We Need to Recognize Conscience
In Provision of Reproductive Services

The Obama Administration made a concession to Catholic leaders yesterday, bowing to conscience-based refusals to subsidize contraception coverage. At the same time, a compromise was struck enabling women who work for Catholic nonprofit institutions to use separate insurance plans independent from the church to obtain coverage for contraception at no out-of-pocket cost. The National Health Law Program stated: “Today’s announcement is largely a victory for women who have been fighting alongside health advocates for the past two years while employers threatened to deny women coverage for birth control in the courts and as lawmakers attacked and resisted implementation. No employer should be able to make personal decisions for their employees, including whether or when a woman is able to access birth control.”

However, the conscience-based contraception and abortion refusers are unlikely to let rulings like this stick. They promise to keep pressing for exemptions to providing reproductive services based on conscience.

But the Catholic Church does not have a monopoly on conscience. I neglected to cover an important New England Journal of Medicine Perspectives piece last fall, also overlooked by the mainstream press by Lisa H. Harris, MD, PhD.  Harris drew attention to recognizing conscience in abortion provision.

Harris pointed to “an ongoing false dichotomization of abortion and conscience, making it appear that all abortion opponents support legal protections of conscience and all supporters of abortion rights oppose such protections, with little nuance in either position.” What perpetuating this falsehood has done is permitted laws that fail to protect caregivers who are compelled by conscience to offer care, rather than refuse it, Harris argues.

Like many readers, I cannot believe that we are back to trying preserve the legalization of abortion and access to contraceptive care services. Day after day, roadblocks to reproductive care services are introduced, many claiming moral superiority, we need to underscore, as Harris and many others before her have done, that before the legalization of abortion, providers performed abortions “for reasons of conscience.”

Harris points out that before abortion was legal, many providers rallied to provide safe abortions to prevent women from dying from self-induced abortions and abortions provided by unskilled providers. This was a matter of conscience. Today, Harris explains, “abortion providers working within the law continue to describe their work in moral terms as “right and good and important” and articulate that the failure to offer abortion care generates a crisis of conscience.” It’s a moral imperative that underlies belief in “women’s reproductive autonomy as the linchpin of full personhood and self determination.”

On one hand, I am glad that the compromise yesterday ensures that women who work for religious organizations will be able to gain the same access to contraception as other women. However, I think we must continue to press for equitable access to contraception for all women. If we must work around conscience-based refusals, it is high time that we recognized conscience-based provision of reproductive care services.

On Don Berwick and the Future of Healthcare Reform

Don Berwick, Administrator, Centers for Medicare and Medicaid

I am supposed to be in a thankful mood, but I can’t help feeling that the bah-humbug mood has come early, with the forced departure of Don Berwick, head of the Centers for Medicare and Medicaid Services (CMS). Berwick was Obama’s pick for the head of CMS and for shepherding healthcare reform. Obama appointed him during the summer recess, aware that Republicans promised to veto the appointment. The GOP relentlessly attacked Berwick.

If anyone is emblematic of healthcare reform in this country, I’d say it is Berwick. To the point of this blog, I doubt that we would be talking much about the patient point of view, trying to elicit it, and together build a sane and responsive healthcare system without him. He was not the first to say this, but he definitely believed that “the patient belongs at the table” on all matters pertaining to health.

Berwick acknowledged that the barriers to reform were political, not technical. In his landmark “Triple Aim” paper in the May/June 2008 Health Affairs, he defined the Triple Aim this way, as: “improving the experience of care, improving the health of populations, and reducing per capita costs of healthcare.” Those very ambitions got a rise out of special interest groups and groups wanting healthcare to stay the same. As his ideas galvanized more people, he became a maverick at innovating quality initiatives, suggesting new infrastructures for building a continuously improving, learning healthcare system, and putting value incentives into healthcare. Berwick pushed for science, not opinion, in healthcare, and he wanted a system that rewarded value, not volume of services.

The Urgency of Healthcare Reform

President Obama signs in healthcare reform, March 2010.

We need to amplify the absolute urgency there is for healthcare reform and make sure it is not thwarted. Without reform, universal coverage vanishes, pre-existing conditions are back, and caps on paying out of pocket are kaput. That is just the tip of the iceberg. Without healthcare reform, it is the same old business, lack of access, and questionable value in healthcare.

Healthcare reform stands at a crossroads, with 3 cases now reaching the Supreme Court.  The Reporters Committee for Freedom of the Press, representing several news organizations, submitted a letter Nov. 18 to the Supreme Court, requesting real time audio and video coverage of arguments on healthcare reform. In it, Reporters Committee Executive Director Lucy A. Daiglish writes:

“Federal health-care reform affects everyone’s well-being, and everyone has the right to see and hear the arguments over this important issue made before the highest court in the country. And they have the right to see it and hear it as it happens.”

Further, the Reporters Committee adds: “To be sure, the American public’s access to affordable health care is among the most significant issues to inform public debate in this country and to come before its highest Court in many years…The time has come” for public access to include visual recordings.

It’s time to level with the American people. Let’s make sure that the SCOTUS briefs on healthcare reform are not presented behind closed doors and not manipulated by special interests. Americans ought to see this.

After New York Passes Lesbian and Gay Marriage,
A Challenge to the Media

I am thrilled to be a New Yorker today!! Marriage is a fundamental right for all Americans. But it is far from over.  I am troubled that so many of my peers ignore lesbian and gay issues, leaving it for someone else to cover. And I am not talking about the obvious villains here like Fox News, but health and science reporters and bloggers, who consider themselves at the forefront of science advancement, social justice, and investigative reporting working for a better planet and fairness on many important issues.

Lesbian, gay, bisexual, and transgender people are not—and should not be treated as if they are at the margins of society.

Advancements in lesbian, gay, bisexual, and transgender policies this year are notable. The Institute of Medicine, for the first time recognized that health researchers should include lesbians, gays, bisexual, and transgender people in research. New York City Health and Hospitals Corporation passed and is now implementing a new initiative to ratchet up staff training and care for lesbian, gay, bisexual, and transgender people, starting with the premise: “If You Don’t Know Me, How Can You Treat Me.” In April 2010, President Obama extended hospital visitation and participation in medical decision making to LGBT partners.

But it is not all progress by any means. There have been setbacks and disappointments. It’s just a handful of states with gay marriage on the books. And getting quality healthcare for lesbians and gays wherever they live needs to become part of the mainstream. And President Obama has a gay marriage problem: he’ll press for rights, but not gay marriage. And this is not all: worst of all, there are hate crimes, even in the great state of New York. They must stop and offenders must be prosecuted.

Anybody who wants to ratchet up the conversation on these issues, let’s go! Please contact me below, follow me on twitter at lauranewmanny, or send me an email, to patientpov “at” gmail “dot” com, and most importantly, talk with each other.

There is a huge opportunity for progressive media to use all the tools of new and old media to educate the public. Let’s move. It’s never too late to be inclusive.  There is so much to say. Let’s expand the audience.