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Who Pays When You Don't Abort?
Karen Kaplan has a piece in the LA Times which questions whether the aborting of babies with genetic diseases has gone too far. A study found counseling for parents who found they had a chance of having babies with Gaucher disease minimized the number of parents aborting. Is this a good thing? Kaplan writes:

One-quarter of fetuses found to have Gaucher disease were aborted over an eight-year period, even though half of all children with the metabolic disorder will never experience any symptoms, such as pain, organ enlargement and anemia. The rest can lead normal lives with treatment.

Importantly, the researchers found that among couples who met with a Gaucher expert and learned that the disease was treatable, only 8% chose to terminate their pregnancies. All of the couples who didn't have those meetings opted for abortion.

Yes, Gaucher is treatable, but at what price, and to whom? Kaplan continues:

Among children who inherit two faulty genes, the most common result is Type 1 Gaucher. Half will become symptomatic at some point in their lives, when harmful amounts of glucocerebroside build up in the spleen, liver, lungs and bone marrow.

Patients can experience pain and suffer from fatigue, although the symptoms can be treated with biweekly infusions of the enzyme that their bodies fail to produce in sufficient quantities. The intravenous infusions take an hour or two at home and cost $100,000 to $400,000 a year.

And you wonder why your health care costs so much? (I'm guessing Gaucher-positive-testing parents who choose to gamble and bring kids into the world aren't all the private jet/multimillionaire set.)

Posted by aalkon at September 23, 2007 11:31 AM

Comments

Amy - do you understand what you are advocating here?

Posted by: brian at September 23, 2007 5:00 AM

Tell me what you think I'm advocating and I'll tell you if you're right.

Posted by: Amy Alkon at September 23, 2007 6:04 AM

I'm with Brian on this one.

I might add that this is where the theology of an existent free market can lead.

Posted by: Machida at September 23, 2007 6:12 AM

So, you're fine with paying almost half a million dollars throughout the lifetime of this person (because it certainly gets factored into the cost of, at the very least) rather than suggesting the parents get rid of a bunch of cells growing in the woman's uterus and adopt?

There was this from the article:

For instance, the high cost of enzyme replacement therapy may tilt some couples toward abortion, Levy-Lahad said. Insurance plans in the United States typically cover the treatment, but patients whose policies include a lifetime cap may run into trouble.

Cost was probably not a factor for couples in the study because the treatment is covered by Israel's national health insurance.


Posted by: Amy Alkon at September 23, 2007 6:24 AM

Amy - What you're advocating, and it's ultimate logical endpoint is obvious. I'll put this as bluntly and as personally as I can.

"We're sorry, Miss Lazar, but the cost to treat your mother is too great. We're going to euthanize her in the interests of economy."

Posted by: brian at September 23, 2007 8:39 AM

I agree with Amy. I know people are going to argue that it's a slippery slope to full-blown eugenics, but I see no evidence for such a thing. Furthermore, I think it's right NOT to bring a handicapped kid into the world, if you know that it has a good chance of suffering, and of being a burden to its family and to society in terms of care. That's what I think, go ahead and rake me across the coals for being a monster.

Posted by: MD at September 23, 2007 8:48 AM

"We're sorry, Miss Lazar, but the cost to treat your mother is too great. We're going to euthanize her in the interests of economy."

A person and a potential person are two different things, Brian.

Personally, I mean to write a letter asking to not be kept alive if I become a vegetable, as I consider it anti-life to spend money on this.

Posted by: Amy Alkon at September 23, 2007 9:03 AM

A person and a potential person are two different things, Brian.

I disagree. And when you consider the potential benefit to society that an as-yet unborn person has as compared with a terminally-ill adult at the end of their life, the calculation becomes very simple.

And that simplicity is precisely why the government can never be allowed to run the health care system. The government should never be allowed to have the power to decide who lives, who dies, and who is born.

Posted by: brian at September 23, 2007 9:29 AM

MD - you're not a monster - yet. You're getting there, however. The slippery slope exists, whether you want it to or not.

How well would you take to a doctor or an insurance adjuster saying "We think it's in the best interest of society if you quench this nascent life before it has an opportunity to become a burden to society".

Let's take another little step. Once you're used to that, it should be perfectly reasonable to say to the welfare recipient "You are not allowed to have any more children, and we will compel you to abort any future pregnancies until you change your financial situation."

Now let's move that to the next step. We've concluded that any offspring you produce with your present mate have a statistically significant probability of being flawed. We hereby enjoin you from reproducing.

If you cannot see how compulsory euthanasia for those with expensive-to-treat ailments is the logical end of that journey, I submit to you that your imagination is not nearly dark enough.

Nothing initiated for the benefit of the public ever stops until the public is ultimately harmed by it.

Posted by: brian at September 23, 2007 9:34 AM

The potential benefit to society? Do we have any statistics showing what percentage of people are actually of any benefit to society? Just curious.

Are we still talking about this particular circumstance or abortion in general? We've already had the abortion debate. Let's go with this new line, yes?

Posted by: Christina at September 23, 2007 10:15 AM

Oh yeah, almost missed the part where a potential person and an existing person are the same. So, by that logic, women who have dangerous pregnancies should not abort, because their lives are the same value as the potential person? If you had to save two people in a fire, would you save the pregnant woman or two actual people?

Posted by: Christina at September 23, 2007 10:25 AM

Christina - you must be running low on straw, as these men are particularly thin.

As far as benefit to society goes, we have no way of knowing in utero what someone may become. But we know that the terminally-ill are certain to be a net drain. Are you a net benefit to society? If not, should you have been aborted?

There is also a significant difference between a woman in a dangerous pregnancy, and a woman pregnant with a potentially inconvenient child. In the first case, the decision is deciding "do we let one person, or two die". In the second, it is "do we kill someone for the sin of being inconvenient?"

Big difference. It's like shooting your grandmother because she gets Alzheimer's. It's just not something a civilized society does.

Posted by: brian at September 23, 2007 11:06 AM

Oh, and to answer your final question: "women and children first."

Posted by: brian at September 23, 2007 11:09 AM

I don't see what's controversial here. If it's acceptable that a woman get an abortion because she is unable to care for a child either financially or personally, then what is the problem with her deciding she wants an abortion because the child is likely to have a painful existence and constant expensive medical treatments?

I feel like this has come up here before, so bear with me if I'm being redundant:

A person and a potential person are two different things, Brian.

I disagree.

So if there were a fire in a fertility clinic, the firemen should save a tray of fertilized zygotes before an infant trapped in the building, right? Several dozen potential persons are worth more than a actual living breathing person.

Posted by: justin case at September 23, 2007 11:13 AM

Christina: If I had to choose in a fire, it would probably be the person or people closest to me who I thought I had a better chance of saving. That having been said, if I had the choice between saving a grown man or woman or saving a child from a fire, I'd go with the child. That doesn't mean that I think the grown man or grown woman has less of right to be alive. Which is why I don't find the "who would you save in a fire?" question to be particularly compelling.

So half of the children with Gaucher's will have no symptoms and require no treatment whatsoever? And all this assumes there will be no advances in treating Gaucher's that will cut the cost of the treatment (which would surprise me)? Okay, then - should we abort fetuses carrying a genetic propensity for heart disease? They're likely to be pretty expensive eventually. Or for obesity, which tends to bring along expensive conditions such as heart disease/Type II diabetes/stroke?

Although, if you really want to save the state money, the best thing to do is to keep people likely to live a long time from being born, because the most expensive thing that people can do, typically, is live a really long time and collect a lot of social security.

I see where Amy's coming from here - there are tradeoffs in life, and we are operating with limited resources. However...I'm willing to bet that Stephen Hawking costs "the system" much more to be kept alive for a year than all of Amy's recent spammers put together. That having been said, if I had to decide who to eliminate in the womb, I wouldn't be taking out the expensive guy in that case. If you're talking about a condition such as, say, Tay-Sachs, it's reasonable to believe that a sufferer will never, from a cold hard perspective, contribute much to society beyond the feelings he/she engenders in his/her family. Gaucher's doesn't appear to be like that except in the extreme cases, which are a small percentage - you're talking about people who probably will be able to have relatively normal, contributive lives but who will require expensive medical treatment. Sort of like people with heart disease. And serious heart defects. And Type I diabetes. And cystic fibrosis. And sickle cell anemia. And cancer (haven't they discovered a gene for colon cancer?). And breast/ovarian cancer (for which a gene has been discovered).

