Abortion rights, women’s rights: A major victory

Lady justice

The government has finally been ushered out of the exam room.

In a definitive step protecting women and their very private decision-making, the U.S. Circuit Court of Appeals for the Fourth District on December 22 permanently blocked a 2011 North Carolina law that created huge physical and emotional trauma for women seeking abortions. Not to mention trampling on doctor-patient relationships and the rights of physicians themselves to have rational conversations with their patients.

Those fighting the extremely punitive law included the American Civil Liberties Union, the ACLU of North Carolina Legal Foundation, the Center for Reproductive Rights, Planned Parenthood and others

The law required providers to show an ultrasound and describe what’s on the screen. That is certainly right and proper if patient and provider so choose. But suppose the woman chooses otherwise? The law allowed her to close her eyes and cover her ears, but said the provider still had to go through this narration, regardless of circumstances. Suppose this pregnancy was the result of rape or incest, or there were serious health risks or fetal anomalies — the woman still had to cover her eyes and ears, perhaps singing “La, la, la, la…” to drown out the narrative. Is there any conceivable way in which any of this makes sense?

Fortunately, the Fourth District Court of Appeals thought not.

What has been so appalling about the evolution of this law and the political fight to keep it in effect is the total absence of empathy or concern for women. The same is true for literally hundreds of other state laws still on the books that are designed to shame or coerce women out of having abortions. Public outcry is raised about “protecting the fetus,” often by politicians and others whose concern for that fetus ends as soon as it becomes an unwanted child. With these laws, sanity, good medical practice and women’s rights go out the window. And who loses? The woman. Particularly if she is poor, or disempowered and thus can’t travel to somewhere safe and free from harrassment.

None of us, whatever our politics, want to see women’s lives made worse. None of us really want to see children brought into the world to suffer, other children forced to bear babies who are the result of personal tragedy, or families plunged into chaos and despair. Most of us credit women with having perfectly good brains and don’t want to see them denied use of their brains or control of their bodies. But these are the results of punitive abortion restrictions. At least this one punitive law is now gone, a holiday gift to us all.

Thank you, U.S. Circuit Court of Appeals for the Fourth District.

 

Good news, bad news for an old week

landscapeThe holiday-week news in review was a doozy. Good news (to most of us) about Cuban-American relations and climate change, bad news for Sony and internet security. Plus the relentlessly ongoing bad stuff: ebola killing off entire families in Africa, terrorists killing children in Pakistan, crazies killing innocents, and a total absence of politicians able to do much besides calling other politicians names.

It was all up for discussion during a recent “Week to Week” political roundtable discussion at the Commonwealth Club in San Francisco. Panelists included San Francisco Chronicle political reporter Joe Garofoli and columnist C.W. Nevius, and writer/attorney Melissa Griffin Caen, along with moderator John Zipperer, Vice President of Media & Entertainment for the Commonwealth Club. Despite the unfunny bad news, the group had a seriously good time dishing about Uber executive Emil Michael – and why not? Set aside the fact that his company sought to make good news (Everybody wants rides! Raise Rates!) of the hostage tragedy in Sydney, Australia, Michael first endeared himself to the fourth estate by launching a campaign to investigate unfriendly journalists. Then came the news about his suit against his landlord for sending a stranger repairman into the apartment to fix something Michael himself had complained of. Throw in Michael’s claim of being buddies with the police chief (quickly denied by the police chief,) the condo cost ($9,500 per month) and its reported amenities such as hot tub and private garden, and it’s altogether too much for any political roundtable to resist.

But the evening opened with good news. Salesforce founder/CEO Marc Benioff, the panelists say, is making news with his 1/1/1 integrated philanthropic model. One of the founding principles of Salesforce, the idea is to give 1 percent of profits, I percent of equity and 1 percent of employee hours to charity. For months, Benioff has been working to bring other tech firms into the plan, and it’s working. Often at odds with their new San Francisco community, tech firms and their employees are increasingly giving their time, talents and money back to help the less fortunate. And who knows? The bad will generated by the likes of uber-rich Uber folks could be outweighed by the goodwill of 1/1/1 programs.

Closer to home, or at least to the heart of this non-techie writer, my friend Tara Culp-Ressler over at ThinkProgress.org posted a similar good news/bad news piece about the year of reproductive justice: “Six victories for reproductive freedom you may not have realized happened this year.” At the end of a year crammed full of legislative assaults on women, with newly-empowered anti-abortion lawmakers vowing to take us back to the dark ages – here is good news worth noting.

And all tiny tidings of joy are welcome.

