New England Journal of Medicine wants Hobby Lobby to lose

Where do the religious rights of a health insurance purchaser end? The New England Journal of Medicine brings up a point I've made before, not here but in conversation: If an employer is a Jehovah's Witness and thus objects to blood transfusions, then can they refuse to pay for health insurance coverage for an employee's blood transfusion? No, because it is objectively ridiculous to refuse blood transfusions. But, on a less ad hominem level, it seriously risks the health and life of an employee who may need a blood transfusion.

But more importantly, it's not your employer's decision whether you get a blood transfusion. It's not your employer's concern what you do with your body when it comes to your and your doctor's medical decisions. Because holy crap, why on god's green earth would you ever order your doctor to consult with your boss when you're about to bleed to death after a car crash or during complications from surgery?

In the Hobby Lobby case, an employer who religiously objects to contraception wants to refuse to pay for health insurance coverage for contraception. But why is this any different at all from an employer who may object to paying for blood transfusion coverage? The payor has a religious objection to something medical a third party wants to do. And there's a power differential, of course -- but it's not like a parent who has a real say (and duty) to oversee their child's medical care. So why is this literally a federal case?

Just like with a blood transfusion, it's a private medical decision that doesn't involve the employer at all. And just like with a blood transfusion, when patients get the contraception they ask for, then they're more healthy:

If the full panel of FDA-approved contraceptive services is made available to American women, the public health of the country will benefit. If a woman's religious beliefs compel her to decline such services, she has the right to do so. But to deny coverage for these vital public health services to women who want them but cannot afford them outside their employer-sponsored insurance would be a personal and public health tragedy.

To be absolutely clear, the only difference between not covering blood transfusions and not covering contraception is the gender of the patients who need it. Never mind the privacy issue, because if it were a privacy issue, then the case wouldn't have made it to the Supreme Court. Nobody would dream of allowing a "blood transfusion exception" to the health insurance coverage requirements of the Affordable Care Act, because it's completely absurd. No, this is squarely a gender discrimination issue. And NEJM puts it in terms of equal protection and full self-actualization:

[P]lanned pregnancy affords women and their children a better quality of life: it gives younger women the opportunity to complete school, start careers, and establish stable relationships, and older women the ability to add to their families only when they have the capacity to care for them.

Recall that this was what Justice Ginsburg said in 2007. Restrictions on access to reproductive healthcare prevent women from "enjoy[ing] equal citizenship stature" and deny them "autonomy to determine [their] life's course" (Gonzales v. Carhart, 550 U.S. 124, 172 (2007) (Ginsburg, J., dissenting) (PDF)). In this case, just as in anti-abortion cases, women risk losing full autonomy and citizenship. It's not a tax issue; it's not a privacy issue; and it's not an anti-President Obama issue. It's a woman's issue.

On stealing $17,000 in cash from a charter school's office

And in a libertarian paradise where anyone can open an under-regulated charter school, a head office without a lick of business sense can lose $17,000 in cash when someone steals a safe full of money:

The 200 pound school safe was stolen from the CEO's office over the Thanksgiving holiday weekend.

It contained roughly $17,000 in cash the students had raised this term from the sale of candy and baked goods. It was money designated for school projects and essential supplies.

Why were the funds sitting in cash in the office? They couldn't possibly have intended to buy supplies and run projects with actual cash money, could they? Didn't they do daily runs to the bank to deposit the incoming cash? Who runs any kind of business this way?

The added problem for the school is they still owe the candy company and other vendors some $12,000.

No, seriously. Were they going to pay these vendors in cash?

And whoa, Nellie, that's a lot of money for candy and cupcake sales.

I think there are two types of charter school founders. One, you have sincere people working in good faith to open a school that will serve their kids better than the neighborhood options, but who aren't actually educators, school administrators, or businesspeople. You don't have to have any particular qualification to start a charter school; you just need to be able to file paperwork. (An opportunity for the underemployed with a "flexible J.D.," perhaps?) These are the types who risk running the schools into the ground through incompetence.

