Summer Reading and Viewing

  ..Stuff to read and watch if you care about... 

Speaking engagements were hard to come by over the summer but there is no shortage of resources to learn more about what's happening in reproductive justice and health care reform.  Here are my top recommendations, most of which are available to stream for free online or check out from the library.

..Reproductive Justice...

The Texas Tribune's Video Series: Fertile Ground

For a comprehensive look at the impact of political games being played with Texas's Women's Health Program. After the SCOTUS ruling, it is still under siege. This 6-part series explains what happened with family planning funding and abortion restrictions during the last Texas legislative session. Data and numbers should give you a good idea of what's at stake.

Rachel Maddow's MSNBC Documentary: The Assassination of Dr. Tiller

Wikipedia image

 

Preview available here. If you subscribe to Netflix streaming service, you can find Rachel Maddow's profile of the political circumstances and events leading up to the day in 2009 when the late-term abortion provider was shot to death in his church. Dr. Tiller's simple explanation of why he chose to perform late-term abortions is an especially profound moment. The documentary also exposes the conditions that have forged a culture of terrorism against abortion clinics and providers.

.. America's Broken Health Care System...

These resources may be a bit dated but give a well-rounded overview of what makes the current model unsustainable. Examining other health care systems around the world gives insight into what we can and cannot accomplish going forward.

Frontline's Sick Around America

Frontline tours the nation talking to patients and representatives from the health insurance industry to answer the question: what's wrong with health care in America?  The insurance industry speaks for itself in this piece and they seem surprisingly on-board with reform. Frontline also produced a series about health care around the world, I haven't got around to watching yet.

Helene Jorgensen's 2008 book Sick & Tired: How America's Health Care System Fails Its Patients

This is personal story about one woman who contracted lyme disease and her battle to afford her medical bills and stay sane doing it. She open's with the story of Nikki White, which is also mentioned in the Frontline documentary. Jorgensen short, but well-researched volume highlights what I see as one of the biggest problems with the current system: conflicts of interest at nearly every level of health care delivery.

The Healing of America by T.R. Reid

I am late to the game on this bestseller from 2010, but, like the Frontline piece, it tours health care systems around the world, many of which serve as models for systems we already use, like Medicare and the V.A. health service. The book leaves you with the haunting question: how much inequity are we willing to tolerate when it comes to healthcare?

...Well, I hope this list helps to kill the last few hours before school starts up again. Many of the issues touched-upon will be big election-year talking points so we should all keep well-informed...
  

On the Eve of the SCOTUS Ruling: Panel on Social Determinants of Health Disparities; Moving the Nation to Care About Social Justice

By: Megan Antonetti-Elford

At the edge of the cliff of good health...
(slide taken from the presentation of Dr. Camara Jones)

I tweeted for everyone to tune in to webcast a few weeks ago to hear discussion about topics that I think are mostly missing from the health care debate. We often hear complaints about constitutionality and the economic pitfalls of controlled markets, but these discussions miss the point with regard to the state of health care in this country. On the eve of the SCOTUS ruling on the Affordable Care Act, we should refocus on the goal of achieving health care equity in America and the impact of social determinants like racism that are at the root of this issue. We have analyze why health disparities arise in the first place.


An archived webcast of the University of North Carolina Minority Health Project's presentation can be viewed here: http://www.minority.unc.edu/institute/2012/. Some points stood out for me particularly and I hope they inspire others to watch the webcast in full and, of course, to tune into the discussion next year, after we have seen the outcomes of the upcoming health care ruling play out.


Dr. Camara Jones, MD, MPH, PhD, Medical Officer for the CDC, opened the program with a electrifying talk setting up a framework for talking about social determinants of health disparities.  She spoke about three levels at which we can approach the problem of health care equity as the "cliff" pictured above -a great metaphor for addressing how health care resources are spent and also how health disparities arise. Dr. Jones argues that disparities arise in quality of care, access to care, and differences in opportunity, exposure, and stress in daily life.  To keep people away from the cliff (getting sick and needing health care), the third level, the differences in opportunity and exposure, must be addressed.