Immigration Then and Now: Three families, three stories

PRELUDE: A contemporary story –

Maluki had what she thought was a minor infection in her chest. She took a couple of pain relief tablets. She is undocumented and uninsured. She had no access to a community clinic where she might have seen a doctor with no questions asked; no one in her suburban family had heard that such things exist. Within a few weeks Maluki was doubled over with pain and was rushed by a neighbor to an emergency room at a major public hospital two hours away.

Two surgeries later the 38-year-old mother of three will be out of work for a very long time. Her husband, partly disabled, works irregular hours when he can, leaving the family dependent on what money the teenaged children – all U.S. citizens – can bring in. The children still hope somehow to finish high school and attend college.

What’s wrong with this picture?

Almost everything, if you asked the five California experts on a recent Commonwealth Club panel in San Francisco. “Undocumented and Uninsured” brought together two heads of clinics where treatment is available to all and two others with unique insight and perspectives. Moderated by Daniel Weintraub, Editor in Chief and Project Director, California Health Report, the panel included John Gressman, President and CEO, San Francisco Community Clinic Consortium and Scott Hauge, President of CAL Insurance & Associates Inc and Co-Founder and Vice Chairman, Clinic by the Bay; Laurel Lucia, Associate Policy Specialist, UC Berkeley Center for Labor Research and Education; and Jirayut New Latthivongskorn, Co-Founder of Pre-Health Dreamers. They were looking at how the Affordable Care Act will impact immigrants unable to get health insurance, and what the healthcare future might hold for them.

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There are, by one estimate, 11.7 million undocumented immigrants in the U.S. Some have health coverage through their jobs, and a few have private coverage; but the vast majority of these are uninsured. The resulting costs, in human terms such as the case above, are inestimable; the costs in dollars are also significant. “If we get the patient into basic care for colds and flu,” said Gressman, “we save thousands in hospital care.” In California, care is widely available through publicly funded community clinics as well as nonprofits – the problem is in getting the word out and building trust. “We look at how to get the patient to care,” Hauge said, “not at anyone’s immigration status.”

While Gressman, Hauge and Lucia each brought extensive understanding of both the policy and the real-world details affecting healthcare needs of undocumented immigrants, it is the personal stories of Lucia and Latthivongskorn that illuminate the remarkable richness of our immigrant nation.

Nearly a century before she was invited to bring her expert knowledge to a Commonwealth Club panel, Laurel Lucia’s great-grandfather was a frequent speaker at the Commonwealth Club himself. Felipe N. Puente was memorialized in the Club’s Journal upon his death in January, 1951. He was, his obituary reads, “by far the most important personal tie between Northern Californians and the Republic of Mexico for nearly a quarter of a century.

“Commencing as a colorful revolutionary Mexican leader in 1917 (as Jefe de Transportacion for the late Revolutionary General Francisco Villa), he had for 25 years been a resident of San Francisco, with five children in our public schools, and the long-time Manager of the Mexican National Railways, San Francisco division, in the Monadnock Building.

“Although a railroadman by profession, his expert and sagacious advice was freely at the service of American travelers by sea, highway or air, and a letter from ‘el Puente de San Francisco’ (the San Francisco Bridge) as he was affectionately known clear down to the border of Guatemala, opened all doors in Mexico.” Great-grandfather Puente’s expertise reached beyond transportation to government affairs. In a Commonwealth Club speech broadcast over KYA Radio in 1942 he spoke of the importance of Mexican-American cooperation in the war efforts, citing cargo lanes and Mexican ores that were critical to the U.S. and quoting President Avila Camacho as saying, “Mexican soldiers are willing to shed their blood anywhere in the world where they may be needed.” His Journal obituary began and ended, “Adios, Amigo Felipe N.Puente!”

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Lucia missed out on knowing her notable ancestor, “but I was quite close to his daughter, my grandmother.” She had not, she says, ever made any connection between his immigrant status and her current work – as a Policy Analyst for the UC Berkeley Labor Center – which partly seeks to strengthen the safety net for those more recently arriving on our shores.

 

Laurel Lucia with Moderator Weintraub

As for the other young person on the “Undocumented and Uninsured” panel, Jiryat New Latthivongskorn (hereafter identified by his familiar name, New) confesses to having been a little startled to hear himself constantly referred to during the evening as “the first undocumented student to be admitted to UCSF (the University of California San Francisco) Medical School.” But that is, in fact, part of his current resume, and a not insignificant achievement.

There were 7,453 applicants to UCSF Medical School for New’s class, out of which pool 490 were interviewed and 149 were accepted. The overall grade point average was 3.77.

