The Pitfalls Of Identity Politics

[UPDATE]:

What was I just saying about wingnuts and the health food movement?

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Eden Foods, you are dead to me.

I’ve come to learn that an inordinate number of people involved in the organic foods/natural medicine/holistic health movement are wingnuts. It seems counterintuitive, one would expect these folks to be hippie-dippy peace freaks. But actually a lot of these folks were nurtured in the anti-government, anti-establishment “homesteader” movement of the ’70s, which was a breeding ground for Libertarians. And a lot of them also come out of the survivalist freak show on the far right, as well.

Such are the pitfalls of identity politics. Just because some company markets itself as embracing such progressive ideals as,

Organic agriculture is society’s brightest hope for positive change

doesn’t mean they don’t also believe such crackpottery as,

[birth control] almost always involve immoral and unnatural practices

and

Plan B and ‘ella’ can cause the death of the embryo, which is a person

… which we all know is utter bullshit. Such is the progressive dilemma: I appreciate CEO and founder Michael Potter’s activism against GMOs, but I find his crackpot views regarding birth control abhorrent. And there are plenty of other organic food companies which don’t hold these bizarre views about birth control, so thanks but no thanks. I’ll take my business elsewhere.

Asshole.

Guess Who Went To The Doctor Today

Last week I went to the dentist. Today I went to my ob/gyn for my annual.

These days, any trip to the doctor is an infuriating, exasperating traipse through our screwed up healthcare system. And I’m a really healthy person, with really good insurance. Still, red tape and insurance bullshit manages to piss me off every damn time.

I had already decided I was going to ask my doctor about the mandatory pre-abortion ultrasound bills currently making their way through the legislature, in particular, the deafening silence from the medical community and ob/gyn’s in general on this and other issues affecting women’s healthcare. But dang, before I could even get to that we got in a debate about socialized medicine.

It started when she told me she wouldn’t perform the ol’ “blood in the stool” test, aka the FOBT, which I’ve had done routinely for 30 something years. This was because, she said, “BlueCross Blue Shield of Tennessee no longer covers it.” Lovely. I repeat: not because I didn’t need it, but because insurance wouldn’t cover it. And that, she said, was because over the past few years insurance has routinely been paying for fewer and fewer things.

This test is an easy, cheap way to detect colorectal cancer. But hey, I’m over 50 now, it’s not like colon cancer is a concern for us olds, right?

Don’t answer that.

It doesn’t matter because she said I need to think about getting a colonoscopy at some point, since I’m an olds, and of course it’s a better diagnostic test. Now, BlueCross BlueShield of Tennessee only pays for one every 10 years if the first one comes back clean. So let’s hope I don’t develop anything in the decade in between tests because apparently I’d have no fucking way of knowing about it.

Okie dokie, let’s hope what I don’t know won’t kill me! Thank you, BlueCross BlueShield of Tennessee! May you all get colorectal cancer and die an excruciating, miserable death.

Yes, Republicans. Do tell me more about bureaucrats coming between me and my doctor. I’m dying to hear.

So then we both commiserated about how awful insurance was. I asked her which insurance company was the best in terms of coverage, since she dealt with so many. She said none of them, they’re all bad. Okay, I said, fine, then why don’t we ditch them all and go to socialized medicine?

“Oh, no! That’s worse,” she said. In England, she said, whether you have a hangnail or cancer, you’re put into the system at the same place. In other words, serious health issues aren’t given any more priority than minor ones. She heard this from a patient who lived in London for two years. Her patient, however, was considered a “guest of the country” and was put to the top of the list, she explained. (I’m a little unclear how the patient would know, plus if that were true, wouldn’t there be astronomical cancer fatality rates there? Which doesn’t seem to be happening.)

“That’s certainly not what my Canadian friends have told me,” I said. “I don’t know about England, but they told me in Canada if something’s seriously wrong, you’re priority. It’s true you might have to wait longer for routine stuff, but heck, I made this appointment a year ago!” It’s true, I had.

