The first time I used a neti pot, I was standing in a friend’s bathtub in the wilds of North Carolina. I was highly skeptical about the whole endeavor; if I recall correctly, I said something along the lines of “WHAT?!?!” when my friend explained that I would feel oh so much better if I poured warm salty water through my nose. Like many of us, I suspect, I was deeply skeptical about the idea of pouring water through my schnozz when the thing which is supposed to go through my schnozz is air, because noses are for breathing, not for pouring warm salty water through.

But I was miserable. I’d spent several weeks evacuating various unpleasant substances through my perennially stuffed nose, and being astounded by the sheer volume of crud which could accumulate there. My eyes were watery all the time because they couldn’t drain, and I snuffled and snorted and splorted like an indignant rhino in desperate need of a king-sized handkerchief.

My friend tolerated my presence for about three days, and then finally couldn’t take it anymore.

“You know,” he said, “if your nose is really bugging you, you should use a neti pot. It will clear the gunk out of your nose and help you breathe easier.”

“I should use a what?”

“It’s like a teapot, but for your nose,” he explained. “You can use it to irrigate your nose with saline.”

“The only thing I believe in irrigating is crops,” I retorted.

“No, seriously! Try it!”

What it came down to was that I was challenged on grounds of cowardice for being too afraid to use a neti pot, and I couldn’t back down from that. I was given careful directions and coaching, and encouraged to do it over the sink or in the bathtub to make a minimal mess, if such a thing was possible. My nose wasn’t fully clogged at that point, just gunky, so I was advised that I could use the pot safely on both nostrils.

I duly trouped into the bathroom and proceeded to stare with deep mistrust at the neti pot. I didn’t really quite understand how this whole procedure should work, even after having it mimed with an empty pot and explained in detail. Hesitantly, I tilted my head, and poured a little bit of water into my nose.

*splat* *clonk*

The water ended up everywhere, because I poured too quickly and at too much of an angle and the lid clattered off. I ended up with a small pool of saltwater in my nose which stung briefly and promptly drained from the same nostril I poured it into. Laughter echoed from the other side of the bathroom door.

I was not going to let a teapot get the best of me. Oh, no. And I certainly wasn’t going to endure mockery for weeks because I couldn’t complete a simple Ayurvedic maneuver which my friend smugly assured me he’d been doing since childhood. If a toddler could do it, I could do it!

So I tilted, more gingerly this time, and poured. To my astonishment, water flowed up my nostril, and out the other side. Oh, it splattered all over my shirt, but still, nasal irrigation accomplished! I repeated the procedure on the other side, snorting with astonishment when I was finished (I do not recommend this, because I ended up with a layer of salt mucus in the back of my throat).

But I didn’t really experience any results. I mean, yes, my nose oozed for a bit. But I didn’t feel like I was breathing any more easily. Until the next morning, when I woke up and my nose was actually clear, and so were my lungs. I would have written it off as a fluke, except that I started noticing a correlation during my visit. The morning after neti pot uses, I could breathe. The morning after days when I didn’t do it? I couldn’t.

Oh, I still needed my asthma medications, and my nose still got stuffed up on occasion. There were days when it was so swollen and tender that I couldn’t really do much at all with it other than gingerly soaking it in warm water to try and loosen some of the mucus to see if that would clear it. It’s not that the neti pot was a magical cureall for all my problems. It’s more that it made things…easier.

I became a neti pot convert. And I duly carried my little pot around with me most places. I’ve lived in a fair number of dusty places, and sometimes been amazed by the crap which I can flush out of my nose with a single shot of saline. Amazingly, the little neti pot my friend gave me held up for a number of years, until Mr Bell broke it last month and I had to go out and acquire a new one.

Now I’m using what basically amounts to a fancy squeezebottle. The main selling point is that it’s designed so that you can irrigate your nose upright, instead of having to do the tilt and shuffle game. And I have to say, it is easier to use, for sure, but there’s something I miss about the old style just the same. Sure, the squeezebottle is easier to use, easier to pack, and so forth, but sticking a plastic nozzle up my schnozz doesn’t have quite the same panache as tilting my head in the middle of the shower and trying not to end up with saltwater all over myself.

The neti pot is one of those things I’ve embraced, but I don’t really evangelize about. For one thing, I’m not really a big fan of people who push treatments on me, whatever their intentions and the origins of the treatment. For another, people tend to look at me really strangely when I say they should try pouring warm saltwater through their noses. But, I have to grudgingly admit; my friend was right all those years ago when he said I’d feel much better if I gave it a shot.

My pal Ouyang Dan from FWD/Forward has written two great posts recently talking about the way the public devours celebrity, and specifically about the way in which the public frames female celebrity. “The Public Consumption of Britney” is up over at Bitch Magazine, and “On Speculation and Boundaries…” was published at FWD after the unexpected death of actress Brittany Murphy.

Both posts stuck with me, and left me with some lingering thoughts and ideas about female celebrities, mental illness, and the way the public thinks about celebrity. Ouyang Dan has a way of doing that to me. Her words are insidious. They incubate in my brainmeats for a while and then BAM something explodes.

The thing about female celebrities is that they are very much viewed as public property. Yes, the public is possessive and proprietary about male celebrities, but not quite in the same way it is about women. Women who are prominent public figures are constantly scrutinized and held to very high standards. Every change in their appearance is noted and discussed.

Every pound lost or gained. Every hair cut. Every outfit. Every word that exits their mouths. Every bite eaten, drink drunk, dance danced. Every moment, from strong to vulnerable, concert stage to hotel room, is considered fair game. And the public very much acts in a way which shows that people think that they are entitled to literally devour female celebrities. When challenged on this, people push back with the argument that if they didn’t want this, they shouldn’t have become famous.

Yes, evidently if you don’t want to be picked apart by buzzards, you should not try to build a career for yourself. If you are a woman and you are a good speaker, writer, actress, singer, musician, artist, you should keep it to yourself. Expressing yourself means that you automatically sign a contract which says that you belong to the public and that the public can do as it pleases with you. The public can make you, break you, and then discard you.

You are, literally, not in control of your own body when you are a female celebrity. Hollywood is sometimes called a fishbowl, especially for women, and it’s a very apt comparison. No place is safe. There is no escape. Private phone calls, emails, conversations, all can potentially be used against you and all of them are.

This cannot be an easy life to live. I’m sure that there are some talented women out there who have seen this and opted not to showcase their talents because they don’t want to deal with it. We are probably missing out on some supercool ladies because those ladies know that this public consumption is not something that they are prepared for or particularly want to deal with.

Nowhere is this more apparent than when women who lead very public lives behave “oddly” in the opinions of their voracious public. Any erratic behaviour cannot possibly be due to random factors, stress about public scrutiny, or any other influences.

No, it must be because of drugs. Or mental illness. But probably both. Especially if you are a female celebrity and you die, get ready for the public to start performing an autopsy within seconds, despite lacking access to training, experience, or facts.

Very few female celebrities have openly discussed psychiatric diagnoses. Yet, many members of the public believe that a number of celebrities are in fact mentally ill, and seem to think that they have detailed information about the nature of this mental illness. They speculate quite freely on what diagnoses celebrities may have, and use their behaviour as armchair psychiatrists to decide what’s “wrong” with female celebrities.