New Latthivongskorn came to this country with his parents when he was 9 years old. His parents worked in Thai restaurants every night until 11:00. But whenever he tried to help, he said in an interview on KQED Radio last May, “the answer never changed. ‘Don’t worry, and do your job.’ My job was to get an education.” So far, he appears to have done his job quite well. New never considered the idea of being a doctor until one scary incident during his junior year in high school when his mother fell gravely ill and had to be taken to the emergency room. The family had, until that time, relied on a medicine cabinet full of remedies for colds and pain and a few old antibiotics from Thailand. But in the ER, when his mother couldn’t understand the doctors and they couldn’t understand her, New realized his job might be more than just a translator.

There are those, including a few who commented on the KQED program, who argue that anyone who is in this country illegally should simply be sent back to wherever he or she came from and until then should receive no benefits – and certainly no healthcare. That may, however, be an overly simplistic – not to mention cruel and unusual – answer to a very complex issue.

“Immigrants don’t come here,” New told the Commonwealth Club audience, “for free healthcare. They come here to escape danger or terrible conditions; they come here to work.” In short, to create a better life for themselves and their families, and ultimately to give back to the communities of their new world. That was definitely true for immigrant Puente a century ago, and is demonstrated by the hard-working parents of doctor-to-be New.

Other than the Native Americans who pre-date most of us, it would be hard to find many U.S. citizens whose ancestors didn’t have similar stories.

 

 

Sign a Contract, Lose Your Rights

scales of injusticeDeep within the contract I signed for a recent $699 purchase were these words:

Arbitration Agreement: Should any dispute arise in regards to this product, I/we agree to settlement by arbitration.

Well, great, I thought, after glancing through the multiple-page document and noticing the clause. I am not a litigious sort of person, and arbitration seems far preferable to courts and lawyers and outrageous legal expenditures. A reasonable solution.

Wrong. That agreement means I signed away all rights in any future dispute involving the product, committing to a decision that will be made by the person or firm hired by the company who wrote the contract. If I complain, and the company is paying the arbitrator, guess who’s going to win? A recent study showed that 94% of the time, in cases like these, the judgment goes in the company’s favor. Appeal? There is none. The decision is binding, and I have signed away my right to appeal – that’s also in the fine print.

“Lost in the Fine Print”, an eye-opening film just released by the Alliance for Justice, explains how these forced arbitration clauses affect millions of people every day, people like you and me who assume we enjoy such constitutional rights as equal protection, the right to appeal – a voice. I could be out $699. But what if the forced arbitration clause in the small print meant you were done in by a for-profit college that took your money, gave you a worthless “diploma” and prevented you from ever getting a job because they’d already flooded the market with others far less qualified? Or suppose it meant you had no power over the credit card company that was ruining your small business with ever-increasing “swipe” fees. Or it meant that though you had been unjustly fired from your job, you were denied even a hearing? These are three of the stories told in “Lost in the Small Print.”

“It’s a rigged system that helps companies evade responsibility for violating anti-discrimination, consumer protection, and public health laws,” says film narrator Robert Reich.

Reich, a noted political economist, author and speaker who served as U.S. Secretary of Labor under President Bill Clinton, explains how forced arbitration clauses usually go unnoticed in the pages of boiler-plate accompanying today’s contracts. But even if they do catch the eye of the signer – as happened with my recent purchase – their potential impact cannot be foreseen.

And that impact can be huge: a job lost, a business struggling, a life wrecked.

“Lost in the Fine Print” runs for just under 20 minutes. You can watch it online, or order the DVD. It’s free. Those could be the most important 20 minutes you’ll spend in a very long time.

 

 

Bold Hope for the World’s Poor

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A Solution to Poverty?

If governments can’t solve world poverty, and nonprofits can’t make serious dents in it… can the private sector be the answer? With the help of you and me and major investors?

Mal Warwick thinks so. Warwick, co-author, with Paul Polak, of The Business Solution to Poverty, spoke recently at the Commonwealth Club in San Francisco about their conviction that the long-term solution to the ongoing tragedy of global poverty lies in coming up with answers that will pay off. Not just to suffering individuals, by helping lift them out of poverty, but to investors by turning a profit.

Warwick’s audience included a variety of interested individuals familiar with much of the work already being doing by nonprofits whose funders tend to seek reward through humanitarian success rather than financial return. But major infusions of capital, Warwick maintains, will be needed to continue building the ladders people everywhere will need to climb out of poverty’s depths, and that will require – business solutions.

