Muddying the Water: The New England Journal of Medicine (NEJM), Health Care Reform and Abortion

It’s been a while since I’ve posted. OK, more than a little while.  Anyway, following is an article I wrote hoping to get published, which it was not. I still think it worth the read. I hope you enjoy it as much as I enjoyed writing it.

Muddying the Water: The New England Journal of Medicine (NEJM), Health Care Reform and Abortion

The NEJM in its 12-31-09 issue granted George J. Annas, JD, MPH a platform to defend the Senate version of health care reform as meeting President Obama’s promise that no federal funds would be used for abortion. Because passage of the bill may hinge on abortion, Mr. Annas makes his argument by providing understanding of the Stupak amendment and the current laws on federal funding for abortion.

He rightly states the Stupak amendment prohibits use of federal funds for abortion and prohibits funding for health benefit coverage of any plan that includes coverage of abortion services. Abortion would be permitted if the pregnancy endangered the mother’s physical life or if the pregnancy resulted from rape or incest.

Mr. Annas sites the influence of Catholic bishops and, more importantly, a Christian group of political leaders who meet together outside of Congress as primarily responsible for the Stupak amendment. He refers to this Christian group of leaders as a fundamentalist, previously-secret group called the Family or the Fellowship.

He states abortion opponents defend the Stupak amendment as merely continuing the Hyde amendment, an amendment attached to every HHS Appropriation Act since 1976. He acknowledges that the Hyde amendment prohibits federal funding for any “health benefits coverage that includes abortion.”

He further acknowledges the health bill requires states to offer at least two health plans to the uninsured, one allowing abortion and one not. The plan allowing abortion must “segregate out” the source of funding allowing only state money, not federal money, be used for abortion. Additionally, insurance companies would receive subsidies, including those companies offering abortion. The Secretary of HHS would set the price to cover abortion services.

He adds that Senators Hatch and Brownback who have promoted the Stupak amendment in the Senate would oppose health care reform in general and therefore would vote against it even if the bill outlawed federal funding of abortion.

He then asks and answers three questions: Do the health care reform bills meet President Obama’s no-federal-funding promise? Do they follow the Hyde Amendment tradition? And do they represent good public health policy?

In response, Mr. Annas’ views regarding the influence of the Catholic bishops and this Christian group of leaders in promoting and passing the Stupak amendment ignore public feeling regarding government-funded abortion in the new health bill. A Quinnipiac poll of likely voters found 72% opposed government funding of abortion in any new health care system created by the government. Is such overwhelming public opposition insignificant? Certainly not. Does public opposition influence legislation? Yes, of course. In addition, are private meetings of Christian leaders allowed outside the halls of Congress? Isn’t freedom of association one of our most basic rights? Yet, Mr. Annas implies a sinister motive behind their association.

Mr. Annas has no trouble dispatching the abortion opposition of Senators Hatch and Brownback as disingenuous since they oppose this health care bill in general. However, his argument makes little sense. Just because they oppose the bill in general does not lessen their desire to eliminate abortion coverage from the bill.

Regarding his three questions, he answers yes to the first, assuring us the health care reform bill fulfills the Presidents wish of no federal funds for abortion. He explains the plan would require funds for abortion come from insurance companies or the states, not the federal government. He adds opponents call this language a “bookkeeping trick.” However, the contention that the funds for abortion come only from the other sources clouds the truth. The federal government provides funds to state plans for the uninsured including those offering abortion and provides funds to insurance companies who offer abortion. The federal government claims innocence as if one hand does not know what the other is doing. But the federal funds are there, subsidizing these plans which offer abortion. A “bookkeeping trick” is an accurate assessment of this proposal. He then equates the salary a federal worker gets from the government as the government funding abortion. His statement ignores what everyone knows. Once a person receives a paycheck, the money belongs to that person to use as he or she would please and is no longer a government fund. Private use of private funds is not government funding of abortion. Also, since the secretary of HHS sets the price the states will pay for abortion services, what is to prevent the secretary from setting the price at any rate? The states and insurance companies contribution for abortions could be next to nothing depending on the whim of that one person.