Make no mistake: If you are a female celebrity, there is something wrong with you. If you’re not mentally ill, you’re a catty uptight bitch. If you’re not either of those things, you are greedy and selfish, looking for your next big opportunity. You can’t be a woman and be value neutral, and just exist, in Hollywood. There’s got to be an angle somewhere, and the public will decide what that angle is.

This plays into a larger issue about women, which is that they are all assumed to be “crazy” and people think that they cannot actually endure high-stress situations like those experienced by celebrities. The assumption is that any woman would develop mental illness if she was a celebrity because women are prone to mental illness, only a paparazzi snap away from losing their shit and becoming certifiable. And, of course, when you are being consumed by the public, the public will pick over your supposed mental illness in exhaustive detail.

It’s not entirely improbable that some celebrities do have mental illness. And maybe if we lived in a society where mental illness was less stigmatized, we would know about it because these women would be open about their diagnoses. They would freely discuss their mental illness and talk about the ways in which it interacts with their careers. But the fact is that we live in a society where mental illness is regarded as a moral failing and where members of the public feel quite free saying that people with mental illness are bad people who probably need to be locked up for the safety of the general public.

In that kind of world, what woman is going to admit to  having mental illness? And what celebrity, even in a psychiatric crisis, is going to say “yes, I am mentally ill”?

The rampant speculation which swirls around female celebrities in general makes me deeply uncomfortable, because it speaks to a lot of problems in our society. But the speculation in particular about psychiatric issues and drug abuse (some people might argue that drug abuse can be considered a psychiatric issue) makes me really upset. The idea that public ownership of celebrity extends even to private medical records is something that I really think we need to address.

Part and parcel with that comes the fact that we need to break down the ableism which surrounds mental illness, and start to force people to reconsider the way they think about mental illness, particularly in women. Not every woman who behaves “erratically” is mentally ill. Not every female celebrity has a mental illness. And mental illness does not make you a bad person.

I was recently introduced to the concept of the sick role, something which has been rattling around in sociology since 1951, when it was discussed by Talcott Parsons. Sociologists are very interested in the structure and function of  society, and people who are sick or disabled play an interesting social role. Both as individuals and as objects of perception. The theory behind the sick role, while not necessarily designed to talk about disability specifically (focusing in particular on sickness as a temporary state) actually has some interesting impacts when it comes to talking about disability and trying to reframe social constructs which surround disability.

The underlying idea behind the sick role is the concept that society, as an entity, craves order. Society likes structure, clear limits, and obviously delineated roles for all members, because otherwise it starts to break down. People who are sick break the rules of society because they are viewed as nonproductive members. Yet, unlike other “deviants,” people who are sick or disabled are not setting out to be deviant. They are forced into that role.

The term I see used is “sanctioned deviance,” based on the idea that society tolerates this divergence from social norms and expectations because of the understanding that there are extenuating circumstances which must be weighed when evaluating the situation. Whether or not this is actually true is a matter for legitimate debate, I think, and it’s an area where the concept of the sick role really falls short. In fact, society does not sanction deviance on the part of people who are sick or disabled, as evidenced by the fact that people feel pressured to work or “contribute” even when they are not able to. It only sanctions it among people with particular types of sickness and disability, and it only sanctions people who behave in a particular way.

But, back to the fundamentals of the sick role. The theory goes that people need to figure out where people who are sick fit into the social framework so that they know how to relate to them and how to deal with them. By codifying the social role of sick folks, people generate the social attitudes to go along with that role. This obviously plays directly into social perceptions of disability because disability can involve sickness and is often viewed as a “sickness,” although I would beg to differ. But we’re talking about social constructs here, not my view of disability.

Parsons theorized that members of society view sick people in a position of having both rights and obligations by nature of their illness. Under the theory, the “rights” afforded to the sick include “exemption from normal social roles” and an understanding on the part of society that sickness is not the fault of the sick person. This, again, I think is something which is very much open to debate, which I will be discussing in a moment.

The responsibilities of the sick are the obligation to get better, and the obligation to seek out and follow a course of treatment. Being sick may not be your fault, persay, but you are expected to take every step to make yourself better. You have, indeed, an obligation to be healthy, which feeds directly into concern trolling about things which are not directly related to health, like being fat.

Using this framework, I think we can point to a lot of examples in society in which sickness is stigmatized, and in which disability is stigmatized, and we can see the origins of the stigma from within the framework of the sick role. In a society which needs order and needs people to adhere to specific behavioral patterns, people who do not perform the sick role to the satisfaction of others are viewed as suspect.

For example, people with mental illness who refuse to take their medications are stigmatized because they do not identify and follow a course of socially approved treatment. Likewise, psych survivors are stigmatized for not giving credence to the psychiatrization of their identities. People with lung cancer are not given respect because their illness is presumed to be their fault. Similarly, people who are sick and don’t get better are subject to social abuse because, again, they break the rules of the sick role by not getting better. They aren’t fulfilling their social obligations as sick people.

This manifests in some really interesting ways with people who have disabilities or illnesses which are not easily read by observers. (“But you don’t look sick!”) These individuals are hard for people to codify because of the fact that they don’t appear to be sick (or disabled) so they can’t be slotted into the sick role and they are also not being “productive” in the estimation of the observer. They are, as it were, unsanctioned deviants. Which explains why some disabilities are disparaged and treated as fake, because it’s easier to dismiss the fact of the disability than it is to confront the ways in which it conflicts with the sick role.

The sick role plays into so many things, like the hierarchy of disability which treats some disabilities as more “real” than others, and the good cripple archetype, which is essentially the disability-centric version of the sick role. The good cripple is an object of pity, but also has social obligations which include not making people feel uncomfortable and being stoic about disability. It plays into the way in which people with disabilities are treated by medical professionals, and in particular into the perception of bad cripples who do not play their parts as required by society.

While the sick role is focused on sickness as a temporary condition, it is interesting to note that many disabilities are treated, surprisingly, as temporary states even when they are not. And, furthermore, disabilities are treated as things which are undesirable. Things which people would want to make better if they could. To say otherwise would be to dismantle the framework of the sick role; if disability isn’t something which needs to be “cured” then both of the obligations of the sick role go flying out the window.

There’s an interesting trend I’ve been noticing more of late at feminist websites. It’s hardly a new trend at all, I think I am just somewhat more attentive to it, for various reasons. And it’s a trend which bears some exploration, because I think that it says a lot about feminism and the issues within the feminist movement.

It’s the idea that certain women don’t know what’s good for them. These women need to be told in no uncertain words about how to take care of their bodies, how to live their lives, how to interact with medical professionals, how to make decisions about their medical care. And, by extension, how to handle their disabilities.

Who are these women? They tend to be women who do things which feminists disagree with. For example, women who opt to have large families are informed that they are endangering themselves with multiple pregnancies and they should stop. Likewise, women who are considered “bad sluts” within the good slut/bad slut dichotomy (about which more later, I promise) which seems increasingly common in feminism are also informed that they’re doing it wrong. That they are incapable of caring for themselves. Women who opt to stay at home, to not go to college, are also informed that they are making bad choices.

I’ve seen supposedly feminist websites saying that women should be subjected to unnecessary medical procedures “to make sure that they get STI testing,” because apparently women wouldn’t get STI testing if they weren’t forced to come in for excessively administered pap smears. I’ve seen sites saying that women should get screenings which are not recommended because otherwise they won’t know to take care of themselves and won’t see a doctor in a timely fashion. I’ve seen sites arguing that women who have multiple children are “brainwashed” and “need counseling.”

