The ACA - Health Reform Explained

Today's Nifty PSA is pretty self-explanatory. Most of us haven't a sweet clue what the Affordable Care Act really says. This video helps to shed light on some of the mystery and misconceptions.

24 Hours In An ER

via USAToday

This video was created in 2009, but many of the issues are still current, especially with Romney/Ryan talk of stripping away even more of the safety net that we, as a civil society, currently have in place.

Take An Ambulance to ER....Really?

Livin' the dream in the Romney/Ryan America! 

On CBS 60 Minutes Sunday night, Mitt Romney surprised viewers with the suggestion that the uninsured would not go unserved under the Romney/Ryan new world order. Of course there would still be access* to medical care for the uninsured and the under-insured! Instead of dying alone in a cold-water flat, a 70 year-old in cardiac arrest can always call an ambulance and be treated in an ER!

Never mind the pesky problem of the heart-attack or stroke victim possibly being unable to reach a telephone or to dial for help. That could happen to an insured person, too (although a person with insurance who is able to visit a doctor regularly is much more likely to have had not only preventative healthcare but also safety measures in place for just such an emergency). Concerns like that do not figure into the Romney/Ryan calculus for smaller government.

What do you mean gutting
Medicare could leave seniors
high and dry?
Let them take ambulances!

Never mind that an ER is, by its very definition, a triage area where waits can be several hours and any treatment given is only intended to stabilize patients until they can be seen by their regular physicians. Oops! Uninsured patients rarely have regular physicians! That heart attack patient will only be stabilized and then sent home with an expensive prescription for stopgap heart meds and/or blood thinners and a stern recommendation to see his (non-existent) regular physician ASAP for follow-up care regarding actual treatment, surgical options and more personally-tailored drug therapy to treat the underlying condition - all prohibitively expensive for the uninsured. In other words, the patient will go home in almost the same condition in which he arrived and he probably will not receive any actual medical care for his underlying cardio-pulmonary disease.

Never mind that not only is the ER not the place for regular, preventative and wellness "health care", but when the patient receives the bills for that ambulance and ER visit (often thousands of dollars for ambulance transport and ER visit, not counting prescription medications), it could very well bring on the fatal heart attack that will finish him off. Of course, in the Romney/Ryan calculus, this may very well be a positive collateral effect.

Never mind all that. We ought to focus on the economic implications of candidate Romney's blithe assurance that no one need ever go without medical care under a Romny/Ryan regime because "we pick them up in an ambulance, and take them to the hospital".

ER treatment is among the most expensive of medical services and unpaid ER bills are one of the drivers of rising medical costs which make the USA the leader in the world in inefficient spending on healthcare. The vexing problem of the poor and the uninsured using the ER as a healthcare facility was one of the things Governor Romney cited as a good reason for passing his universal healthcare law in Massachusetts. Yet, now he describes it as an option for the proposed Romney/Ryan federal revamp of medicare and medicaid? How exactly does Mr. Romney think such an expensive form of medical attention will save taxpayers money?

Pimp my ride - ambulance edition!

Of course, he probably knows very well that such a backup "plan" for the uninsured makes no sense at all from a fiscal perspective, which makes it even more ridiculous coming from the candidate who claims he will run America like a successful business.  One is tempted to believe that Mr. Romney will say almost anything to avoid giving the President any credit at all for the improvements to healthcare made possible by the Affordable Care Act.

Perhaps Mr. Romney's stunning announcement was a secret message to the bottom 47% - those whom he is "not going to worry about" - that he plans to look the other way while all you freeloaders out there cash in on taxpayer largesse. After all, Mitt has already told us that millions of Americans - nearly half of the entire population, in fact! - are inveterate moochers, impervious to the efforts of productive citizens like Mitt and Bain Capital to get them to be responsible for their own lives. What can anyone expect, Mitt seems to imply, of the feckless rabble of incorrigibly lazy takers?

