Weekly Pulse: America’s Next Top Doctor

Lindsay E. Beyerstein

As surgeon general, Dr. Sanjay Gupta will be an effective public advocate for public health goals, but will he be a good administrator and an effective leader of America's public health professionals?

2009 already is shaping up to be a year of surprises. Yesterday, we
learned that America’s favorite TV doctor, Dr. Sanjay Gupta, will
likely be the next Surgeon General of the United States.

President-Elect Barack Obama is assembling a healthcare dream team. In November 2009, Obama named former Senate Majority Leader Tom Daschle
as Health Czar and Secretary of Health and Human Services. The Daschle
pick was widely taken as a sign that Obama was determined to pass a
healthcare plan. Daschle’s political skills will be critical to getting
a plan through Congress.

While Daschle will be in charge of selling the politicians on
Obama’s healthcare agenda, Gupta will be tasked with winning over the
general public.

Ezra Klein of the American Prospect is delighted with prospect of Gupta for Surgeon General:

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Gupta is a great pick. To illustrate why, here’s another
question: Who’s the current surgeon general? Odd that you just blurted
out Steven K. Galson are low. That’s not necessarily a problem. The
surgeon general isn’t just the guy who writes warnings for cigarette
labels. He commands the 6,000 health professionals in the Public Health
Commissioned Corps. He gives out awards. There’s no evidence Galson is
failing in those duties.

But Gupta is not leaving CNN and Time to give out medals.
The surgeon general has an informal role as the country’s leading
medical and lifestyle educator, and it’s that role the Gupta is
uniquely positioned to fill. There’s not a doctor in this country with
half his media training and experience, nor one with a rolodex of
editors and reporters a tenth as large.

Steve Benen of the Washington Monthly is cautiously optimistic,
even if Gupta isn’t what you’d call red meat for the progressive base.
Benen recalls a famous 2007 exchange between liberal documentarian
Michael Moore and Gupta in which Moore took Gupta to task for a number
of errors in Gupta’s "fact-check" of Moore’s healthcare film, Sicko:

Clearly, Gupta will be the biggest star to occupy the office of
Surgeon General since C. Everett Koop. Certainly, the 39-year-old will
be the first Surgeon General in history to have been deemed one of the Sexiest Men Alive by People Magazine.

Gupta hasn’t officially accepted yet, but he’s expected to say yes,
if all goes well with the final vetting process. However, Gupta is
reportedly concerned that he’ll have to take a pay cut to become America’s next top doc.

The Gupta pick won’t get rave reviews from everyone. He’s a great communicator, but his political experience is limited-though he did serve as a White House fellow in the late 1990’s and advised Hillary Clinton on healthcare.

Howie Kurtz of the Washington Post claims that Gupta has a longstanding interest in health policy
and that he has even negotiated an expanded policy role for himself as
Surgeon General. However, surprisingly little is known about which
policies Gupta, a Michigan-born brain surgeon, actually supports.

The choice of a celebrity commentator
with a background in high-tech, interventionist medicine will make some
public health professionals uneasy. The Surgeon General is America’s
top public health official. Ezra Klein anticipates that Gupta will be
an effective public advocate for obesity prevention and other public
health goals. However, it’s not clear from Gupta’s record if he will be
a good administrator or an effective leader of America’s public health
professionals.

In other healthcare news this week, Mother Jones kicks off the New Year with a miscellany of facts and figures on obesity in America. Last month, the Washington Post
reported that Barack Obama is setting an example when it comes to
physical fitness, noting that the president elect had been to the gym
every day for at least 48 days. It’s only a matter of time before conservatives start blaming eating disorders on an imaginary "Obamarexia" epidemic.

But maybe prevention is overrated. At the American Prospect,
M. Gregg Bloche says that preventative medicine won’t save the
healthcare system money in the long run. Yes, it costs less to prevent
a case of diabetes than it does to treat the condition once it sets in.
But people who avoid diabetes tend to live longer. And the longer we
live, the more healthcare resources we consume:

If we’re to get better at averting illness, we’re going
to have to spend more. The Tufts Medical Center Cost-Effectiveness
Analysis project tracks published data on the costs and benefits of
thousands of tests and treatments, including 279 preventive measures.
Fewer than 20 percent of these measures actually save money, the Tufts
group recently reported in the New England Journal of Medicine.
The rest raise medical spending, and that’s not even counting the extra
costs patients incur down the line, for illnesses they could have
avoided by dying.