As a shining example, Warwick cited the treadle pump. It is a human-powered device, inexpensive to manufacture and simple to use, which enables farmers to multiply the yield of their land and thus, in many cases, raise themselves and their families out of poverty. It works as a business solution on a number of levels. Factories needed to manufacture the pump were set up in villages, providing employment for people there, village shops distributed them, workers were employed to drill the wells and financial institutions made loans for purchases.

The problem, Warwick says, was with marketing – radio, TV, newspapers and traditional advertising methods weren’t available. The solution? Roaming troubadors and a Bollywood movie.

Among the facts Warwick brought to light were: One billion people lack access to electricity. One billion people lack access to safe water. One billion farms are without irrigation. The 20 million people lifted out of poverty between 1981 and 2006 by international aid programs, Warwick says, are only a drop in the bucket to the numbers who continue to suffer.

“It’s possible,” Warwick says, “to create brave new companies” with the lure of “reaching at least 100 million $2/day customers.” Some of those companies already at work include Australia’s SunWater which is developing a variety of safe-water solutions, several businesses working toward turning organic waste into affordable charcoal briquettes, and SpringHealth, which is addressing the problem of contaminated drinking water.

If governments and nonprofits can’t solve global poverty, can businesses? It might take all of the above – plus you and me, ordinary citizens.

Thanks, Brittany

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Brittany Maynard, 1984-2014

No one was surprised by the news of Brittany Maynard’s death on November 1, as she had planned. The news arrived in my Inbox late Sunday night, November 2, in an email from Compassion & Choices, an organization I have supported — as a volunteer, Northern California board chair and in all other ways — for well over 15 years,

What Brittany did for Compassion & Choices, and for you and me, though, far exceeds what any one person might ordinarily have done. Hers was an extraordinary demonstration of how to live, and die.

More of how she lived will continue to be in the news. But it’s how she died, with generosity and grace, that is worth noticing right now. Just to touch on a few things:

Brittany, in making her own choice, showed us how to make our own choices. Demand the right to control your destiny, she was saying. Fight for legalized aid in dying. Complete your own advance directives and make sure EVERYONE in your family and circle of friends knows what your own wishes are. Death with dignity was Brittany’s choice, and she wanted it to be yours — if you choose.

“The freedom is in the choice,” Brittany said.  “If the option of Death With Dignity is unappealing to anyone for any reason, they can simply choose not to avail themselves of it.”

Brittany was irate over insinuations that she had been “manipulated” by anyone. She was a strong, educated, independent, intelligent woman who led a joy-filled life and confronted its abbreviated end with remarkable courage. The reality was simply that she took control of her own final months, weeks, days, by moving to Oregon where aid in dying is legal. The reality is that she wanted her life — and death — to have meaning for all of us. She hoped that by sharing her story all of us might benefit.

It’s about freedom. Brittany, thankfully, is now free of the terrible pain her illness was bringing, a pain that was certain only to increase. Her family will mourn for a long time, but they are free of the pain and anguish that comes from watching someone you love suffer.

You and I are free to choose. We can continue to let those who hold differing views deprive us of our right to control our final weeks and days. Or we can fight to legalize our right to choose a compassionate death. Eventually, that right will prevail.

Thanks, Brittany.

WHI: Strengthening Women’s Health

WHICould the health and wellbeing of a few million women be improved, and a few billion dollars saved in the process? A very big dream.

When the Women’s Health Initiative was established more than 20 years ago, no one was talking in grandiose terms and few would have anticipated the wide-ranging health benefits (and huge cost savings) that would result in the decades ahead. Many of us were simply saying, “Imagine this. At last we’re studying women to find answers about women’s health issues.”

This writer was proud and happy to enlist in the first WHI study. I joined more than 100,000 other postmenopausal women volunteering to fill out forms, have blood drawn and answer questions over the next 15 years. That initial focus was on tracking the effects of hormone therapy, dietary patterns and/or calcium/vitamin D supplements on prevention of heart disease, cancer and osteoporotic fractures. I had not yet had breast cancer – that would come about 10 years into the study; a family history of osteoporosis added to my personal interest in WHI. Over the years I volunteered to participate in some of the wide-ranging ancillary studies looking at other health-related things like physical activities, lifestyle, tobacco and dozens of peripheral issues. (My personal favorite question appeared on one of the multi-page annual update forms. It read – Yes or No – “When you enter a room full of other people, do you have the feeling they are talking about you?” There may someday be a report on women and paranoia.)

Mysterious questions aside, WHI is serious business. Here, excerpted from the latest Extension Study newsletter are a few facts about what has been learned from the historic initiative, and a little of what is still ahead.

