Wednesday, August 29, 2012

To Protect the Life and Health of the Mother

We found out Christine was pregnant in the emergency room.

We wanted to have a baby. But our enthusiasm was dampened by the circumstances that brought us there. Christine had been experiencing severe, crippling abdominal pain for days. We were saddened but not surprised by the doctor's news. They thought it was an ectopic pregnancy. The fertilized egg was growing in one of Christine's fallopian tube instead of her uterus. If allowed to continue, the condition was guaranteed to be fatal to both Christine and the embryo.

The doctors recommended an operation to terminate the pregnancy. Immediately. We agreed.

After the operation we learned that the original diagnosis had been incorrect. It was not an ectopic pregnancy. The pain was caused by a substantial ovarian cyst. Christine was still pregnant.

Six months later we were back in the ER. Once again Christine had been experiencing severe pain. At this point she was 27 weeks pregnant - visibly bulging, but a very long way from the ingested-watermelon-look of a full term pregnancy. Once again we got the news that the pregnancy was killing her. She had HELLP syndrome and was hours away from a coma and death. The cure was to end the pregnancy. Immediately. Again.

Our local hospital was not equipped to handle the situation. We both grew up in Lebanon, New Hampshire and our parents were still living there. We asked that Christine be taken Dartmouth Hospital. The doctors were very concerned about her health deteriorating during the two hour ambulance ride. Ultimately, that's where they took her. Shortly after she arrived, our daughter Mattea was born, and Christine recovered.

Mattea weighted 1 lbs. 12 oz. at birth. Initially, she did very well and had no major health issues other than her low birth-weight. At six weeks, in yet another emergency setting, a new set of doctors informed us that Mattea had necrotizing enterocolitis. Her intestines died. Once again we were thrust into decisions involving the life and death of our child. And once again we really had no choice at all. Five days later Mattea died. She was our first-born child and the only daughter we will ever have. We were able to spend only a short amount of time with her. But we fell in love with her with an intensity that I had not anticipated and that the years without her have not diminished.

Following the murder of late-term abortion provider George Tiller, the blogger, Andrew Sullivan published a series of posts telling the stories of Tillers patients and of other women and families that have faced similar situations. I read through the stories of loving families thrust into impossible situations, of pregnancies gone horribly wrong, of children who could never be. What happened to us was tragic but not unique. The ectopic pregnancy was a false alarm. When Christine's HELLP appeared, the way to save Christine was to deliver Mattea. I have no illusions that another outcome was impossible. If the conversation had taken place a few weeks earlier, the baby could not have survived. A few hours later and Christine might not have.

Bringing life into this world is complicated and often dangerous. We don't often discuss it with anyone but our closest confidantes. But for so many families, pregnancy does not go smoothly. Many couples, many women experience infertility, miscarriages, complicated pregnancies, ectopic pregnancies, premature births, pregnancies where the life of the mother is threatened, pregnancies that will not result in a child that can thrive, pregnancies that are the result of rape, incest, coercion, or abuse. It's complicated.

When we talk about pregnancies being terminated, we usually only talk about the unwanted pregnancies. We act as if the inconvenient pregnancies are the whole story. They are not. Biology does not care if you are married or unmarried. It does not care if your baby is wanted or unwanted. Especially in the case of late-term abortions, if you are wondering how anyone could make such a terrible choice, you must remember that sometimes people have no choice.

When these issues are debated in our public spheres and in our august legislatures we need to recognize our limitations. Congress does not have to power to abolish tragedy. It can not legislate right or wrong. It can not save us from biology. They can create laws that compound tragedy with criminal trials and incarceration. It seems inconceivable that legislators would be willing to take tragic circumstances, like we experienced, and call them crimes. But the laws they propose would do precisely that. We have to see life as it really is and not just how we wish it to be.

