They're Taking Away Abortion, for Real

By Amanda Marcotte, Salon

04 March 20

 

ith everything going on in the news these days, most Americans have no idea that the religious right is, after over four decades of trying, quietly on the verge of ending Roe v. Wade as we know it. The case is being heard March 4, and is called June Medical Services vs. Russo. Even though the Supreme Court ruled, a mere four years ago, that the state of Texas couldn't use medically unnecessary regulations on abortion clinics as a backdoor way of banning abortion, Louisiana thought they'd take another go at it. 

What changed? Not the medical science or rationale for these backdoor bans. No, it was the makeup of the court. With Donald Trump appointee Brett Kavanaugh on the bench instead of Justice Anthony Kennedy, anti-choice activists believe they have just enough votes to end Roe in all but name — precedent be damned. 

But, as reproductive health researchers Carole Joffe and David Cohen argue in their new book, "Obstacle Course: The Everyday Struggle To Get An Abortion in America," for many women in America, it's already a post-Roe world. Years of state Republican legislators passing restrictions on abortion in a piecemeal fashion has created a situation where the procedure may be legal, but out of reach for millions of women. The court's expected ruling this year will simply make this already terrible problem much worse. 

Joffe spoke with Salon about what life looks like when legal abortion access is denied to so many. 

On March 4th the Supreme court will be hearing a case called June Medical Services vs Russo. It's about Louisiana state regulations that threatened to shut down abortion clinics in that state. So what's this case about and how worried should we be about it affecting access to abortion in the U S?

Well, I think we should be very worried on two counts. One, the case ignores Supreme Court precedent, in the 2016 case Whole Women's Health vs. Hellerstedt. The court decided, that if you're going to impose restrictions, there had to be evidence and the benefits to women had to outweigh the cost.

Put more colloquially, the courts said to state legislators, you can't make s**t up. Scientific experts, both medical and social science, showed that these restrictions would impose hardships, and that there was no medical benefit.

So, reasonably enough, people in the pro-choice movement thought this was settled. And now just a few years later, here comes the state of Louisiana totally ignoring it.

There's another, less noticed, aspect of this case that in some ways is even more troubling. And that is the issue of whether or not abortion providers have standing to bring cases on behalf of their patients.

The overwhelming amount of abortion litigation are brought by providers. Pregnant women have very little incentive to go before a court. Court cases take a long time. By then they will lose their window to have for the case to be resolved in their favor. A lot of pregnant people simply don't want to come forward and be in the headlines and subject themselves to all kinds of trolling and attacks. So if the idea that abortion providers can no longer bring suit on behalf of their patients is very, very troubling.

The state of Louisiana is claiming that all providers really care about "is providing as many abortions as possible" and being "free from government oversight." And that's absolutely not true.

Abortion providers don't care about doing as many abortions as possible. Over the years studying this field, I found numerous examples of when patients are ambivalent, the providers will encourage women to take their time, to go home, think about it.

One provider we quote in the book told us she has nightmares on doing an abortion on someone who didn't want it.

It's such a weird stereotype. I recently visited an abortion clinic in Philadelphia and was talking to the workers and all they were talking to me about was how, after they do abortions, they really try to get the women to have a conversation with them about contraception. Which strikes me as not the conversation you'd be having, if you were trying to do more abortions, right?

It's the standard of care, that you should initiate conversations about contraception if the patient is open to that.

Currently abortion is harder to get than it ever has been since it was illegal. Why is it so hard to get, despite Whole Women's Health?

The number of abortions before Roe, I mean no one knew exactly how many, but there were reasonable estimates, and some people put it as high as a million, which is more than we have today. A lot of that is better contraceptive methods available. But some of the decline in abortions has to do with self-managed abortions. People are ordering drugs used in medication abortion off the internet. No one's officially counting them.

The reason it's so hard to get an abortion is a decline in the number of abortion facilities. We have six states with only one clinic. If Louisiana wins its case, there will be only one facility left in Louisiana.

The key point is that so many abortion patients now are poor. The Guttmacher estimates are that 50% of abortion patients live below the poverty line. Another 25% are classified as working poor. So for these people not having enough money to pay for abortion is only the beginning. Thirty-three states now do not use Medicaid dollars for abortion.