The Romney/Ryan plan for the future of America is one which not only repeals the Affordable Healthcare Act, but one which goes much further, ending current Medicare and Medicaid programs, too. But, Lord Romney does not see that as something the 47% ought to be complaining about. After all, if he and Paul Ryan succeed in getting elected, the soon-to-be uninsured seniors, veterans and poor children - like Reagan's "welfare queens" - still can (and probably will, damn them!)  ride in style to the ER since they probably won't have the decency to just expire in their slovenly digs and get off the taxpayer dime.  It's pimp my ride - ambulance edition!

No Health Insurance? No Problem. Romney Says That Freeloading In the ER Is Now All Good, Rick Ungar, Forbes Magazine, September 24, 2012.

Hey, maybe Gramps can mooch a
free scooter from the taxpayers, too.
What d'you say, Mitt?

Apparently, when 2002 Mitt Romney decided to divorce himself and split into two, distinct entities, the ‘other’ Mitt Romney gained possession of the Governor’s cognitive skills —including the ability to recall why Romney supported the Massachusetts universal care effort in the first place. It was, after all, 2002 Mitt Romney who often highlighted the inefficiency of emergency room care as the sole option for uninsured Massachusetts residents, allowing them to get free care while those who are insured are left to pay the bill.

It would also appear that it was the ‘other’ Mitt Romney who gained custody of the understanding that while our laws require emergency rooms to treat patients in an effort to stabilize their health condition, the law does not require the treatment that can ultimately restore all of these patients to health.

Mitt Romney, On 60 Minutes, Cites Emergency Room As Healthcare Option For The Uninsured, Huffington Post, September 24, 2012.

"Well, we do provide care for people who don't have insurance," he said in an interview with Scott Pelley of CBS's "60 Minutes" that aired Sunday night. "If someone has a heart attack, they don't sit in their apartment and die. We pick them up in an ambulance, and take them to the hospital, and give them care. And different states have different ways of providing for that care."

This constitutes a dramatic reversal in position for Romney, who passed a universal health care law in Massachusetts, in part, to eliminate the costs incurred when the uninsured show up in emergency rooms for care. Indeed, in both his book and in high-profile interviews during the campaign, Romney has touted his achievement in stamping out these inefficiencies while arguing that the same thing should be done at the national level.

Romney's New Health Plan: Go to the ER, Jonathan Cohn, The New Republic, September 24, 2012.

Not kidding, America.

It’s possible to believe simultaneously that ERs provide care to everybody who needs it and that they are an inefficient, expensive way to do that. But the Romney who made that statement in 2010 was making the case for having government do more to cover the uninsured, while the Romney who made that statement yesterday was making the case for having government do less.

And that’s really the most important point of all. Remember, Romney doesn’t simply want to repeal the Affordable Care Act, effectively taking health insurance away from 30 million people who, starting in 2014, are likely to get it from the law. He also wants to end Medicaid, making cuts that would leave between 14 and 27 million additional people without insurance. And he wants to change the tax treatment of employer health benefits, in ways that could make coverage more expensive or harder to get.

Medicare, Just Elderly Welfare Queens: And What IS Insurance Anyway? Heartland Liberal, Daily Kos, September 24, 2012.

What we are talking about here is the attempt by the Republicans to demote and denigrate the elderly on Medicare to the status of welfare queens. After all, they have been so successful with their past campaigns of demonization of target segments of the electorate, recently upping the ante and telling us that unions, teachers, firemen and policeman are the great drain on the economy, why stop now?

But it occurs to me what is totally missing from the Republican definition of the problem is the very simple and straightforward issue of just what is medical health insurance, anyway?

The Republicans seem to think that everyone, even those Americans at the poverty level, if they just set aside enough savings, will have plenty of money to cover all their medical expenses. After all, isn't personal responsibility the watchword of the Republicans?

But that is not how medical insurance works. That is never how it has worked, since it's current incarnation started really less than 100 years ago, nor is it how any insurance works.