“Oh no,” my doctor responded, wagging her finger at me. “I know someone who lives in Vancouver and when she needed something done she went to Seattle.”

Clearly we weren’t getting anywhere, trading our stories about “people we knew.” What I did say was, what do we do? This can’t be the best there is. What we’re doing now isn’t working, too many people are uninsured, and the poor are suffering the most.

“Oh, the poor have TennCare,” she said.

And so it went. Clearly my doctor didn’t know the first thing about people who weren’t her patients. She worked at a nice office in the heart of Nashville’s central healthcare campus, not the Vine Hill or Downtown clinics. Her clients weren’t the uninsured or marginalized. Nor did she know anything about what was happening in the state legislature. I asked her if she was aware that there were bills in the legislature requiring women to get an ultrasound before receiving an abortion.

“Really?!” She seemed genuinely surprised. Jesus, lady! I wanted to scream. You’re a gynecologist! This is your field! Don’t you pay attention to what legislators are doing affecting your own business?

I asked if there was any medical reason why this procedure would be necessary. “They need to do it,” she said, “to determine the age of the fetus.”

“But what if a woman is positive that it’s within the first trimester?”

“They still need to do it, to make sure.”

“To make sure?”

“To make sure she’s telling the truth.”

Wow. So we have this law to mandate a diagnostic procedure because women are liars. Got that, ladies? The government thinks you’re all liars, just like with all of that “legitimate rape” stuff, and so they need to check up on you with a diagnostic tool whose sole function is to make sure you’re telling the truth.

Yes, Republicans. Do tell me more about your belief in “small government.” I’m dying to hear.

Keep in mind, I was just told I wouldn’t get a routine colon cancer diagnostic because my insurance won’t pay for it.

Like an idiot, I asked my doctor if she performed abortions. She told me no.

“Does anyone here perform them?”

“No.”

“So where does someone go if they need one? Someone with insurance, who can afford it, where do you refer them?”

“Planned Parenthood, I guess,” my doctor answered. “Or Atlanta.”

Keep in mind, Nashville is a healthcare city. Healthcare is one of the largest industries here. We have several major hospitals here. The Nashville Chamber of Commerce proudly touts how healthcare contributes $30 billion to the local economy and creates over 210,000 jobs. But that’s all bullshit. None of that matters if you’re a woman who needs an abortion. For that, you go to Atlanta.

I asked why, although I already knew the answer. But I wanted to hear her say it. And she did. It’s just too controversial, she said. “It’s the religious people, they don’t want it,” she said. Insurance won’t pay for it. Hospitals don’t want to have anything to do with it. And finally she said, “doctors have been killed.”

I’m sure “the religious people” will be thrilled to learn they have successfully intimidated doctors in Nashville into not performing abortions. What’s sad is that Nashville is touted as being a progressive city, a patch of blue surrounded by a sea of red. But we’re still a city where women are second-class citizens because our healthcare needs aren’t treated equally.

It’s not just abortion. My doctor told me that as of January 2009, she can’t perform tubal ligations at Baptist Hospital. Baptist is one of the major hospitals here in Nashville and in 2002 Baptist merged with St. Thomas, another major player, so both are now under the Ascension Health umbrella, which is a Catholic non-profit. I had read that because religious hospitals all receive federal funds, they had to offer some kind of “secular floor,” where stuff the Catholics find religiously offensive can be done.

“It was a room, not a floor,” my doctor told me. “A separate room.” And the nurse technician that would assist her had to clock out, clock in again for the hour of surgery, and clock back out again, so she could be paid out of separate, non-religious funds. But as of January 2009, that room is no longer there. Someone who is not a Catholic will nonetheless have their medical choices made by the Catholic church.

Yes, Republicans. Do tell me more about your belief in “religious freedom.” I’m dying to hear.

This is all just so crazy to me. I didn’t intend to write a novel, but we just covered so much ground. What I wanted to know is why the medical profession hasn’t spoken up as the state house and senate legislate their profession. I mean, good lord, every time something happens in Washington we have a flurry of industry associations and phony astroturf groups telling us why it’s a bad idea. Where’s the TN Medical Assn.? Besides offering “doctor of the day” volunteers and lobbying for tort reform, I mean. It seems they haven’t spoken up because the just don’t know or don’t care.