Here you're talking about very poor women, who very likely don't have cars, have to depend on somebody else to drive them. Many of these women are in rural states where there's not good public transportation. Add to that the factor of a waiting period some states impose.

Sixty percent of abortion patients are parents. You're poor. You have children. You need to go away from your home. You need to figure out someone who will drive you. And we heard heartbreaking stories of people who have boyfriends or family members will say, yeah, I'll drive you and then literally don't show up.

If you're working, you're losing wages. You have to pay for childcare. Plus, you get to the city where your abortion will take place and they tell you, we'll counsel you today, but you can't have the procedure till tomorrow or the day after. Or, if you're in the state of Utah three days from now.

All these things cost money. That's part of the reason it's so hard to get an abortion.

This gives you a sense of just the obstacle course that women have to go through. It's unconscionable. I mean, no other part of the healthcare system is like this.

We're looking at June Medical Service as this turning point where the Supreme Court might functionally ban or reverse Roe vs. Wade. If they won't ban abortion outright, they will allow states to use red tape to get rid of legal abortion services within their borders. But it sounds like functionally for a lot of women, abortion is all basically banned already.

Yes.

You mentioned women using pills online. They're obviously not getting those directly from doctors, right? They're buying them from India or Mexico or someplace like that. Does this concern you? 

Here's what bothers me, is that abortion is healthcare. It is a medical procedure, but for various reasons, has never been integrated into mainstream healthcare. And I could go on a great length why that's the case, but let's just say issues of stigma, controversy, and so forth have kept abortion provision separate from mainstream healthcare.

Now what do I think of self-managed abortion from getting the medications online through the mail? The good news here is that this is actually quite safe.

People have actually tested the quality of the drugs that are available online. Many people in the pro-choice movement were afraid that people, desperate women, would send in money and then just get sugar pills or aspirin. It turns out that the stuff that's being sent, by and large, is of good quality. So that's very reassuring. If you compare self-managed abortion now using these pills with what happened before Roe, it's night and day.

Your readers presumably have all heard the tales of the "back-alley butchers." I mean they weren't the only people doing illegal abortions, but that was a big part of it. Many women died, many more women were injured.

The relatively speaking good news is that people using these pills will not have the same level of injury. The bad news potentially is that I believe there'll be much more legal surveillance of  this practice. In 1962, when you attempted to do your own abortion, that was very dangerous medically. But there were very few prosecutions.

We don't know how much legal prosecution there would be if you go to an ER and you're bleeding too much. Will the doctor be forced to report you?  If he or she advises you, will they be seen as accomplices in abortion, in those states that have banned it? We face a very uncertain legal environment, both for women and for providers.

Down With These One-Minuters, Out With "Don the Con"

By Ronnie Dugger, Reader Supported News

04 March 20

 

his is not just another four-year election. The American Presidency now gives only one of our citizens much more power than any of us to accept the climate change that will soon determine our earth’s livability and, even more dangerously, gives that same single citizen total one-person control and command over the exploding of our nuclear-weapons arsenal that can totally destroy humanity. The 2016 election outcome gave the safety of life on earth to Donald Trump. The deterioration of the Democratic candidates’ press-seized TV “debates” must be fixed fast if the still-standing candidates for the nomination against Trump are to produce for the people a fully and fairly heard nominee. Every one of these events should be real debates instead of the one-minuters the press networks conduct.

As demonstrated again last week in the chaotic snarl on TV among the candidates for the Democratic nomination, the press conducts these events in pluralized press conferences that insult the candidates and the American people and blur the case for a new president. The press is almost totally controlling what the candidates talk about before tens of millions of us. After firing their often bullet-like questions, the five questioners last week, CBS the major sponsor, gave the candidates only one minute and 15 seconds to answer each question — 75 seconds! If a rival crossed a speaker the questioner might, might, allow 45 more seconds, but only 45, for a refutation. 