*Emergency Medical Treatment and Active Labor Act, U.S. Act of Congress, 1986 (wikipedia)

The Emergency Medical Treatment and Active Labor Act (EMTALA) is a U.S. Act of Congress passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA). It requires hospitals to provide care to anyone needing emergency healthcare treatment regardless of citizenship, legal status or ability to pay. There are no reimbursement provisions. Participating hospitals may only transfer or discharge patients needing emergency treatment under their own informed consent, after stabilization, or when their condition requires transfer to a hospital better equipped to administer the treatment.

Move over, Welfare Queens! Granny the ER Queen is on a roll! (photo via daughternumberthree)

I Am My Brother's Keeper

        Sr. Simone Campbell speaks at the Democratic National Convention, September 5, 2012

Sr. Simone Campbell spoke yesterday at the Democratic National Convention and she nearly brought down the house. At times, she could hardly continue because of the applause. Please make time to watch her brief  (6 minutes) and moving speech.

This is the best of Christian ideology. How did the Republican Party's faithful lose their way?

"I am my sister's keeper. I am my brother's keeper!"

"Paul Ryan says his budget is in keeping with the values of our shared faith. I disagree."

Transcript of Sister Simone's remarks. 

“Good evening, I’m Sister Simone Campbell, and I’m one of the ‘nuns on the bus.’ So, yes, we have nuns on the bus. And a nun on the podium!

Let me explain why I’m here. In June, I joined other Catholic sisters on a 2,700-mile bus journey through nine states to tell Americans about the budget Congressman Paul Ryan wrote and Governor Romney endorsed.

Paul Ryan claims his budget reflects the principles of our shared Catholic faith. But the United States Conference of Catholic Bishops stated that the Ryan budget failed a basic moral test, because it would harm families living in poverty.

We agree with our bishops, and that’s why we went on the road: to stand with struggling families and to lift up our Catholic sisters who serve them. Their work to alleviate suffering would be seriously harmed by the Romney-Ryan budget, and that is wrong.

During our journey, I rediscovered a few truths. First, Mitt Romney and Paul Ryan are correct when they say that each individual should be responsible. But their budget goes astray in not acknowledging that we are responsible not only for ourselves and our immediate families. Rather, our faith strongly affirms that we are all responsible for one another.

I am my sister’s keeper. I am my brother’s keeper. While we were in Toledo, I met 10-year-old twins Matt and Mark, who had gotten into trouble at school for fighting. Sister Virginia and the staff at the Padua Center took them in when they were suspended and discovered on a home visit that these 10-year-olds were trying to care for their bedridden mother who has MS and diabetes.

They were her only caregivers. The sisters got her medical help and are giving the boys some stability. Now the boys are free to claim much of the childhood they were losing. Clearly, we all share responsibility for the Matts and Marks in our nation.

This is part of my pro-life stance
and the right thing to do...
We care for the 100%!

In Milwaukee, I met Billy and his wife and two boys at St. Benedict’s dining room. Billy’s work hours were cut back in the recession. Billy is taking responsibility for himself and his family, but right now without food stamps, he and his wife could not put food on their family table.

We all share responsibility for creating an economy where parents with jobs earn enough to take care of their families. In order to cut taxes for the very wealthy, the Romney-Ryan budget would make it even tougher for hard-working Americans like Billy to feed their families. Paul Ryan says this budget is in keeping with the values of our shared faith. I disagree.

In Cincinnati, I met Jini, who had just come from her sister’s memorial service. When Jini’s sister Margaret lost her job, she lost her health insurance. She developed cancer and had no access to diagnosis or treatment. She died unnecessarily. That is tragic. And it is wrong.

The Affordable Care Act will cover people like Margaret. We all share responsibility to ensure that this vital health care reform law is properly implemented and that all governors expand Medicaid coverage so no more Margarets die from lack of care. This is part of my pro-life stance and the right thing to do.

