Instead of just tying health care reform to the train tracks and letting nature take its course, Lieberman had to kick the Dudley Do-Right Dems when they were down, waiting until they had confidently announced an impending compromise to reveal he was against the plan. He chose to do this on Face the Nation.

Watch CBS News Videos Online

According to TPM, Lieberman has threatened to filibuster over the expansion of Medicare to those 55 - 64 years in age.

This should be no surprise. After all, Lieberman's relationship with the Democratic Party has generally gone like this:

Yglesias also points out that unless Democrats are willing to push for reconciliation, Lieberman, Nelson, and the Republicans have them over a proverbial barrel:

Can't liberals be just as stiff-necked as Lieberman? Sure, they could. But liberals members do have an incentive to compromise-the tens of thousands of people who die every year for lack of health insurance. The leverage that Lieberman and other "centrists" have obtained on this issue (and on climate change) stems from a demonstrated willingness to embrace sociopathic indifference to the human cost of their actions.

Speaking of sociopathic indifference, there are two major developments on the women's health front- neither of which appears geared toward improving the actual lives of women.

Senator Ben Nelson, saddened by the defeat of his "this is not extending Hyde...but it really is" amendment, swears to fight on, saying that he can't support a bill that doesn't allow him to get his way. Interestingly, back in 1991, Nelson's anti-abortion stance put him in a precarious position within the Democratic party. Now, the Democrats are no longer as staunch in their defense of a woman's right to choose, which has allowed Nelson to gain some traction.

Meanwhile, the recent advisement about changes to breast cancer screening guidelines has become the latest political football, with both Democrats and Republicans dog-piling on the issue. But make no mistake - this is done to score points, not to do something silly like figure out what is best for women. Dems want to prove that Republicans don't care about women; Republicans want to win back female voters.

The end result? Who cares about that?

Welcome To The Lieberman Administration [Think Progress]
Health Care Reform In Peril; Lieberman Threatens Filibuster Over Medicare Buy In [TPM]
Nelson: Won't Vote For Abortion Language [UPI]
A Senator's Moral Dilemma On Health Bill [Washington Post]
Mammograms As Political Weapon [Politico]

Earlier: New Breast Cancer Screening Guidelines Spark Confusion, Criticism

[New York, December 10. Image via Getty]

NEW YORK - DECEMBER 10: Police prepare to arrest a woman blocking the front door of the building where Sen. Chuck Schumer's office is located December 10, 2009 in New York City. Around ten protesters advocating for expanded Medicare insurance benefits and unhappy with Sen. Schumer's recent health care stances were arrested by New York police after blocking the entrance to his offices in midtown Manhattan. (Photo by Chris Hondros/Getty Images)

Passing a reform bill is close, but it's becoming increasingly clear that it may not be what people hoped for. Outside of ending the insurance industry's discriminatory practices, all kinds of compromises are being made that may not be in the best interest of the people who need this plan. In fact, Nancy Pelosi continues to back away from the public option:

House Speaker Nancy Pelosi (D-Calif.) has strongly supported the proposal to create a government-run health insurance option, but she left the door open on Thursday to accepting a health reform compromise from the Senate that does not include a public option.

"We in the House believe that the public option is the best way to hold insurance companies honest — to keep them honest and also to increase competition," Pelosi said at a press conference today, reports CBS News Capitol Hill Producer Evelyn Thomas. "If there is a better way, put it on the table. As soon as we see something in writing from the Senate, we will be able to make a judgment about that."

Senate Democrats are currently considering a set of proposals — including expanding Medicare and creating national, private plans for consumers — in lieu of a public option. Some of the public option's strongest advocates, like former Democratic leader Howard Dean, have said they like the Senate plan. Liberal grassroots groups, however, are adamantly opposed to it.

Pelosi has shifted to promoting the Medicare buy-in:

The speaker stopped short of embracing the broader contours of a fragile compromise worked out by liberal and moderate Senate negotiators in an effort to nudge forward broad changes to the health-care system. Still, she said: "There's certainly a great deal of appeal" to expanding Medicare.