I'd be in favor of gene therapy that could eliminate all of those conditions, but I don't think they warrant aborting merely because they're likely to cost the system money. Especially given the sheer number of able-bodied people I know who contribute little or nothing to society (Barbara Ehrenrich's son, perhaps?). If we're going to debate the role that the perceived value/cost of a life should play in decisions about existence, fine...but I personally consider a person who needs treatment for his Gaucher's but is working to develop a hydrogen-cell car to be far more valuable to society than the apparently ablebodied Ben Ehrenreich, just to name one.

Posted by: marion at September 23, 2007 11:23 AM

Way to build that straw man, Justin. A frozen zygote is no more a potential person than a cum stain on a blue dress. Without being implanted in a womb, it is nothing.

And we aren't talking about a woman deciding to not bring a potentially defective person into the world, we're talking about her being actively counseled, and eventually forced to do abort.

This is why it is impossible to discuss this topic in a reasonable manner. Too many reasonable people throw logic to the four winds when the subject comes up.

Posted by: brian at September 23, 2007 11:24 AM

I don't see it as a straw man, Brian. This example illustrates the fundamental problem with the "potential person" perspective.

A frozen, fertilized embryo has the potential to become a person under the correct circumstances. But as long as it's frozen you say it doesn't count. Once it's implanted, only then does it become a potential person. At the moment it affixes to the uterine wall, poof! Not potential person becomes potential person. What makes this line the place that counts? How is this not utterly arbitrary?

Posted by: justin case at September 23, 2007 12:14 PM

cum stain on a blue dress

It's like a reflex, isn't it?

Posted by: justin case at September 23, 2007 12:16 PM

Pregnant women/couples are already making decisions to abort based on their resources, genetic testing or not.

I think the article was clear that if couples were faced with the 50-50 chance they had to pay out of their own resources about $100,000 per year to keep their potential offspring healthy and pain-free, they would probably opt for abortion. However, if the taxpayers (or other policyholders of the insurance plan) were the ones on the hook, they might follow through with the pregnancy.

If I've interpreted Amy's post correctly, the issue here isn't "what's a person," the issue is "who pays." By saying that public policy should be "No-one's going to pay but the parents," Amy's position is not "forcing" abortion on anyone - it's leaving the choices - and the consequences - to the parents alone.

I may or may not agree with her, but the logic is entirely consistent and not to be confused with euthanasia or eugenics.

As an aside, may I point out that none of the anti-abortionists ever use scoundrels as an example of what humanity might "lose" through abortion on demand. If we would be worse off if Beethoven and Hawking, etc had been aborted, wouldn't we be better off if Hitler, Mussolini, etc had been aborted? There's a flaw in logic here that makes my spidey-senses tingle.

Posted by: Tori at September 23, 2007 12:41 PM

Good post, Tori.

As an aside, may I point out that none of the anti-abortionists ever use scoundrels as an example of what humanity might "lose" through abortion on demand.

Levitt makes this point in a chapter in Freakonomics, arguing that legalization of abortion in 1973 contributed significantly to the decline of violent crime in the early 90s.

Posted by: justin case at September 23, 2007 1:03 PM

Justin - any definition of "potential life" is going to be arbitrary. Capricious even. The fact of the matter is that once a zygote has undergone implantation it has a finite (and relatively large) probability of becoming a living, breathing, crying human being. So long as it is frozen, it has no such chance.

I'm also not sure that Levitt has properly analyzed his data. Violent crime is not simply a function of race and wealth. And it's a bit of a reach to insinuate that abortion contributed to the decline of same.

Tori - Let me burst your bubble. Sure, you could use Hitler as a pro-abortion argument. Let me point out the flaw in that argument. Once Hitler was born, and he began to put his plans in motion, many people had the opportunity to stop him. They all refused. There is no way that anyone is going to take a man and make him Hawking, no matter how much he may want to.

Besides, there are some of us who believe that Hitler was inevitable. In other words, had his mother aborted, someone else would have done what he did. He was a product of his time.

Posted by: brian at September 23, 2007 1:37 PM

Brian- I'm not suggesting that we should or even can rate a person's potential worth in utero. You actually brought that up: "And when you consider the potential benefit to society that an as-yet unborn person has..." I was just pointing out that it was a silly line of reasoning, apt to spin off into increasingly unresolvable arguments.

I think that you should have an option to gamble on whether your child will have a full life or instead be a burden. Advocating options for people in those circumstances is not the same thing as mandating abortion, which is why I don't understand the "shoot your grandmother" argument. Those circumstances are so radically different that even comparing them seems ridiculous to me.

Existing person and pre-pre-person: NOT the same. Why are we having difficulty with this concept?

That said, I DON'T think you should have an option to gamble with OTHER people's money, but that's the position we're in. Perhaps if we resolved the insurance mess, and people actually paid for their health decisions (or lack thereof) this wouldn't even be a question.

Marion- I said pregnant woman, not living child. There is a rather large difference, and if you translate a pregnancy into an actual child, you change the basis of the argument altogether. I'm not sure how you can knock down my question as "not compelling", when you actually weren't considering my question at all, but rather another that you composed from it.

And I doubt that Steven Hawking costs the system anything at all. Isn't he rich?

Posted by: Christina at September 23, 2007 1:45 PM

Christina - Hawking's wealth, or lack thereof is irrelevant. Under the scenario presented here, his mother would have been told "there's a 50% chance your son will develop a debilitating disease that will leave him unable to talk, walk, or care for himself in any meaningful way." Had she aborted, we would be down one serious physicist.

The reason you don't understand the "shoot your grandmother" argument is because you are approaching this from the wrong angle. There is no way that insurance is going to substantively change from being a means of spreading risk and cost. Therefore, at some point, the insurance companies (or the government, if some politicians get their way) are going to start to dictate terms when it comes to things that are preventable and have a large potential loss for them.

Look at it this way. You are the insurance claims adjuster. You have a pregnant insured who has been presented with this quandary. We both know that the insurance company is going to say "you must abort, or we will cancel your policy."

Which is not materially different from an insurance company telling a terminally-ill adult "We're not treating you, it's too expensive. Go die somewhere."

That something is unknowable doesn't mean that it is irrelevant, either. Just because we don't know if your child is the next Hitler or Hawking, doesn't mean that the potential for positive contribution should be ignored.

Aborted fetuses don't grow up to be taxpayers. They don't grow up to be scientists, or rapists, or mass murderers or artists either.

And if there is, as Amy asserts, no God, and everything is random, then every time a baby is aborted, there is the possibility that the next great scientist has just been snuffed. And there is an equal possibility that the next Pol Pot got the hook.

I'm not comfortable with those odds.

Posted by: brian at September 23, 2007 1:56 PM

My father had Gaucher's as an adult. As an adult it was debilitating, but it wasn't (to the best of my knowledge) painful. But it definitely limited his physical activities, made it difficult for him to heal wounds, and he died young. There was no treatment for him (and in fact he would bus across Los Angeles to help participate in research to create a treatment.)

But Gaucher's as a child is supposed to be very painful.

What is the difference between screening for Tay Sachs, Downs, and screening for Gaucher's?

Posted by: anon at September 23, 2007 2:05 PM

In the second, it is "do we kill someone for the sin of being inconvenient?"

This is why the abortion debate in this thread, let alone this country, will never end. So long as people come to the discussion table with preconceived notions of sin and redemption (giving birth to a disabled child, perhaps?), and how those relate to what goes on in a woman's mind and heart when her feet are up in the stirrups, we'll never find complete agreement.

Putting aside religious objections and the notion of "sin", all the clever sophistry and cold logic in the world are less than meaningless when you're faced with real life, Brian. Sin doesn't even come into play when a pregnancy is unplanned, or if there's a chance of a genetic defect. No one seriously sits back in the clinic's exam room and thinks about Hitler or Hawking. You muddle through the decision to abort, and worry about the philosophical arguments later.

One of my best friends has an autistic child. Last year, she and her husband found, despite the faithful use of birth control, they were pregnant again. Since there was a very good chance their second child would be autistic too, she had an abortion. In addition, he got a vasectomy. There was no fretting about "sin" or giving birth to the next great scientist or Pol Pot. The notion that people are or should do that, well, it's condescending at the very best. They simply wanted to avoid pain, heartache, and the very real chance their family's life might become unbearable. Sin? No, cold, hard reality.