But you also get slick operators will game the system and rob the children and school districts blind. Which scenario do you think happened at West Philadelphia Achievement Charter Elementary School over Thanksgiving weekend? The school's CEO has a Ph.D. from the University of Pennsylvania in educational leadership and worked as a financial analyst before founding the school. Why would her school keep $17,000 in cash in a safe on-site?

Private ambulance service closes, giving you what you ideologically pay for

When a business owner can't make a profit, they close up shop. And in a libertarian paradise where government services are outsourced to private, for-profit third parties, that means ambulance companies may close up shop, too:

A private ambulance service that transported more than a half-million patients a year in six states abruptly shut down without explanation, leaving dozens of cities and towns scrambling for medical transportation options Monday without a word of warning.

First Med EMS, based in Wilmington, N.C., served hospitals and other medical facilities in more than 70 municipalities in Kentucky, North Carolina, Ohio, South Carolina, Virginia and West Virginia. It operated under the names TransMed, Life Ambulance and MedCorp[.]

It's not clear whether the outsourcing deals required First Med EMS to give anyone notice that they were leaving the medical transportation biz. After all, there's no law saying that any ordinary for-profit concern has to tell their customers that they're not going to open their doors from one day to the next. Sure, you have to officially wind down the business and pay your last rounds of taxes and settle up outstanding accounts and bills. But you can take a long time doing it, if you like, or even declare bankruptcy and drag the process on for years. And it's not as if you have to alert the media or call the county to put the government on notice, because mostly, it's nobody's business.

Medical facilities said the shutdown took them by surprise, too, and at least one county -- Bertie County, N.C. -- declared a state of emergency at noon Monday. The county board of commissioners said in a statement that it would pursue legal claims against First Med.

Oops. But I do wonder what kind of contract was in place. And I wonder what rhetoric was used to convince the county that outsourcing its ambulance services was a good idea. Operating a medical transport service isn't the same as running a taxi company. And libertarian paradises are all fun and games until people can't get to their dialysis appointments because somebody decided an ambulance is nothing more than a taxi with flashing lights.

Monday morning grousing about bad parenting, booster seat edition

The further I get away from having a baby in my house, the less tolerant I am of babies and small children and their moron parents. Who in the world would perch a booster seat on top of a kitchen stool? A parent who's lucky their child fully recovered from a skull fracture, that's who.

When my daughter was little, I seem to have had a window where I liked, or at least put up with, other people's children. Now I think I'm back to the "childfree" tendencies I had before I dove into parenthood. Though where I didn't like kids too much back then, now it's more that I get irritated at children's misbehaviors that I think they wouldn't exhibit if their parents would just put some time into thoughtful parenting.

Almost as irritated as I get at misleading headlines. That article's headline mentions high chairs, but the skull fracture child was injured because the parent had strapped her into a booster seat and hitched the seat to a tall chair. Predictably, the now top-heavy piece of furniture fell over when the child pushed against the kitchen counter. Jesus, what a stupid, avoidable injury that could have been a real tragedy.

Friday jukebox: The Specials

Drexel Law is Drexel Law again, follow-up

Of course, the most reasonable explanation for Drexel Law's ending its naming rights relationship this week isn't that Earle Mack has been spending his days hunched over a computer, looking at the school's statistics and becoming disillusioned with his namesake. It's far more likely that the school simply failed to continue cultivating the relationship with its donor. You can't just take the $30 million and run; you have to keep in touch with the benefactor. To be clear, I don't know that the school administration wasn't on the phone to Mack's secretary twice a week. But I do see that they don't have their own dedicated officer for institutional advancement. There's not even much outreach to alumni, from what I can see on the Events and Continuing Legal Education ("There are currently no scheduled Continuing Legal Education events") listings.

Here's something I notice looking at the make-up of the school's faculty and staff. Outside of administrative support, Drexel Law is run by ex-lawyers, law professors, and former court administrators. But what you don't see in the faculty and administration bios are individuals with a background in actual academic administration. Do law schools get tripped up with their own myth of the "fexible J.D."? Or has Drexel Law, at least, done so? You need professional academic administrators to run an academic institution.

