Watching Rachel Maddow recount the views of many Republican candidates who emerged from last night’s primaries, I realized that most of you, younger than I, grew up taking the right of a woman to choose for granted. But the current crop of Republican candidates for the fall elections does not. Many of them believe a woman should have to bear her child even after a rape. Most don’t believe in abortion for women with serious illnesses.Their goal is 100% live births. And one of them believes in convenant marriage — no divorce ever. (Although I don’t always agree with Rachel Maddow, I have learned to trust her research.)

But you are not outraged. And that’s because you don’t seriously believe this right will be taken away. To you, it was always there.

Let me tell you a story.

Just after I graduated from college, I was working at a publishing company and Carol, the girl at the next desk, with whom I used to eat lunch, got pregnant by a married dentist. This was in the “Mad Men” days, and it was an overwhelming situation from which I distanced myself, having no counsel to offer. She wasn’t even a good friend, just an office buddy.

And then she told me she had arranged to get an abortion in New Jersey, and she asked me to come with her. I said yes, because although I never imagined that I, a “good little girl,” would ever be in that position, I felt sorry for her. Meaning I was glad it wasn’t me this time.

We had to take the subway to a place where we were picked up by a “nurse” and driven to a place we were not allowed to see the outside of. We were driven around the back. No one even gave us the address, just the directions. We were both young, about 21, and we were terrified.

When we got inside the dark building, they took Carol away from me into a back room. I waited, afraid to breathe. When she came back, she was pale and silent, but stoic. She was so proud of herself, and she thought she had made the married dentist happy. He paid the bill, although he wasn’t there, in cash up front.

We got back on the subway, and Carol began to bleed. She bled all over the subway, all the way home. By the time we got off, she was almost too weak to stand, and we got in a taxi to her house. I was freaked out. I had no idea what to do. She called the dentist to ask what to do.

She did not die, but it was very close. There was no 911, so I called the hospital nearby. They told me what to do for her, and said she should come in. They took her in, and I went home, terrified, and told my parents.

Days later, Carol came back to work, depressed and miserable. Soon after, I went back to graduate school, where I forgot about it all until I got pregnant myself nearly ten years later. And then, although I was not married either, and the father of the child still was, I had the baby. And became an abortion rights activist. Just seeing someone have an illegal abortion made me one, even though I never had an abortion myself.

Years later, when I was a foster mom, my sixteen-year-old foster child got pregnant. I marched her down to Planned Parenthood, where they gave her the “morning after” pill. I never even asked permission of the agency that licensed me. I had seen enough. She is now a mother herself, but at age 26, and she still thanks me for taking her to Planned Parenthood that day.

Life is complicated, women. Protect your rights. Believe me, you won’t want to be without them.

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Until the 1970s, most medical care was primary care. Certain primary care doctors were known to be better at diagnosing things than others, and if you thought something was really wrong and your own doctor couldn’t figure it out, you went to a diagnostician. While these talented people may have charged a bit more, I don’t remember it being 5x or more, as a visit to a specialist costs today.

As medicine became more and more influenced by technology, however, it quickly became more specialized.  That’s why HMOs were founded: to keep people out of the offices of specialists. HMOs used primary care providers as gatekeepers to specialists,and unless you were referred to. a specialist by your PCP (Primary Care Provider), you couldn’t go.

Sick people stared over the gate at the coveted “specialists,”  feelIng denied and rejected by an uncaring system. Eventually, enough of them sued or voted with their wallets and the HMO system collapsed. Without the gatekeeper, people descended In hordes upon the specialists, who were only too happy to receive them, having been nearly bankrupted by the HMOs.

And that is how we got here–to the place where an under exercised and overfed population has lost the will and the ability to care for itself and goes trotting off to the specialist to treat the problems caused by–themselves: their obesity, lack of conditioning, sleep deprivation and prescription drug dependence. The specialist radiates, operates, and medicates, turning what should have killed us evolutionarily into “chronic conditions” that cost 19% of the GDP to control.

Not only have we lost the will to correct our behavior, we have also become unwilling to be penalized for those costly conditions. How dare they raise my insurance premium or tell me I am too old for a liver transplant or a hip replacement?

And now comes the backlash. Here come the studies that finally prove the new cancer drugs don’t really work better than the older ones and the cardiac surgery doesn’t prolong life, followed by the indications that too much salt, or too much fast food, is the cause of it all.

And here we come back to the concept of the family doctor, now perhaps renamed the ” medical home,” whose job it will be to give you the same advice your mother used to give: get enough rest, go out and play, eat your vegetables.

Good luck finding a primary care doctor as the culture shifts back to the pre-eminence of prevention and the control of costs. The past two decades have driven them almost to extinction, abandoned to the “specialist” with his bag of pills and black box of scans. All the technology finally leads us back to the same conclusion: it’s cheaper and easier to prevent illness than to cure it. We change the oil in the car and run the virus scan and the spyware filter. Now we have to set up maintenance contracts with ourselves. As a culture, we can’t afford to trade in these bodies, like “cash for clunkers.”

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Insurers really, really want a public option. No, really. They do.

by Karoli 07.23.2010

They didn’t use those words, but that’s what they’re saying, nevertheless. There are two principles at stake here: First, that discrimination against sick people is a thing of the past; and second, that the days of cherry-picking insured groups are over. Either insurance companies can get on board, or else they are begging for Lynn [...]

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Health Care Reform: HHS Beacon Program

by francine 07.21.2010

President Obama’s HiTech Act, enacted right after he took office, should produce a major transformation in American health care when it gets going. Along with the health care reform legislation that was dragged kicking and screaming through Congress last spring, the Act could put the planets in alignment for real change in the way care [...]

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