Such an expansion is an old idea among Democrats, but one that was largely absent from this year's congressional health-care debate before it made a Phoenix-like appearance in recent days. The "buy-in," as the idea is known, is intended to help 6.5 million Americans who lack health insurance or purchase expensive policies on their own. They are in an age group in which medical problems become more common and coverage is particularly expensive.

But how many of those people could afford to sign up — and how many would prefer the option over other avenues to insurance that lawmakers are contemplating — hinge on critical details that even the senators embracing the idea have not resolved. The team of senators that proposed the Medicare expansion is declining to disclose the proposal's fine print until congressional budget analysts examine the impact for patients and the federal budget.

Live Pulse has the scoop on some of the initial number crunching - but the prognosis is grim:

PREMIUMS COULD BE HIGH, reports NYT's David Herszenhorn and Robert Pear: "Senate Democrats have provided few details about their latest health care proposal, but this much seems clear: Anyone who wants to buy the same health benefits as members of Congress, or to buy coverage through Medicare, should be prepared to fork over a large chunk of cash. According to the Congressional Budget Office, a family of four earning $54,000 in 2016, when the health legislation is fully in effect, would be eligible for a subsidy of $10,100 to help defray the cost of insurance under the health legislation being debated by the Senate. By then, one of the most popular federal plans, a nationwide Blue Cross and Blue Shield policy, is projected to cost more than $20,000. That could leave the family earning $54,000, slightly more than the current median household income, with monthly premium costs of more than $825. The Democrats' proposal would also allow some people ages 55 to 64 to ‘buy in' to Medicare, starting in 2011. That could cost about $7,600 a year per person or $15,200 for a couple, according to a budget office analysis of an earlier version of the concept. No subsidies would be available until 2014. … Preliminary back-of-the-envelope calculations reflect the steep challenges that Senate Democrats face as they await a new cost analysis of their plan. The numbers also reflect potential pitfalls in the politically appealing message to constituents that they might get benefits similar to those of federal lawmakers."

But the self-proclaimed "defenders of freedom" aren't having it. Adamantly opposed to the push for heath care reform, and insisting this is still a government takeover, they plan to take it to the steps of the Capitol:

A group called the Tea Party Patriots, which is affiliated with the Dick Armey-backed lobbying group FreedomWorks, is calling on supporters to "storm Senate offices" on December 15th in order to "to flex our muscle and exert that influence to hold the line in our fight against the government takeover of healthcare."

"The intention is to go inside the Senate offices and hallways, and play out the role of patients waiting for treatment in government controlled medical facilities," according to a message on the group's Web site. "As the day goes on some of us will pretend to die from our untreated illnesses and collapse on the floor. Many of us plan to stay there until they force us to leave."

They may need to pack some tents extend the camp out. According to recent news coming down the pipeline, the national debt ceiling may have to rise, causing high blood pressure in many a fiscal conservative:

With the national debt projected to soar by nearly $1.4 trillion this year, congressional Democrats are planning a year-end push to dramatically increase the legal debt limit so they don't have to revisit the politically uncomfortable issue before facing voters in November.

House Speaker Nancy Pelosi (D-Calif.) said Thursday that she will include legislation to raise the debt ceiling in a must-pass defense spending bill headed to the House floor next week. [...]

Treasury officials have told congressional leaders that they must raise the cap before Dec. 31 or risk running out of money for Social Security checks and veterans' payments due in early January, Democrats said. By law, the Treasury can borrow no more than Congress legally permits.

In light of our current woes, is health care reform going to end up being worth what we are spending?