I asked my doctor why people in her profession didn’t speak out. And she said it’s because nothing was ever going to change. That was just it, it’s too big, too hard, too controversial. It’s not going to change. I was so outraged. I just refuse to believe nothing will ever change. I said, what if people said that back in the days of Jim Crow? We’d still have black hospitals and white hospitals. Yes, she said. You’re right. And that was that.

It was the most disheartening conversation I’ve ever had. Apparently the doctors just can’t be bothered. I mean, I don’t know what else to say and I’m way beyond needing to wrap this up. But I guess I had somehow thought that doctors cared about their patients’ healthcare. Silly me.

Because It’s Not About Birth Control

Okay, who didn’t see this one coming a mile off?

Bishops Reject Birth Control Compromise
By ROBERT PEAR
Published: February 7, 2013

WASHINGTON — The nation’s Roman Catholic bishops on Thursday rejected the latest White House proposal on health insurance coverage of contraceptives, saying it did not offer enough safeguards for religious hospitals, colleges and charities that objected to providing such coverage for their employees.

The administration said the proposal, issued last Friday, would guarantee free employee coverage of birth control “while respecting religious concerns” of organizations that objected to paying or providing for it.

[...]

Under the latest proposal, churches and nonprofit religious groups that object to providing birth control coverage on religious grounds would not have to pay for it. Women who work for such organizations could get free contraceptive coverage through separate individual health insurance policies. The institution objecting to the coverage would not pay for the contraceptives. Costs would be paid by an insurance company, with the possibility that it could recoup the costs through lower health care expenses resulting in part from fewer births.

How does this “not offer enough safeguards” to address religious groups’ objections? Simple: women can still get their hands on some birth control, that’s how! They want a law that gives employers control over women’s health choices. Hell, they’ve already done it.

Look, can we stop trying to appease people who will never, ever be appeased? This is not about birth control! Half the institutions fighting this were already offering their employees contraception coverage and only stopped when it became news.

This is about the failure of the church. This is about the church’s great shame at being completely impotent in the face of cultural change. This is, specifically, about the Catholic church preaching against contraception for years and years and years and nobody paying attention — hell, even Catholic priests and nuns have ignored that piece of church doctrine. The church hierarchy wants the U.S. government to do what they’ve been unable to do, which is to get people to stop using birth control by making it too expensive and too hard to obtain.

That ain’t happening.

Stop paying attention to these idiots. Catholics don’t even pay attention to them. And if the Catholic church wants to spend its money fighting a legal battle it lost long, long ago instead of using that money to care for the poor and marginalized, then that tells you everything you need to know about the Catholic church. They’re a bunch of phonies.

Today’s Post

Over at First Draft I write about the completely predictable scenario of Red State governors refusing to implement their portion of the Affordable Care Act. Give it a read.

I know blogging has been sporadic lately, and I apologize. It’s just that I’ve started a new project which is infinitely more enjoyable than the crazy which has overtaken our national discourse. You know what? If a Democratic presidential candidate refused to release his tax returns, we’d see a flurry of state legislation mandating such documents before a candidate could get on the ballot. President Obama was required to show his birth certificate, President Clinton was required to show his penis, but Republican candidates like Mitt Romney can sock their money away in offshore accounts and it’s nobody’s business where it is so SHUT UP.

Hey, just for shits and giggles, imagine the right’s reaction if the overwhelming butt-hurt expressed by VIPs at Romney’s Hamptons fundraisers had actually been recorded at a Democratic event. Forget it, we already know: we saw this during the 2004 Kerry campaign, when “limousine liberal” entered the lexicon. The IOKIYAR that guides Republican messaging these days is off the charts; Republicans have become a parody of a political party.

God I am so over this shit, you have no idea. It’s not even interesting anymore.