Racism can be difficult to talk about in this context but Dr. Jones pinpointed it quite well, defining it as "a system of structuring opportunity and assigning value based on the social interpretation of how we look." Like all of the other power structures at play, from sexism to capitalism, racism  "unfairly disadvantages some individuals and communities" while providing a reciprocal unfair advantage for others outside those populations.  This may contribute to the fact that knowledge of a persons perceived race and zip code can accurately predict his overall health or BMI. Identifying and correcting the mechanisms of institutionalized racism in decision making in this country may be the most important way to achieve health equity.


What is health equity? According to Dr. Jones, it is "the assurance of the conditions for optimal health for all people." It is a process guided by reason and social morality requiring these three tactics:

• Valuing all individuals and populations equally
• Recognizing and rectifying historical injustices
• Providing resources according to need

How did the U.S. get so behind in looking after the health of its citizens? We have to look at how the system of racism, in its history, in its manifestation outlined by Dr. Jones, and in its limiting of access to health care colors the opposition to the health care law. Racism is a component in this debate we can't be afraid to talk about, especially because it is institutionalized at levels beyond the availability of health care, to public education, protection of reproductive rights and access to accurate sex education, and even the prison system. We have to look at the motivations and actions of the unfairly advantaged because they hurt us all.


*hyperlinked text links to relevant films, viewable online for free

Juxtaposed Panels: Healthcare Future & Reproductive Health

Healthcare business people and women's rights scholars talk about recent events.. Audio coming soon!

 By: Megan Antonetti-Elford 

I was crunched for time last Thursday evening but speed-walked across campus to catch two overlapping panel discussions on two different, but overlapping subjects.

 
1. 5pm - Managing Uncertainty in the Future Healthcare Environment put on by the MBA Healthcare association as part of the McCombs Health Care Symposium at the plush AT&T Conference Center

2. 6pm - The Texas Observer and The Center for Women’s & Gender Studies jointly-hosted “Politics Becomes Personal” panel in Burdine 106.  


Here's a table of highlights of the panels:

Managing Uncertainty...		Politics Becomes Personal
	setting
professional, too many water glasses for the amount of guests and panelists, chattering  people breezing in and out		dank, vacant, (I took a physics exam here once), panelists sitting on each-others laps at a folding table
	MC
young president of the MBA healthcare association - Jim Ryan		englishwoman director of Center for Women’s and Gender Studies - Sue Heinzelman
	what brought them there
things are changing because of affordable care act, changes in health care delivery and electronic information but we don’t know how		how we came to see broad attacks on women’s health and reproductive rights and how we can respond
	readability
tough - full of acronyms I still couldn’t decipher even after looking them up		a breeze - facts and numbers provided by Kristine Hopkins of the Population Research Center at UT and Sarah Wheat
	emotional appeal
Katherine Henderson’s pledge that, based on their mission statement, Seton Health Centers will continue to provide care regardless of a patients’ ability to pay of the outcome of the Supreme Court Decision on the Affordable Care Act.		Caroline Jones’s post-sonogram law experience will break your heart
	audience
Dr. McDaniels big-shot in McCombs school, healthcare salespeople - people who know what the acronyms mean		aging activists accusing young people of not paying attention, surprising amount of young men, bloggers
	similes
health care reform is “..like asking me to redesign a nuclear reactor, it's just not gonna come out well.” - Thomas W. Knight, MD St. David’s Chief Medical Officer		political use of the term “informed consent” in defense of the sonogram law is like “.. calling something the clean skies act when in fact it is a permission to pollute.” -Sarah Wheat, Interim Co-CEO of Planned Parenthood of Greater Texas
	what I think I learned
the health care industry is open to changes, aware of alternative models, and humbled by the inefficiency of the current system. As Ben Gawiser, VP of health software developer Advisory Board Company pointed out, they need more data and strategies to reduce costs.  And I think, curbing greed would help too.		As Christen Smith, UT Department of Anthropology chair put it, “lawmakers are using women’s bodies as a political playing field.” And I think voting (more people voting), not rallying or paneling, will be what puts an end to it.