Pelosi open to recess work on healthcare [UPI]
Pelosi Does Not Rule Out Senate Health Plan [CBS News]
Pelosi backs Medicare buy-in plan in Senate health-care deal [Washington Post]
Live Pulse [Politico]
Tea Party Protesters Plan to "Storm Senate" [CBS News]
Democrats to seek higher limit on the federal debt [Washington Post]

[Kansas City, Missouri; December 9. Image via AP]

Stephanie Cole, left, has her blood pressure checked by volunteer Suzanne Henley at a free clinic at Bartle Hall Wednesday, Dec. 9, 2009, in Kansas City, Mo. Cole, who said she has been without insurance after cancer made her so sick she had to leave her assembly job at Ford Motor Co., was one of about 1,000 people who showed up to for the free clinic sponsored by the nonprofit National Association of Free Clinics. (AP Photo/Ed Zurga)

The Associated Press' explanation of events is forcing me to read between the lines (emphasis mine):

After agreeing tentatively to jettison a key liberal priority - a full-blown government-run insurance option - Democrats say they are getting close to pushing President Barack Obama's health care bill through the Senate.

So we agreed to drop the public option?

Greater government involvement would potentially kick in if private insurance companies declined to participate in the nationwide plan, although details weren't available. One possibility was for the personnel office to set up a government-run plan, either national in scope or on a state-by-state basis.

Wait - is this that trigger thing Olympia Snowe was so insistent on? We're waiting for insurance companies to decide to throw in to our plan before we get more coverage?

The health legislation passed by the House last month includes the tougher abortion language as well as a government insurance plan; those differences would have to be resolved, assuming the Senate passes its bill.

But a little bird tells TPM not to be so quick to declare the public option off the table:

As you know, the AP and NYT reported tonight that the new deal dumped the Public Option. Our Brian Beutler, up there on the Hill was not so sure. And Sen. Reid said definitively this was not true. And now the Times seems to be backing off their report. And we're getting hints that those reports may have been premature.

TPM also has more details on this potential-kinda-sorta-maybe-perhaps a public option thing:

As has been widely reported, one of the trade-offs will be to extend a version of the Federal Employees Health Benefits Plan to consumers in the exchanges. Insurance companies will have the option of creating nationally-based non-profit insurance plans that would offered on the exchanges in every state. However, according to the aide, if insurance companies don't step up to the plate to offer such plans, that will trigger a national public option.

Beyond that, the group agreed—contingent upon CBO analysis—to a Medicare buy in.

That buy-in option would initially be made available to some uninsured people aged 55-64 in 2011, three years before the exchanges open. For the period between 2011 and 2014, when the exchanges do open, the Medicare option will not be subsidized—people will have to pay in without federal premium assistance—and so will likely be quite expensive, the aide noted. However, after the exchanges launch, the Medicare option would be offered in the exchanges, where people could pay into it with their subsidies.

It appears as if liberals lost out on a Medicaid expansion that would have opened the program up to everybody under 150 percent of the poverty line. That ceiling will likely remain at 133 percent, as is called for in the current bill.

And, in keeping with the no one is going to be happy theme, both Snowe and Nelson are jabbing at the bill with a sharp stick:

Nelson has said he won't support a final bill without the tougher language in his amendment, but he also has signaled his stance could change.

Other ideas in the health care reform package under discussion include expanding the Medicaid program more than currently called for in the bill and expanding a proposal in the bill that would give states money to cover low-income people through existing programs instead of Medicaid.

Snowe flatly rejected a possible expansion of Medicaid.

"It's a huge burden on the states," Snowe said. "It is without question and without a doubt a very expensive proposition."

Can we deny health insurance from all of the members of Congress until this is resolved? I mean, they can afford to pay right? Just like they assume all of us over 133% of the poverty line can? (By the way, to meet the guidelines for coverage at 133%, a family of four would need to bring home less than $29,327.)