You need institutional advancement professionals to maintain positive, long-term, fruitful relationships with past donors. It's way beyond having a little public ceremony to announce a gift. When there's a donor who gives $30 million to an organization, it needs to be a specific person's job to reach out to that person multiple times per year to check in, visit personally, chat them up over an expensive dinner, and explore the future of their contribution to the institution. A benefactor who is not cultivated will feel no reason to continue funding a gift, or to ever give again, or to suggest their past beneficiary to their rich friends.

It's not rocket science. It's Institutional Advancement 101, and it's based on what your mom was trying to teach you when she sat you down to write thank-you notes for your birthday presents.

But beyond the 101, this is an entire discipline. Practicing law for a few years doesn't prepare you for academic fundraising, even if you focused on tax law or served on a couple of non-profit boards. Never mind if you've been the ivory tower your entire career, or if you worked for the government. The organization has to hire actual professionals in the field of academic or nonprofit development.

Who knows what Drexel Law's development strategy is. Likely everything is channeled through the university's development office and they have little control over the big institutional advancement picture. But from where I'm sitting, it really looks as though someone at Drexel Law dropped the ball in this particular relationship, and that is a huge blunder.

Drexel Law is Drexel Law again

Drexel University's law school, inaugurally known as its College of Law, then re-named after commercial real estate magnate Earle Mack, has now been re-re-named the Drexel University College of Law again. Tongues are being wagged; tweets are being tweeted; and a few alumni colleagues of mine have questions.

Didn't the alumni association just start an "@earlemackalumni.org" e-mail service?

The announcement said it was a financial decision considered mutually between Mack and the law school. But couldn't Mack simply liquidate some of his portfolio, or place it in the instrument funding the naming rights? He must have actively wanted his name off the school. Did the administration piss him off personally? Does he object to the new two-year J.D. scheme?

Is it Drexel Law's little bar passage problem? The declining gender and ethnic
diversity among its student population? The dropping U.S. News ranking?

Is there another sugar daddy waiting in the wings?

Does this mean all that swag and my diploma are collector's items, now?

One particularly cynical alumnus is predicting the imminent death of the law school, once the university decides to quit subsidizing it, not seeing a reasonable ROI on the perceived prestige of having a law school attached to it. I'm not sure I'd go that far. But I do think Drexel Law is apt to become eastern Pennsylvania's Duquesne -- the also-ran school in Pittsburgh that you can never recall when you try to list all the law schools in the Commonwealth, whose grads also seem to struggle a little with the bar exam, but out of which you can probably wrangle a job in a small firm or government in western or central Pennsylvania once you do pass, especially if you're Catholic.

Kind of like Villanova Law and employment in southeastern Pennsylvania. Burn!

So, will Drexel Law still exist in 10 years? Will they find a new buyer for the naming rights? Will anyone call the school by that name, or will it be like Temple Law, which nobody but the bumper stickers refers to as the Beasley School of Law?

Full e-mail sent to alumni under the cut:

Reminder of the days before Griswold

Posting this to remind people what life was like for American women before Griswold v. Connecticut:

Before the 1965 Griswold ruling, states were allowed to outlaw contraception, even to married people. Let that sink in. Before 1965, it was illegal in many states for married women to get birth control. And it wasn't until 1972 (Eisenstadt v. Baird) that the Supreme Court found fit to reject bans on contraception for unmarried people.

This isn't just within living memory; these results are actually younger than a lot of people in my generation -- I was born in the early 1970s.

So when I ran across this ad a few days ago, in a magazine called Personal Romances, aimed at teen girls and young women and published by the Ideal Publishing Corp. out of New York, I kind of felt blindsided. I knew, intellectually, that my parents hadn't had access to the pill and diaphragms and condoms and so on, as easily as I had by the time I was sexually mature. And of course I know the basic facts behind Griswold, Eisenstadt, and their progeny. But there's knowing the cases and the penumbral convolutions of law they led to; and there's living in a world where you can't plan the next few months of your life -- never mind the next 20 years -- because you don't know if you're going to get pregnant, and you won't be able to terminate the pregnancy because it's not yet 1973.

Maybe you've had a baby or two, and your family feels complete. Or the pregnancy experience was terrible. It damaged your health; or your marriage is in bad shape and you don't want to bring another baby into the mix; or (literally) heaven forbid you'd simply like to have sex without marriage or babies or both. I can't imagine being in these positions, because by the time I was at university I could get free condoms at the student center whenever I wanted them. Contraception wasn't controversial.