Objectivist Talk: Pro-Choice = Pro-Life

Dr. Andrew Bernstein brings Objectivism to the abortion debate.... We weren't sure what to expect. (Liz, you shoulda been there)

-By Megan Antonetti-Elford

On April 11, 2012, UT’s Objectivism Society welcomed Dr. Andrew Bernstein, author and  instructor of Philosophy at SUNY Purchase on the subject of a woman’s right to have an abortion. Objectivism follows the philosophy outlined in the writings of  Russian-American author Ayn Rand and is based on her ideas of an individualistic connection with reality and laissez-faire capitalism.

Dr. Bernstein’s hour-long discussion, which depended heavily on the semantics of the debate, chipped away at the issue from many angles often pitting objectivist-style nature as biology against views based on religious sentiment. He began with a dispute about the anti-choice’s use of the phrase “right-to-life.” In essence, he argued that life, defined by ‘individuation’ and independence could only be attributed to a woman in this context and not to “a growth inside a woman’s body.”

Throughout, he drew upon the ancient western philosophy of Aristotle and Plato and popular anti-abortion writers to articulate the misgivings of some of the anti-choice’s most characteristic arguments including:

• abortion is murder and should be outlawed

• a fetus is human from the moment of conception and should be granted all rights given to other humans

• evidence that a fetus is a human is that a fetus is a living being and has the genetic material of a human being

These were followed by quite rigorous and amusing counterarguments from the objectivist point of view - citing, in basic principle, that the “the acorn is not the oak” -a point, I think, that many pro-choicers get.

Though this well-cited succinct outline was of great value to understanding where anti-choice ideas come from, Bernstein’s uncertainty about the morality of later term abortions (after the first trimester) and minors’ right to abortion seemed to be a great disappointment to the audience.

What could be gathered about the objectivist argument for the right to abortion is that this particular right simply falls under the category of rights in general; that is, pro-choice = choice. Tacking on modifiers that it is a right only before certain moments in pregnancy or only to people above a certain age certainly muddled the philosophical purity of the task at hand with its arbitrariness.

Dr. Bernstein went on to cite his apparent disdain for many of the national services that by restricting choice, aim to alleviate injustice, and help the poor and disadvantaged in society- programs paid for with taxes such as environmental protection and health care aid.  These points were probably lost on anyone who does not value people based on the “effort” that they are capable of exerting to survive everyday American life. Additionally, if you are someone who does not feel that paying taxes places you under “involuntary servitude” to the state, you would have shifted in your chair as well. And so Bernstein spent the last part of his talk disparaging government policy in general, pointing out that both liberals and conservatives want to control the lives of individuals and only fight about how much control they should have and in which areas of life.

In my view, a genuine pro-choice stance is far simpler and less far-reaching than the one Dr. Bernstein outlines. Countless anecdotal evidence, especially in the context of abortion, shows that the treatment of moral dilemmas is not reducible to a list of philosophical maxims. Still, that shouldn’t stop us from framing our opinions and fighting for them. Medical abortion should be safe and available to any woman without stigma. And being pro-choice is simply being willing to defend and trust a woman to make this decision for herself. 

Looking at the Affordable Care Act Through a Pre-Med Lens

Dr. William M. Sage speaks at UT Austin

Dr. Sage holds "the most expensive medical
technology in the world."

Last week the UT Kappa Rho Honor Society hosted an informal talk with MD/JD Professor of Public Health, Dr. William M. Sage about the intersection of law and medicine.  I attended along with about 30 of my peers hoping to hear an expert's perspective on the week's events in the Supreme Court and the future of medical practice in America. Dr. Sage is the vice provost for health affairs at The University of Texas at Austin and carries an impressive resume that includes a joint degree in medicine and Law from Stanford University, membership in the President’s Task Force on Health Care Reform in 1993 under Bill Clinton, numerous publications, awards as well as seats on the leading committees in the field of health care policy and research. Last week he composed lengthy blog entries about the Supreme Court proceedings for Health Affairs online.  