Posted by: Rebecca at September 23, 2007 2:41 PM

Tori gets it exactly:

I think the article was clear that if couples were faced with the 50-50 chance they had to pay out of their own resources about $100,000 per year to keep their potential offspring healthy and pain-free, they would probably opt for abortion. However, if the taxpayers (or other policyholders of the insurance plan) were the ones on the hook, they might follow through with the pregnancy.

If I've interpreted Amy's post correctly, the issue here isn't "what's a person," the issue is "who pays." By saying that public policy should be "No-one's going to pay but the parents," Amy's position is not "forcing" abortion on anyone - it's leaving the choices - and the consequences - to the parents alone.

I may or may not agree with her, but the logic is entirely consistent and not to be confused with euthanasia or eugenics.

How about those of you who think it's terrible to abort in such a case help pay -- half a mill throughout the person's lifetime -- and the rest of us opt out?

Posted by: Amy Alkon at September 23, 2007 2:44 PM

Sorry, I meant, half a mill EVERY TWO WEEKS throughout a person's lifetime.

Posted by: Amy Alkon at September 23, 2007 2:48 PM

any definition of "potential life" is going to be arbitrary. Capricious even.

Which sort of concedes the point, no? You wrote earlier that you equate potential life and life, and then admit that potential life is defined at an arbitrary point that is rhetorically convenient for you. You may have been on to something when you previously noted that people have difficulty discussing these issues logically.

I'm also not sure that Levitt has properly analyzed his data. Violent crime is not simply a function of race and wealth. And it's a bit of a reach to insinuate that abortion contributed to the decline of same.

Have you read the book chapter or checked his regression equations, or are you merely speculating? I'm sure he'd provide the data if you'd like to have a go at it. Levitt's main point is that people most likely to have abortions (i.e., young, poor urban women) are the people whose children (if born) are more likely to grow up to be violent criminals. Lots of these women in the post-Roe world chose to have abortions; 18 or so years later, violent crime started to decline dramatically. Please feel free to refute the existence of this relationship - the implications aren't entirely pleasant.

Posted by: justin case at September 23, 2007 3:02 PM

Rebecca - I was not using the word 'sin' in a religious sense. Please leave the anti-religious fervor at the door.

The issue is, to my mind, one of basic human rights. If you have determined that a being that is not alive as an entity separate from its mother is not a person, then there is absolutely no libertarian argument on right of existence that is going to change your mind.

Amy - here's a counter-offer. If you contract a non-deadly but expensive to treat disease, the rest of the customers of Kaiser get to determine if you ought to pay for those treatments yourself, or if the insurance ought to cover it.

You've all convinced yourselves of the rightness of your cause by saying "it's not a human being yet". And that somehow makes it OK to say "well, it's going to be too expensive to care for, best to put it down" like it was a blind dog.

The entirety of my argument comes to this: You do not know with any certainty what the child's life will be. Therefore it is illogical to assume that you can play the odds and win.

Posted by: brian at September 23, 2007 3:15 PM

Justin - I don't have the figures at my disposal right now, but I seem to remember the refutation of Levitt's point being that the people who HAVE gotten the most abortions, and not the ones that we'd like to believe have, are middle-class and upper-class whites.

Discussing the relation between abortion and crime is, to me, as ridiculous as the correlation called "the Roe effect" by some on the right who imagine that Democrats having abortions led to the 1994 Republican revolution.

I call bullshit on both of them. There are far too many variables to be controlled for for me to buy into it.

No, I haven't read Levitt's book. It's in the list. Which is already 20 books long. I'm going from other sources and refutations I've read.

Posted by: brian at September 23, 2007 3:18 PM

Oh, and I picked my "arbitrary" point at which a potential life should be considered to deserve at least right of existence to be the point medically defined as "pregnant". Because any zygote that fails to get to that point, naturally or assisted, doesn't have any chance at the Life Lottery at all.

Once it's implanted there is a finite chance that it will not be born alive. Prior to implantation, there is a 0.0 probability of life.

I don't think that many people who evangelize on either end of the issue have given that a whole lot of thought. Hell, I've heard some argue that destroying frozen embryos is murder. I've also heard it argued that killing a child after it's been born isn't any big thing. It seems to me that both of those extremes are ones reached in an effort to either derail the debate by being absurd, or to end the debate by being deliberately shocking.

Posted by: brian at September 23, 2007 3:22 PM

Brian-
No, Brian, the reason I don't understand the "shoot your grandmother" argument is because telling a terminally ill person to "go die somewhere" IS different than an abortion. Do you really think it is the same, or are you just trying to be shocking by equating the two?

Amy purchased health insurance. Amy is in the pool of actual people already sharing that risk. She had to be admitted into that pool; she very well could have been denied. Isn't denying benefits to a person with pre-existing conditions the same as kicking a mom out of a health plan if she decides to keep a baby with a pre-existing condition?

Aside from the insurance aspect, I do not believe in keeping people on life support, or otherwise prolonging lives full of suffering if the person does not wish to live. The difference is, that those people are already born, and thus they get to choose. One of the perks of surviving to that point is the eventually attaining the right to make those kind of choices.

Posted by: Christina at September 23, 2007 3:50 PM

The problem with arbitrary criteria is that they're only persuasive to people who agree with you. For example, I might pick viability of a fetus as the arbitrary point at which it becomes a human being with rights. I can defend it - after all, if it can't live and breathe on its own, how can it have any rights? And others can attack it, and we'll all have a fun time.

Prior to implantation, there is a 0.0 probability of life.

This isn't true, at least in a purely logical sense. Some fertilized frozen embryos are implanted; some embryos that are implanted survive. Therefore, unless it has been destroyed, p(life) > 0.

But I see your point about implantation, it's a perfectly OK arbitrary point. I don't buy it, but I'm not obliged to.

Posted by: justin case at September 23, 2007 3:56 PM

The reason the treatment is so expensive is because there are so few patients requiring it. The reason there are so few is because people are aborting the fetuses that have it.

Logically, I think we should be giving every pregnant woman a retrovirus to ensure her child has treatable Gaucher's. And then outlaw the abortions. This would cause the product's demand to go way up, would increase supply, would help manufacturers travel down the learning curve, and would end up in costs more associated with an aspirin than a Rolls Royce.

I'm just brainstorming here, I've been told that we aren't supposed to be judgmental during brainstorming sessions, so no criticism you haters!

Posted by: anon at September 23, 2007 4:05 PM

I was not using the word 'sin' in a religious sense. Please leave the anti-religious fervor at the door.

And...

You've all convinced yourselves of the rightness of your cause by saying "it's not a human being yet". And that somehow makes it OK to say "well, it's going to be too expensive to care for, best to put it down" like it was a blind dog.

I'll follow your instructions the second you start paying my bills, Brian. Until then, spare me the sudden interest in human rights. You've written many posts before on the wretchedness of human existence and intelligence (elsewhere this week you claimed 95% of humanity is stupid). Your comments are easy to remember. Not because I'm being stalky, but because, as Amy herself has said, you're a guy who likes to make outrageous statements. Why care now who aborts what under which conditions? Again, I think your deep concern is with nothing more than showing how clever you are with the King's English.

Amy's point is simply that we should allow parents to make the tough decisions--even if that includes the very real, very legitimate consideration of finances--unless you're willing to pony up for the child's care, too. No one's comparing that fetus to a blind dog. Hyperbole might work with the kids down at the Ayn Rand Fan Club, but when it comes to the decisions involved in an abortion, it's complete bullshit.

I'm coming to this from a very personal place. You see, I'm facing an unplanned pregnancy too. I've got a decision to make. You've mentioned in past posts you don't trust women. Perhaps you've not had a date in a long, long time. Again, I know this from *your* own words. Well, believe this woman when I say this: finances ARE important. Health IS important. Last but not least, my ability to care for the child IS important. I don't give a fuck if I'm possibly carrying the next great genius or, conversely, Ronald Reagan. If that makes me deliberately shocking, so be it. Those are the very real decisions everyone has to make, rare genetic disease or no.

Lastly, like it or not, we live in a society with ample government resources. For someone who believes in a "Libertarian right of existence", which would you rather pay--the socialized health care of a disabled child (because you *will* pay even with private insurance--your premium will go up because of someone else's choices), WIC and/or cash allowances for a poor child, or nothing--the cost to you of someone's very private, heartwrenching decision.

Posted by: Rebecca at September 23, 2007 4:09 PM

Sorry, this isn't one of those no-criticism sites. Anything goes, as long as you don't impersonate somebody else or threaten somebody's life.

Moreover, what's with being all sensitivity-training'y about this when you post as "anon"?