As one might imagine, I find this extremely irritating. Because, here’s the thing. I think that everyone is capable of making informed choices. And when I make an informed choice, I do not need to demonstrate to anyone that I have satisfied their requirements of what an “informed choice” is, and I do not need to justify my choice, ever. If a woman decides that she wants to have 12 children and she’s making an informed choice to do that, and it is not my business to tell her that she is engaging in risky behaviour and she is brainwashed.

People are welcome to disagree with the choices I make, and to feel that they would not make those choices (but they can’t know my situation so they can’t speak to the issues specific to me which might have shaped my choice). But to tell me that my decisions are not valid because they do not meet someone’s definition of “how to take care of yourself” or “how to be a feminist” is extremely problematic. Please note that I do not view coerced and false “choices” as true choices, and I think there is a legitimate discussion to be had about the “choices” women are forced into. Not whether or not women who make those choices are “feminist enough,” but about the circumstances which force them into those choices. (See the difference there?)

I cannot help but find it intriguing that mainstream feminism is remarkably supportive of “choices” which fit in with the framework of things that it views as “feminist.” Using birth control, for example, is supported and regarded as an informed choice when in fact many birth control users are not well informed and are not making an informed decision. Choosing to only have one or two children is also viewed as a choice worth supporting, but apparently choosing to have more children than that isn’t a “valid” choice any more. Mainstream feminism has a checklist of “what’s feminist” and choices which fall outside that checklist “aren’t feminist” even though decisions do not occur in a vacuum, not even one of perfect feminism, and do happen on a highly individualized basis which means that one choice does not fit all.

This attitude is especially troubling when it comes to medical matters, because it reinforces the idea that other people know more about women’s bodies than they do, and that doctors can and should force procedures on their patients. That ladies don’t know what’s good for them, and therefore it’s up to other people to tell them what to do.

Try making an informed choice at your doctor’s office. Really. Try asking for more information so that you have a complete picture before you make a decision. And try informed refusal: “no, I do not want this test, it is not necessary.” “I don’t need an appointment right now.” “Given that I’m a virgin, a pap smear is not appropriate.” Informed refusal is met with “well, we have to do it.” Subtext: You silly woman, you don’t know what’s good for you.

This attitude is a form of policing. There’s one way to take care of your body, and one way only, and you cannot deviate from it. Only certain things are feminist and everything else is antifeminist. If you do not “choose” the “feminist” choice you are a “bad feminist.” It all ties into prescriptive feminism and the idea that it is not only ok but obligatory to tell other women what to do when they are doing something which you disagree with.

Here’s the thing.

I can make an informed choice.

I can research a situation, I can weigh the pros and cons. I can think about the impact which various choices will have on me personally. I can think about what I need to do to meet my needs and to take care of myself. And, considering all of this information, I can make a decision about what I want to do and how I want to handle the situation. When it comes to medical care in particular, I think I know a little bit more about my situation and my body than other people, and I can in fact be trusted to do the right thing, for me. I can even, yes, consider the cultural context of my choices.

To tell me otherwise is to deny me agency. To tell me that a choice I am making is “antifeminist” or “not good for you” is to tell me that I am a stupid clueless person who should not be allowed to make choices for myself. Demanding that I justify my choices is invasive, rude, and inappropriate. I don’t demand to know why other people do or do not do something. I trust them to make their own decisions, based on their experience as unique individuals.

If people ask me for information or thoughts while they are making choices, I may offer it, although I try to structure it carefully to make it clear that I am not speaking for them or prescribing any course of action. But if my input has not been requested, I don’t give it.

It is not appropriate to tell women that they should undergo unnecessary, invasive, and sometimes harmful medical procedure “for their own good.” It is not appropriate to tell women that all bodies are the same and that therefore there’s only one way to take care of them. It is not appropriate to tell women that they cannot make informed, considered, thoughtful choices. It is not appropriate to tell women that there’s only one kind of feminism and only one way to be feminist. Or that a specific choice is always inherently antifeminist, no matter what.

I may choose a different thing for myself than you might choose for yourself. You might opt to respond to things differently than I do. But that does not mean that a woman’s personal decision about something like, say, cancer treatment is invalid. Or that she is “stupid” for not choosing what I would have done. Or that she’s “not feminist” because she did something I disagree with (or even that her individual choice is “antifeminist” because I don’t like it, even if I grudgingly recognize that she might be feminist despite that).

I can make an informed choice. You can make an informed choice. Can we trust each other to do that, and move on to more important things than policing each other?

The many problems in the American health care system are so numerous that it almost seems silly to try and profile individual issues, but this is an issue particularly dear to my heart, so I’m going to go ahead and go for it. I think it’s a perfect example  of the storm of circumstances which is causing such problems right now; you have fear of a malpractice suit, the need to generate reasonably easy income for a practice, and the desire to at least try and keep up with patients who will not set foot in a doctor’s office unless it can’t be avoided, because of the expense.

I’m talking about the Pap test, also known as the smear test.

Here in the United States, Pap tests are given annually. During the annual exam, as a matter of fact. Having a conversation with a friend from another region of the world recently, this topic came up, and she was astounded that Paps are given so frequently. So, I started poking around, and I found that guidelines in other countries recommend screening every three to five years, and that screenings stop after age 60 if a woman hasn’t had any abnormal results.

Here in America, we like to think that our health care system is best, even as we are bemoaning how broken it is. Something like an annual screening for cervical cancer is touted as an example of how terrific our system is. We don’t cut corners. We’re better than everyone else. We make sure that our women get routine screenings for a very serious disease so that it can be caught early. I’ve even bought into this to some extent; I hate the smear test, I would like to not have it every year, but I submit “for my own good,” because I’ve been told that this is the best way to do it.

Except that I actually started reading the studies used to justify a three to five year schedule, and I found that, uhm, we’re doing it wrong. These studies showed that doing smear tests annually increases interventions, which sounds like a good thing on the surface but actually isn’t, because sometimes cells are abnormal and there isn’t a problem. Indeed, women have been subjected to very invasive procedures for, well, for nothing. The same issue arises with mammography. While it seems like a good idea to screen a lot, it actually increases the rate of false positives, and when you get a positive on something like a mammogram or a Pap, you are definitely going to consent to invasive procedures like biopsies “just to be sure,” and that exposes you to risk.

Other nations use evidence-based medicine to decide on guidelines for things like this. They conducted a lot of studies, and they found that a three to five year interval was actually optimal. Not because they didn’t want to pay for annual screenings, but because a three to five year schedule hits the sweet spot. It’s not too frequent to get false positives, it’s not too infrequent to catch cervical cancer early. In other words, this interval is best for women.

But if I approached my gynecologist and asked to have tests less frequently, or exercised informed dissent and asked that a smear not be conducted during my annual exam, she would refuse. She would probably refuse to write me a prescription for birth control (which is, yes, why I bother to go every year), because she would be concerned about liability. She may well agree with me that smear tests happen too frequently, but if I got cervical cancer, I might find some way to blame it on her, and she can’t take that risk.

So she has to do it every year. Because, if she doesn’t, she’s at a financial risk. Indeed, it’s probably a practice policy; even if she was willing to space my smear tests out more, she might not be allowed to, because she has to follow the standards of the practice. Even though conducting a smear test every year endangers my health. In this case, quite literally, the status quo trumps my health and bodily autonomy.