I have so many other stories but will only tell one more. In Hershey, Pennsylvania, a woman in her late thirties approached us. She asked for the names of some people she could talk to, because she felt alone and isolated. Her neighbors have been polarized by politics masquerading as values. She cares about the well-being of the people in her community.

She wishes they, and the rest of the nation, would listen to one another with kindness and compassion. Listen to one another rather than yell at each other. I told her then, and I tell her now, that she is not alone.

Looking out at you tonight, I feel your presence combined with that of the thousands of caring people we met on our journey. Together, we understand that an immoral budget that hurts already struggling families does not reflect our nation’s values. We are better than that.

So I urge you to join us on the bus. Join us as together we stand with Matt and Mark, Billy and his family, the woman in Hershey and the Margarets of our nation.

This is what we nuns on the bus are all about: We care for the 100 percent, and that will secure the blessings of liberty for our nation. So join us as we nuns and all of us drive for faith, family and fairness.”

Obamacare Coverage

A few words from the President which distills in a few minutes just why the Affordable Care Act is so important.

Also, Mano Singham gives an excellent brief review  of some of the reasons why continuing to put up with the current "system" makes no sense at all for the vast majority of Americans.

NPR reports that many doctors welcome the Supreme Court ruling that upholds Obamacare,  but, (as expected), they are also reporting that the Roberts grenade - calling the Healthcare provisions a "tax" - will indeed be deployed by Republicans seeking to use the ACA as a weapon against the president and Democratic candidates in their election campaigns.

Memo to Republicans:  That strategy will be a loser. People like and want affordable healthcare!

Speaking of losing strategies, Mitt Romney continues to campaign on the platform that he will repeal Obamacare on Day 1 if he wins the presidential election. No coherent explanation of how this stance squares with his confused stance regarding the embarrassing reality of his own Massachusetts healthcare law - aka Romneycare. Romney has had trouble striking just the right note of criticism for Obamacare without slamming his own effort at better healthcare in Massachusetts (which, incidentally, is highly popular in Massachusetts - people like affordable healthcare!). Romney wants to cash in on the success in Massachusetts while essentially saying that what was brilliant when he did it suddenly morphs into a disaster when President Obama delivers it for the country.

Hmmm. No wonder Mitt Romney is in difficulties. Good is bad, right is wrong, justice is injustice...oh wait. Romney is a religious man. He ought to be well-used to this sort of cognitive dissonance. Perhaps he won't have such a devil of a time with this after all!


Updated to add: This alternet article, Why Justice Roberts' Opinion Could Set Alarming Precedents, by Steven Rosenfeld fleshes out the reasons behind that uneasy feeling many people had yesterday when it was apparent that Chief Justice Roberts - a deeply conservative Bush appointee - had an ulterior motive for siding with the more progressive end of the Judicial bench. The tax/election red meat is only the tip of the iceberg, unfortunately. But, of course.


Also, it is always a good time to provide a link to PNHP (Physicians for a National Health Program).

The Affordable Healthcare Act Stands!

The news is good:  The Supreme Court has upheld the Affordable Healthcare Act in its entirety.  Chief Justice John Roberts wrote the decision for the majority, affirming the provisions for the act, including the individual health insurance mandate.

Roberts did manage to throw one big, meaty bone to the Republicans:

"The Federal Government does not have the power to order people to buy health insurance. Section 5000A would therefore be unconstitutional if read as a command. The Federal Government does have the power to impose a tax on those without health insurance. Section 5000A is therefore constitutional, because it can reasonably be read as a tax," Roberts said in his opinion. (emphasis mine).

Look for a quick turnaround in Republican campaign strategy now as they raise the spectre of new taxation.  This will no doubt inflame the teavangelicals and the rabid fringe (Bachman, et al). Supporters of healthcare reform need to get to work immediately to counter the inevitable lies and fear tactics leading up to the November election.