The more we see how this debate is shaping up, the more I'm inclined to agree with G.D., who wrote:

Like [Leigh Graham, blogging for Change.org] said, members of Congress live in a world with relatively high job stability. They pull in $170, 000/yr and make use of an extremely generous healthcare plan in which the government pays up to 75 percent of the premium. The major legislative players in health care reform have never worried about their employers switching to an inferior plan with a higher contribution or dropping their insurance outright. Their plans have no lifetime caps, they face no rescissions or any of the constellation of obstacles that are par for the course for their fellow insured Americans (to say nothing of the folks with no coverage at all). And then there are folks like John McCain, who despite his considerable wealth would have a hard time getting covered on the individual market thanks to his history of cancer, and has been insulated from from that reality by receiving government-funded care as a member of the Armed Forces, a veteran, and a U.S. Senator. Or Dick Armey, the former House majority leader-turned-professional-healthcare-reform-obstructionist, who received public health care as a young professor at a state university in Texas before spending the next several decades in Congress.

If the impression you've gotten from the way our lawmakers have handled the health care debate is that this whole thing is a big abstraction to them, that's because it probably is.

G.D. titled the post "They Don't Understand the Language of People With Short Money." It's one of those things that would hysterical if it wasn't true.

In other this-battle-isn't-over news, Bart Stupak has taken to the op-ed pages to let us know that's he's really not a bad guy! He's just maintaining the Hyde Amendment:

Under our amendment, women who receive federal subsidies will be prohibited from using them to pay for insurance policies that cover abortion. The amendment does not prevent private plans from offering abortion services and it does not prohibit women from purchasing abortion coverage with their own money. The amendment specifically states that even those who receive federal subsidies can purchase a supplemental policy with private money to cover abortions. [...]

The language in our amendment is completely consistent with the Hyde Amendment, which in the 33 years since its passage has done nothing to inhibit private health insurers from offering abortion coverage. There is no reason to believe that a continuation of this policy would suddenly create undue hardship for the insurance industry - or for those who wish to use their private insurance to pay for an abortion.

For example, the Federal Employees Health Benefits Program provides health insurance through a variety of companies to more than eight million Americans - but it does not allow abortion coverage in any of its policies. Yet the same companies that offer these abortion-free plans to federal employees also offer plans with abortion coverage to non-federal employees. Given that insurance companies are able to offer separate plans with and without abortion coverage now, it seems likely that they would be able to continue to do so on the newly established health insurance exchange

.

So, in sum, no one knows what we're getting, Stupak is still looming like some super villain resurrected for multiple franchises, and the news still sucks.

Senate Dems near agreement on health care bill [MSNBC/AP]
Maybe Not [TPM]
Democrats Agree To Tentatively Trade Opt-Out For Trigger, Medicare Buy In, And More [TPM]
White House lauds Senate Democrats' health care deal [CNN]
2009 Federal Poverty Level [Coverage for All]
They Don't Even Understand the Language of People With Short Money. [PostBourgie]
44% of Congress are millionaires [Change.org]
What My Amendment Won't Do [NY Times]

Campus Progress has the transcript of the above video:

BOXER: There's nothing in this amendment that says if a man some days wants to buy Viagra, for example, that his pharmaceutical coverage cannot cover it, that he has to buy a rider. I wouldn't support that. And they shouldn't support going after a woman using her own private funds for her reproductive health care. Is it fair to say to a man you're going to have to buy a rider to buy Viagra and this will be public information that could be accessed? No, I don't support that. I support a man's privacy, just as I support a woman's privacy.

That was all well and good, and fitting for a Congressperson. But you know what she really wanted to say was, "It Ain't None Your Business!"

What' s the matter with your life? /Why you gotta mess with mine? /Don't keep sweatin' what I do/'Cause I'm gonna be just fine!

Can we formally vote to make this the pro-choice anthem? Just saying.

At any rate, Senator Nelson of Nebraska seems to want to make it his business to keep bringing up old stuff. The Guttmacher Institute did a comparison of Stupak-Pitts and Nelson's Amendment and confirms what we all knew going in - the bills are the same shit, different day:

"As with Stupak-Pitts, this amendment would restrict abortion coverage well beyond the status quo and could have profound implications even for coverage in the private market, paid for with private funds," emails Adam Sonfield, senior public policy associate of the Guttmacher Institute. "It also, like the Stupak-Pitts amendment, takes what had been even-handed language respecting and protecting the conscience of providers on both sides of the abortion divide and turns it into biased language that allows for discrimination against health care providers willing to provide or refer for abortions."