Personally, I like my late friend Cathy's Seipp's take on making "value judgments"; best I can recall, "I've got the values, therefore I make the judgments."

Why pussyfoot around, whomever you are?

Posted by: Amy Alkon at September 23, 2007 4:10 PM

My sympathies, Rebecca. I had an abortion in the past. Many women in their 40s have. In my case, I was in NYC at the time, and this wonderful artist, Annette, drove me to Kaiser's outpost in White Plains (they said I needed somebody to take me and bring me home; I couldn't take the train and a cab by myself). We got there and there were all these people holding up these old framed pictures. I thought, "Oh, look, it's a garage sale!" Then I saw that they were Jesus pictures, and noticed the people were jumping up and down and shouting. Asshats.

Anyway, I just wrote a piece on abortion for Pajamas Media. Should be out in a few days. Hope it will help. PS I'm for it, in case anybody has the slightest question in their minds. In fact, I sometimes look at people shouting into cell phones and dream of post-term abortion.

Posted by: Amy Alkon at September 23, 2007 4:17 PM

There's a very old joke on this topic that may lighten the mood a little. I know it from the Ozark tradition, but when I told it to a Jewish colleague, she supplied the punch line.

Preacher:
Look at Ecclesiastes 4:2-3. "Wherefore I praised the dead which are already dead more than the living which are yet alive. Yea, better is he than both they, which hath not yet been, who hath not seen the evil work that is done under the sun." See, brother that means the only happy people are the ones that never existed.

Laymember:
Yeah, but how many are that lucky? Not one in a thousand. Not one in ten thousand!

Posted by: Axman at September 23, 2007 4:28 PM

Thanks, Amy. I'm the last of my friends who's been in this situation. I'm 36. Lucky me. Every woman I have ever known--with the exception of my mother and grandmother, and who knows with them, I've never asked--has had an abortion. Good times!

We have a knot of those Jesus jumpers in our town. They show up at our local clinic every Wednesday morning to intimidate staff and clients. Last summer, I had the misfortune of having a Wednesday morning appointment for a regular check-up. There they were, yelling at everyone, including the seven year old boy going into the clinic in front of me.

If I decide to abort, it will be on a Wednesday morning, just so I can shove it in their sanctimonious, unsympathetic, hypocritical, ignorant faces.

Posted by: Rebecca at September 23, 2007 4:31 PM

(I'm only anon because talking about Gaucher's disease actually makes my normal pseudonym googleable in a way I would prefer it not be. This "nym" said this at that forum, and the same "nym" said that at that forum, therefore this "nym" is Person X, and I think I will tell the judge that Person X is posting things at this site Y that say...

Where site Y has nothing to do with what ordinary people consider a crime, but only has to do with divorce custody issues and support of fathers.

Judges are temperamental (mental) creatures and going to / from court is more expensive than I can handle so I try to keep personally identifying markers out of my googlespace. That was actually the advice and wisdom of my lawyer that said, "don't let it become known in court that you belong to groups like Fathers & Families, judges don't like hearing that."

Sorry for the long explanation.

Also I was kidding about the "brainstorming ... no criticism" -- I just love tacking that on to various outrageous comments.)

Posted by: anon at September 23, 2007 4:39 PM

Well, we who hang here just prefer a name other than "anon," as there have been "anons" here before. "Butthead," "King Lear," or "Mr. Pooky" and the like are preferable.

Posted by: Amy Alkon at September 23, 2007 5:09 PM

There they were, yelling at everyone, including the seven year old boy going into the clinic in front of me.

I doubt they've ever persuaded a single person with this.

I'm guessing persuading people isn't actually their intention.

Posted by: Amy Alkon at September 23, 2007 5:28 PM

You're right, Amy. The woman who leads our protests had an abortion herself years ago and has since come to regret it. She spends her life in deep mourning. You and I and every woman we know feels for her on a certain level. We've been there, we've done that. That doesn't excuse the obvious human truth: she doesn't get to exorcise her psychological demons on the rest of us.

I know the pro-life movement in America is trying to float the false notion that all women secretly regret and mourn their own abortions. There is no real scientific evidence than an abortion permanently damages a woman's mental health, and no one should use their own personal regrets to harm the rest of us.

Posted by: Rebecca at September 23, 2007 6:00 PM

Rebecca - Personally, I don't care about your situation, because by not having insurance, I'm not being asked to finance it.

The point I have been so indelicately trying to make here is that if you start with asking the question "should insurance pay for treatments for a genetic disease that can be detected in utero, should the parents decline abortion", you end with the insurance companies deciding that people who are too expensive to treat are left to die. Amy's point isn't that she wants parents to have the choice, it's that she wants them to be encouraged to do it so she doesn't have to pay higher premiums or taxes to care for the child.

Maybe you're OK with that. I don't know. I'm not sure I am. And as far as 95% of humans being stupid - I don't think I've ever (seriously) advocated wiping the stupids out.

Oh, and the pro-life movement in America is simply trying to make sure they keep getting money. I yell at them every chance I get, because they don't add anything to the sum of human existence. In fact, I'm hard pressed to find any incident in history where people running around with signs and screaming has actually improved anything.

Posted by: brian at September 23, 2007 6:17 PM

Personally, I wasn't thrilled to have one, but I certainly wasn't about to have a kid.

Posted by: Amy Alkon at September 23, 2007 6:18 PM

Amy - If you were so dead set against having children, then why did you not have your tubes tied? You of all people should understand that there are no foolproof mechanical systems of birth control.

You have sex, you are giving your body permission to make a baby. That's what sex was designed for. And anyone who goes into it not expecting that it is a possibility regardless of precautions is being irresponsible at best.

Posted by: brian at September 23, 2007 6:21 PM

Personally, I don't care about your situation, because by not having insurance, I'm not being asked to finance it.

Just out of curiosity Brian: If you were to suffer a serious injury while doing something you enjoy, and ended seriously disabled, who would be asked to finance your care?

Posted by: justin case at September 23, 2007 6:31 PM

Justin - I had always expected that I should pay the bill myself. I'm often stunned that more people don't feel that way.

If I could get insurance that was actually insurance I'd buy it. There are things showing up that approach that now, but the return isn't there yet. All I want is a policy that covers major medical incidents 100% after some largish deductible. I've seen 80/20 coinsurance high-deductible plans, and I've seen HMO-lite plans (co-pay for a certain number of doctor visits per year, other limits) that are a bit more expensive.

I regard HMO and PPO plans as cost-spreading schemes, and I can't see any reason why I ought to volunteer to finance other people's bad lifestyles. But having insurance to cover catastrophic incidents would be nice, so I wouldn't have to sell my house to pay the hospital.

Posted by: brian at September 23, 2007 6:52 PM

"If you were so dead set against having children, then why did you not have your tubes tied?"

This is surgery and can lead to complications, such as perimenopause. I looked into it and decided the risk wasn't worth it. I had an IUD for many years, which I used in addition to condoms, but then it gave me an infection and I had to have it removed.

FYI, I know now that I'm the shape that's most fertile (per Jasienska's study). My body type, according to her study, has three times the estradiol, potentially making me three times as fertile as women who don't have my shape (hourglass figure, large breasts). I have always been careful about birth control, but one time, there was an accident. I had an abortion a few weeks in, and it wasn't a groovy thing, but it wasn't a big deal either. I live a science and reason-based life, and I don't believe a pinprick-sized bunch of growing cells is a person. Sure, it can become one -- but I wasn't about to let that happen.

Posted by: Amy Alkon at September 23, 2007 6:57 PM

I highly recommend Kaiser.

Furthermore, you can rationalize why it's not worth it for you to have health insurance, but the fact remains, unless you're a multimillionaire with disability insurance, the rest of us are going to end up paying for you if you get a catastrophic illness or get into a catastrophic accident.

Posted by: Amy Alkon at September 23, 2007 7:00 PM

Amy says:

"I doubt they've ever persuaded a single person with this.
I'm guessing persuading people isn't actually their intention."


I think Amy's on the money here. We human beings, with our talent for abstraction, stake out metaphorical territories in the same way we and other primates lay claim to physical space. Neighboring troops of howler monkeys meet at the boundary of their territories early in the morning and howl at the monkeys on the other side. They're not persuading each other of anything except "You're on that side, we're on this." Each side claims "We're a lot better than you," but the apparent purpose of that message is to unify their own side.

Anti-abortion protestors have staked out their territory, and they yell to define its boundary and to announce they are superior for being on the "right" side of it.