But for today, let us all celebrate the fact that for the second time in recent memory, the Supreme Court has done (mostly) the right thing:  The Affordable Healthcare Act has been ruled constitutional.

Here is a brief look at what that means to Americans as individuals and for businesses.

NPR coverage.

New York Times.

I'm still on the road, but will pull together as much information as I can, and will post links to sources and analysis.

Good Luck to Darth Vader Junior, Max Page!

Remember this wonderful VW ad featuring a pint-sized Darth Vader trying to magic things around his house and finally "succeeding" to his immense surprise?

The boy actor, Max Page - who also plays a character on the popular daytime soap "The Young and the Restless"- was born with a heart defect which requires surgery, which he will undergo this week.

Max, though understandably nervous about major open-heart surgery, is determined to put on the best face he can going in. But, even more admirably, Max and his family - along with the ad agency Deutsch - are using this opportunity to help raise money so that other kids with similar diagnoses can get the surgeries they need, too.

At a difficult time, a young boy - and his family and friends - still finds it inside himself to think of other kids who, like him, are facing scary health issues necessitating surgery but who, unlike him, may lack the financial resources or health insurance to get the heathcare they need.

Good luck to you, Max.  May your surgery go perfectly, your recovery run smoothly and swiftly and may you enjoy great happiness and success in your future endeavors!

This Won't Hurt A Bit!

Amber Cooper with her son Jaden

On NPR this morning, an interview with Amber Cooper - a wife, mother, worker and liver transplant recipient - reminded me to get cracking on a healthcare series. 

Amber Cooper had a successful liver transplant when she was ten years old. She grew up, married, had a child, bought a house and holds down a job. She is a great success story for liver transplantation. She is a great success story full stop.

Life-preserving drugs for transplant
patients, as well as for heart disease
and other chronic life-threatening
conditions cost hundreds, even
thousands, per month.

Ms. Cooper requires expensive medications every day of her life to prevent her body from rejecting the transplanted organ that keeps her alive.  Because of her pre-existing condition, health insurance was always going to be a challenge, but Amber had insurance prescription coverage with her employer - until recently. 

At an all-employee meeting, Amber learned that her company was changing their health insurance coverage and the new "coverage" would not cover any of her most urgent healthcare needs.  You can read or listen to the story.

This story is only one of thousands of stories of Americans who literally face life or death decisions every day because they have no access to affordable healthcare services.  Millions of other Americans have no or not enough coverage, and their stories will join these sooner or later. The richest country in the world has made a huge business out of health, life and death. And Republicans fight tooth and nail to preserve it.

I think it is time that people honestly ask themselves: is this morally defensible?

A group called Physicians For a National Health Program put up an excellent webpage with questions and answers that people might have about the relative merits of a single-payer healthcare system compared to the current for-profit system. While I do not agree with everything they have written (more in future posts), overall this page is an excellent source of information to help people form clear and concise responses to the common concerns that many people have about socialized healthcare.

I will end this brief post with one quote from the site linked above, which is, I think, the fundamental reality of our situation in the USA:

"Q. Won’t this result in rationing like in Canada?  A. The U.S. already rations care. Rationing in U.S. health care is based on income: if you can afford care, you get it; if you can’t, you don’t. A recent study found that 45,000 Americans die every year because they don’t have health insurance. Many more skip treatments that their insurance company refuses to cover. That’s rationing. Other countries do not ration in this way." PNHP FAQs.

"If you can afford care, you get it; if you can't, you don't."  Words to ponder.

In a just society, should decent healthcare be a privilege reserved for the wealthy?

Liberal Media, Godless Scientists...Murderous Doctors?

Will doctors refuse to play the "enforcer"?

I was recently thrilled to see a doctor stepping forward to call government intrusion into the private decisions of female citizens the outrage that it is. I think it bears reposting. Writing anonymously, the doctor made a case for principled medicine, and provided some tips on how doctors should practice civil disobedience in states where these ghastly laws are in effect. The essay was originally posted on the blog Whatever.  Also anonymously. I think that is disturbing.