Amy Sullivan of Time is letting Nelson have it over at Swampland:

What is it about those Nebraska governors-turned-senators? Did they not get enough attention as children? Do they chafe at being told they hail from a "flyover" state? Does that unicameral legislature leave too few adoring supporters? Bob Kerrey was infamous for waiting until the verrrrrry last moment to make up his mind on important pieces of legislation, waiting until he'd been courted and wheedled and begged. And now it appears Ben Nelson is looking to make himself similarly indispensable to the Democratic effort to pass health reform legislation.

So what happens when the Nelson amendment fails? Last week, Nelson was threatening to filibuster health reform if his abortion language was not included, but he's since walked that back. Even a Nebraska attention-seeker can only go so far, after all. Democratic leaders have said they're working on other compromises to win Nelson's support for the final bill, but it's unclear that he was ever willing to vote for health reform, even if his amendment were to pass. And other pro-life Democrats—like Bob Casey, who is a co-sponsor of Nelson's amendment—have not said the issue will determine their vote.

Casey has talked about introducing parts of his Pregnant Women Support Act in order to insure that the bill contains measures to reduce abortion rates. But such a move would be almost entirely for his own comfort, and not to bring more pro-life senators aboard or placate the Catholic hierarchy. Richard Doerflinger, associate director of the U.S. Conference of Catholic Bishops' secretariat of pro-life activities, told the Wall Street Journal over the weekend that compromise in the wake of a defeat of the Nelson amendment was "not a negotiation we're prepared to have," adding, "I really don't know how you compromise further."

Another factor arguing against additional abortion amendments is the fact that if Reid cannot count on Nelson to get to 60 votes, he will have to pin his hopes on Olympia Snowe, a strong supporter of abortion rights. Snowe's main stated concern about health reform is the public option. But stronger abortion restrictions would only make her less likely to sign on to be that crucial last vote to pass reform. Which is why as of Monday night, Democratic leaders were much busier crafting a public option compromise than worrying about abortion negotiations.

Speaking of the public option compromise, some of the initial news is in: Senators are backing away from a public option and instead are looking at expanding the scope of existing programs.

After five days of intensive talks among five moderates and five liberals, the outlines of a compromise aimed at appeasing both ends of the Democratic political spectrum were emerging: a plan designed to expand insurance coverage without creating a new government-run program.

Under the compromise, the public option would be removed from the bill and replaced with a new government-administered national insurance plan similar to the Federal Employee Health Benefits Plan, which serves members of Congress and federal workers.

To sweeten the deal for liberals, people 55 and older would be able to "buy-in" to Medicare and purchase coverage in the popular government program for the elderly. Liberal Democrats such as Sen. Sherrod Brown of Ohio and Sen. John Rockefeller of West Virginia have been pushing the idea for years.

It's currently unclear how much this plan would help, particularly considering what passes as an increase:

The negotiating group is also looking to expand Medicaid to cover people with incomes 150 percent above the poverty line, up from 133 percent under the Senate bill, and to impose stronger regulations on private insurers.

This doesn't seem to be good enough for Republicans, who trying to throw monkey wrenches into the process however, and whenever, they can. When Harry Reid spoke on the Senate floor yesterday comparing the stalwart stance of the GOP to the opponents to abolishing slavery, desegregation, and suffrage for women, the GOP complained they were being smeared.

Then, RNC chair Michael Steele sent a message to Obama to "delay" health care reform, saying:

"Congress can't afford to throw the American people further in debt now and splurge on a risky health care bill when we may need all the resources at our disposal next year to rebuild a sagging economy," Steele wrote in a letter than will be sent to the White House on Tuesday.

"We are asking you to delay your efforts to push your health care bill through Congress by the end of the year," Steele continued. "Until we are sure job creation has begun in earnest, we should put aside our differences on health care. We should watch our spending. We've got an economy to rebuild and restore."

