles and co-pays when choosing a plan, but still aren’t seeing the whole picture.  Muriel was grateful to her son-in-law for making her sit down and develop a budget for all the costs she should expect. In addition to the trip to Houston, there would be the cost of temporarily living in Seattle as required for the stem cell transplant protocol. Travel, housing, copays, deductibles and home care is anticipated at $32,000 to $36,000. It is a hard number to face at a time when she is also facing long term unemployment while receiving and recuperating from treatment.

The ancillary costs add up quickly. Will treatment reduce your immune system’s capacity? Then you’ll need to pay someone else to care for your house, garden and pets. Muriel is blessed with five capable daughters old enough to help; she can’t imagine what someone in her position would do with toddlers. In any catastrophic illness, the indirect healthcare costs plus the deductible plus any co-insurance requirements still threaten people with medical bankruptcy. Family, friends and fundraisers provide the safety net.

I became aware of Muriel’s story after seeing a Facebook post about the trip to Houston for consultation. Not having much money myself, I offered her this forum to describe her situation and make a pitch for some of the fundraising efforts underway on her behalf.  If you feel inclined to help out with even a few dollars, you’ll find a Go Fund Me campaign at http://www.gofundme.com/u5bh2k for Medical Expenses for Muriel. Another opportunity will be a pass the hat celebration and send off for stem cell treatment, organized by Muriel’s Irish step dancing community and set for Thursday, June 4th at O’Doherty’s Irish Bar and Grill in downtown Spokane (check out the link here https://www.facebook.com/events/445611275600574/ ).

There are currently 274 campaigns in the Spokane area on the Go Fund Me system in the category of Medical Expenses. While raising the numbers of people with health insurance was a laudable goal, the Affordable Care Act didn’t focus on making health care more affordable or provide additional tools to help families better prepare.  Deductibles of $5,000 per person or $10,000 per family are common, and ordinary middle class families don’t commonly have $10,000 in the bank.  One of Muriel’s fears is how to face paying that deductible every year as her treatment post-transplant hopefully turns from acute to chronic. Go Fund Me is not a long term plan.

As we continue the dialog on reforming healthcare reform, we have to start on common goals. How do we provide a safety net for those hit with catastrophic medical bills? Encouraging pre-tax savings in Health Savings Accounts for the holistic costs of healthcare is one approach, rather than tying HSAs only to the so-called high deductible plans. In the case of a catastrophic diagnosis, the ancillary costs will always exceed the deductible. And even a healthy HSA can be drained if a condition requires ongoing treatment; how can we most fairly and sustainably manage long term treatment costs?

At the close of the interview, I asked Muriel if she had any advice for people as they evaluated their health insurance options this year. “Don’t assume you’ll never have to use it,” she replied. We like to  think of ourselves as invincible, but someone will draw the short straw and it might be you.

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Mandating Paid Sick Leave – The Utilitarian Argument

A recent Shawn Vestal column on a proposed ‪Spokane ordinance mandating paid sick leave (http://bit.ly/1FiYPkI) lacks depth. Frankly, rather than arguing that mandated sick leave hurts the economy, the issue is the very basic question of whether this is an area where government should act. The column focuses on utilitarianism.

The utilitarian argument has flaws on both sides, and Shawn’s column points out the flaws in the utilitarian objection to such an ordinance. He cites a UW survey of Seattle businesses before & after a Seattle sick leave ordinance, but with so many questions unanswered.

• “Implementation was easy for some employers and caused temporary hassles for others.”
[Questions: Did employees notice any changes in how current sick leave policies were administered? For example, did businesses start requiring a doctor’s note when they used to just accept an employee calling in? Did employees who had been happily using a single Paid Time Off (PTO) system lose that flexibility? Did employers change how sick leave was accumulated and whether it could roll over from year to year?]

• “Costs to employers and impact on businesses have been modest and smaller than anticipated. … There is no evidence that the Ordinance caused employers to go out of business or leave Seattle.”
[Questions: Has there been a benefit to employees? How many employees who did not have sick leave prior to the ordinance benefited after the ordinance? Is it major and large, or modest and smaller than anticipated?]