This is a problem. We should not be endangering women’s health. We should be revising the guidelines for the smear test to make it clear that it does not need to happen annually. I won’t deny women who want an annual Pap the right to get one, but I would like to exercise the right to make informed decisions about my medical care, based on evidence-based studies which clearly demonstrate that my desire to get a smear every three to five years, rather than every year, is actually better for me.

This is a country in which concerns about bureaucracy override the rights of patients. Doctors perform smear tests annually because, well, because the patient is a captive audience. She has to get the test to get her birth control, and she’s been told that she needs the test for her safety. So she submits. It’s easy money for the practice, it covers the doctor in terms of legal liability, and it allows the doctor to make a connection with a patient; at least, if someone comes in once a year, a doctor can identify signs of medical problems early and perhaps intervene.

Annual wellcare visits are pretty critical. But we need to change the structure of those visits, to shift the focus onto preventative care rather than using unnecessary procedures to get people in the door. We need to shift the way Americans think about going to the doctor. You shouldn’t go because there’s a problem, or because you have to in order to access medication that you need. You should go because regular checkups are a good idea, because early intervention can make a big difference.

I don’t view a fetus as morally equivalent to a human life. Other people disagree with that, and I respect that; this post is not about trying to convince those readers that I am right and they are wrong, or that they should feel ashamed of thinking the way they do. Actually, it’s an exploration of why the nuance in discussions about reproductive rights has been lost, and what we could do to reclaim that.

I do recognize a fetus as a symbol. As something which has potential, huge potential. And a wanted fetus, a fetus that a woman wants to carry for 40 weeks and then give birth to, has more moral weight to me than an unwanted fetus. The fetus is often likened to a parasite, which in a lot of senses it literally is, but it’s a morally loaded parasite; you can’t take a course of metronidazole and forget about it. This is a parasite we need to talk about, no matter how you feel about it.

Here’s the problem, for me, with the way in which the debate over reproductive rights is being framed. It focuses on abortion, not the larger issue of reproductive rights. The right to control the timing and spacing of your children. The right to access safer sex. The right to prevent pregnancy. The right to control your body and your future.

But, if we’re talking about abortion, let’s, for a moment.

Views on abortion seem to fall into two broad camps: It’s always unacceptable and morally wrong (usually because people believe that a fetus has personhood) or it’s always acceptable (and the jury seems a bit mixed on morals). That doesn’t leave room for a lot of nuance, something I note in particular whenever discussions about abortion and disability crop up.

And this is worrying, because the conversation about abortion and disability is one that needs to happen, and it’s not going to if we have no room for nuance in this discussion. Someone who believes that abortion is always unacceptable loads it with their own moral issues, while someone who believes that it is always acceptable may in fact feel some moral qualms, but think that it’s more important to support abortion than it is to explore those qualms.

That’s not a good way to think. You can discuss the fact that you have qualms about the morality of abortion in some circumstances without actively working against reproductive rights and freedoms. You can identify as pro-choice and still think that there are some settings in which abortion is complicated. Hell, you can identify situations in which you personally think that abortion should not happen, even though you might not take the next step and work to prevent other women from exercising choice in those situations. There’s a difference between thought, discussion, and action, people. The fact that I think that aborting a baby with Down’s Syndrome is problematic doesn’t mean that I think there should be a law against it.

Because, abortion for disability? It’s a problem.

I support the right to choose abortion if you feel that it is right for you and your circumstances. I do not place limitations on when that abortion should occur. I think that you should have the right to a safe, legal, compassionate abortion and that you are not obligated to tell anybody why you are choosing abortion. You should not be obligated to tell your parents, if you are a teenager and you do not feel safe talking to your parents. It’s your choice. If you want me to drive you or hold your hand or bring you soup afterwards, I’ll be there.

But, if we’re going to talk about abortion for disability, I am going to speak up. Because abortion in general, in the abstract, for people who are pro-choice, it’s centered around women’s bodies and autonomy. And that’s something I can support. But when we start discussing abortion for disability, you’re invoking another kind of body.

You’re invoking a disabled body. And you’re saying that disabled bodies shouldn’t be alive. Shouldn’t have the right to live. That people with disabilities are burdens. That people with disabilities are too hard for parents to deal with. That it is acceptable to abort if you don’t think that your baby will meet your standards of ability. And, dare I say it, perfection? You’re also making value judgments about different kinds of disabilities; saying that disability is objectively bad, and some disabilities are worse than others. Disability-as-tragedy. Disability-as-horrible-burden.

It’s important to make a distinction at this juncture. If a fetus is unlikely to survive to full term, that is not a disabled body, and I am not questioning the right to abort if a fetus has died in the womb, or is likely to do so. Or if it is possible to carry to term, but the baby will die shortly after birth. Likewise, if carrying a fetus threatens the life of the mother, whether or not the fetus has disabilities, she absolutely has the prerogative to terminate and I have no moral qualms about that.

But when a prenatal screening identifies disabilities (or the potential for disability, which I will get to in a moment) and a mother decides to abort, there’s a value judgment going on there. It’s not a judgment about whether or not abortion is acceptable, it’s a judgment about whether or not disability is acceptable. When you abort for disability, or suggest that there are no moral complexities involved when a previously wanted fetus is aborted because screening reveals disabilities, this is a consequence of ableism.

Straight up.

And let’s talk about the implications of prenatal screening. Prenatal screening is often overapplied, and it can be wrong. Which means that when people abort for disability, they may literally be aborting because there is a possibility of a disability, not because disabilities are actually present. That should cause some moral qualms. No matter who you are.

But the complexity doesn’t stop here. The situation is not as simple as “aborting for disability is wrong and an ableist choice, the end.” Because we live in an ableist society. And there are very real barriers to access for some people with disabilities, and for some parents of disabled children. Children with mental illness who have to be jailed to get help, for example, because their parents cannot access services they need. Parents who are forced to institutionalize their children because they are unable to care for them. Older parents who may be worried about dependent adult children.

This is not simple. This is why we need to have this conversation, because we need to promote informed consent. Doctors need to know that it is not ok to frame disability as a tragedy, that they need to provide expecting parents with information and resources which they can use to make an informed decision. People with disabilities need to know that they can be parents, if they want to, and darn good ones too. People with disabilities also need to know that their lives and their bodies have value.

Can we admit that there is nuance? Can we have this conversation? Can we not make this black and white?

The health care debate rages on. The whole thing upsets me, really. My father and I keep instituting a moratorium on talking about it because it’s so infuriating, and yet, within 10 minutes of seeing each other, we’re off and running on health care again. So many obvious solutions that aren’t being talked about. So much bigotry. So much backdoor dealing and refusal to respect the will of, well, a lot of Americans.

What’s especially infuriating me is that the abortion debate is being dragged into this. And that people are digging their heels in so thoroughly over it that it’s hanging up the entire discussion. There’s so much time being devoted to arguing about abortion that very real issues and problems are being ignored. Dare I say it? We are fiddling while Rome burns, people.

It goes like this: It’s been pretty clearly decided that any type of reform of the health care system is going to exclude abortion services. Most proposals for reform specifically and explicitly state that federal funds will not be used for abortion services.

And now, we have the Stupak proposal, which would effectively bar private insurers from covering abortion if government subsidies are used to purchase coverage.