Funny that Steele's pronouncment comes as the health care reform process is inching toward a close. That argument may have had a shot before the townhall meetings, and before the Republicans allowed fear-mongering to define their talking points on health care reform. Now, it just seems like too little, too late.

Boxer's message to men who support abortion riders: How would you like it if we singled out Viagara? [Think Progress]
Guttmacher: Nelson Abortion Amendment Virtually Identical To Stupak [TPM]
The Health Reform Abortion Wars, Part Deux [Time]
Public option compromise takes shape [Politico]
GOP erupts over Reid slavery, segregation remarks [Politico]
Michael Steele to President Obama: Delay health care [Politico]

The AP summarizes the situation thus far, and where it could potentially go:

Buoyed by a presidential pep talk and intense rounds of negotiations, Senate Democrats hope to move closer to embracing a major health care bill this week by tackling the nettlesome issue of abortion. [...]

A government-run insurance program, or "public option," is one of the bill's most contentious issues. At the urging of Senate Majority Leader Harry Reid, a group of moderate and liberal Senate Democrats met again Sunday to seek a compromise, after Obama's pep talk.

One idea calls for national nonprofit insurance plans to be administered by the Office of Personnel Management, which oversees the popular Federal Employees Health Benefits Program.

The proposal seems to appeal to a key Republican, Sen. Olympia Snowe of Maine, who met with Obama at the White House on Saturday.

On Sunday, Snowe called the possible compromise "a positive development" because it would give consumers more options for buying insurance.

Snowe's potential support for the Democratic-crafted bill is crucial. Supporters need 60 votes to overcome filibusters, and the chamber's 40 Republicans hope to draw at least one Democrat to their side.

It could be Nelson, who says he will not support final passage of a health care bill unless it includes the tight abortion restrictions he wants. If so, Democrats would have to woo moderate Republicans such as Snowe.

So what's at stake if the Dems can't overcome a filibuster? The health care bill may suffer the same fate as the bill to strengthen the options currently provided by Indian Health Services, which is responsible for providing health care and social support for the indigenous community in the United States. However, IHS is plagued with shortfalls and necessary infrastructures and equipment simply aren't available when needed. A senate bill was proposed in 2008 to strengthen IHS services and plug some of the gaps in service - but this was quickly derailed by Sen. David Vitter. Racewire reports:

While native communities have a big stake in health care reform, they're also prone to becoming a political football. Last year, a Senate bill to strengthen IHS foundered when Sen. David Vitter injected a poison pill amendment specifically aimed at restricting access to abortion for native women. Vitter's amendment could be seen as symbolic in that it replicated the language of the Hyde Amendment's broad restrictions on federal funding for abortion services. That longstanding anti-choice policy disproportionately impacts all poor women.

Still, since the proposed amendment would codify Hyde in the IHS statute—and because native women suffer from huge health disparities and barriers to care, advocates argued that Vitter's move would subject native women to an especially discriminatory, more permanent and restrictive version of Hyde. Vitter figured that in attacking abortion rights, there was no better place to start than one of the most medically disenfranchised groups of women in America.

Last Friday, Senator Byron Dorgan submitted an amendment to reauthorize the Indian Health Care Improvement Act and added an amendment to offer contract medical care to supplement IHS services. On Saturday, Senator David Vitter submitted two amendments to restrict access to abortion services for Native Americans.

Beyond the question of abortion coverage, the public option still remains as the other key issue to be resolved. As Ezra Klein puts it:

Currently, insurance plans are regulated by the states, which means they're different in every state. That makes it hard for them to achieve certain efficiencies of scale or maximize their leverage against providers. But back in September, I noticed a promising provision in Max Baucus's draft that would allow for national insurance plans, so long as they met a minimum level of federal regulation. That seemed like a potentially huge change, but I never heard another word about it, so I let it go.