No candidate was permitted more than a minute or two on any subject, health care, foreign policy, taxes, climate change. Even while one was speaking, some of the others on both sides of him or her rudely raised and kept their arms high, begging to be called on next. Foreign policy? One of the candidates touched on her plans concerning half a dozen different nations in her one minute 15 seconds! The press deciding and thus controlling what’s discussed within their own time-limiting so jams together and rushes the candidates that most of them seem to speak at 60 miles a minute. Several times this week candidates were yelling at each other, once all at once — it was quite a seizure. The millions of people around the country, of course, often losing track watching a jumble of subjects and ideas so speedily sloganized, get little or no time to think clear-mindedly as they watch and listen. 

The half dozen or so candidates challenging Trump who are left on civic TV (and thus radio), out of respect for themselves, each other, and the American people, ought to meet together privately and take back, plan, and insist on controlling together the rest of their own debates. In any such occasion on nationwide TV and radio the candidates, not the press, are the subject. Each candidate is owed, needs, and deserves 10, 20, or more uninterrupted minutes for his or her own thoughts, proposals, and values. Each should also have ten or 15 uninterrupted minutes for refutation. When down to two candidates, each of course should have at least one or two hours total. Most of all, the people, before choosing our one life-controlling and death-controlling president, are greatly entitled to the candidates’ sufficiently long and serious thinking and their sensibly-timed presentations. Anything like this is altogether absent from these one- and two-minute brain flashers. The TV networks, putting themselves first, in fact are reducing the informedness and intelligence of the entire American people on our one biggest decision. The candidates could wisely implore the League of Women Voters to preside over real debates as long ago they used to so fairly and well. The League could for example consult, later on, with Trump and his people. Surely networks, presented the candidates’ own rules for their own debates, would compete for the media honor and, if commercial, for the profits of airing them.

The few (is it three?) candidates left running against Trump on civic TV (and thus radio) have been roughly divided between the leading liberals Bernie Sanders and Elizabeth Warren along with billionaire Tom Steyer and the several centrist moderate Democrats, led by Joe Biden in most polls until recently. Concerning the two billionaires, Steyer, who dropped out of the race last weekend, is firmly liberal, even campaigning for reparations for African-Americans because of the criminal slavery whites did to them. Michael Bloomberg, who withdrew Wednesday, though a financer for some important liberal campaigns, is also somewhat right of center; for example he has opposed raising the minimum wage, and he supported a Republican candidate against Warren in the election for the U.S. Senate seat she holds. 

Sanders and Warren are of course competing against each other as amicably as they can, and so are the remaining centrists. Trump has signaled his readiness to slam his lies and slanders into the face and heart of the Democrats’ nominee, but given his famous identity as a deliberate and chronic liar, the thrust of his campaign attacks cannot be reliably anticipated. The prospect of a bitter Democratic national convention, especially given the opposition to Sanders now more obviously attributed to the “Democratic establishment” (including presumably most of their 77 convention “superdelegates”), suggests it’s likely that the anti-Trump candidates will resume trying to work together more pleasantly with fewer Trump-usable damnings of each other even as each seeks more support until the one nominee is chosen. 

Two situations might suggest the leading Democratic candidates’ present problems.  

During the Senate trial of Trump’s impeachment (all of which but one day I covered via TV), Trump clearly displayed one of his campaigning intentions if his often-targeted Biden becomes the nominee against him. The impeachment charged the President with corruptly coercing the newly-elected President Zelensky of Ukraine with extortion (arguably by threatened bribery) to get Zelensky to publicly announce that Ukraine would investigate Trump’s then leading opponent Biden and his son Hunter. The investigation was to concern Hunter Biden’s having become a board member of a corruption-accused company, Burisma, a natural gas firm, that belonged to a corrupt oligarch. Trump ordered the withholding from Ukraine of an almost $400 million grant already appropriated by Congress to help our ally fund its war against its invasion-supporting neighbor Russia. In the whistleblower’s document that caused his impeachment, Trump is quoted telling Zelensky he thought the case involving the Bidens was “a horror.” Trump let Zelensky know that if he didn’t make Trump’s by-then-required announcement against the Bidens the annual  grant to Ukraine would stay withheld. 