That doesn’t mean that we shouldn’t spend money on preventative
medicine, Bloche says. We just have to think of prevention in terms of value,
not savings. In other words, prevention may be expensive, but it’s
worth it because it works better than treatment. Preventing diabetes
may turn out to be expensive in the long run, but someone who never
gets the disease will live a longer, healthier life compared to a
patient who depends on insulin and drugs.

In December, Obama sparked controversy when he picked conservative
mega-church Pastor Rick Warren to give the invocation at the
inauguration ceremony. As we’ve discussed before in the Weekly Pulse,
Warren’s worldly political agenda makes him a troubling pick. The
pastor opposes abortion, gay rights, and science-based sex education.
He favors the discredited
abstinence-only until hetero-marriage approach to preventing STDs and
unplanned pregnancies home and abroad. Warren is clearly positioning
himself for a prominent role in shaping the Obama administration policy
on healthcare and international development, especially AIDS in Africa.

Elsewhere on the reproductive health front, Mike Ervin, writing for the Progressive,
urges President Elect Obama and the new Democratic Congress to swiftly
repeal the eleventh hour regulations that raise out-of-pocket costs for
Medicaid
services. Erwin notes that higher Medicaid costs disproportionately
burden poor and disabled Americans and may discourage them from seeking
treatment.

In Rewire, Sam Sedai outlines the key reproductive health policy decisions
facing the incoming administration. One of the most important questions
is the fate of Bush administration’s radical "conscience clause" rules,
which allow federal healthcare workers with religious qualms to opt out
of virtually any task connected to birth control or abortion.

Clearly, 2009 holds many challenges and a great deal of opportunity in store for advocates of progressive health policy.

Commentary Abortion

It’s Time for an Abortion Renaissance

Charlotte Taft

We’ve been under attack and hanging by a thread for so long, it’s been almost impossible to create and carry out our highest vision of abortion care.

My life’s work has been to transform the conversation about abortion, so I am overcome with joy at the Supreme Court ruling in Whole Woman’s Health v. Hellerstedt. Abortion providers have been living under a very dark cloud since the 2010 elections, and this ruling represents a new day.

Abortion providers can finally begin to turn our attention from the idiocy and frustration of dealing with legislation whose only intention is to prevent all legal abortion. We can apply our energy and creativity fully to the work we love and the people we serve.

My work has been with independent providers who have always proudly delivered most of the abortion care in our country. It is thrilling that the Court recognized their unique contribution. In his opinion, after taking note of the $26 million facility that Planned Parenthood built in Houston, Justice Stephen Breyer wrote:

More fundamentally, in the face of no threat to women’s health, Texas seeks to force women to travel long distances to get abortions in crammed-to-capacity superfacilities. Patients seeking these services are less likely to get the kind of individualized attention, serious conversation, and emotional support that doctors at less taxed facilities may have offered.

This is a critical time to build on the burgeoning recognition that independent clinics are essential and, at their best, create a sanctuary for women. And it’s also a critical time for independent providers as a field to share, learn from, and adopt each other’s best practices while inventing bold new strategies to meet these new times. New generations expect and demand a more open and just society. Access to all kinds of health care for all people, including excellent, affordable, and state-of-the-art abortion care is an essential part of this.

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We’ve been under attack and hanging by a thread for so long—with our financial, emotional, and psychic energies drained by relentless, unconstitutional anti-abortion legislation—it’s been almost impossible to create and carry out our highest vision of abortion care.

Now that the Supreme Court has made it clear that abortion regulations must be supported by medical proof that they improve health, and that even with proof, the burdens can’t outweigh the benefits, it is time to say goodbye to the many politically motivated regulations that have been passed. These include waiting periods, medically inaccurate state-mandated counseling, bans on telemedicine, and mandated ultrasounds, along with the admitting privileges and ambulatory surgical center requirements declared unconstitutional by the Court.

Clearly 20-week bans don’t pass the undue burden test, imposed by the Court under Planned Parenthood v. Casey, because they take place before viability and abortion at 20 weeks is safer than childbirth. The federal Hyde Amendment, a restriction on Medicaid coverage of abortion, obviously represents an undue burden because it places additional risk on poor women who can’t access care as early as women with resources. Whatever the benefit was to late Rep. Henry Hyde (R-IL) it can’t possibly outweigh that burden.