Take The Health Reform Quiz

Test your knowledge of the Affordable Care Act with this simple, 10-question quiz. Tell me how you did in comments – no cheating!

I should say your humble scribe got all 10 correct. A+ for me!

Memory Hole: ACA Edition

And the early reports are in: the entire healthcare law, including the individual mandate, has been upheld. The only exception is the federal government’s right to terminate state Medicaid funds.

Suck on that, Ginni Thomas.

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Nothing to see here, move along:

Justice Thomas’ wife says healthcare law is unconstitutional

Virginia Thomas is working to repeal the law through Liberty Central, a conservative group she founded. Her husband, Justice Clarence Thomas, could provide a key vote to strike down the law.

October 21, 2010|By Kathleen Hennessey and David G. Savage, Tribune Washington Bureau

Reporting from Washington — Virginia Thomas, the wife of Supreme Court Justice Clarence Thomas, is working to repeal what she believes is President Obama’s “unconstitutional law” regulating health insurance, an issue likely to be decided by the high court.

“With the U.S. Constitution on our side and the hearts and minds of the American people with us, freedom will prevail,” says a position paper posted on the website of Liberty Central, the group formed by Virginia Thomas this year to advance conservative principles and candidates.

The story goes on to talk about the most important issue of the day: Ginni Thomas’ phone call to Anita Hill. Well done, media.

Memory Hole: Rep. Jim Cooper On SCOTUS

While we’re all waiting for the Supreme Court to issue its ruling on the Affordable Care Act, I remembered Rep. Jim Cooper touched on this at our blogger meet-up back in January. I revisited the recording which Sean Braisted posted and threw up a quickie transcript, because I thought you guys would be interested. Cooper of course is a Democrat and he voted for the ACA, and he also teaches a course in healthcare policy at Vanderbilt University.

Here were his thoughts on SCOTUS and the healthcare bill (and if you listen to it at Braisted’s place it starts around the 14 minute mark, I think…):

This is an amazingly important moment in America and hopefully it won’t be a Bush v Gore case where they make a totally political … the court needs the credibility when they’re deciding things according to the law. If they were to overturn the individual mandate that would be getting rid of eight years of Commerce Clause precedent. Now it is true before the New Deal that they had a much narrower view of government. But ever since the New Deal it’s been settled, Republican judge, Democratic judge, Commerce Clause is broad. If they were to suddenly narrow that, they’d be taking America to the 1920s.

And then for them to roll back Medicaid coercion? That would be astonishing. We would lose highway programs, we would lose tons of stuff. So what I have trouble helping people understand is, they think John Roberts, he’s conservative, Alito, he’s conservative, Scalia we know he’s conservative, and Thomas … what they don’t understand how they’re radical conservatives. Like, this idea that corporations are people? That is crazy. That is absolutely, flat-out crazy.

Some interesting headlines have hit the papers lately on the “what ifs” of the pending SCOTUS decision. (The funniest so far, hands-down, has to be Indiana Senate candidate Richard Mourdock, who accidentally posted all of his possible responses on YouTube before his team had a collective woopsies.)

Constitutional scholars seem to be of a like mind with Rep. Cooper, noting the court will lose all credibility if it overturns the individual mandate because it will so obviously be a political not legal decision.

Via Ezra Klein we have Yale constitutional law scholar Akhil Reid Amar noting:

“I’ve only mispredicted one big Supreme Court case in the last 20 years,” he told me. “That was Bush v. Gore. And I was able to internalize that by saying they only had a few minutes to think about it and they leapt to the wrong conclusion. If they decide this by 5-4, then yes, it’s disheartening to me, because my life was a fraud. Here I was, in my silly little office, thinking law mattered, and it really didn’t. What mattered was politics, money, party, and party loyalty.”

Well, um, duh. Welcome to the world. Seems to me we’ve been headed down that pathway since the mid-90s. Where’ve you been, buddy?