To the second question Mr. Annas implies the Stupak amendment goes far beyond the Hyde amendment in restricting abortion. A closer look finds otherwise. With the Stupak amendment, any insurer on the government-mandated, government-approved exchange could not offer abortion services effectively eliminating expansion of abortion much like the Hyde amendment. Without the Stupak amendment, however, the government could approve admission to the insurance exchange for a plan offering abortion service and deny admission to the exchange for a plan not offering abortion services since the bill mandates government approval of plans. Thus, abortion coverage could be greatly expanded, the opposite of the effect of the Hyde amendment today. Had the government required approval for every health plan in the US in 1978, the Hyde amendment would have been worthless.

Mr. Annas answers his third question by contending the Stupak amendment eliminates medically necessary abortion, defining medically necessary as allowing abortion for the health of the mother. Therefore, the Stupak amendment is not good public health policy. But, the health exception opens the door for abortion for nearly any reason, reasons as minor as “I’m stressed by the pregnancy.” That statement qualifies as anxiety, a diagnosis which would allow abortion to improve the woman’s “health.” The Stupak amendment rightly closes that door.

In spite of President Obama’s recent assurances, his past statements make clear his commitment to seeing abortion included in any health care reform law. The Senate version clearly allows that.

Matt Anderson, MD

Wrongful Life–A frightening concept

It seems Great Britain is determined to catch up in two areas–medical malpractice and the concept of wrongful life.

The US leads the world in medical malpractice lawsuits because of our contingency fee system. The contingency fee system means the lawyer gets a percentage, usually a high percentage, of the winnings. Thus, it pays to sue if you win and especially pays to sue if you win big. I think, don’t know for sure, but think we are the only country which has such a system. In other countries, lawyers are paid for the work they do, not on the outcome of the trial. Thus, lawsuits are much less frequent.

But it seems a woman in Great Britain is bucking the trend and is suing for “wrongful birth” (wrongful life is another term that means the same thing). Her baby was born 5 years ago with a disability. Had she known, she contends, she would have aborted.  You can read about it here.

How would you feel to know that your mother wanted you dead? Or, at least wanted you dead as an unborn baby? I think I’d be glad I slipped past the abortionist’s suction curette and made it into the world alive. Then, I’d want to leave home as soon as I was able. How do you live with someone you know would have killed you if they knew you were…just you! Warts and all. Disabilities and all. Would you have to apologize to your own mother for your existence?

I object fundamentally to the whole concept of  “wrongful life”. (Lawyers sue all the time for “wrongful death.”) I believe life is a gift from God, a gift to be cherished, loved and nutured. We are made in God’s image! Think of that! No other being carries the image of God. What a privilege it is. The Bible says nothing about the disabled being less of God’s image. So to see your own child, made in God’s image, as a wrongful life just sends chills up my spine.

I pray she will drop her suit and love her child unconditionally.

Matt Anderson

Sarah Palin Sees Through the Smoke-Screen

All due respect to the mainstream media (MSM), but they must have just fallen off the turnip truck. They’re contending the death panels mandated in the house version of the health care reform bill are not really death panels, just patient education sessions.

My goodness! The proposed house version of government health bill includes a provision of mandatory “education” regarding “end of life decisions” every 5 years for people medicare age, the education repeated each time they are admitted to a hospital.

How do you spell, “Hurry up and die already,” with a “here’s how you do it,” added in? Can anyone with half a brain miss the meaning of that?

Sarah Palin, bless her heart, has called these mandatory counseling sessions, death panels, which they are. The MSM in the article here becomes apoplectic, stating her claim has been debunked. They then go on to describe just what she was talking about! Governor Palin states such panels invite rationing of health care. It does more than that. It mandates it! (Just try to opt out of one of these sessions. You can’t.)

Fortunately for the pro-life movement, what Sarah Palin says makes waves in the MSM. They cannot ignore her, as hard as they may try. Because of  her recent run for the white house and her probable candidacy in 2012, she a big fish in the political pond. God bless her for saying what needs to be said. Let’s pray she stays strong in her pro-life views and physically safe as the months and years pass. I pray God will grant her high political office for the cause of life.

Prolife Discrimmination

Dear Reader,

Following is a piece I recently wrote to a reporter from WORLD magazine explaining some pro-life discrimination I experienced long ago, brought up to date with some recent events. With ACOG now declaring pro-life behavior unethical, the experience remains a valid look at the thinking of the abortion supporters.