The compromise being discussed is built atop that provision. The idea is that the Office of Personnel Management would choose nonprofit plans that met national standards and offer them on every state exchange (unless states opted out). These plans would be private, but the OPM would act as an aggressive purchaser, ensuring that they met high standards and conducted themselves properly. It's a private option with a public filter, essentially. But more importantly, it's a menu of national, nonprofit plans, which would be much more interesting from a competitive standpoint than state-based, pubic plans.

But the fact remains that private plans are not public options, no matter how much extra scrutiny they're subjected to. Though the liberals in the room are listening to this compromise, sources close to the discussion tell me that the conversation is opening up beyond the insurance offerings.

Today might mark the Senate's vote on abortion coverage in the health care bill, according to Majority Whip Dick Durbin. This vote will determine what is put forth in the final bill to Obama, and while abortions rights advocates are hopeful, nothing is set in stone until the final votes are in on the outstanding amendments.

Feingold: Deal on public option 'getting closer' [Politico]
Public option compromise still in the works [Politico]
Senate to confront abortion in health care debate [AP]
Indian Health and Abortion Rights: A Dose of Hope Laced with Poison Pills [Racewire]
Latest amendment list [Politico]
The not-a-public-option compromise, and beyond [Washington Post]
Abortion vote could come Monday, Durbin says [Politico]

[Aurora, Colorado; December 1. Image via Getty]

AURORA, CO - DECEMBER 01: An immigrant from Mexico holds her four day-old son during a newborn care class at a community health center for low-income patients on December 1, 2009 in Aurora, Colorado. The Metro Community Provider Network (MCPN), which has 11 health centers in the Denver area, has seen a 138 percent increase in patients during the last year of recession. Non-profit community health centers such as MCPN could play a major role nationally if health care reform is passed, with increased subsidies from the federal government as well as millions of newly-insured low-income citizens seeking care. Health coverage for immigrants remains a contentious issue in the reform debate. (Photo by John Moore/Getty Images)

In an op-ed in Salon (which appears in slightly abbreviated form in the LA Times, Ehrenreich writes that women's response to the Stupak Amendment, which "will snatch away all but the wealthiest women's right to choose," has been "muted" compared with the outcry against the new mammography guidelines. This is despite the fact that mammograms for women under 50 haven't been shown to decrease breast cancer mortality, and some evidence suggests they may even increase cancer risk. Ehrenreich writes,

It's not just that abortion is deemed a morally trickier issue than mammography. To some extent, pink-ribbon culture has replaced feminism as a focus of female identity and solidarity. When a corporation wants to signal that it's "woman friendly," what does it do? It stamps a pink ribbon on its widget and proclaims that some miniscule portion of the profits will go to breast cancer research. I've even seen a bottle of Shiraz called "Hope" with a pink ribbon on its label, but no information, alas, on how much you have to drink to achieve the promised effect. When Laura Bush traveled to Saudi Arabia in 2007, what grave issue did she take up with the locals? Not women's rights (to drive, to go outside without a man, etc.), but "breast cancer awareness." In the post-feminist United States, issues like rape, domestic violence, and unwanted pregnancy seem to be too edgy for much public discussion, but breast cancer is all apple pie.

On the one hand, Ehrenreich's comments seem like a somewhat heavy-handed indictment of modern feminism. She says, "Once upon a time, grassroots women challenged the establishment by figuratively burning their bras. Now, in some masochistic perversion of feminism, they are raising their voices to yell, 'Squeeze our tits!'" But just as not everything a woman does is empowering, not every extra-scientific position a group of women takes is a blow to feminism. Also, plenty of us have been far from muted on Stupak.