When did contraception become controversial again?

Note that one of the biggest selling points of the gadget up there is that it's "sanctioned by churches of all denominations." These are the same churches who are behind the Hobby Lobby case and the hilarious assertion that the only thing preventing the Catholic church from supporting health care for sick Americans is that Obamacare pays for pills. But religious oppression is the same, whether it comes in a Supreme Court opinion or a plain paper wrapper. And I'm very sorry to say I'm not optimistic about the result we'll see in June in Hobby Lobby.

Meet the new Anabaptists; same as the old Anabaptists

Gay members of an anti-gay church are shocked, shocked that the church is seeking to suppress them.

I feel like a blog-writin' version of "let me Google that for you." Look, Circle of Hope traces its roots to Anabaptist Christians called the Brethren in Christ. Whether they're a subset of Mennonites, or Mennonites are a subset of the Brethren in Christ, or they're parallel groups, I'm not entirely sure. But the main idea here is that they're Anabaptist Protestants! This is the same place the Old-Order Amish come from. They're not going to dig gay people, no matter what the young, hipster-y Circle of Hope congregation says to get them to their meetings! And it took me about three clicks to affirm my suspicion that a modern group of Anabaptists opposes same-sex relationships (PDF), considering them as sinful against their deity's plan for adult relationships as adultery, divorce, and spousal abuse. Though, to be fair, since the Brethren in Christ are modern Anabaptists, they're OK with homosexual inclinations -- so long as they're not acted upon.

Now, there does exist a Brethren Mennonite Council for Lesbian, Gay, Bisexual And Transgender Interests, which seeks "to cultivate an inclusive church and society and to care for the Mennonite and Brethren lesbian, gay, bisexual, transgender, and allied community." The suppressed members of Circle of Hope's congregation should look into starting up a local group.

H/T Ryan Briggs at the Philadelphia City Paper.

Don't smile for the camera, citizen

Got a driver's license in Ohio? Then your state Attorney General has added your face to a database where it can be checked against faces of criminal suspects. Announced this week, the A.G. has been using this system all summer before telling every driver in Ohio that they are presumed guilty of a crime before facial-recognition software determines that they aren't.

ACLU of Ohio is calling it a privacy problem. I don't think it is, because you don't have a reasonable expectation of privacy in your driver's license photo. You have to show it in many situations; and driving is a privilege, not a right. The problem is one of due process.

I mean, fine: test my driver's license photo against the photo of a crime victim (or the reconstruction of their face) or some unidentified person to try to put a name to a body or find someone. But don't take that photo and test it against enhanced surveillance photos of unidentified perpetrators of a crime! In the first case, the assumption is that I'm an ordinary suspicionless citizen who may be the victim of a crime or misadventure. In the second case, though, the assumption is I'm a suspected criminal.

First case: All drivers are beneficiaries of police protection.

Second case: All drivers are suspected criminals subject to police action against them.

Holy deprivation of due process, Batman!

Over half the states are using this kind of scheme. Not sure if your state is one of them? Ask yourself this: last time you got your driver's license photo taken, is it the rule that you're not allowed to smile? (Note about that link: the infographic indicates that Ohio doesn't have a facial-recognition system, though the article was posted only in June. How many other states do you figure provided incorrect or incomplete information?)

The day after the funeral

Back to work after attending what I believe is my eighth funeral in as many years.

I think the ritual is very important, at least for most people, to help them mentally shut the door on the relationship they had with the deceased and get on with their lives. The ritual doesn't need to encompass the full suite of wake, viewing/visitation, religious ritual, trek to the cemetery, graveside ritual, and final reception. But I tell you what, I come away more emotionally satisfied and ready to face work the next day when I'm leaving the end of a full Catholic send-off than when I've attended a brief meeting in a funeral parlor.

Must be the incense. Or the obligatory references to prayers for the unborn, which will come as surely as will the Protestant "sinners in the hands of an angry God" warnings to choose the right kind of resurrection when it comes to the listeners' own turn to go to sleep and await the event.