I’m somewhat hesitant to bring up my experiences because of what Christian through the centuries have endured for the cause of Christ. My minor skirmishes seem trivial. Anyway, I received a note from a medical student wondering about referring for abortion and prenatal genetic testing and how one responds being pro-life.

Congress codified our rights of conscience, but the proabortion folks want that changed. So, standing for life will likely still involve some persecution. And I expect the persecution to intensify.

Here’s my story.

Pro-Life Discrimination

The year was 1977. I was just starting my last year of medical school at University of South Dakota. My class rank was high, #1 or #2. I had done well on the National Boards. Residency programs viewed me as a desirable candidate. My wife and I, always committed Christians, had three children. I feared my pro-life views could be a problem when applying for an OB/GYN residency position. Many publicly-supported OB/GYN residency programs ran large abortion services staffed by resident physicians. I knew I would face the issue, but hoped to get into a good residency, nonetheless.

I interviewed at St.Paul-Ramsey County Hospital in St. Paul, MN, and, as I came to expect, I met with the chairman of the department last. His name was Eric Hakenson, MD. During our talk, he got around to asking if I would do abortions. I told him I would not. He got nervous, started to pace and explained that the abortion service was very busy and having a resident not perform abortion upset the order of things and put more burden on other residents and staff. Then, with a firm voice, his hands on his desk leaning forward, he looked me straight in the eye and said, “If two candidates are otherwise equal, I will always choose the one who does abortions.” Translation: You won’t match for this program.

I interviewed at the University of Wisconsin in Madison and met with Ben Peckham, MD, chairman of the department last. It was a “hurry-up” meeting as I was not scheduled to interview with him. I think someone with whom I interviewed must have told him I was a good candidate. Just speculation, of course. Dr. Peckam invited me sit and then spent some time perusing my file. After about 5 minutes, he asked, “Will you do abortions?” (He got right to the point.) I said no. He then leaned back in his chair and went on to explain with great flourish how busy their abortion service was, how important it was to have everyone on board and what a problem it was to have a resident try to opt out. Then, he leaned forward and said, “I can tell you, Dr. Anderson, if you won’t do abortions, you are at the very bottom of our list.” His fat jowls shook back and forth as he emphasized the word, “bottom”. He impressed me for three reasons. One, he called me “doctor” and I wasn’t a doctor yet. Two, his declaration of my lowly position because of my pro-life views surprised me. Maybe stunned is a better word. Third, only two of us were in the room. He could deny ever having said that if I made a fuss. No one witnessed his statement but me.

I then understood that being pro-life meant more than a philosophy, a religious conviction or a world view. My pro-life views contained a real, tangible cost–job denial. But I didn’t care for the Wisconsin program anyway.

When I interviewed at Iowa, I spoke with the only pro-life staff member and one of the only pro-life residents. They both assured me the abortion service was optional and that I could opt out without penalty. At that time, a new chairman had just been appointed. William Keetel, MD, the outgoing chairman, had worsening health and was stepping down. James Scott, MD, and Roy Pitkin, MD, vied for the chairmanship. Both were outstanding candidates for this prestigious position to which Dr. Pitkin ascended. (He later went from Iowa to chair the OB/GYN department at UCLA and edit Obstetrics and Gynecology, probably the premier OB/GYN journal in the world. Dr. Scott went on to chair the department at Utah and I think edited the same journal later.) Of my two interviewers, neither had worked significantly under Dr. Pitkin and so based their statements about the optional abortion service from their experience with Dr. Keetel as chairman. I discovered later just how wrong they were.

In any event, the interview thrilled me. The Iowa OB/GYN residency program ranked near the top of OB/GYN programs in the country. My wife’s parents lived only 3 hours away from Iowa City. I applied and matched for Iowa.

I started in July, 1978. In September, I rotated through the outpatient clinic. During that rotation, those residents who did abortions would spend 2 ½ days a week in the abortion clinic. I told my chief resident I wouldn’t be going to which he replied, “Who you going to get to cover?”

“What?” I stuttered. “What do you mean? Get to cover.” He explained that the rotation was my responsibility and it had to be filled by me or someone who would fill in for me. “Well, who would that be?” I asked. “One of your resident-mates, of course,” he replied.