• “Overall 70 percent of employers support the Ordinance.”
[Questions: What percentage of employers already provided sick leave? If it was 70%, did they see this as a levelling the playing field move, or just didn’t care because it didn’t affect them? If it was greater than 70%, why was support lower?]

• Sixty percent of businesses said they could not quantify the impact the ordinance has had on their operations, and 24 percent didn’t even know if they were tracking the costs. So few businesses had this data that the reliability of estimates provided by those who did is limited. Still, for the 26 businesses surveyed on that question, costs ranged from zero to $125,000, with an average of 0.125 percent of annual revenue.
[Questions: Probably even less useful to ask employees how they benefited, they are just as unlikely to be tracking this kind of minutiae. But perhaps a survey of 100 employees would be useful, and we could determine that the value to their lives ranged from zero to $600 (5 full time days at $15/hour). Might be as much as 1% of their annual income, assuming they were sick for 5 days and needed/used the whole benefit.]

• The number of people employed in Seattle, which was rising in 2012, continued to rise after the ordinance was implemented. Total wages paid in the city, which were rising before the ordinance took effect, continued rising after, though the growth slowed. The study’s authors said it’s possible some employers had held down wages to offset the cost of the ordinance, though they said the evidence for this was “not strong statistically.”
[Questions: Not surprising that it’s “not strong statistically” because until the ordinance came along there wasn’t great reason to track a relationship between sick leave and wages in that manner. Decisions about benefits to offer were driven by competiveness in attracting employees. If necessary to attract workers, employers offered sick leave.]

• Overall, economic data for the city suggest the ordinance had “no or very moderate impact.”
[Questions: Overall, do we know if economic, job satisfaction or happiness for employees had any noticeable impact? Or was it all just an exercise in grandstanding by people who think all business owners are greedy, immoral vultures who need to be told how to run their businesses?]

I’ll close with the conclusion from the writer for the Bloomberg News Service cited by Shawn: “He found the laws had an effect, but not a large one.”

Without the whole picture, it’s just more progressive liberal theater.

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The (Un) Affordable Healthcare Battleground

The Affordable Care Act was doomed to be a partisan battleground. Passed by a lame duck Congress in 2010, it was a rough draft, intended to be refined and repaired in conference committee when the Democrats had the majority in the House.  The 2010 elections flipped control of the House, leading the Democrats to pass it without a single Republican vote, after no serious attempts at bipartisanship, and without being able to fix its known flaws.

It’s been over 4 years since passage and the early wins the law was designed to provide have shown up in increased numbers of people with health insurance, although more than expected has been through Medicaid expansion.  As the tortured economics of the ACA have been unraveled, it’s becoming clear the cost will be much higher than anticipated. The Affordable Care Act is unsustainable.

So what next?  Reality is what’s next. The ACA will not be repealed. Oh, there will be another repeal bill passed by Republicans as political theater to demonstrate they’re listening to their base.  But reality is that even if a repeal bill was passed with a perfectly crafted replacement ready to slide into place, President Obama would never sign it.  And to Democrats who like to hold out for moving to a single payer system, that’s not happening either.  It’s time for everyone to move on.

When intervening in any complex system, and healthcare is certainly complex, it is essential to monitor for the earliest signs that things are going wrong. If you only monitor for anecdotes and statistics confirming you were right, you’ll miss critical correction points. Authors of any legislation must assume they are wrong, and that’s a tough position for any politician.

Republicans as a whole have been quick to point out what’s wrong, a little slow to acknowledge what’s working so far. On the other hand, Democrats demonize anyone who wants to talk about problems. Neither attitude is useful.

There are pieces of the ACA that have been helpful to some people.  There are pieces of the law that just reauthorize and extend existing programs and are not controversial.  There are pieces of the law that have caused new problems, the unavoidable unintended consequences that accompany any complex legislation. There are pieces of the law that have hurt people now and will in the future. There are critical concerns about what happens when the hidden subsidies disappear and the economic energy is drained.

Facing reality isn’t a partisan enterprise.

Join me on Better Health podcasts on SpokaneTalksOnLine.com and follow this blog to explore where we’ve been, where we are and where we’re going. Doing nothing is not an option.

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