This pisses me off. I really, really, really cannot express how strongly it pisses me off. To selectively deny coverage in this way is, well, it’s monumentally offensive. Especially since abortion is a very common service which is needed for a lot of reasons, by a lot of women. This specific exclusion hurts low income women most of all, of course, because they struggle to pay for abortion services. Apparently the government would prefer that they remain pregnant and have children they cannot afford and do not want.

But, now it’s getting even more complicated. It’s not enough to deny abortion services. People, including supposedly liberal Democrats (and people wonder why I am registered non partisan), want to actively restrict access to abortion. It’s not enough to say that low income women who qualify for government programs can’t get abortions through those programs. Now, these elected officials would like to exert controls over women’s bodies.

Denial of coverage is bad enough, because, yes, it does act as a de facto barrier to abortion services for many women. If nothing else, it forces women to wait longer to get an abortion, which can push them into the realm of needing a “late-term” abortion, a service which is more expensive and harder to access. But to structure anti-choice measures which will actively restrict women from controlling their bodies into health care legislation?!

Health care is not about morality. Reform of the health care system is not about forcing your morals and beliefs on someone else, or, rather, it shouldn’t be. Reform should be about ensuring that everyone in America has access to safe, competent, respectful medical care, no matter what they need that care for. To make sure that people are not going bankrupt because of health expenses. To make sure that early intervention is provided for health problems, before they have an opportunity to balloon into something bigger and potentially very problematic.

It is, yeah, about valuing human life. The lives of breathing humans on this Earth who need health care. It’s not an appropriate venue for debating fetal personhood, for trying to restrict women’s lives, for sneaking in anti-choice clauses. It’s not an appropriate venue for so-called liberals to capitulate, to say “ok, we’re going to let you turn women into second class citizens if it’s the only way to pass reform.” It’s not an appropriate venue for slut shaming, for ableism, for sexism, for misogyny. All of which are cropping up on a regular basis in Congress.

The fact is that conservatives (and a fair number of alleged liberals) don’t really want health care reform, and they’ve found an ideal sticking point. If it wasn’t abortion, it would be something else, because the entire point here is to avoid having to actually reform the system. To reject the idea that health care is a right and that everyone should be able to access health services. Abortion is just incredibly convenient because it is such a contentious issue in the United States.

I would rather that my body not be used as a sticking point for political convenience. I would rather that my body not be used, honestly, as a political tool. It is extremely disempowering to know that my body and bodies like it are being used to hold up the entire health care debate in this country, that we red herrings being used to distract from the real issues and the big picture.

This is not about abortion.

It’s about whether or not women should have autonomy over their own bodies. It’s about how far the system and the American people can be pushed. How far can we go, when it comes to rolling back women’s rights? How much will the public take before serious pushback starts to happen? Denial of abortion services? Denial of access to birth control? Denial of all women’s health services?

And it’s about a refusal to engage in good faith. The health care debate has been flawed from the start, and this is just yet another example of the way in which the bargaining and the discussion are being twisted to political ends. These people don’t care, really, about whether or not abortion happens, although they certainly are threatened by women who decide that their bodies are their own. They just need something to latch on to, to point to, so that when people say “why are you holding up the health care debate, why are you not engaging in good faith, when are you going to do something,” they can say “well, I have morals.”

We all have morals. My morals include not marginalizing people by denying them health services or telling them what they can do with their bodies. And my morals include not using marginalized bodies as political tools for self-advancement. Or for any other reason, really.

Read a Czech translation of this post, done by Vera!

In the furor of discussion on my post about breast cancer awareness campaigns which use exclusionary tactics, several commenters brought up some important points when we talked about why breast cancer has become such a high profile cause. Anna pointed out that breast cancer awareness started as a grassroots movement among women who were angry about the lack of awareness and the large numbers of preventable deaths going on, many commenters (including myself) pointed to the potential monetary gains to be reaped for companies which support charitable causes in order to be seen as socially responsible, and both kaninchenzero and Amandaw referenced the fact that breast cancer is a form of “no fault” illness, in the sense that people who get breast cancer are presumed to be innocent victims. The cancer, in other words, is not their fault.

This is not another post about breast cancer.

But it is a post about why some medical conditions become popular causes, and others do not. Because, in America, we definitely have ideas about what makes a good cause, and what does not, and a lot of those ideas are rooted in the idea of personal responsibility. This concept has deep roots in American culture and society, and it has pernicious and lingering effects which continue to this day.

The entire nature of American social policy is specifically structured around the idea that we can determine who is at fault for everything, that specific individuals can be faulted for things, and that those individuals should not be helped. Take the American approach to the poor. Despite ample evidence to the contrary, many people seem to believe that people should be held personally accountable for their poverty. Even though poverty is a classic example of an intersectional social issue in which the class one is born into, one’s race, and one’s gender all play a role, people persist in thinking that if poor people “just worked a little harder” or “showed some initiative,” then they wouldn’t be poor. I actually had a sociology professor tell me once that if the poor “weren’t so lazy, they wouldn’t be poor.”

Lung cancer was specifically brought up as a great example of “it’s your fault”  in action. Lung cancer is the deadliest cancer in the United States, in terms of numbers of people who die from it each year (so says the American Cancer Society). However, it is not nearly as popular, as a cause, as breast cancer. Why is that? Because only icky gross people who smoke get lung cancer.

That’s right. Did you know that people exposed to carcinogens due to their jobs/social class/homes, second hand smoke, particulates in the air which cause cancers, asbestos, etc, don’t get lung cancer? Only smokers do. Fact! And that means that lung cancer can safely be ignored, as a cause, because people are personally responsible for getting it. I’ve known a few people with lung cancer in my day, and every one of them has had some version of this conversation over and over and over again during diagnosis, treatment, and recovery:

A: “I have cancer.”

B: “That’s terrible, what kind?”

A: “Lung cancer.”

B: “Oh.”

A: “…”

B: “Do you smoke?”

Cardiovascular disease is another example of a very serious medical issue which involves huge numbers of people and is not highly publicized. Sure, the American Heart Association has some PSAs out, and some branded products of questionable usefulness, but many people are not aware of the scope of cardiovascular disease and its causes. Screening, prevention, and treatment are not as freely provided as services to support people with more palatable conditions. Why? Because only gross fat lazy people get cardiovascular diseases, so it’s their fault, therefore, it’s not a social cause.

Diabetes, again, another condition which is deemed to be the fault of the person who has it. If you are diabetic, it must be your fault. In addition to displaying a limited understanding of diabetes and how diabetes works (hey, did you know that there are different forms of diabetes?), this is also not terribly beneficial when it comes to actually dealing with diabetes.

The list goes on. You get the point. If a medical condition can safely be blamed on the person who has it, we can safely and collectively ignore it, as a society. If we were to admit that these conditions should be social causes and should be addressed, that would be tantamount to saying that we should provide support to people regardless of fault. And that, as we all know, is socialism.

AIDS, strangely, is a condition associated with personal responsibility which has become a cause, to some extent, although not on the same level as breast cancer. I think that this is in part due to some serious grassroots lobbying on the part of very diverse folks. But at the start? AIDS was written off as “gay cancer” and ignored. It was only after people realized that things like a tainted blood supply, needlestick incidents at hospitals, and heterosexual sex could be vectors of transmission that AIDS started enjoying some popular attention. AIDS was also furthered as a cause when prominent members of society openly discussed the fact that they had AIDS, humanizing the cause. Yet, AIDS continues to be a highly stigmatized condition. Fundamentalist preachers continue to rant about how the gays are getting their compeuppance, for example, and people with AIDS are usually assumed to have gotten it because of risky sex or drug abuse (in all fairness, IV drug users are a huge risk group for AIDS, in part because social programs like needle exchanges are severely limited, because Americans are not interested in providing intervention for preventable diseases which are deemed to be the fault of reckless or morally unacceptable behavior).