Posted by: Axman at September 23, 2007 7:02 PM

PS New method of tube-tying (not tube tying, actually) but permanent birth control for women:

http://www.essure.com/

Posted by: Amy Alkon at September 23, 2007 7:05 PM

What Amy said. Brian, you can justify not having insurance however you like, but unless you have staggering resources, a serious and debilitating injury or illness would be likely to cost much more than your home, savings, investments and etc. You are a bright person, you must know this. And you must know that you wouldn't be turned out in the street once you ran out of money. I don't see how your choice in this matter is a responsible one.

Posted by: justin case at September 23, 2007 7:08 PM

Justin -

I'm gambling. Life is risk. I know what my risks are. I'm more likely to end up dead than debilitated. I'm gambling that I'm not going to get shot or hit by a bus and live to tell the tale.

And when the cost of insurance per year exceeds your total lifetime expenditures for healthcare, it's pretty hard to justify.

Posted by: brian at September 23, 2007 7:20 PM

We prefer you gamble on your own dime, thanks.

Posted by: Amy Alkon at September 23, 2007 7:51 PM

And just like with any other kind of gambling, from Las Vegas to the sterilized scene over at Brian's house, there are costs to the rest of society.

Do you mind if the rest of us make sure, Brian, you a) never ride in or drive a car, bus or train; b) never drink, smoke or take drugs, prescription or otherwise; c) never board an airplane; d) never engage in sex; e) never use the crosswalk on a busy street; f) never travel outside your country; and finally, g) never actually exist outside your cubicle at work. Accidents can happen anytime anywhere, and everyone else here will have to eventually pay for your care in the case of catastrophe because thanks to the high cost of care in this country, we will cover the uninsured like you. It's great you've lived such a sheltered life up until now. However, please sign here, because we're going to assume, despite your pronouncements otherwise, you don't live in a vacuum. Thanks.

Posted by: Rebecca at September 23, 2007 9:00 PM

Rebecca -

When you start paying my bills, I'll consider listening to you. You have absolutely no justification in saying that you will be forced to pay for my care, because there is no way you CAN be forced to.

The high cost of care is not what you think it is. I pay less for a doctor visit than your insurance company does because the doctor has less hassle when I pay cash. And because I don't have an overpriced insurance policy hiding the true costs of care, I'm not overusing the system.

So, in the immortal words of Bender, kiss my shiny metal ass.

Posted by: brian at September 24, 2007 3:40 AM

When you start paying my bills, I'll consider listening to you.

The point is, we'd like to avoid it. And if you have something catastrophic go wrong with you, unless you're a multimillionaire, chances are, we'll be forking out for your care.

You can bet, based on not smoking, not being in the presence of smokers, walking vigorously for an hour every day, being of normal body weight, and eating right, that you won't get, say, lung cancer. Cathy Seipp was shocked that she got it, and so were all of her friends. (I remember her making a crack that it really messed with her "Nietzschean sense of superiority."

Luckily, she had the good sense to have Blue Cross and disability, too, which is the right thing to do if you have a daughter. When I was going over there to be with her, I'd often answer the door to the delivery guy and check her med bag for her pain infusions he brought over to make sure everything was there. The tiniest things in it -- tubes and things -- cost HUNDREDS of dollars.

Posted by: Amy Alkon at September 24, 2007 5:48 AM

Well, if you think you're going to spend the rest of your life only seeing the doctor for routine injuries and illness in between watching cartoons, good luck with that.

My insurance company hasn't paid for a single thing in years. See, there's a little thing called a "deductible". Mine is $750. I don't get $750 dollars worth of sick in a year, so when I go in to the local family clinic, I pay out of pocket, and never more than $100. I can afford that. Everyone's basic doctor visit, insurance or no, tends to be fairly cheap. The high cost of care comes when you or I are hospitalized, placed on non-generic prescriptions, or decide to see a specialist for something. You might never have or want to see a specialist or need drugs. Great!

But if you ever turn off the cartoons, get out of the house, and suffer a stroke while crossing the street that leaves you paralyzed and brain damaged, please spare the rest of us from paying for your care. Don't apply for Medicare or any other public health care assistance after you've run out of cash, lost your home, and tapped all your mother's financial resources.

Posted by: Rebecca at September 24, 2007 6:02 AM

Whoops. *Medicaid*. I'm guessing not many 60- and 70-somethings are watching Futurama. They're too busy watching Fox News.

Posted by: Rebecca at September 24, 2007 6:12 AM

60 is the new 35 if you do it right.

Posted by: Amy Alkon at September 24, 2007 6:42 AM

I'm sure when Angelina Jolie is 60, she'll still look better than me at 35.

Posted by: Rebecca at September 24, 2007 7:13 AM

And even exercise can get ya. I'm scheduled to go in for a hip replacement in January, two months short of my 51st birthday. Either the multitude of high impact activities or one of many falls I've taken in my years of horsebackriding, skiing, Morris dancing or just slipping and falling have taken their toll on my right hip. Yes, I'm insured to the hilt.

I held off commenting about the primary topic until I could formulate my thoughts because this hits close to home. I'm the mother of a severely retarded 10-year-old. If someone had told me at 10 weeks pregnant that I'd have a child who would probably never develop mentally beyond a 3-5 year old, and would be dependent for his entire life, I probably would have elected to abort. His problems though, result not from genetics but from a detached placenta and lack of oxygen near full term. Today I'd probably step in front of a moving train to save him, but yes, his care is expensive. And we're doing everything we can to not have that burden fall on society, though after we're gone, we'll just have to have faith that whoever is responsible for his trust fund doesn't run off to Tahiti with it. Life has no guarantees. When it comes to either your health or your kid's, you can do everything right and still get thrown some pretty nasty curve balls.

Posted by: deja pseu at September 24, 2007 7:35 AM

Rebecca - such bitterness. Are you related to Joe? Maybe you can justify paying 200-300 a month for insurance like that. I can't. And that's what the rates are for insurance with that low a deductible are around here. See, we have minimum mandated coverages here that drive up the rates for everyone. Which is why I'm not sure I can even GET the insurance I'm willing to pay for.

Amy - wasn't Cathy involved in quite a bitter feud with Blue Cross, who didn't want to pay for her very expensive treatments?

Posted by: brian at September 24, 2007 7:56 AM

She was feuding with them at some point - about a treatment they considered experimental, but which worked for her. Ultimately, she got it, but I can't remember the details. I've also had differences with my primary care doctor - so I fought her, got a second opinion, got the care (I rightly thought, based on studies a friend pulled for me) I needed. And then I switched doctors to my current primary care physician, who's wise about preventive care without going nuts where there can be a lot of false positives (ie, the people who go in for full body screenings and the like).

Still, my point remains: Cathy's care, even just a day of chemo, cost thousands and thousands of dollars. You mow through anything but a serious fortune real fast. I'm guessing your name isn't Brian Rockefeller.

Posted by: Amy Alkon at September 24, 2007 8:11 AM

Here's Cathy on health insurance in NRO -- she, like me, thinks it should be mandatory:

http://www.nationalreview.com/seipp/seipp200604280608.asp

Posted by: Amy Alkon at September 24, 2007 8:12 AM

Eugenics? Health insurance?

The eugenics objection is a “slippery slope” fallacy. The fact that one offers (or implies) an extreme example as an objection to the policy in question shows that the necessary distinctions of degree to prevent one from leading to the other can be made.

Regarding health care, people make choices everyday that could increase my health insurance premiums. No one realistically expects to be able to control any significant portion of these things.

I think the central point is this:
The only reason not to encourage abortion when faced with the likelihood the child will be born with a debilitating disease is some objection to abortion on moral grounds. Since free, on-demand, no questions asked abortion is a key component of the nihilist modern lifestyle, any objection or even lukewarm enthusiasm for abortion must be rooted out and ridiculed mercilessly. The goal is to get to the point where an abortion is a common as a teeth cleaning or better yet, an OTC vitamin supplement.

Posted by: Geoff at September 24, 2007 8:32 AM

I'm glad you said that deja. an opinion from someone who has to live with those kind of consequences is important. I'm sure the mommy-bloggers are shrieking in agony that you could be rational *gasp* about your child, but I appreciate hearing it.

Btw, where is Crid? Are we boring him?

Posted by: christina at September 24, 2007 8:41 AM

The goal is to get to the point where an abortion is a common as a teeth cleaning or better yet, an OTC vitamin supplement.