Some of these have already been rejected by the Court and, in Alabama’s case, an attorney general, in the wake of the Whole Woman’s Health ruling. Others will require the kind of bold action already planned by the Center for Reproductive Rights and other organizations. The Renaissance involves raising an even more powerful voice against these regulations, and being firm in our unwillingness to spend taxpayer dollars harming women.

I’d like to entertain the idea that we simply ignore regulations like these that impose burdens and do not improve health and safety. Of course I know that this wouldn’t be possible in many places because abortion providers don’t have much political leverage. This may just be the part of me that wants reproductive rights to warrant the many risks of civil disobedience. In my mind is the man who stood in front of moving tanks in Tiananmen Square. I am yearning for all the ways to stand in front of those tanks, both legal and extralegal.

Early abortion is a community public health service, and a Renaissance goal could be to have early abortion care accessible within one hour of every woman in the country. There are more than 3,000 fake clinics in this country, many of them supported by tax dollars. Surely we can find a way to make actual services as widely available to people who need them. Of course many areas couldn’t support a clinic, but we can find ways to create satellite or even mobile clinics using telemedicine to serve women in rural areas. We can use technology to check in with patients during medication abortions, and we can provide ways to simplify after-care and empower women to be partners with us in their care. Later abortion would be available in larger cities, just as more complex medical procedures are.

In this brave new world, we can invent new ways to involve the families and partners of our patients in abortion care when it is appropriate. This is likely to improve health outcomes and also general satisfaction. And it can increase the number of people who are grateful for and support independent abortion care providers and who are able to talk openly about abortion.

We can tailor our services to learn which women may benefit from additional time or counseling and give them what they need. And we can provide abortion services for women who own their choices. When a woman tells us that she doesn’t believe in abortion, or that it is “murder” but she has to have one, we can see that as a need for deeper counseling. If the conflict is not resolved, we may decide that it doesn’t benefit the patient, the clinic, or our society to perform an abortion on a woman who is asking the clinic to do something she doesn’t believe in.

I am aware that this last idea may be controversial. But I have spent 40 years counseling with representatives of the very small, but real, percentage of women who are in emotional turmoil after their abortions. My experience with these women and reading online “testimonies” from women who say they regret their abortions and see themselves as victimized, including the ones cited by Justice Kennedy in the Casey decision, have reinforced my belief that when a woman doesn’t own her abortion decision she will suffer and find someone to blame for it.

We can transform the conversation about abortion. As an abortion counselor I know that love is at the base of women’s choices—love for the children they already have; love for their partners; love for the potential child; and even sometimes love for themselves. It is this that the anti-abortion movement will never understand because they believe women are essentially irresponsible whores. These are the accusations protesters scream at women day after day outside abortion clinics.

Of course there are obstacles to our brave new world.

The most obvious obstacles are political. As long as more than 20 states are run by Republican supermajorities, legislatures will continue to find new ways to undermine access to abortion. The Republican Party has become an arm of the militant anti-choice movement. As with any fundamentalist sect, they constantly attack women’s rights and dignity starting with the most intimate aspects of their lives. A society’s view of abortion is closely linked to and mirrors its regard for women, so it is time to boldly assert the full humanity of women.

Anti-choice LifeNews.com contends that there have been approximately 58,586,256 abortions in this country since 1973. That means that 58,586,256 men have been personally involved in abortion, and the friends and family members of at least 58,586,256 people having abortions have been too. So more than 180 million Americans have had a personal experience with abortion. There is no way a small cadre of bitter men with gory signs could stand up to all of them. So they have, very successfully so far, imposed and reinforced shame and stigma to keep many of that 180 million silent. Yet in the time leading up to the Whole Woman’s Health case we have seen a new opening of conversation—with thousands of women telling their personal stories—and the recognition that safe abortion is an essential and normal part of health care. If we can build on that and continue to talk openly and honestly about the most uncomfortable aspects of pregnancy and abortion, we can heal the shame and stigma that have been the most successful weapons of anti-abortion zealots.

A second obstacle is money. There are many extraordinary organizations dedicated to raising funds to assist poor women who have been betrayed by the Hyde Amendment. They can never raise enough to make up for the abandonment of the government, and that has to be fixed. However most people don’t realize that many clinics are themselves in financial distress. Most abortion providers have kept their fees ridiculously and perilously low in order to be within reach of their patients.