There were 6 of us first year residents. I would have to ask one of my residents-mates to give up the rotation they were on, either surgery, OB, NICU or whichever to help me. Fat chance of that, I thought. I had to fill the spot or get coverage—and there was no coverage.

Then, the chief resident explained I could just go over to do the history and physical exams (H&P’s) in the abortion clinic, and not actually do the abortions. That would fulfill my requirement. He didn’t see a problem with that even being pro-life since I wouldn’t actually be required to do the abortions. The OB/GYN staff would the actual abortions. Following that conversation, two or three staff doctors pulled me aside to “enlighten” me about abortion. I was naïve, I was told. I didn’t understand the problems these women faced they said. I was just obviously stupid I was told. If I went to work in the abortion clinic and saw the plight of these women, saw what a great and needed service abortion was, then, by the end of the rotation, I too would be pro-choice. (Looking back, I believe I was “tag-teamed” by the residents and staff at the direction of Dr. Pitkin, the new chairman.)

So, I caved. I went over and worked the clinic; doing the H&P’s and having the patients sign a consent form. Then I stood back while staff did the abortion. Following the abortion, I dug through the “POC’s” (products of conception) to see if all the parts were there—arms, legs, head, hands, feet, placenta. Part of helping without actually doing the abortions, you understand.

I did that for two months my first year and two months my second year. (A supposedly pro-life resident who started the next year also didn’t do abortions, but decided do them for a week, just to get good at the procedure. Oh dear.)

To understand my behavior, realize that I was 27 years old and had been a student my whole life. My teachers were my bosses and authority figures. I wrote down and memorized everything they said. So I felt incredible pressure to work the abortion clinic when they told me I was stupid and could not possibly understand about abortion since I hadn’t been there. I have no excuses though. I took the easy way. I should have stood my ground and raised a ruckus. I should have known you don’t have to crawl into the pigpen to know it smells bad. But I didn’t stand my ground, much to my shame.

When I started my third year, I slowly realized I had been duped. I remained pro-life and had not changed my mind at all. Abortion-minded women faced problem pregnancies, but none of these problems justified ending a baby’s life in my mind. I heard again and again: I’m not ready, my boyfriend wants me to, I’d have to leave school, my parents will never understand, I’m too young, I’m too old, and on and on. Abortion counselors always reached the same conclusion: the reason these women gave justified abortion.

Then, I started to think about all those conversations, about how I was naïve, stupid and uninformed. About how I would change my mind if only I could understand these women and these problem pregnancies by working in the clinic and seeing and speaking with those women desiring abortion. But I didn’t change my mind. My pro-life views solidified. The more I thought about it, the angrier I became. I asked to see Dr. Pitkin to share my concerns. I wanted him to understand the pressure I felt and how wrong that was. In my mind, I thought he would listen and issue some directive that such coercion stop. At that time, I hadn’t considered that he directed my experience intentionally.

As I explained to him my experience, he argued back, telling me the process had worked just as planned, that I needed that exposure and that he wouldn’t change a thing. What an eye-opening experience as the realization settled in. He was glad I had been coerced!

Shock and anger filled me. I had to do something. I couldn’t let this go unchallenged. I looked up right to life organizations (pre-internet) and was somehow placed in contact with Bob Dopf, a pro-life lawyer in Des Moines who did pro-bono work for pro-life organizations. I explained my story to him. He told me not to go to the newspapers or press (which I suggested), but to just calm down. He would write a letter to Dr. Pitkin asking for clarification. In the letter, he stated that if indeed pro-life residents were coerced into working the abortion clinic, any available remedy might be pursued.

Later that week, the letter hit like a bomb. I got this frantic call from Dr. Pitkin’s secretary telling me to drop everything and meet with Dr. Pitkin ASAP. When I came in, he was holding the letter from my attorney while pacing back and forth. (He had a plaque in his office that said, “Lead, follow or get out of the way.”) After about five minutes of pacing, he said, or rather yelled, “Does this mean you are suing the department?”

“No,” I replied, “not if you change your policy.” I don’t remember much after that except about 15 minutes of ranting and anger directed at me. I felt I was in a position of equality with him. He could harass me all he wanted in his office, but the letter made it clear I already felt harassed which meant he would certainly face repercussions if he fired me now. Even feeling that way, I left his office shaken. I wanted to explain myself to someone higher up than Dr. Pitkin. If I could get Dr. Pitkin’s boss to see my dilemma and support me, I could better survive. I went right to the president of the hospital’s office and asked to see him. He was just hanging up the phone—from Dr. Pitkin!