Was much more involved in arrangements this time than I've ever been previously. Medical ventilators are violent things. Coffins, vaults, and related services are expensive. Embalming is bizarro. There should be a website called "remove-your-damn-ballcap-when-you-enter-the-funeral-home dot com." And everyone is unlikely to be truly prepared for the actual volume of legal paperwork afterward.

And so I've spent some time today getting over my trauma -- which can't possibly compare to that of the deceased's immediate family -- by reading up on end-of-life practices in North America and round the world.

Also reviewing my advanced health care directive.

Voter ID, the death of the Voting Rights Act of 1965, and the 19th Amendment

The Pennsylvania voter ID trial begins today. I still think voter ID laws are a 19th Amendment issue.

Who changes their names after marriages and divorces? Women.

Who has to run the paperwork gantlet to get a new driver license or passport, digging up marriage certificates, divorce decrees, and birth certificates or sending away to out-of-state agencies for proof that they're who they say they are, only to risk being turned down by a DMV functionary who orders them to transfer the title of their home into their maiden name (PDF)? Women.

Who are disproportionately represented in the Pennsylvania anti-voter ID case? Women (PDF).

And I'll go there. You think the prisoners fasting for Ramadan in Gitmo, or the 29,000 prisoners in California, are the first to go on hunger strikes for their cause? They're only the latest. Who was force-fed during their struggle for the right to vote? Women.



A hundred years ago, Emily Davison was about my age when she was killed attempting a theatrical gesture for women's suffrage. A 7-minute doc includes a film clip and calls her "a radicalized woman with nothing to lose" (4:10). Though she probably wasn't a suicide and never intended to be a martyr, she had a hero's funeral.

You can roll back the business end of the Voting Rights Act of 1965 and implement anti-voting measures right away, but it can't end well. The little old ladies with no driver licenses will die off. Those of us born before all the birth records were digitized or originated on the computer will get our acts together and get the right ID. And people my daughter's age, who were in the computer from the get-go, won't have a problem getting their voter ID. Requiring state-issued ID and then making it hard to obtain is not a sustainable strategy. And it won't be too long now before that daughter of mine is voting.

Since, after all, your grandfathers and great-grandfathers were so gracious to vote for the 19th Amendment.

Employers should embrace paying for health insurance, because abortions should be rare

Just as I don't understand why a health insurer itself would decide to cover pregnancy and birth costs (some $20,000 per event, and most women who do it once do it at least once more) but not pay for birth control (some $360 per year for pills, less for an IUD per year over its lifetime), I don't understand why an employer would be happy to pay for pregnancy and birth insurance, plus the real risk of high turnover among its female employees, but refuse to pay for birth control insurance.

I'm a small business owner. I've been one for years, and I spent a good part of the 1990s as a successful small business owner who hired employees. When I've had employees, I've paid for their health insurance. And I will in the future, if I ever get into the position where I can hire them again, even if the number of employees is below the Obamacare mandate threshold. Why? Because it's good business. It's cheap -- you have to do some research and some math, but it's not terribly expensive per employee. In the 1990s, I found a trade association that hooked us up to a group that tailored its plan to small businesses (even tiny ones, like mine) that wouldn't have been able to negotiate a good deal on their own. I bet there's a trade or professional association for every darn industry out there, and I bet to a one that they have affiliate health insurance programs. I know my local and state bar associations do. A business owner who doesn't do this research and math in their own industry just isn't doing the best job they can do as a business owner.

To be clear, I don't recall the numbers offhand, because it was over 15 years ago and the paperwork is long gone. And the numbers weren't negligible, and the 1990s was a very easy decade to make money in the industry I was in, and my employees were young, healthy people. But offering health insurance to them was worth every penny we spent on it. Combined with a reasonable sick and vacation day policy, the work environment allowed a sick employee to stay home, see a healthcare practitioner, and get back to work quickly. They didn't lose productivity, coming into work because they felt forced to though they were feeling lousy, getting everyone else in the office sick. And for the love of Christ, I never asked the women about their birth control. (Though I do know that if they were on the pill, they were covered, because they got the same coverage I did, and you know damn well my pills were paid for.) And you know why? Because one, it's none of my goddam business. And two, I didn't want "these fool feemale women" having unintended pregnancies and bringing drama and grief to the office, and needing time off.