Also from the Ezra link, here’s Kevin Drum (not a constitutional scholar, but whatever):

Overturning ACA would be a whole different kind of game changer. It would mean that the Supreme Court had officially entered an era where they were frankly willing to overturn liberal legislation just because they don’t like it. Pile that on top of Bush v. Gore and Citizens United and you have a Supreme Court that’s pretty explicitly chosen up sides in American electoral politics. This would be, in no uncertain terms, no longer business as usual.

Again, what rock have you guys been living under? If even my Blue Dog congressman sees the radicals on the bench for what they are, what the heck is wrong with you pundits and scholars?

Ezra says SCOTUS has always been political and I’m not sure that’s the case, certainly not the level we see today. But as I noted back in March it does have a long history of making really crappy decisions like, for instance, Buck v Bell.

(h/t Kay at Balloon Juice)

Losing The Message Wars

A new Pew Study shows that the “liberal media” adopted conservative language and ideas when covering healthcare reform, helping sell the opposition’s message. Shocking, I know!

Pew studied a 10-month period that ended on March 31, 2010, on various platforms including network and cable news, newspaper, magazines and online publications. It found the three main themes expressed by opponents — that the plan called for further government involvement, it raised taxes and rationed health care — were mentioned some 18,181 times.

Terminology used by supporters to convey that the legislation increased marketplace competition, insured more pre-existing conditions and combatted greedy insurance industry practices received 10,883 mentions, Pew said.

Wow, that’s almost twice as many mentions for opponents’ viewpoints as supporters’. No wonder people are confused and mistrust the law.

Of course, this was just two years ago. We all remember the summer of “Town Brawls.” We remember the lies about “death panels” and “socialized medicine” and “government bureaucrats coming between you and your doctor” which opponents spread through the media. We were all collectively going “Huh?!” — when we weren’t bitching and sniping at one another about the compromises in the bill, of course.

I found this interesting:

Phrases used by opponents, calling it government-run health care, a government takeover of health care and “death panels” were “really evocative,” Rosenstiel said. They were also used more consistently, an indication that opponents were better organized than supporters, he said.

Meanwhile, some of the phrases and ideas set forth by supporters to define insurers or talk about pre-existing conditions were more abstract and there was less coordination among people pushing for its passage, he said.

Therein lies the problem. I’d love to say, “c’mon, Lefties, get it together. Come together … right now …” But really, is that ever gonna happen? No. It’s not in our constitution. We are not a homogenous, authoritarian group like the Right. We’re different and need to be approached differently.

Here’s how the Affordable Care Act — a Republican idea, let me add — was suddenly transformed into evul Lefty Obamacare “socialized medicine.” First the corporate moneybags leading the Republican Party funneled their fearmongering about healthcare reform through the wingnut wurlitzer — the Fox News shows like Glenn Beck, radio blowhards like Rush, the e-mail FWD:s, etc. It’s easy to get everyone riled up and repeating the same language when you have that kind of machinery eager and willing to do your bidding. And then just when people were hot and bothered enough, along comes a corporate-funded bus to load everyone up and take them to a rally which those same message outlets had promoted.

Ah, the Tea Party. Y’all were very useful idiots for the plutocrats, weren’t you? You always are. Feeling ignored these days? Don’t be. I’m sure they’ll call you guys up to be foot soldiers for the status quo again soon. /snark.

Anyway, this is why we can’t have nice things, like get the fucking lamestream media to stop adopting right wing talking points. We don’t just need a liberal Frank Luntz to help us with “framing” (God how I hate that term.) Democrats can’t get their message out there because a) we don’t have the same infrastructure to do so and, b) the left’s big tent is not filled with the same follow-the-leader types as the authoritarian right. We’re always going to be arguing amongst ourselves about how Obama and the Democrats have failed us because of this or that thing. And yes on healthcare reform I did it too, I’m not absolving myself of blame here — I called the healthcare reform law a shit sandwich. It was. I didn’t get everything I wanted and I was pissed.

I’m not even saying this is necessarily a bad thing. I’d rather be part of a group that asks a lot of questions and engages in a hearty debate and fights for the things it sees as necessary than be part of a group that robotically falls in line when it’s ordered to do so by Big Daddy.