Christian terrorism is rarely called
out by a cowed and cowardly media.

When citizens feel they can only speak out "anonymously", the chilling irony should not be lost on us - it should be ringing alarm bells. Loudly. People who still believe in the principles of equality and freedom, even if they do not agree that it might be a good idea to consult experts before writing terrible laws, ought to be worried when free speech is suppressed. People who value a free society should be horrified that there are citizens among them who are too frightened to speak openly when they disagree with the government.

Some doctors are angry about being used by the government to intimidate a subset of its citizens. They are rightly aghast at being compelled to be the brutal enforcers of this Republican governmental violation of women's most basic human dignity - doctors being forced by law to commit state-mandated rape as a method of anti-abortion rights coercion - when there is no medical reason for compulsory testing of this kind prior to an abortion. Some have begun to realize that part of the anti-abortion strategy is to undermine both their authority as medical experts and their trusted position in society. But most of these doctors remain silent.  And the very few who do speak out, tend to do so anonymously. Why?

Christian jubilation after the
murder of Dr. Tiller sends a clearly
threatening message to doctors.

One reason is pressure from within the profession. Some doctors are perfectly happy to put religious ideology over the welfare of their female patients and may privately support laws forcing their peers to bow to church authority.  Many other doctors are understandably alarmed by the violent rhetoric and physical harassment directed at pro-choice doctors by anti-choice groups, so they pressure their peers not to offer the full range of women's health services, not to speak out about the immorality of withholding appropriate medical care, not to make waves which could endanger them all. The few doctors who dare to protest unconstitutional laws based on religious ideology are intimidated into anonymity by threats to their livelihoods and reputations and even threats to their physical safety. They are presented with an ethical catch-22 situation: they know that invasive procedures - including vaginal penetration with an ultrasound wand against a patient's will and for no legitimate medical reason - goes against everything most doctors say they believe about doing no harm to a patient, but those who try to apply those ethics to women patients are threatened with prosecution if they disobey these draconian anti-woman laws.

Already wealthy, tax-exempt churches
lobbied for access to federal funds to
duplicate secular public services. The churches
can  supplement their grants with cash
from their own fat reserves and wait patiently
for the cash-strapped secular agencies
 to starve and shut down, leaving the field
clear for a total church takeover.

The intimidation of doctors is just the latest in a steady round of attacks on traditionally respected professions by an unholy alliance of religious and corporate elites and their political arm, the Republican party. Their long term strategy is to replace the current political system in the United States - democratic republicanism - with an authoritarian theocratic regime: a Bible-based government, led by godly men and answerable only to God (whose "commands" are, naturally, communicated only through those same godly men). That strategy has relied heavily on the tactic of stirring up fear, suspicion and resentment to undermine public confidence in an array of once-trusted professions while simultaneously planting and building churches around the country. The targeted groups have long been hated by religious hardliners and wealthy, powerful elites because of their relative inability to control the information coming from these sources. The goal is to replace the secular resources that serve society with church-controlled resources.

Republican candidates like
Rick Santorum vied for the title
of "most devout Christian"
to the delight of the
religious elites.

Republican strategists capitalized on the natural (but usually milder) anti-intellectualism that is common in a population that believes it can point to its own physical strength, raw ingenuity and dogged determination for the country's success as much as, if not more than, the work of highly educated, high-falutin' "experts". When tough economic times hit the middle class hard in the late 70's and again in the early 90's, those smoldering resentments were all too easily fanned into the raging flames of a culture war. Government agencies (It's not Uncle Sam, it's big brother!), scientists (godless evilutionists!), teachers (lazy, freeloading glorified babysitters!) and journalists (It's not the free press, it's the commie, liberal media!) were the first casualties of the manufactured "populist" rejection of formerly respected experts and secular representatives of peoples' interests. Political operatives worked hard to sow doubt, distrust and contempt for the essential human resources upon which a civil society relies and they have succeeded to an alarming degree. Where once a public servant's religious views were a non-issue, today virtually any candidate for public office in the USA must pass a religious test - specifically must display Christian bona fides - to have any hope of winning a nomination.