Consider this: In 1975 when I had my first job as an abortion counselor, an abortion within the first 12 weeks cost $150. Today an average price for the same abortion is around $550. That is an increase of less than $10 a year! Even in the 15 states that provide funding for abortion, the reimbursement to clinics is so low that providers could go out of business serving those in most need of care.

Over the years a higher percent of the women seeking abortion care are poor women, women of color, and immigrant and undocumented women largely due to the gap in sexual health education and resources. That means that a clinic can’t subsidize care through larger fees for those with more resources. While Hyde must be repealed, perhaps it is also time to invent some new approaches to funding abortion so that the fees can be sustainable.

Women are often very much on their own to find the funds needed for an abortion, and as the time goes by both the costs and the risk to them increases. Since patients bear 100 percent of the medical risk and physical experience of pregnancy, and the lioness’ share of the emotional experience, it makes sense to me that the partner involved be responsible for 100 percent of the cost of an abortion. And why not codify this into law, just as paternal responsibilities have been? Perhaps such laws, coupled with new technology to make DNA testing as quick and inexpensive as pregnancy testing, would shift the balance of responsibility so that men would be responsible for paying abortion fees, and exercise care as to when and where they release their sperm!

In spite of the millions of women who have chosen abortion through the ages, many women still feel alone. I wonder if it could make a difference if women having abortions, including those who received assistance from abortion funds, were asked to “pay it forward”—to give something in the future if they can, to help another woman? What if they also wrote a letter—not a bread-and-butter “thank you” note—but a letter of love and support to a woman connected to them by the web of this individual, intimate, yet universal experience? This certainly wouldn’t solve the economic crisis, but it could help transform some women’s experience of isolation and shame.

One in three women will have an abortion, yet many are still afraid to talk about it. Now that there is safe medication for abortion, more and more women will be accessing abortion through the internet in some DIY fashion. What if we could teach everyone how to be excellent abortion counselors—give them accurate information; teach them to listen with nonjudgmental compassion, and to help women look deeper into their own feelings and beliefs so that they can come to a sense of confidence and resolution about their decision before they have an abortion?

There are so many brilliant, caring, and amazing people who provide abortion care—and room for many more to establish new clinics where they are needed. When we turn our sights to what can be, there is no limit to what we can create.

Being frustrated and helpless is exhausting and can burn us out. So here’s a glass of champagne to being able to dream again, and to dreaming big. From my own past clinic work:

At this clinic we do sacred work
That honors women
And the circle of life and death.

Roundups Law and Policy

Gavel Drop: Welcome to the New World After ‘Whole Woman’s Health’

Imani Gandy & Jessica Mason Pieklo

With the recent U.S. Supreme Court ruling, change may be afoot—even in some of the reddest red states. But anti-choice laws are still wreaking havoc around the world, like in Northern Ireland where women living under an abortion ban are turning to drones for medication abortion pills.

Welcome to Gavel Drop, our roundup of legal news, headlines, and head-shaking moments in the courts.

The New York Times published a map explaining how the U.S. Supreme Court’s ruling in Whole Woman’s Health v. Hellerstedt could affect abortion nationwide.

The Supreme Court vacated the corruption conviction of “Governor Ultrasound:” Former Virginia Gov. Bob McDonnell, who signed a 2012 bill requiring women get unnecessary transvaginal ultrasounds before abortion.

Ian Millhiser argues in ThinkProgress that Justice Sonia Sotomayor is the true heir to Thurgood Marshall’s legacy.

The legal fight over HB 2 cost Texas taxpayers $1 million. What a waste.

The Washington Post has an article from Amanda Hollis-Brusky and Rachel VanSickle-Ward detailing how Whole Woman’s Health may have altered abortion politics for good.

A federal court delayed implementation of a Florida law that would have slashed Planned Parenthood’s funding, but the law has already done a lot of damage in Palm Beach County.

After the Whole Woman’s Health Supreme Court ruling in favor of science and pregnant people, Planned Parenthood is gearing up to fight abortion restrictions in eight states. And we are here for it.

Drones aren’t just flying death machines: They’re actually helping women in Northern Ireland who need to get their hands on some medication abortion pills.

Abortion fever has gone international: In New Zealand, there are calls to re-examine decades-old abortion laws that don’t address 21st-century needs.

Had Justice Antonin Scalia been alive, explains Emma Green for the Atlantic, there would have been the necessary fourth vote for the Supreme Court to take a case about pharmacists who have religious objections to doing their job when it comes to providing emergency contraception.