I’m just saying, Democrats, that this is a problem you’re going to need to solve if you ever want to win political battles. You need your base to help you sell your message. You just do. Look what happened when we were all arguing amongst ourselves and feeling ignored and irrelevant on healthcare reform. You lost the message wars.

If you want to sell a huge piece of politically expensive legislation like healthcare reform, you need to figure out how to get the Left on board. I don’t remember you guys doing that. I don’t remember you selling the healthcare reform compromises to us. I don’t remember you reaching out through those liberal channels that do exist — the few Lefty talk shows on radio and cable TV and even The Daily Show and whatnot. I remember you throwing us under the bus and telling us to STFU and let the grown-ups be in charge. Maybe I’m remembering it wrong.

Anyway, I’m just throwing some ideas out there. When we’re having a debate there needs to be two sides of a conversation, not the right-wing side shouting everyone else down. That was a problem during healthcare too, the sheer volume on the conservative microphone drowned everyone else out. I don’t know how we fix that problem, but I do know it needs to be resolved.

First Draft Tuesday

Over at First Draft I write about that TNR story on Tennessee’s uninsured. See you over there.

Have A Heart

As the Supreme Court begins deliberating the healthcare reform law it’s important to remember how we got here. And there is no more perfect example of our flawed, inequitable healthcare system than the fact that Dick Cheney got a heart transplant last week. This troubles bioethicists because of his age and his extremely poor health:

It is concerning that a 71-year-old got a transplant. Many of those who manage to even make the waiting list for hearts die without getting one. More than 3,100 Americans are currently on the national waiting list for a heart transplant. Just over 2,300 heart transplants were performed last year, according to the United Network for Organ Sharing. And 330 people died while waiting.

According to UNOS, 332 people over age 65 received a heart transplant last year. The majority of transplants occur in 50- to 64-year-olds.

Most transplant teams, knowing that hearts are in huge demand, set an informal eligibility limit of 70.

Cheney is not the first person over 70 to get a heart transplant. He is, however, in a small group of people who have gotten one. Why did he?

Cheney has an advantage over others. It is not fame or his political prominence. It is money and top health insurance.

Heart transplants produce bills in the hundreds of thousands of dollars. The drugs needed to keep these transplants working cost tens of thousands of dollars every year. Organ donations are sought from the rich and poor alike. But, if you do not have health insurance you are far less likely to be able to get evaluated for a heart transplant much less actually get a transplant.

I wrote about this last October when I reminded everyone that Steve Jobs used his wealth and mobility afforded by a private plane to “game the system” and fly to Memphis for a liver transplant. Two years later he was dead.

The wealthy and powerful will always pull out all the stops when it comes to their healthcare needs; the healthcare law is not designed to address that, nor should it. But there are millions of people in this country with failing organs who never even get in the door of a hospital, let alone find their names on the transplant list. Millions of people without health insurance and therefore without healthcare for whom getting on the national organ transplant registry is never going to happen. But we’ll happily take their healthy organs when they die.

It really makes me wonder what kind of society we have where the poor are so expendable. Texas’ women’s health clinics have been shut down over a wholly misguided ideological battle, that’s thousands of women who aren’t going to see a doctor for a variety of needs now. Sorry poor people, sucks to be you, too bad we didn’t catch that cervical cancer sooner, but if you die can the former Vice President have your heart?

This country is seriously fucked up. The greatness of a nation is judged by how it treats its most vulnerable citizens, not its most powerful. Right now the status quo which conservatives are bizarrely fighting to maintain is an unworkable, expensive, ineffective system. Once upon a time they loved the very healthcare reform legislation they’re now spending millions of dollars trying to dismantle. It is truly strange.

I don’t know how SCOTUS will rule on healthcare reform but I do know that our existing system is completely unworkable and gets moreso every year. If parts of the Affordable Care Act are ruled unconstitutional and other parts are shredded by Republicans in Congress, what we’re left with is a system in utter tatters. I just don’t see that standing for very long. We might end up with that “Medicare For All” everyone has been clamoring for.