Those hormones millions of postmenopausal women were taking, widely thought to be miracle answers? Studies showed the risks far outweighed the benefits, and millions stopped taking them. Hormones in different combinations had been commonly taken to minimize chances of cardiovascular disease, cancers, fractures, diabetes, gall bladder disease and a variety of quality-of-life measures; quitting the hormones proved a better choice. Health benefits can’t be precisely measured, but the reduction in hormone use has led to a decrease in rates of breast cancer and cardiovascular disease.

And in dollars and cents? Some $37.1 billion, (in 2012 when all costs and quality-adjusted years of life are considered, has been the total economic return of the WHI trial.

By June, 2014, over 1000 papers based on WHI data had been published in scientific journals. What’s ahead? Researchers are looking at pet ownership and risk of cardiovascular disease; physical activity during childhood and risk of Alzheimer’s disease; breast cancer distribution by rural/urban areas and geographic differences in cognitive decline/dementia.

Every year on their birthday, WHI study participants receive a card – some of us call it the “Hooray, you’re still alive” card. For women everywhere, it represents something worth more than gold.

Abortion in Texas: The small fraction

Medievalpreg

Only a small fraction of Texas women will suffer.

With the closing of thirteen abortion clinics in Texas, one out of six Texas women seeking an abortion will have to travel 150 miles or more, and never mind all the other obstacles about waiting periods, increased costs, hassling protesters and having to listen to medically incorrect messages. But one out of six? That’s only a small fraction, according to the United States Court of Appeals for the Fifth Circuit.

“In our circuit,” wrote Judge Jennifer Elrod, a George W. Bush appointee, “we do not balance the wisdom or effectiveness of a law against the burdens the law imposes. We do not doubt that women in poverty face greater difficulties.”

What a bother, those “women in poverty.”

Judge Elrod argued that the court had to find that “a large fraction” of women would be affected by the law – the medically unnecessary requirement that all abortion clinics in the state meet the same building equipment and staffing standards as hospital-style surgical centers. And those 900,000 women in rural Texas the judge acknowledged would be affected, well, they’re just a “small fraction.”

Judge Elrod may not know a lot about what it feels like, being part of the small fraction. Born in 1966, she grew up in the Houston-area city of Baytown, Texas, which bills itself as a city “where oil and water really do mix.” She graduated from Baylor and Harvard Law School. Her Wikipedia and Judgepedia pages make no mention of marital or family status, but presumably she never sought to have an abortion. If she had, she would have definitely been in the large fraction – women with money who always have access to safe and legal procedures, even in Texas.

This writer was in another large fraction: women without access to safe or legal abortion in the days before Roe v Wade. Much like today’s small fraction, faced with no viable options we took desperate measures to end unwanted pregnancies. Some of us survived, countless others did not.

This is the fate to which the three-judge panel of the Fifth Circuit is consigning the small fraction. Danger, expense, family trauma, health risks and occasional death. Even for a small fraction, that seems hardly what America is about. And hardly in tune with the antiabortion forces’ proclaimed wish to “protect women.”

Some in the small fraction will face primarily family distress and exorbitant costs (usually upwards of $1,000 or $1,500) like “Maria,” whose story is recounted by RH Reality Check Senior Political Reporter Andrea Grimes. Some will face very real danger traveling to Mexico for drugs that can cause permanent injury or death if improperly created or improperly used. Some will maim or kill themselves in efforts to self-abort.

There will be hundreds of women like Elvia Yamell Hamdan, whose story was reported in a recent New York Times article by Laura Tillman and Erick Eckholm. Ms. Hamdan, 44, showed up at the Whole Woman’s Health clinic in McAllen, TX with her husband after a three-hour drive from their home, only to find that clinic professionals could suddenly no longer provide abortions. Ms. Hamdan already has four children and three grandchildren, and seeks to end an unplanned pregnancy. The U.S. Constitution says she has a right to make that choice – but Texas law says her best remaining option is an appointment three weeks later in San Antonio, 240 miles north.

Denise Burke, Vice President of Legal Affairs for Americans United for Life, is quoted in the New York Times story as saying the Fifth Circuit decision endorses anti-abortion forces’ argument that “abortion harms women, and states may regulate in the interest of women’s health.”

“Maria” and Ms. Hamdan seem likely to secure, eventually and at significant risks to their own health and wellbeing, the safe and legal abortion guaranteed to American women. How many others will now, instead, wind up sick, maimed or dead because of this latest ruling will never be known.

Because those others are just part of “the small fraction.”

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