The attack on medical doctors - probably the most trusted profession in the modern era - is a part of this series of attacks on the secular foundations of American society. It is not accidental that doctors have joined scientists, teachers and journalists in the crosshairs of Republican operatives. Like scientists and journalists before them, doctors as a group were once able to work fairly independent of ideological influences. Individual doctors brought their own beliefs to their practices, of course, but the profession as a whole was not under pressure to conform to a particular politicized religious ideology.

This state of affairs could not be permitted by the Republicans or their powerful backers. Authoritarian political systems demand ideological purity and social conformity, so doctors - like journalists and scientists before them - posed a threat to the political ambitions of the Republican party, especially in terms of their strategy to use abortion as the rallying "cause" which could impassion voters enough to vote blindly against their own interests. If left unthreatened, doctors might challenge the lying propaganda that the anti-abortion movement was spreading and puncture the bubble of misguided passion the religious right had so carefully blown up. If permitted to retain their respected and trusted position in society, doctors might undermine the attempts of religious political operatives to replace trusted public resources with private Christian agendas.

Prison for doctors?

Hence the push for legislation which targets doctors as well as women. When pressed to say what penalty abortion should bring to a "guilty party" should their dream of criminalizing abortion be realized, anti-abortion leaders usually shy away from suggesting a punishment for the women involved (probably sensing that it would be a loser at the polls), but nearly all declare that, as the "butchers" who "kill babies", doctors should be thrown into prison for murder. Sensing the target on their backs, doctors have fallen silent as wave after wave of unconstitutional and medically unsound legislation has been passed, heaping untold misery upon women.

Thus, the goals of the Republican party may soon be achieved. Doctors may be rightly disrespected for standing silently by as the medical ethics they claim to believe in are violated by these laws: as women are grossly mistreated, legal medical procedures are withheld - even in potentially life-threatening situations - and patients are harmed by bad medical practices. Furthermore, doctors may be rightly distrusted by women (and many men) for many of the same reasons, in addition to the betrayal of doctor-patient trust upon which competent health care must rest.

If principled doctors fail to act to stop this looming crisis of public confidence, the consequences for society extend far beyond the impact on doctors and women. The public confidence has been successfully undermined in the media, in teachers and in scientists with predictably terrible results. Religious conservatives may claim that their holy books can provide all of the answers to the needs of humankind, but even science's most vindictive critics turn to medical science for help when a health crisis occurs or - irony of ironies! when they need assisted reproduction using technology developed through evolutionary science - while they work tirelessly to deny that opportunity to others. Should they, and other hypocrites like them, succeed in convincing enough people that doctors, like teachers and scientists, are not respectable authorities who can be trusted, then to whom will the people be able to turn when they need real assistance?

Keeping a low profile and hoping that this madness is only a temporary cultural spasm fueled by a fringe group of religious fanatics will be a mistake. It did not work for scientists, teachers or journalists.  It did not work for the people who believed such radical theocrats could never seriously win elections and form governments. It has not been working - with frightening consequences - and the situation will only get worse as long as professionals shrink back fearfully from challenging the lies and disinformation that are being deliberately disseminated to undermine public confidence in them. I am encouraged by the letter I linked to at the top of this post, but it sure would be nice to see many more doctors stand up and say "Enough is enough!".

The manipulation of public trust in doctors, scientists, teachers, the media, and even their elected representatives is a dangerous power play by the conservative right wing. Destroying trust in the resources best-equipped to provide the public with the services it needs is a strategy which has had terrible consequences for millions of people, and ultimately could tear apart the very fabric of our civil society.  That is a game that should never have been played.