I knew word of this would be everywhere within a day, given that academic institutions thrive on gossip, so I decided to write a letter to the resident physicians explaining myself. I knew whatever they heard from administration would be negative.

So I did.

It didn’t help.

I lost all my friends. People avoided me. Conversations were strained. When I would approach a group, all talking would cease. People started wearing buttons in support of abortion and pro-choice politics, making sure I saw them everywhere.

More letters between Mr. Dopf and Dr. Pitkin followed with a promise from Dr. Pitkin that the department would respect the conscience of pro-life residents. Mr. Dopf and I discussed Dr. Pitkin’s response. Mr. Dopf wanted to be sure Dr. Pitkin’s response was adequate and that I felt satisfied. We both wanted to help future pro-life resident physicians. Dr. Pitkin’s letter satisfied me that future pro-life resident doctors would be free from harassment which resolved the issue. I heard later from other resident-mates that Dr. Pitkin stood his ground and that nothing had changed and I was defeated. Oh dear.

One good thing came as a result of my actions. As a result of our conversations, Mr. Dopf’s political connections came to realize Medicaid (Title XIX) paid for abortions in Iowa at that time. In January, two months later, Iowa passed a bill into law stopping Medicaid funding of abortions.

In time, the issue cooled and, by my last year of residency, I was again one of the group—sort of.

About four years into private practice in Burlington, IA, a pro-life patient of mine asked about my views on abortion, so I shared some of my story. That led to many speaking engagements and eventually a position on the board of directors of Birthright, a mostly Catholic crisis pregnancy organization. Eventually, I was asked to sit on their international board.

In private practice, I’ve worked almost exclusively with pro-choice doctors but I’ve always told them up front that I was pro-life and would leave the practice if any of them did abortions. So, life issues were not much problem. Unfortunately, the office staff would preferentially route abortion-minded patients to my pro-choice partners, so I saw few women considering abortion.

In 2004, my wife and I moved to Minnesota to be closer to children and grandchildren. (Four children, twelve grandchildren with #13 on the way!) I found work with a large health care organization. No abortions are done in the hospital at which I work.

After WORLD published my piece on the Hippocratic Registry of Physicians (Life and Death, June 20, 2009), my employer blocked my blog site, http://www.mdviews.wordpress.com, from their network. WORLD listed my blog site address at the end of the piece. I showed the article to some doctors and nurse friends around the hospital. Apparently, word got out that I had a blog and someone complained that my site contained inappropriate content since I advocated for the traditional family. My employer (specifically, the vice-president of nursing) viewed such advocacy as anti-gay and anti-unmarried-having-children-and-shacking-up. (“Very sad” read her e-mail describing my blog.)

So, in addition to facing possible government censure or loss of livelihood should Mr. Obama get his way, I can’t even view my own blog at work! I rank right up there with the pornography sites.

So at what price do I stand for life? Not much price, really. We 21st century Christians are a coddled bunch, I think. Consider Christians in the first and second centuries who were thrown to the lions for sport just for counting themselves as followers of Christ. Consider the reformers, Martin Luther in particular, hiding out at Augsburg for over a year to avoid capture. Consider William Tyndale, captured and killed for translating the Bible into English from Greek and Hebrew. Consider John Bunyon, imprisoned for not bowing to the Church of England. Consider David Brainard, missionary to the Indians in colonial America, developing tuberculosis and dying at the house of Jonathon Edwards. Consider Adoniram Judson, missionary to Burma, losing 3 wives to tropical diseases, then becoming ill himself and dying on board ship with no family or friends while trying to make it back to America.

So I can write my own story of discrimination and despair, but I feel silly doing it when I place it in the perspective of the centuries. But, having said that, one can possibly see economic sanctions and loss of livelihood on the horizon, and who can tell what next? Perhaps our sovereign God will deign for us persecution—real persecution—as our Christian forefathers faced. In all, my faith and hope rests in Him, “For from him and through him and to him are all things. To him be glory forever. Amen.” Rom 11:36 (ESV)