This is a bad idea, since abortion is an operation and stresses the body. Also, if women are honest, I think a lot of them feel bad about having an abortion - wondering about what the kid would've looked like, etc., even if they don't like kids and have no intention of having one.

The problem is, the religious nutters against abortion are often against contraception. For years, I had to buy Plan B in the pharmacy in France (nonprescription, since they don't infantilize adult women like we do) because I couldn't get it here without a trip to the doctor. (And it was a long time before I even knew about it -- the religious nutters liked it that way.)

I don't use abortion as birth control -- but accidents sometimes happen, even if you are careful, which I always was.

Posted by: Amy Alkon at September 24, 2007 8:49 AM

Are you related to Joe?

I might be. I'm one of seven children, my father was one of fourteen. I've never even met some of my cousins, aunts and uncles. Gotta love those Catholics!

Posted by: Rebecca at September 24, 2007 9:01 AM

I had an abortion many years ago. Conception was an accident, he didn't love me, I loved him but wasn't ready to be a single parent. Yes, I regret that I had to make the decision, but I don't regret the actual act. I am so much better off now than I would have been. It took me a while to get over it, but with time, all things are put into better perspective. I refused to guilt-trip myself or to let anyone else do it for me. Was it selfish of me? Maybe, but I wasn't in a good place emotionally at the time, and the child would have been as miserable as I was. Probably moreso. I would not have had the strength or selflessness to give it up for adoption. The possibility of ruining both our lives was very real. I chose not to.

Posted by: Flynne at September 24, 2007 9:34 AM

Perhaps having babies with Gauchers disease is entirely avoidable. But so is AIDS, as long as you don't take any blood transfusions in France or Libya. And I'm willing to bet that more of my insurance premiums and taxes are spent on AIDS than on Gauchers disease. In any case I have to pay for the lifestyle choices of others. And I certainly have less of a problem with money being spend on the baby as it did not cause it's own predicament.

Mandatory insurance and differentiated premiums may provide additional revenue. I'm sure there are ways to improve efficiency and reduce waste. But in general I think that voters in Western countries are willing to increase spending on health care, and that is why costs will keep rising, and it may actually result in better care as well.
Redistribution from the haves to the have-nots seems to be a major feature of democracy, but differentiating between the deserving and undeserving poor seems much less important (after all, one never knows whether one might one day wind up on the undeserving list). So I see major penalties for high risk behavior as unlikely.

Posted by: Daran at September 24, 2007 10:50 AM

There is emergency-only insurance available. Mine was 66/dollars a month and it covered everything past 5000 bucks. So I didn't see the doctor regularly, but in case I got in a car accident, I was covered. There's no excuse for not having insurance, but then, we've already had this debate. Brian is invincible, remember?

Posted by: christina at September 24, 2007 11:07 AM

Very smart, Christina. In case anybody else is interested, who is it through, and any tips?


Posted by: Amy Alkon at September 24, 2007 11:08 AM

> Are we boring him?

Nevah!

"Only talk when it improves the silence." -- Matthews

"Better to remain silent and be thought a fool than to speak out and remove all doubt."" -- Lincoln

Posted by: Crid at September 24, 2007 11:24 AM

> There's no excuse for not having
> insurance, but then, we've already
> had this debate. Brian is
> invincible, remember?

Riiiiiiiigght.

> I'm gambling that I'm not going
> to get shot or hit by a bus and
> live to tell the tale.

Yes, and you're gambling with other people's money:

> the rest of us are going to end
> up paying for you if you get
> a catastrophic illness

You know full well that society can't afford to leave you on the sidewalk bleeding, so it's preposterous to pretend you're talking this thoughtful, masculine risk. You're counting on us like Blanche DuBois used to do. And that didn't work out so well.

Posted by: Crid at September 24, 2007 11:44 AM

Amy-
I believe it was blue cross, but any number of insurance companies offer it. For some, Tonik (also by blue cross) is a great option, and they even offer a limited number of doctor visits per year that include labs and x-rays. It's harder to get into, though, and I believe there's an age cutoff. I've switched to that so that I can see the doctor now and then, and my ladyparts exam is covered. It's about 100 bucks a month. Ehealthinsurance dot com is a good place to check. You can put in what you want, and it spits out who offers it. They are really helpful.

There's Crid!

Oh, and are we talking to/about the same Brian that rides a motorcycle and doesn't have insurance? Remember that part?

Posted by: Christina at September 24, 2007 2:40 PM

Well, Christina, you may have answered the question for me. They certainly imply that they aren't interested in selling Tonik outside of the 18-34 demo. I'm guessing they assume that once you hit that age, you are supposed to be married and have a family, and therefore shouldn't want high-deductible insurance.

And the only things I've found on ehealthinsurance that come near it are either more than I want to pay, or 80/20 coinsurance. And 20% after $5000? I may as well take the whole thing at that point.

Posted by: brian at September 24, 2007 2:52 PM

You ride a motorcycle without insurance?

Posted by: Crid at September 24, 2007 9:16 PM

Phew, Crid, we were starting to worry about you!

Posted by: Amy Alkon at September 24, 2007 11:50 PM

I don't know how old you are, but I put in a 1960 birthdate, and got $199 a month, 0% coinsurance, $1500 deductible. I think if you're almost 50, that's fantastic. How cheap are you?

Posted by: Christina at September 24, 2007 11:52 PM

Oh, and Health Net, $4000 deductible, 0% health insurance, $129 a month.

Posted by: Christina at September 24, 2007 11:54 PM

Without health insurance, Crid, if it's the same Brian. I seem to recall a Brian mix up and there are more than one. Oh, and he also rides without a helmet if I remember correctly. We've already done the health insurance thing, and I don't think it was concluded. We did discover that Brian is celibate (risk management) and that "only promiscuous people need yearly std testing".

The rest is here: http://www.advicegoddess.com/archives/2007/02/playing_health.html

Posted by: Christina at September 25, 2007 1:14 AM

Yep. That's me.

And I don't get any of those things you do, Christina. The only thing I get that's under $100/mo is a PPO plan with a $5,000 deductible. But I'm not certain they will write that policy for me. I intend to call today and find out.

$100/mo is worth it to defend against the odd broken leg or heart attack. $200 is not.

Posted by: brian at September 25, 2007 4:20 AM

Ah a topic long after it’s born-on date—I guess I will contribute! For Brian, your shinny metal ass is full of crap (and I think you know it). The very real potential cost of a disabled life (especially a 50-50 shot, that ranks in the millions of dollars) is greater than your probable healthy person. It is a legitimate question: with limited resources is it really ethical to essentially ask everyone else will pick up the tab for your all-you-can-eat buffet of medical care? I get to see the consequences of this all the time: children whose care is on the dole coming in for the umpteenth operation or spending their next frequent-flier week in the ICU. But hey, “you’ve got to do everything!” because if it is not on your dime, ‘money ain’t a thing’! The topic can be misled all you wish but the basic argument remains: is it really fair to foot your exorbitant bill on everyone else? Don’t argue Alzheimer’s, diabetes, cancer or other crap that comes at the end of life (and is another topic of debate). We speak of the Great Roll of the Dice, except when you know the odds are massively stacked against you.

BTW: this same topic cost me a spot at Albany Medical School (many, many years ago). Some Ivory-tower Family Practitioner did not agree with my pragmatic approach to the distribution of limited medical resources. Why should a millionaire blow his wad on an extremely experimental operation (less than 1% survival) for his sick child when the (poor) janitor did not have the same benefit? My answer: it is his money to do with as he wished; the (poor) janitor did not have the luxury. Ohhhh snap, done with that interview!

Amy: still love reading your stuff (especially now that I am posted overseas for the military [read: EXTREMELY CONSERVATIVE}).

Posted by: Doc Jensen at September 25, 2007 6:05 AM

BTW Brian: good choice on the high deductible insurance plan. I think everyone should be one something similar: you pay low prices when you lead a healthy life, you pay more for the 'odd broken leg or heart attack' and are covered for the rare catastrophic car accident or cancer treatment. Oh, and I certainly hope your dumb-ass is wearing a helmet while riding on a donor-cycle! You know, keep the brain stem functions alive while you get your organs harvested.

Posted by: Doc Jensen at September 25, 2007 6:12 AM

Thanks, Doc J, great to have you back. And this entry is still going strong.

Posted by: Amy Alkon at September 25, 2007 6:16 AM

Thanks for that link to Amy's previous post, Christina. Here we are, seven months later having almost the same exact discussion with Brian.

So, seven months from now, everyone? Pencil it into your calendars.

