Wednesday, December 25, 2013

Is misogyny (distrust of women) on the move in these three states?

Datelines California, Indiana, and Michigan, 12/26/13

The California Supreme Court refused to halt same sex marriages when it poured cold water on a legal challenge to ban  these marriages. Californians know the story: proposition 8 passed in 2008. Same sex marriages were supposed to be banned because that's what the citizens voted for. But in 2010 the ban was ruled unconstitutional. In June of 2013 the U.S. Supreme Court let the ruling stand -- the ban was gone, same sex marriages were on. Governor Brown ordered that county clerks could begin issuing marriage certificates. That's how that matter stands now.

It appears that antipathy to transgender issues has taken its place: As of 1 January 2014 transgender students will be allowed to use the locker rooms and washrooms that match up with the genders to which the students identify. One need not stretch the imagination to understand why issues of genitalia are confusing to parents and coaches alike. Opponents to the new law want to repeal it and have mounted an effort to get the issue on the November election ballot. It is in its own way a revisit of Proposition 8.

The argument that misogyny applies to California's effort to stop same sex marriages probably fails on the basis that the proposed legislation is equally unfair to all who apply, does as much harm to men as to women, excludes both sexes from participation in joint healthcare insurance, prevents both sexes from enjoying the tax benefits of marriage, and generally discriminates equally against both sexes. The currently proposed separate-by-sex restrooms and lockers equally inconveniences both sexes as well as transgender persons. So misogyny isn't an accurate label since the proposed legislation is equally unfair to both sexes as well as to transgender persons.

The Indiana legislature, meanwhile, is preparing to vote on HJR-6 which would amend the state's ban  on same sex marriage. Meanwhile, proponents of the ban on same sex marriage want to extend the ban to include anything similar to marriage, e.g., tax exemptions, shared health insurance, and civil unions. Indiana's proponents of banning same sex marriage go beyond California's Prop. 8.

This bill takes a serious swipe at same-sex anything. Not only does HJR-6 outlaw same sex marriage, it also takes an extra step by refusing to recognize legal alternatives to same-sex marriage, e.g., it would deprive same-sex couples of any status that could be deemed substantially similar to marriage such as civil unions and domestic partnerships.

The irony is that Indiana law already makes same-sex marriage illegal. If enacted HJR-6 would actually change the state constitution and tie the hands of future legislatures to prevent passage of legislation that would allow same-sex marriage.

One may reasonably argue that HJR-6 is mean-spirited but not that it is misogynous. It is equally unfair to everybody.

Not so In Michigan where a legislator recently spoke out against a push for what opponents are calling "rape insurance." The legislator disclosed more than a passing interest in the matter when she revealed in public that she'd been raped 20 years ago and that had the proposed "rape insurance" law been in effect at the time she could have faced untenable consequences.

Here's the scenario in brief along with our conclusion that the Michigan law is misogynous. The Michigan legislature just passed legislation banning health insurance plans from covering abortion unless it can be shown that the woman's life is in danger. The impact of this change in the law is that it means women and/or their employers will be obliged to buy separate insurance policies or "riders" to their insurance policies if rape or incest result in pregnancy. Opponents call this law "rape insurance" and argue that women who wouldn't want an abortion under any circumstances shouldn't pay for it since so doing enables abortions by others.

Although this law passed the Michigan legislature last year, it was vetoed by Governor Rick Snyder. If the law passes the legislature again this year, it becomes law without having to run the gubernatorial gauntlet a second time. In effect, under Michigan state law this move is a way to sneak one past the governor despite the popular will of the people (polls show widespread popular opposition).

This bill meets our definition of misogyny: it is directed against women. That is why State Representative David Knezek, State Senator Gretchen Whitmer, and others have called it "misogynistic." We also find it misogynistic.

We call your attention to an editorial entitled "The Most Misogynistic Law I've Ever Seen" by Sen. Whitmer, posted 12/23/13, published in Huff Post, 12/26/13. The opening line should knock your socks off even if you're not wearing any.



Sunday, December 1, 2013


"I'm sorry," tolls the receptionist in a bored voice, "but your doctor isn't in our plan anymore."

Senator Reid opts out: click on comments at end of this editorial re Reid's Obamacare snub

Item A concerns a doctor whose healthcare policy was abruptly canceled when her own physician announced he was quitting the health care plan, would no longer accept insurance, and would henceforth require monthly "concierge" style payment, plus a cash fee for office visits, and that she'd have to have separate insurance for hospitalization whether needed or not.  As for the healthcare plan he was leaving -- the plan would either be disbanded or taken over by doctors who could speak English.

Note: for the uninitiated, "concierge" style practices require advance payment arrangements such as monthly, quarterly, or annual payments plus fees applicable to the services patients use. Medications are not included. Insurance plans are not accepted.

Item B is about several doctors in various settings who have in common that they've sold their practices to corporate entities, foundations, exchanges, or other business groups. It works like this: the corporate entity buys the practice, then employs the doctor or somebody else to run it on a day-to-day basis. The corporate entity pays the staff, the rent, and the expenses. To recoup its money, and to make more money, the practice is required to double or triple its volume. To accomplish this task, the time spent with  each patient must be reduced, say, to a few minutes. That'll be the job of the staff who now no longer works directly for the doctor or the patient but who instead is responsible to the employer. In this plan, insurance is still accepted, in fact, is welcome. If the on-site managing doctor and his staff can't meet these goals, they'll be replaced.

Healthcare Plans that cover patients, doctors, and insurers vary widely. They may assign doctors to multiple plans and keep track of so-called "production," how many patients each doctor sees and how long the average visit takes. Doctors whose "production" numbers are profitable to  the company will have a higher rate of retention providing they don't rock the corporate boat in other ways (then they're called "disruptive" and get fired anyway).  What procedures and surgeries are allowed will be a corporate decision dependent on cost-benefit ratios, not patient need.

Healthcare Plans may be narrow and include a minimal number of specialists and no highly sub-specialized surgeons. It's your  personal out-of-pocket lookout if services not included in your medical provider network are sought.

Utilization Review (UR) is already used in California for injured workers who may be denied access to specialized care by a UR doctor who is not licensed in California and who has never seen the patient. The UR doctor's judgment may nonetheless overrule the California-licensed primary treating physician's judgment even though the primary physician has spent hours with the patient.

In this way, UR in California and the ACA throughout the USA are joined -- see our previous editorials on the Independent Payment Advisory Board (IPAB) which was originally rejected for Medicare under its previous name, the Independent Medicare Advisory Board (IMAB). Some pundits assert that the ACA under the guise of Obamacare is actually a nationwide watered down HMO and that to keep it that way it's necessary to eliminate as many hospitals and specialized centers as possible, and as many doctors as possible, while making the remaining doctors act like cattle herders trying to avert a stampede.

Stay tuned. These issues have long legs.


"How to practice medicine without a license," San Francisco Chronicle, 8/29/08