Saturday, August 18, 2012

Romney's $716 Billion Medicare Ad Campaign

Romney and Ryan have a new ad up explaining that they won't keep the cost controls Obama added to Medicare:

The ad complains that changes made in the ACA cut $716 billion dollars from Medicare spending over the next 10 years. This is true. Most of the cost reductions come from two changes to Medicare:

  • Medicare Advantage: Medicare Advantage is an option that allows Medicare recipients to purchase private plans instead. The program will continue, but previously we paid 14% for the private plans than we pay for traditional Medicare plans. Under the ACA the playing field is leveled. We pay the same amount for the private and public plans, and save many billions of dollars.
  • IPAB: The Independent Payment Advisory board is a an independent body with the mandate of controlling Medicare costs. They are charged with insuring that Medicaid costs don't grow faster than GDP + 1%. Previously, Medicare didn't really have a budget and so health care costs have been growing out of control. The IPAB is there to find inefficiencies and set policies to insure Medicare stays within its budget.
These changes, along with anti-fraud initiatives and other pilot programs, are on track to reduce Medicare spending by $716 billion over the next decade without a reduction in benefits.

Mitt Romney and Paul Ryan have pledged to get rid of these changes. They promise to spend an extra $716 billion on Medicare. 

The Romney and Ryan plans call for a similar mix of private and public plans competing on price. Cost growth is subject the same caps on rates. But their plan doesn't go into effect until 2023 at the earliest. That would mean pissing away the 716 billion dollars with another decade of runaway health care costs. And even then, they don't actually do anything to control health costs. The limited growth rate just applies to the voucher you'll get. The cost of the health plans can continue to rise, unconstrained. Patients will have to make up the difference with their own money.

They plan to convert Medicare to a voucher program. They waste a ton of money in the next decade. Over the long term, costs to taxpayers and consumers continue to rise. And even when it's fully implemented, their plan still costs the government and taxpayers more than the laws they seek to repeal.

Under Romney and Ryan that $716 billion doesn't get us a reformed Medicare system. It doesn't reduce the deficit. It doesn't provide affordable health care to all Americans.

It just allows them to run that ad.

Sunday, August 12, 2012

Romney - Ryan

The more I think about it, the more I think Ryan was a smart pick for Romney.

The Ryan pick is not show of strength. Romney's plan seems to have been to to stay vague, complain about Obama and the economy, and coast to victory by keeping himself and his part out of the spotlight. The Ryan pick is an acknowledgement that the plan wasn't going so well.

Ryan brings a lot to the ticket. He's the movement conservatives hero and the favorite wonk of GOP elite. This helps Mitt with a still-suspicious base. Ryan is good looking, good-natured, is not a known culture-warrior, articulate, a loyal partisan, and has a particular talent for presenting radical policies with soothing manner and a straight-face.

Paul Ryan does bring substantial baggage in the form of his sweeping, transformative budget blueprints. There's concern that his extreme positions will scare off moderates and elderly. But, until yesterday, anyone who knew how Paul Ryan was also knew how they were going to vote. The low-information middle has never heard of this guy. This gives both parties to the chance to try and define him.

The big question is will the Ryan Budget become the Romney (or the Ryan-Romney) Budget? Democrats will push for it. They would love to run a choice campaign, know a big target when the see it, are sure to mention Ryan's-plan-to-end-Medicare at every opportunity. Republicans will push for it as well. They've already voted for it twice. Ryan's policy initiatives are what catapulted him to prominence and led the GOP powers that be push for him to be on the ticket.

The person least interested in seeing the Romney-Ryan ticket run on the Ryan plan is probably Mitt Romney. Ultimately, I expect him to (semi-successfully) move away from the Ryan plan. If Romney wanted to run on the details for the Ryan plan (such as they are), Ryan would be an obvious assent. But if Romney wants to run away from the plan, then neutralizing Ryan by drawing him close, is also a smart plan. Ryan won't be an independent voice calling the shots from Congress and nobody will push the plan without him.

The Romney campaign has been maddeningly vague up until now. Every policy issue has been answered with a mish-mash of contradictory talking points and devoid of substance. The Ryan pick might mark a move toward and honest policy discussion. But since both Ryan and Romney have reputations as policy wonks there's a serious risk that they will simply try to ride their repudiations and continue to avoid policy specifics. They can wave in the general direction of their various "plans" while declining to offer anything that could actually be evaluated.

Both liberals and conservatives are clamoring for battle over their policies and visions for the country. The Ryan pick offers the promise of a campaign with renewed focus on policy and legislative proposals. We should all hope, and strive to insure, the rest of the campaign lives up to that promise.