Joe Biden has bragged that, when he was vice-president, he forced a certain Ukrainian prosecutor to quit within six days or else Biden would withhold a billion dollars of (presumably U.S.) money from Ukraine. The prosecutor did quit, but the facts on the meaning and implications of that event are controverted. During Trump’s lawyers’ defense of him against his impeachment, two of them specialized and focused on national TV for about an hour charging Biden and his son Hunter of corruption in this matter. One of Trump’s lawyers, Eric Herschmann, alluded to Hunter’s income from the firm as “millions of payments” to Joe Biden’s family, and he exclaimed that “his own son corrupted a corrupt oligarch.... What was going on?” When asked  about this matter on MSNBC, Joe Biden called these charges “a total lie,” but he has not been quoted on the matter extensively. Hunter Biden under interview has conceded that his being the son of his father has affected most of his life, and he refused to say how much money he was paid as a result of his Burisma board membership. 

Hunter Biden has conceded “poor judgment” in taking his role with Burisma. In a feature concerning him in its society section last Saturday, The New York Times reported, “There has been no proof of any wrongdoing by Mr. Biden related to his business dealings in Ukraine,” but that Hunter “declined to answer questions” about his five or so years with Burisma. He joined the company’s board of directors in 2014 when his father, as the vice president, was leading Obama administration actions against corruption in the energy industry in Ukraine. Hunter now paints and lives in a rented 2,000-square foot house in Hollywood Hills, which, its owner told the Times, was leased last June 15 for $10,000 a month. “Democrats worry,” the story said, “that [Hunter’s] curious overseas dealings could pose a threat” to his father’s campaign for president. In 2015, also according to the story, Hunter began working for “a Romanian oligarch ... who was facing corruption charges,” but this fall he quit working for a Chinese firm and said “he would not work for or with any foreign-owned companies if his father became president.”

Healthcare evidently was the most decisive factor when Democrats won back a majority of the House of Representatives in 2018. The sharp dispute on healthcare between the candidates’ liberal and central groups is important now. Among the candidates, Sanders has been the most ferocious and compelling champion of expanded “Medicare for All,” extended to all U.S. residents, eloquently joined on that by Warren. The most recent 100-page bill Sanders introduced for “M4A” last year is interpreted, after a three-year transition from present health law and private insurance onto his M4A, as effecting the abolition of private, profit-making medical insurance. 

The national health insurance systems in the world’s major nations (except the U.S.) are so various they obviate a general description. Clearly they all do result in most of their peoples’ acceptance and strong appreciation of their cheaper government-paid healthcare. However, most or all of their systems also let citizens who want to do it instead go on paying for their private, or some private, health insurance. Socialized or profit-only care, take your choice. In England, when I was in school there, I knew a couple who lived on the English Channel who chose instead to just keep on paying for their private insurance, and who cared? In Germany, as of 2015, about nine million Germans are still using private for-profit insurance. Sanders is being challenged to follow that pattern instead of killing private insurance. One even hears the accusation that the Democrats want to take 160 million Americans' health insurance away from them. Warren, of course aware of all this, has modified her Medicare for All plan, now starting it off if she's elected with only a partial “public option” and finalizing it only after her own, but new to her plan, three-year transitional period.

Perhaps both Sanders and Warren or just either one of them might decide, while carrying forward for single-payer public health insurance, to okay what would then be, one could say, “the private option.” The candidates against Trump might be able to stop barking repeatedly at each other and be unarguingly for Medicare for All, and Trump and the health insurance companies would be mostly pushed back on the issue other than Trump’s charge that even democratic socialism in Western nations is communism. If not, however, one of them, if the nominee, favoring abolishing private health care entirely would surely be in for blasting on this from Trump as the American people may be deciding the future of the earth and our species.

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Ronnie Dugger, winner of the 2011 Polk Award for lifetime journalism, is the author of presidential biographies of Lyndon Johnson and Ronald Reagan, books on Hiroshima and on universities, articles and essays in Harper’s, The Atlantic, The Nation, The New Republic, The New York Times, The Washington Post, Los Angeles Times, The Progressive, The Texas Observer (of which he was the founding editor), and other publications. In November 1988, with necessary disregard of covering-up local election officials, he wrote, published in The New Yorker, a 26,000-word essay exposing the truth that counting elections in computers endangers even presidential elections being stolen unprovably by, for example, computer equipment companies’ paid machine programmers. He lives and writes in Austin, Texas. This e-mail address is being protected from spambots. You need JavaScript enabled to view it

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