I admit I’m particularly unqualified to write about this subject, having spent the last three years with my head buried in chemistry textbooks and with a generally panicked outlook on my career future.  I have not read the Affordable Care Act, nor have I read the transcript of the Supreme Court proceedings but I have been paying attention.. I have been addicted to NPR’s coverage of the story and, I thought, if anyone could wade through the complexity of health care legislation, Dr. Sage seemed qualified to do it.

At the outset, he asserted “You should expect yourselves to become leaders and society should expect you to be leaders...” He went on to describe the current state of health care in this country as “mediocre” at best.  It is a system whose structure and culture are inhospitable to efficiency and fair commerce; “a huge cottage industry.” Doctors don’t think they are being compensated appropriately and patients think they overpay.  At one point Sage borrowed a pen from an audience member in the front row, holding it up, he called it “the most expensive medical technology in the world.”  He said doctors are responsible for the strain of “a largely discretionary, often unjustified expenditure of a trillion and a half dollars a year... to write prescriptions for drugs, referrals for services, hospitalization, diagnostic imaging etc., etc..”

Title III of the Patient Protection and Affordable Care act of 2010 addresses these concerns.  Last week the Supreme Court did not. So what does an aspiring doctor take away from the discussion? On one hand, the Court makes it seem like the future of health care in America hinges on an individual mandate to buy insurance.  On the other hand, Dr. Sage, says the insurance problem merely scratches the surface of the reform this country needs.  The admissions essay answer is that the discussion doesn’t matter; what matters are the patients.  But what myself and my peers often fail to appreciate is that our job satisfaction and our success at being healers depends a great deal on this discussion and what we have to say.  

If Dr. Sage is right, then the future of healthcare is uncertain. I don’t think any doctor would argue that being allowed to take control of a patient’s treatment requires doing it responsibly and efficiently. And I don’t think any citizen would deny that society would benefit if people did not go bankrupt because they got health care.  Furthermore, by taking responsibility for the delivery of preventative care a reformed system can keep society from having to pay for people who are already sick. It is uncertain how we can reconcile all of these goods without sacrificing the goods in our current system. My hopes echo what Dr. Sage wisely advised; in the future doctors will no longer “merely deliver services,” but will take a leading role in shaping the future structure of American healthcare, not just the way it is paid for.  We can, hopefully, overcome many of its flaws and build a great system.

Op-Ed by Katy Waters- Texas Further Complicates Abortion With A New Sonogram Law

Texas Further Complicates Abortion With A New Sonogram Law

The new sonogram law that requires women to listen to the fetal heartbeat and a description of the fetus by their doctor is shaming, demeaning, and most importantly, medically unnecessary.

Texas House Bill Number 325 was written to interfere with a woman’s decision to terminate her pregnancy, while lengthening the process. (And it is a process due to the new 2-day waiting period that was enforced starting October 1, 2011.)

Doctors (not ultra sound technicians) must now verbally explain ultrasound images: the dimensions of the fetus, if it has arms, legs, or internal organs, and must describe heartbeats if audible. But don’t worry, the woman can “choose to look away from the images.” Directions were not explicit on if she could plug her ears, too.

An exclusion offered in the bill states that if the fetus has an irreversible medical condition, or in cases of rape or incest, that women can opt out of the fetal images and their descriptions.

When the Center for Reproductive Rights challenged the sonogram law on the basis that it infringed on doctors’ free speech rights, the 5^th U.S. Circuit Court of Appeals overturned the temporary order against enforcing the law. Chief Judge Edith Jones wrote in her statement, “The point of informed consent laws is to allow the patient to evaluate her condition and render he best decision under difficult circumstances. Denying her up-to-date medical information is more of an abuse to her ability to decide than providing the information.”

Then why the exclusion for certain cases? While I’m glad that victims may opt-out, the exclusion is a contradiction to the reasoning of upholding this law that assumes women don’t understand what being pregnant means, and that there is a good chance it will change her mind. (Although it may be too early to tell, Amy Hagstrom Miller, the owner of five Whole Woman’s Health clinics, has confirmed that the same percentage of women come back after their sonogram since the enforcement of this law.)