Fibromyalgia is, I think, another great example of how Americans cannot deal with medical conditions when they cannot attribute fault or find a causative agent, bundled in with some serious sexism. Although it affects all genders, it is often assumed to be a specifically “female complaint,” and it’s laden with the double burden of being a “faker’s disease” in the eyes of the American public. Who are apparently incredibly knowledgeable about medical issues, especially treatment options, judging from the ever-helpful advice they provide people with all the time. When you can’t point to a causative agent of a condition, people are less likely to accept that the condition actually exists. Even when they are confronted with people who are obviously experiencing that condition.

Mental illness also falls into this category. Because we can’t point to something on a microscope slide, mental illness is assumed, on some level, to be fake or not real. And people with mental illness are assumed to be, in some part, responsible. They must be faking it, because the alternative explanation is that people can be sick without any clear cause, without any neat treatment or cure, and that is unacceptable.

In order to be an acceptable cause to support, a medical condition must be pure and untainted. Victims cannot in any way, shape, or form be responsible for their condition and the condition must have a clear and obvious cause. Thus, awareness campaigns and research and so forth ignore a panoply of serious medical issues, because they do not meet these criteria.

This means that numerous very serious medical issues in this country go underfunded and underaddressed. When education about issues is limited to issues which are considered blameless, people are missing out. Including people who may be at risk. When funding is limited to no-fault conditions, it means that serious issues are allowed to be ignored, and people with conditions linked with personal responsibility have a hard time getting respect, let alone treatment.

This disproportionately impacts some of the most vulnerable populations, like people of low income, who can exercise little choice when it comes to issues like medical conditions caused by occupational exposure, nutritional deficiency, and living in polluted communities.Like people with disabilities who could actually really benefit from, you know, funding for supportive programs.

The thing is that even conditions which can be clearly attributed to lifestyle choices are still intersectional in nature. Plenty of people smoke and do not get lung cancer, for example, just as plenty of people who do not smoke and do not have any other obvious risk factors in their medical histories do get lung cancer. Yet, the failure to even dedicate a little bit of time (comparatively, I am aware that there is ongoing research into lung cancer and that there are educational campaigns) to funding and awareness means that useful information about these conditions remains undiscovered or undistributed.

I was thinking about this lately during the flurry of outrage over domestic violence being listed as a preexisting condition. Domestic violence is another thing which is linked with some sort of personal fault or action on the part of victims. Where’s the outrage about numerous other things being listed as preexisting conditions? Why aren’t we angry about the fact that basically any medical issue/medical history under the Sun is considered a preexisting condition? The very idea of a preexisting condition is exclusionary and repulsive and disgusting.

It doesn’t matter how, why, when, or where the origins of a medical condition or disability lie. What matters is providing the appropriate intervention. To say this, however, is to undermine one of the cornerstones of the American belief system, which is why you so rarely hear it said in the mainstream.

October is Breast Cancer Awareness Month, in case you’ve been wondering why the world around you suddenly went pink. Now, I happen to think that breast cancer awareness is a very good thing, and that educating people about breast cancer and numerous other health issues is a terrific idea. I hate breast cancer. And cancer in general. Cancer, in my opinion, can go take a long walk off a short pier, and anything which improves prevention and treatment of cancer is awesome, in my opinion.

But I hate Breast Cancer Awareness Month, or, as Laura aptly puts it, “Objectify Women’s Bodies Month.”

There are a lot of reasons why. Let’s start with the obvious, which is that most breast cancer awareness campaigns focus on using exploitative images of women’s breasts. Many include sexist language in their very campaign names, like “Save the Ta-Tas.” Women of all walks of life, including prominent celebrities, participate in ads which focus on breasts. And by focus on breasts, I mean “do not address the whole body,” as in ads with floating, disembodied breasts, tight camera cuts onto women’s chests, etc.

You know what I think when I see disembodied body parts? I do not think “oh, what a great way to raise awareness.” I think “oh my Pete, this is incredibly fucking triggering and I am flashing on centuries of violence against women right now.” I think of the centuries of torture techniques which involve cutting or ripping off women’s breasts. I think about the fact that purses made from women’s breasts were popular keepsakes among some Latin American death squads. I think about the time that I was on a BART train and a drunk man groped my breast so fucking hard that I had a purple bruise for weeks. I think about the fact that human society has thought that it owns women’s breasts for hundreds and hundreds of years.

When these ads go on to say things like “grope for the cause” and to use language about how we need to protect women from breast cancer so that they can keep their breasts, it makes me want to vomit. Literally, it makes me physically ill. The focus isn’t on the fact that breast cancer kills people, it is a focus on the fact that breast cancer makes breasts go away. And what’s life without the funbags?

Note that I said “kills people,” above. That’s because breast cancer kills people, not women, which brings me to another problem with breast cancer awareness month, which is that it is cissexist all to hell. Not everyone in this world has breasts, but everyone in this world can get breast cancer. And the focus on breasts, specifically, means that breast cancer goes untreated in people who are not cis women. Those people? They die.

Something else, which I am editing to add, is that I don’t heart breasts. My position on breasts? Is actually pretty neutral. I feel the same way about breasts that I do about arms, legs, noses, ears, toes. I don’t attach any special value or importance to them. In fact, I would probably have a prophylactic double mastectomy if I could afford one. Without reconstruction. That is how much I do not care about breasts.

You know what I do care about? I care about health. I care about the health of all people. I care about the fact that cancer kills people. Cancer does not confine itself to specific areas of the body. Cancer likes to metastasize. Cancer likes to sprawl its little cancer tentacles all over the body. As a result, I care about brain cancer. Stomach cancer. Throat cancer. Colon cancer. Skin cancer. Pancreatic cancer. Liver cancer. Etc. I don’t see any awareness-raising shirts shirts that say “save the esophagi” or “I heart colons.” If breast cancer awareness ads which use sexualized and disembodied breasts aren’t exploitative and sexist, then why don’t we see awareness campaigns for, say, cancer of the bile duct featuring cutesy little pictures of bile ducts? (end edit, original resumes after this)

I’m also not a huge fan of the cause marketing, in which every corporation slathers their crap in pink (also sexist) in the hopes of appealing to people who want to make a difference. The proceeds from sale of pink-branded crap? Don’t necessarily go to breast cancer research. When they do, they often go to organizations which do not use funds in efficient ways. And they also go to funds with nebulous connections to breast cancer, like “women’s health initiatives” which focus on scaremongering about abortion.

You want to make a difference? Donate directly to organizations which research breast cancer and which have high ratings from third party organizations which rate charities. Donate to funds which provide mammograms, education, and other intervention for low income women.

There’s something else that I want to say about the tone of breast cancer awareness campaigns, which is that it’s my body they’re talking about. I have multiple family members who are breast cancer survivors and I have variant BRCA1 & 2. So, when I talk about how much these campaigns offend and upset me, I am speaking from a personal place. Because it is my fucking body that is being exploited by these campaigns, it is my fucking health that is at risk from breast cancer.