And three, because there's that Clintony pro-choice line that abortion should be "safe, legal, and rare." Anti-choicers jump on that, with their favorite gotcha: "Why rare? If abortion is OK, why do you agree that it should be rare? You must actually think it's not OK, or else you wouldn't say it should be rare. Gotcha!" That "gotcha" is a logical fallacy. Do you see it? They beg the question as to Clinton's premise for why abortions should be rare. The reason isn't that pro-choicers think an embryo or fetus has the same right to life as the woman gestating it. The reason is that any abortion, even a very early or straightforward one, takes resources. It takes a woman away from her work or studies for multiple trips to the clinic or hospital (plus a trip to court if the patient is a minor in a state where she needs to get a judicial bypass around the parental notification law). It takes money, both in the cost of the procedure and travel costs to get it, plus lost wages from time off work. And it takes an emotional toll from the stigma, drama, and grief largely inflicted by the religious right.

Abortions should be rare because they cost women time, money, and work and educational opportunities. Abortions should be rare because they cost employers money. Oops, I think that makes me a capitalist! But hey, it's not me who wants abortions to be rare. It's just good business.

Proposed: the Indiana Church of Homo Matrimony

You know what the state of Indiana needs? A church the only doctrine of which is same-sex marriage in the great State of Indiana. It should be called the Indiana Church of Homo Matrimony, and its greatest -- because only -- sacrament would be same-sex marriage. Which is a misdemeanor for a pastor to solemnize in Indiana. And I dearly, dearly want to see the pastor of the Indiana Church of Homo Matrimony to be arrested and charged for performing their congregation's most holy act. The law in question, via ThinkProgress and AmericaBlog:

IC 31-11-11-7 Solemnization of marriage between persons prohibited from marrying Sec. 7. A person who knowingly solemnizes a marriage of individuals who are prohibited from marrying by IC 31-11-1 commits a Class B misdemeanor.

A "Class B misdemeanor" in Indiana can set you back $1,000 and a half-year in jail. That's a lot of collection money going out the door, and a lot of Sundays with an empty pulpit.

You know, the Founding Fathers foresaw the trouble that comes when the state gets involved in deciding religious questions. As they put it when they were debating the text of what became the First Amendment, it's all fun and games for the legislature to mandate bible instruction in public schools, until you find out that the bible to be taught isn't your bible. Wars have been fought and countless people have been executed for hundreds of years over theological questions from "Should women be allowed to preach?" to "Which of the dozen commandments over multiple chapters and books are the actual Ten Commandments?" And when the government lays out religious doctrine as law and public policy, everyone except for rich, connected men loses.

Which, of course, is the point. It's the real reason underlying invasive, liberty-destroying restrictions on abortions: keep women from controlling their own reproduction, and they'll have to juggle duties at home and work, which keeps them from focusing on work as hard as their co-workers with fewer perceived home-based responsibilities (read: dads, and child-free men), which keeps them from being in a better position to bargain for higher wages and more power in the marketplace and the political arena. Keep young women from terminating unwanted pregnancies, and they'll have exponentially more trouble to finish vocational training or a college degree, which keeps them from fully actualizing themselves and earning more money.

And note that however it's done, when women don't earn decent money, they don't pay much into Social Security, which hurts both Social Security in general but also, and more importantly, themselves in particular, when they've retired (ha-ha) and receive smaller payments than what they would have seen if they'd had the credentials to earn higher paychecks in the first place. Again, fully actualizing themselves. (Which is why Justice Ginsburg practically begged women's rights proponents to give up on due process and aim for equal protection -- the strategy that finally worked against DOMA -- to attack abortion restrictions: privacy isn't the issue, because restrictions on abortion prevent women from "enjoy[ing] equal citizenship stature" and deny them "autonomy to determine [their] life's course" (Gonzales v. Carhart, 550 U.S. 124, 172 (2007) (Ginsburg, J., dissenting) (PDF)).)

But you know what is still available to a woman? Going to Indiana and starting up a church whose sole practice and faith is solemnizing same-sex marriages.