Advocates against abortion claim that women believe that their fetus is just a “blob of cells,” and that hearing and seeing the fetus will be so dramatic that she will actually reverse her decision to terminate her pregnancy. 65% of women who have abortions already have at least one child. They know a fetus is not a “blob of cells.”

That opinion is condescending of women’s mental capabilities. As Hagstrom Miller puts it, “We haven’t had a woman say, ‘Oh, my goodness, I didn’t expect to see a fetus,’ and then change her mind. She knows she’s pregnant.”

Imagine if restrictions of this sort were passed for different services. Let’s take getting your driver’s license for example.

Cars are death machines on wheels. In 1998, nearly 42,000 people were killed in traffic crashes, and another 3.2 million were injured, according to the Insurance Institute for Highway Safety.

Now imagine you have to make two trips to the DMV. (Waiting times at abortion clinics are much longer and obviously more traumatic than waiting at the DMV, but many Americans can relate to the dread they feel at even the mention of the DMV.) You wait and you wait and you wait, just to get to the front desk, and the friendly DMV associate tells you, “here’s some information about driving a motor vehicle, now wait 24 hours and come back.”

America would have a fit. But since this law only causes undue burden on pregnant women (not men, the second party involved in unwanted pregnancies), it’s okay.

Let me be clear. Women don’t waltz into abortion clinics. Women don’t come to an abortion clinic before they have heavily considered all of their options. Abortion isn’t fun. Women don’t become pregnant just so they can have an abortion. No one expects or wants to have an abortion.

Women will wait for 24 hours after their sonogram to have an abortion. They will sign extra forms, even listen to belittling details of the fetus they carry. This unnecessary medical information was passed to deter women from pregnancy, but it’s not the right tactic.

Passing legislation that addresses outcomes of an undesirable behavior is not the way to resolve the behavior. The right tactic is trying to reduce unintended pregnancies before they happen. But even if every sexually active woman has access to birth control, and used it consistently and correctly (assuming that’s the route you would take to prevent unintended pregnancies) the need for safe abortion will never be eliminated.

Adding petty restrictions such as medically unnecessary information and waiting periods is a disgrace to women’s intelligence, their will, and their ability to make choices for their family. 

EMERGENCY: Rick Perry is anti-women's healthcare

“Even as more than one-quarter of Texas women are uninsured, and women in Texas have the third highest rate of cervical cancer in the country, Governor Perry is determined to make a bad situation worse for women in the state of Texas. Texas would rather throw health care for hundreds of thousands of women overboard than allow Planned Parenthood to provide health care like breast and cervical cancer screenings, birth control, and STD prevention through public health programs.” - Cecile Richards

This is a way bigger deal than most people know about. Rick Perry is sabotaging the entire Medicaid Women's Health Program in Texas. We know everyone is tired of hearing about Planned Parenthood cuts and you might be thinking, "this always happens, but they're still up and running- why is this a big deal?"- but we can assure you that this is definitely the worst thing to happen to us all year- not just Planned Parenthood, but all women participating in the Women's Health Program.

Rick Perry cut funding for women's health services by two-thirds. You should be outraged if you are a woman or if you love someone who is- Rick Perry is preventing women from receiving LIFE SAVING cancer screenings and birth control. Oh yeah, also, no one can complain about abortion here because Medicaid Women's Health Program is a federal program- so it DOES NOT PROVIDE ABORTION. This has nothing to do with abortion. So, even if you're pro-life you should disagree with Perry's (illegal) decision.

Even more unfortunately, Planned Parenthood is not the only organization affected. What Rick Perry has done violates federal law. It's ILLEGAL. The federal government decided that if any state excludes Planned Parenthood (or any other qualifying provider), that state will be KICKED OUT of the Medicaid Program. 

Does anyone have any idea how big of a deal this is?? 130,000 Texas women will no longer have affordable healthcare.

At Planned Parenthood, we've been working as hard as we can to get back into this Medicaid Program, and we need all the help we can get. The original article about this violation of women's right to health and a petition against it are listed below:

Planned Parenthood Press Release

TAKE ACTION! Click here to sign the petition.

This petition can also be found on the Texas Voices for Reproductive Justice Facebook.