So when people tell me that I should “lighten up” and “not be so offended” and that these campaigns aren’t problematic or sexist or, ok, maybe they are a little but it’s for a good cause, I want to scream. You do not get to tell me how to feel. You do not get to tell me that I should not be offended, furious, and upset by campaigns which exploit women’s bodies. Which reduce women to disembodied sexualized body parts.

(Incidentally, this post is part of a larger conversation which started at Adventures of a Young Feminist and moved to Small Strokes Fell Big Oaks, so you may want to check out the posts/comments there as well.)

Natalie’s comment on Tuesday’s post about health care issues reminded me of the fact that many of my readers are not American, and that many of them don’t know a lot about health care in America. Which is, you know, totally reasonable, because I know zero about health care policy outside the United States, beyond having a vague understanding of how some European health care systems work. In addition to not knowing a lot about the specifics of health care in America, foreign readers may also not be accustomed to the jargon used in the United States to talk about health care issues, so I decided I’d do a very quick overview of how health care in America works, currently, and talk about some of the language being used in the health care debate. (Keep in mind that this is “quick” in this ain’t livin’ terms, not “quick” in real world terms; there is a lot of ground to cover here, so you may want to pull up a chair and a bar of marzipan.)

Now, I want to stress that I am not a health care policy expert, a health care provider, or even an allied health professional. So, this is going to be a very broad overview with some gross simplifications, and while I am trying to be as accurate as possible, I may get some information wrong, in which case I would appreciate it if more knowledgeable readers would correct me. I also want to open the floor to questions from non-American readers: if you’ve been wondering about things but been afraid of asking, now is a good time to do it. If I can’t answer your questions, hopefully one of the docs who reads can.

So.

Welcome to America!

Health care in America is really complicated, because we have a number of different systems going on, some of which sometimes actively conflict. I’m going to start by talking about the different health care options available to Americans before I delve into the debate over health care policy. Since the readership is pretty diverse, people who have actually experienced the myriad aspects of the American health care system can probably also answer questions folks may have

If you are over 65 or you have certain disabilities, you are eligible for Medicare, which is administered by the federal government and funded through taxpayer contributions (which scale, based on income, although they eventually max out). Medicare was brought into being in 1965, as part of the Social Security Act, and President Johnson actually had to fight really, really hard to get Medicare passed, because the idea of providing health care to older adults was repugnant to the Republicans. Medicare is what’s known as an entitlement program; you qualify automatically for the most part, rather than needing to demonstrate that you qualify.

Medicare has several components, known as “Parts.” Part A provides hospital insurance, Part B provides outpatient medical insurance, Part C/Medicare Choice allows people to keep private plans while getting Medicare benefits through them, and Part D provides prescription coverage. Needless to say, all of these parts are severely restrictive in terms of what they will/will not cover, and all have copays and limitations. (Which is why you see heart-rending stories in the news about old people eating dog food so that they can afford their prescriptions.) So, if you’re 65 or disabled and an American, the government basically provides you with a health insurance plan which covers some of your medical expenses (if they qualify under the extremely complex rules of the system).

If you are a low income American or you have certain disabilities, you are eligible for Medicaid, which is funded by the federal government and the states. Each state runs its own Medicaid plan, with different eligibility standards and benefits available. Medicaid, also established under the Social Security Act, is a means-tested program; you aren’t automatically eligible, you must demonstrate that you are eligible. Incidentally, just being below the poverty line (currently $10,830 USD in the lower 48 for a single person, $22,050 USD for a family of four, slightly higher in Alaska and Hawaii because of the high cost of living there) doesn’t automatically mean that you are eligible for Medicaid, so not all low income Americans are covered under the plan.

If you are a child from a family of low to moderate income, you may be eligible for SCHIP (State Children’s Health Insurance Program), which is supposed to cover uninsured children who don’t qualify under Medicaid. Uninsured children are a huge problem in the United States, and this was designed to help address that. Needless to say, since its passage in 1997, SCHIP has been controversial, especially among the Republicans; President Bush the Second actually specifically vetoed several attempts to expand coverage.

If you are a member of the United States Armed Forces, you get what is widely considered to be the gold standard of health care in America. Coverage for members of the armed forces is provided through a military health care program which provides an extremely high level of coverage. Some of the most advanced medicine in the United States is being practiced in military facilities (which kind of echoes the historical trend of seeing advances in military science/technology before they show up in the civilian world).

Veterans of the armed services are eligible for care under the Veterans Administration (VA, and yes, it’s “Veterans” with no apostrophe). However, you are not automatically eligible just because you are a veteran; coverage is allocated in a series of “Priority Groups” based on whether you have a service-connected disability and some other factors. VA coverage is also widely believed to be very good, if you can get it, although it is not without problems. (Not least of which is the steadfast refusal to treat vets with PTSD and problems related to TBIs.)

If you are an employee of the federal government or a state government, you are eligible for health insurance provided through the government. The situation here is a little bit complicated, but basically, the government pays for health insurance provided through a private insurer, as a general rule. The government (or a union of government employees) negotiates a group rate, and you get to pick the plan you want. The plan also covers your immediate family.

If you are a Native American*, you are eligible for care through the Indian Health Service (IHS) at IHS facilities, and the IHS will pay for some types of treatment at non-IHS facilities. The IHS has been widely criticized for providing incredibly crappy care and for having very outdated facilities.

It’s important to note that health care for members of the armed services, veterans, and Native Americans is the only form of health care provided by the government; all other government health care programs provide health insurance, not health care.

If you are none of the above, welcome to the brave new world of health care in America!

Basically, you have several options:

Option One: Pay for all of your health expenses out of pocket. Many health care providers and allied professions actually offer a discount for people who pay in cash, ranging from hospitals to pharmacies. People opt to go this route when they: are uninsurable, can’t afford health insurance, are between insurance policies, or don’t think that they need insurance (“I’m young and healthy, what could go wrong?”).

Option Two: Purchase a health insurance policy to cover medical expenses. The kinds of medical expenses covered depends on the policy. In addition to the premium, you have to pay a deductible (they won’t start paying until you’ve spent a minimum amount, which can sometimes be very high, like $5,000 or more) and co-pays (which vary in cost, with some good plans they might run $5, with others they might be a “share of cost” which may be up to half the price of the services provided), assessed at each visit/prescription purchase, etc. Most health insurance policies do not cover dental and vision; if you want insurance for these, you need to buy it separately. There are a lot of different types of individual policies available, which I don’t really want to get into right now. Suffice it to say that you must not have any “pre-existing conditions” from acne to zoonotic infections, and the insurer can engage in something called “rescission” in which they drop you because they claim you lied on your application, or because you got sick and they don’t want to pay for it. If you have insurance, you will fight every step of the way for every benefit you receive.

Option Three: Get health insurance through work. Some American employers offer health insurance plans as benefits. Most negotiate a group rate, allowing people to get insurance more cheaply than if they paid privately. Some insurers (few) cover the cost of insurance along with deductibles and copays, some pay for the insurance, some split the cost of the insurance, and some offer insurance plans which employees can buy into, but don’t defray any of the costs. In a workplace where insurance is offered and the employer pays all or part of the cost, if an employee declines it, the employer may give the employee reimbursements for health expenses, up to a certain amount.

Option Four: State risk pool. Basically, in recognition of the issues faced by people who are uninsurable, some states have created risk pools. People who are eligible can pay a (usually very high) fee for the privilege of getting insurance through the state. That insurance usually don’t cover a whole heck of a lot.