Posted by: Rebecca at September 25, 2007 9:43 AM

You're the ones who keep bringing it up. In the past six years, I've saved anywhere between 7,000 and 30,000 by not paying for insurance I don't need.

And nobody has yet indicated to me how they will be forced to subsidize my care. You've all just ASSUMED that I would be willing to beg the government to care for me.

Posted by: brian at September 25, 2007 9:51 AM

Just a personal anecdote:

This hit on a personal note for me, as my wife and I had a similar discussion. Her pregnancy was very deliberate (IVF), so we had some time before to discuss whether we'd even consider abortion, and under what circumstances.

What it came down to was whether or not we'd be subjecting the child to suffering and pain by proceeding. We tested ourselves, and after enough development, we had further tests done (amniocentesis, for example). We went through all tests we felt were reasonable, and things looked good. But if we had come back with a 90% chance for Down Syndrome (for example) we most likely would have aborted.
However, if Athena is born (due date is Oct 19th) with defect/s that we couldn't detect, then at that point we will make the best of it, AND do whatever we can to shoulder the responsibility as best we can.
To bring a child into the world with knowing there's a high risk of living a life of pain or suffering is completely selfish and irresponsible. To do so presuming others will help you with the financial responsibility is criminal as well. I also believe that if an adult decides that they cannot deal with the pain of an affliction, they also must have the right to end their own lives as well. Most "culture of life"ers seem to me to be utterly cold-hearted in this respect.

Posted by: Jamie at September 25, 2007 10:30 AM

And nobody has yet indicated to me how they will be forced to subsidize my care. You've all just ASSUMED that I would be willing to beg the government to care for me.

How about if you end up unconscious in the emergency room? They're going to provide care without researching your bank account balance or insurance status first.

Posted by: deja pseu at September 25, 2007 10:37 AM

If you are unconcious, you don't get to opt out of medical treatment. And even if you were concious, they may not allow you to opt out. I bet they might even go so far as to have your power of attorney passed over to someone else, as you'd obviously be "crazy" not to want to live. In case you hadn't noticed, we're a little obsessed with prolonging life here, no matter what.

Posted by: christina at September 25, 2007 10:44 AM

Deja, Christina - You are making the same logical error that all of the "40 million without access to health care" arguers make.

Lack of insurance does not equal lack of access to care.

Access to care without insurance does not equal expecting a free ride.

What part of "I pay my own way" doesn't register with you?

People willingly borrow $50,000 to buy a new Lexus. Why is it so insane to expect to assume a similar debt to pay for medical care?

And why do you assume that any incident that occurs will suddenly render me unable to be productive?

Insurance runs out, you know. Hit a few million bucks in care, and you're on your own anyhow.

Posted by: brian at September 25, 2007 11:54 AM

Brian:
You argue on one side that people should be willing to shoulder a reasonable debt for medical care. Fair enough. However, insurance and this whole 'net' of medical care concept is based on shared risk and pooled resources. To put another way, we as a bunch of people pool our monies (via insurance), paying a small amount in order to insure against a financially devastating and random occurrence (i.e. finding yourself fairly messes up in the ER). For most all people $50,000 would set us back quite a bit. Viola! That is what insurance is for. However, this basic concept has been hijacked by 'resource eaters' like the Gaucher's kids, extended life support, etc. leaving the rest of the normal population to deal with the upcoming question of just how do you fairly distribute a limited resource.

Must go to work now...

Posted by: Doc Jensen at September 25, 2007 2:27 PM

My goodness, what a crock oh crap being spewed. I'm sorry, but it is quite reasonable for a couple to decide not to have a child that is likely to either suffer or cost a fortune to alleviate the suffering. Should the taxpayers have to pay for it, if the couple decides to have the child, knowing that they can't afford treatment? That is more of a fucked up question to force on society, than the rightness of the abortion.

We are expecting our second child in December. About six weeks ago, in a fit of absolute stupidity, a nurse called me to inform me that we needed to come in and talk to them about further embryonic testing and the implications, as tests had shown an elevated risk of downs syndrome. What she failed to say, is that about one in fifty pregnancies with these risk factors actually is a problem. So this lead to a short, very difficult (we, my parter, myself and our son, are very excited about the new addition to our family) discussion about what to do. Abortion was the only option deemed reasonable by either of us, if the tests came back positive. Indeed, it would be the height of irresponsibility for us to have decided to have the child under those circumstances. If for no other reason than we have a child already, who deserves to have some attention from his parents.

Is it remotely reasonable for people to saddle society as a whole, with the immense expense of caring for their child? Is it reasonable to assume that society will have the political will to do so, for the life of that child? Is it reasonable to assume that said child will be happy with the restrictions placed on it by it's health condition? I stop short of forced abortions, but I think that it's extremely important that doctors make very clear the implications, more than just the financial ones.

There are a lot of children, desperate for parents. The decision that we made, if the tests came back badly, was to abort and adopt. It is quite likely, that when our children are older, we will do that anyways - unless of course, we seriously fuck up our kids, in which case we'll accept that we are failures as parents and not inflict that on anyone else. . .But we seem to be doing ok thus far.

Posted by: DuWayne at September 25, 2007 8:16 PM

Wise words, DuWayne.

Posted by: Amy Alkon at September 25, 2007 9:33 PM

Just a few more words and a small quote from USA Today editorial (Wed Sept 19th):
“About 47 million people are uninsured, and many get no-cost treatment at crowded emergency rooms, imposing a hidden tax of more than $1,000 a family on those of us whose insurance premiums indirectly cover the bills. Insurance premiums have almost doubled in the past six years, and health care cost inflation is unchecked. Individuals get stuck in jobs because they dare not give up work-related health insurance. As more employers drop health insurance, families are stuck paying the cost — a stunning $12,000 a year for an average family — on their own, or going without.”
Let’s take myself, for example: 34 years old healthy male whose adult medical costs include a few blood draws to check my cholesterol and yet I have been contributing to insurance premiums since I was 21. Taken a step further, a healthy female who has yearly paps and regular birth control (all of which she will most certainly have copays for) contributes a hell of a lot more money for her insurance premiums (seems insurance companies think being a woman of reproductive age is a health risk). As above, the average family cost of insurance for 2007 is $12,106 with $3,281 paid by the worker (http://www.kff.org/insurance/ehbs091107nr.cfm). That is a shload of money paid by people who are usually healthy, nonutilizing customers (because if you are sick you either will be denied insurance or have to pay much, much more for premiums).
But back to the original point Amy has been trying to drive through Brian’s head:
The currently existing treatment of Gaucher's disease, Cerezyme, costs up to $400,000 annually for a single patient and the treatment should be continued for life! That is about the total insurance monies contributed by 33 families for a year to take care of ONE CHILD for ONE YEAR! Brain, I don’t know from which alternate reality you reside but that seems like an extreme amount for one person, for one year. To put this in prospective, in Iraq today there is a cholera outbreak where 11 people have died, so far (http://news.yahoo.com/s/ap/20070925/ap_on_re_mi_ea/iraq_cholera;_ylt=Apk3N.4ibTUiuVclYSOFlR1Z24cA). Yup, people are shitting themselves to death because they don’t have clean water. Oh yeah, people like Brian really have their priorities strait.

Posted by: Doc Jensen at September 25, 2007 10:49 PM

Sorry all, if I had a doctor she would probably tell me not to get so worked-up over medical issues.

Posted by: Doc Jensen at September 25, 2007 10:53 PM

Mankind is the only animal to encourage the weak, stupid, and genetically unviable to reproduce.

I am all for passive eugenics, and FYI if you want to have a kid you know is going to be hadicaped and racked by pain their entire life feel free, just dont expect society to pay for it.

My solution, test every fetus for everything(including paternity) and make your decision. But if you have a half baked bun in the oven how about we disclose that fact to all insurace provideres upfront so they can tell you to try your luck elsewhere

Posted by: lujlp at September 26, 2007 2:06 AM

Doc - I'm supposed to get worked up over the idea that someone in Iraq is unable to grok bleach? Or should those kids have been aborted too?

I understand Amy's point completely. I suspect that nobody understands mine, or have decided to dismiss it out of hand because I don't have insurance.

Look. I'm not in favor of abortion per se. If your conscience can handle it, fine. My objection to the argument presented is simple. Does society have the right to dictate a maximum cost that a child will impose where it will say that child has no right to exist?

The reason I have a problem with this is simple. There IS a slope. It may not be slippery, but with every decision we make, we walk another step down the hill.