Option Five: Young adults. In some regions, people up to 25 can be carried on a parent’s policy, if they are still dependents. People in college are usually covered through mandatory health fees which provide them either with access to the college clinic, or with an insurance policy which allows them to access care.

Pretty much, no matter what plan you have, you are going to end up having a lot of out of pocket expenses for health care. You are also going to fight for coverage and benefits, and you are probably going to lose unless you have someone with clout to back you up. Every plan discussed above (except paying in cash, obviously) routinely denies benefits to which people are entitled, and even paying in cash, as I do, can have problems. For example, the pharmacy often refuses to fill my prescriptions (to the point of not ordering specialty items prescribed for me) until I demonstrate my ability to pay, because they don’t want to restock if I don’t have enough money. Basically, the default from insurers is rejection, because they hope that people will accept the rejection and not appeal. If you are a person with disabilities trying to navigate the health care system, the issue gets even more complicated than if you’re a relatively health person who just happened to break your leg. (For example, if you need prescriptions for narcotics for pain management, you will be forced to jump through an absurd number of hoops. Every month.)

So, let’s talk about the debate over health care reform in this country.

Roughly 46 million Americans have no health insurance. Many more than that are underinsured, lacking the coverage they need to access adequate health care. The leading cost of bankruptcy in America is health care expenses. Tens of thousands of Americans die every year because they have no insurance or do not have adequate insurance (I want to note that emergency rooms must provide treatment to everyone, regardless of insurance status, so people aren’t allowed to bleed out in the street, but people with chronic conditions regularly die because they can’t access the treatment they need). The cost of health care in this country is skyrocketing. At the same time, malpractice suits are exploding, public hospitals are failing, and government plans like Medicaid are running out of money. So, obviously, something needs to be changed.

The obvious solution is what Americans call a nationalized single payer system (or “socialized medicine,” said with a sneer, because “socialized” is a pejorative statement in the United States, in case you’ve been wondering). Under this system, the government would either directly provide care or payment for care to all Americans. The plan available to members of the armed forces is an obvious model; it’s already really, really good, and it works really, really well. Some Republicans have said publicly that they think  members of the armed forces “deserve a higher standard of care” than civilians, though, so, you know. Uphill battle here, to say the least.

However, single payer isn’t getting much serious consideration. This is for several reasons.

The first is that the private insurance companies do not want it to happen, for obvious reasons. This might not really be an issue, because one would think that the government would override corporations to do what’s right. Unfortunately, private insurance companies have huge amounts of political and economic clout, thanks to the fact that campaign finance in the United States is largely unregulated. So, basically, the private insurance companies have bought themselves some security.

The second is that a very large faction in America fears the idea of providing basic human services to all American citizens. These are the people running around with the infuriating signs. These people are not only wrong, they’re also gravely misinformed. They believe that countries with socialized medicine leave people dying on the side of the streets, endlessly delay care, cost lots of money, cover undocumented immigrants (which, you know, separate issue, but if my tax dollars pay for health care for undocumented immigrants, I really don’t care), deny care all the time, and so forth. They think that a “public option” will be accompanied with all sorts of nastiness and be really expensive, and they haven’t even been introduced to the concept of single payer yet.

A lot of this rhetoric has been deliberately cultivated. For example, claims about the percentage of the American economy health care accounts for, provided courtesy of insurance companies; people argue that the current system must be maintained because otherwise the economy will collapse. Or, the death panels (sorry, Natalie, had to address it). The “death panel” is actually a conversation between a patient and ou doctor in which the doctor talks about various situations which could come up and treatment options, and asks the patient about what ou wants done in those situations. If the patient says “sustain life at all costs,” life must be sustained at all costs. If the patient says “I don’t want to live on a ventilator,” then the approach to treatment would be, you know, different. Incidentally, Republicans were the original sponsors of mandating this kind of doctor-patient discussion. Conservative commentators are basically pushing every button they can find to elicit the desired response, which is a “populist uprising” of people who are sadly too ignorant to realize what they are protesting about.

I don’t want to get too into the rhetoric, but, basically, conservatives in the United States are feeling very threatened right now. They lost control of Congress and the White House, and they feel like all kinds of things are going on that they don’t like, and they are lashing out in a major way. These people you see in the news carrying protest signs, for the most part, have no idea what they are talking about, they’re just parroting what they’ve been told by talking heads. Some of this rhetoric is clearly racially motivated, and it has less to do with the issue of health care reform than with their idea that society is collapsing, and they are angry and upset about it. Personally, I just eat a bowl of ice cream when I think society is collapsing, but, you know, whatever floats your boat.

So, most of the current proposals for health care reform are revolving around how to get Americans to buy health insurance, rather than how to provide health care reform to Americans. And some of these proposals are including what they are calling a “public option,” which would basically be government-sponsored health insurance for some Americans, while maintaining the current framework. In other words, instead of doing away with the myriad options discussed above and just having one plan cover all Americans, these plans advocate for creating yet another plan. I’m opposed to this because I think it’s inefficient and unwise and will ultimately cause more problems than it solves.

Some plans reject the public option altogether, instead focusing on things like forcing insurance companies to carry people, eliminating rescission, and limiting health insurance costs with the goal of making health insurance (not necessarily health care) more accessible. These plans sometimes also contain mandates: every American would be obligated to buy health insurance. If you were extremely poor, the government might help you out a little, or issue an exception (despite the fact that poor people are probably most in need of insurance). One of the biggest problems with mandates is that the limits are pretty unreasonable. Including premiums, copays, payments out of pocket for things that aren’t covered, and deductibles, some currently uninsured people would be expected to spend close to 50% of their income on insurance (supposedly, the costs would be capped at 12-15% depending on the plan, but that’s only the cost for the premium).

The argument used to defend mandates is that car insurance is mandatory in the United States, so, therefore, health insurance should be too. There are a couple of problems with this, like the fact that buying a car is a choice and being alive is not a choice (in the same sense, at any rate). Furthermore, uninsured motorists pose a threat to others, while uninsured Americans only pose a threat to themselves, so car insurance mandates are more about collective social responsibility than personal responsibility (many Americans believe that health care is a personal responsibility, not a right, although, needless to say, I do not subscribe to this view). Another problem, as pointed out by a doc, is that car insurance is designed to provide coverage for catastrophic events, while health insurance (theoretically) covers routine ones; you don’t use your car insurance policy to buy gas, you do use health insurance to pay for a checkup.

As has been pointed out, in Massachusetts, which already has a health insurance mandate and a public option, the insurers all promptly dropped everyone they didn’t like, shunting the costliest patients over to government care. This is probably what would happen if a federal law with a “public option” passed, allowing the insurers to continue making huge profit margins and forcing the government to carry the most expensive patients. Whereas, if the government was covering everyone, the risk would be more evenly distributed, and thus less costly, because everyone would be paying into the system, but people would be taking out at different levels. Studies seem to suggest that it would be cheaper to run a nationalized single payer plan than it would to continue running the current level of government care: Yes, that’s right, it would be cheaper to eliminate the current system and provide care to all Americans than it would be to continue with the status quo.

What this debate is fundamentally about is profits, not health care. Insurance companies want to protect their profits, politicians want to protect their sources of money, and all Americans want is some goddamn health care, already.

*Hey Canadians! I understand that the correct usage in Canada is “First Nations,” but here it’s Native American. You probably already knew that since the United States is a hegemonic monster, but I thought I’d mention it, just in case.