Do you want to live in a world where someone is afflicted with a treatable disease and they are instead sent home to die because society has decided that they cost too much?

That is the logical endpoint of abortion as a cost-saving measure.

Posted by: brian at September 26, 2007 4:54 AM

Oh, and doc? You know why that insurance keeps going up at 9 times inflation?

1) Lawyers
2) Politicians
3) Consumers

Lawyers with malpractice suits where there is no malpractice. They know the insurance companies would rather settle, and they rake in the bucks. The insurance companies raise premiums to cover the loss.

Politicians decide that all insurance plans need to cover breast cancer screening and psychological care for all insureds. The insurance companies raise premiums to cover the loss.

Consumers, who have no clue or care about the true cost of service, go to the doctor or the ER for the most trivial of issues. Service providers raise their prices as a result of demand outstripping supply. The insurance companies raise premiums to cover the loss.

You wonder why you got a paltry 2% raise? Because the other 5% were in the insurance premiums the politicians made sure you don't know the true cost of.

You want to see the cost of care and the cost of insurance come down? Eliminate the tax benefit to employer-provided insurance plans. Once people are required to self-insure, I guarantee you that the single males are going to opt out of the $300-500 a month cover-every-pimple-on-your-ass plans. I also guarantee you that when people see the REAL cost of going to the doctor every time they get the sniffles

Posted by: brian at September 26, 2007 5:19 AM

Couple of points:

One of the main reasons insurance is raising? Dumb-ass doctors who can't get organized and say no to all the crap being forced upon them.

While I completely understand (and agree) with people paying for what they need, the system would not work. The original ideal of insurance, pooling risk so that any one person does not take it in the shorts, is a good one. While I am healthy now, there is no predicting if I am the one who has that retroperitoneal mass that needs operation, chemo and radiation (all to the tune of about $75,000 to $125,000 [very rough estimate, no data to back it up other than knowledge of general costs]). No one, not even you, should ever have their lives devastated because of a freak circumstance. In a society as rich and (relatively) healthy as ours, while you should pay into the system to cover the occasional bill for an otherwise productive person, it is not the right of someone to drop a big steaming pile of 'resource consumption' upon everyone else when there is a choice.

If there is one thing I am it is pragmatic. Some of my believes fall into the far left, some fall into the far right but overall, I believe in an informed, understanding public that tries to do the best for the population while placing limits on that which benefits no one. If you ever come into the hospital dying of some cancer I will do my damnedest to get you back to society as a productive citizen without too much emphasis on the costs. However, I am willing to draw the line. Putting precious resources into an unproductive person who will never be productive is a waste. I know I sound like some horrid monster when I say that because who am I to play God. However, when the choice becomes treating you or treating the genetic anomaly, you will have preference, and if there is a lack of funds, you will be the recipient of the public's money and my time and care. Brain, you should never have to pay an exorbitant amount to see a physician for common preventative care (for those sniffles may easily become pneumonia) but I will be damned if I will stand passively by and pay for some couples 'pet rock' baby who feels it is their right to burden you, me and the rest of society with astronomical costs they do not share! Yes it is heartless, yes it smacks of eugenics but as the years pass it will quickly become a very real question as to who deserves to be cared for: you, me, Amy and everyone else posting on this board or a cost of a single child for one year. For me that is a simple choice.

Posted by: Doc Jensen at September 26, 2007 6:15 AM

DuWayne,
"I stop short of forced abortions,"

Bear with me if I sound obtuse but why? Please explain to me why stop there. Try not to make too many assumptions about where I am coming from but please take a moment and explain to me what mechanism prevents someone from being coerced into aborting.

Suppose a pregnant woman who is not rich undergoes a test that shows her baby is very likely to be born with a debilitating condition and that woman declines all medical advice to abort. Her insurance company notifies her that, given the doctor's recommendation, only an abortion will be covered and only then does she consent to termination of her pregnancy.

Is that a forced abortion?

Posted by: martin at September 26, 2007 7:38 AM

Martin -

Yes. Yes it is.

And that is precisely the danger in starting with counseling abortion for a condition that is treatable, and given the pace of bio-science might even be curable within our lifetimes.


Posted by: brian at September 26, 2007 7:56 AM

Martin -

Coercion and legal requirements are two different things. I don't personally have health insurance at the moment, in a month or so, I will be getting an HSA for myself and my family.

So lets say that our test had come back badly, lets say that it was 99% certain that our second child would have down syndrome. Lets also say that rather than aborting, we decided to have him anyhow. What are the odds that I could get insurance that would cover him? Pretty damn slim. So while I might be able to get insurance for the rest of my family, he would be stuck on the Oregon Health Plan, like my son and pregnant partner are now. While I daresay that care for a down child is not quite as expensive as the illness we're talking about here, it is still very expensive and will be for the life of the child, who would never be more than a child.

Is it really reasonable for me to expect that the insurance company would agree to cover the cost? What happens if I do have the child and instead of public health expanding to cover everyone, it shrinks to cover very few in five years? Who will take care of his care then?

If the insurance company told me that if I have a down syndrome child, I will be stuck covering the cost, certainly it's coercion for my partner to abort. If the insurance company told me that they wouldn't cover any cost for the child, if he likely has Gaucher's disease, it would in effect be coercion to get an abortion, making the decision to have the child anyways, just that much more selfish. I still have the option, it's just that the selfish cruelty of that decision is that much more apparent.

Posted by: DuWayne at September 26, 2007 8:41 AM

To be clear, though I have my doubts that most people here agree with me, I am a huge supporter of some form of universal health care. Preferably a multi-tier, single payer that's optional, with tax deductions for those who op out. Whatever it's form, UHC is only going to be possible, if we make costs reasonable. This means that hard discussions and hard decisions will have to be made.

Posted by: DuWayne at September 26, 2007 8:46 AM

DuWayne -

The only way to make costs reasonable is to expose the consumer to the entire cost of medical care. Insurance ought to be on either a reimbursement basis, or on an estimate/invoice basis so people are able to comparison shop for care.

Any form of "single-payer" health care ultimately ends up with an unelected, unaccountable bureaucracy making decisions involving life and death.

And any single-payer system with opt-out is going to fail, as the good doctors will end up in the privately-financed system. So we end up with, at best, the Canadian system, and at worst the British.

Posted by: brian at September 26, 2007 9:58 AM

I completely disagree that insurance not covering an impaired child is "forced abortion". Forced abortion is when you are actually made to have an abortion, with absolutely no choice in the matter. Saying that they won't pay for it is NOT forcing you to have an abortion; it IS forcing you to accept the consequences should you decide not to.

Coercion? Maybe. Pressure? Certainly. I think this all goes back to our serious entitlement complex. You aren't entitled to do whatever you want. You are entitled to do whatever you want, provided that it hurts no one else, and often, not even yourself (drug laws). Where that line is drawn is not black and white, but that's where this argument comes in: where is that line? What kind of cost can you reasonably expect society to bear for you? Where did we get the idea that we are no longer personally and *solely* responsible for our own choices?

I disagree that denying care for the ill is the same as denying care for a pre-person. Again, my point is that you and I have (hopefully) already been a contributing member of society and deserve to be given the chance to continue to do so, or at least to die as comfortably as possible. I think the difference is fairly obvious, but if you consider a zygote the same as yourself, than I guess we'll never come to agreement on this point.

Posted by: Christin at September 26, 2007 1:07 PM

Martin,

I apologize, re-reading it, I wasn't very clear, as I was rushing around this morning. No, I absolutely do not think it's forcing an abortion. It is simply putting the consequences for the decision entirely in the hands of the potential parent.

Brian -

While I am happy to argue the ins and outs of UHC, it is not the topic of this post. The only reason that I mention it, is that is peripherally relevant. If you would like to discuss it, I have a post or two up at my blog on that very topic. They're old, but I would be happy to debate it with you there.

I would add to that, that I not only have a "do not resuscitate" living will, but I believe that in certain circumstances it would be far more humane to give someone a fatal shot of sodium morphate, than to remove them from life support to die naturally. Given the choice between drowning in my own fluids, while conscious (such as happened to a women in Texas last year) or being given a lethal injection, I think the only reasonable response is lethal injection.

I do not wish to burden my family or society, with caring for me, in a persistent vegitative state or even significantly diminished capacity, nor would I want the indignity of living that way. Again, I am not a supporter of forced euthenasia, but I think voluntary euthanasia deserves far more serious discussion.

Posted by: DuWayne at September 26, 2007 2:11 PM

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