That said, however, there's good evidence that the breast cancer awareness movement as it currently exists isn't necessarily good for women. Though many fear that the new guidelines are simply an attempt by insurance companies to save money, Ehrenreich argues that the old guidelines actually pumped money into the pockets of oncologists, who offered chemotherapy for mammogram-detected cancers that might never have needed treating. Unfortunately, we don't yet know how to distinguish these cancers from those that do merit aggressive treatment — and the treatments we do have could be a lot better. Ehrenreich says,

What we really need is a new women's health movement, one that's sharp and skeptical enough to ask all the hard questions: What are the environmental (or possibly life-style) causes of the breast cancer epidemic? Why are existing treatments like chemotherapy so toxic and heavy-handed? And, if the old narrative of cancer's progression from "early" to "late" stages no longer holds, what is the course of this disease (or diseases)? What we don't need, no matter how pretty and pink, is a ladies' auxiliary to the cancer-industrial complex.

Ehrenreich's language is harsh, but as someone who suffered breast cancer herself, she knows whereof she speaks. And while research into cancer treatment is ongoing, the focus of breast cancer awareness could use a shift. Much of the focus is on women themselves — their responsibility to schedule regular mammograms, to lead a healthy lifestyle, and to perform self-exams (a practice also jettisoned under the new guidelines). It makes a certain amount of sense — individual women want to feel that they can have an effect on their health. But there may be systemic factors, like additives and pollutants, that contribute to breast cancer, and the pink-ribbon movement might do well to advocate for more research into those. And although mammograms can save lives, new screening options might be even better — cutting-edge research deserves just as much support as awareness and prevention currently get.

The "pink-ribbon breast cancer cult," as Ehrenreich calls it, may not be the sign of a large-scale failure of feminism. But women are being asked to accept a lot of symbolic gestures — like Sen. Dick Vitter's superfluous mammogram-access amendment — instead of the reproductive rights and truly life-saving treatments they actually need. Ehrenreich argues persuasively that rather than getting angry about new guidelines for a useful but flawed procedure, women should save their anger for what really matters — that we still don't know how to heal our breasts, and that the government is trying to control our wombs.

Slap On A Pink Ribbon, Call It A Day [Salon]
Can Mammograms Increase Cancer Risk For Some Women? [Time: Wellness Blog]
Annual Screening With Breast Ultrasound Or MRI Could Benefit Some Women [EurekAlert]
Targeted Breast Ultrasound Can Reduce Biopsies For Women Under 40 [EurekAlert]
David Vitter Will Protect Ladies From Medical Recommendations [Wonkette]

• He went on to say that Knox is a "clean-faced young girl, swept away by a tsunami." • Two California girls, ages 12 and 14, have been arrested for attacking a 13-year-old classmate - twice. The girls lured the victim, who they believed had been talking shit about them, to a field, telling her that they had some belongings of hers to return. Police caught the attackers after they posted videos of the beatings on YouTube. • Accused Cleveland serial killer Anthony Sowell has been indicted on murder charges in the deaths of 11 women, plus dozens of other counts, including kidnapping, abuse of a corpse, attempted murder, assault and rape. Authorities say many of the 10 identified victims were homeless addicts he lured into his home. • NPR's Richard Gonzales, who grew up in Richmond, California, returned to see how the town is coping after a teenage girl was gang-raped at the high school. He spoke to sophomore Lizette Franco, who said, "We don't want it to be our identity, because there is so much more to Richmond than what they're portraying in the media. We're not animals. We're not savages. We're students striving to be better people." •  Former track star Marion Jones has announced plans to sign up with a W.N.B.A. team. Jones, who was busted for steroid use and has since toured the country speaking to students about making good choices, says she hopes the W.N.B.A. will provide a larger platform for her message, as well as a "second chance." •  Good news: According to the DCist, a bill instituting same-sex marriage has just passed in the D.C. council. Ben Smith from Politico notes that this is "a sign that same-sex marriage has really become a quite mainstream Democratic cause, one embraced equally by a Massachusetts court and an urban City Council." • The Senate is expected to vote today on an amendment that would increase health insurance benefits for women in the first vote on the health care overhaul legislation. The amendment was introduced by Senators Barbara Mikulski, D-Md., and Olympia Snowe, R-Maine and inspired by the recent and controversial mammogram and Pap smear recommendations. "My amendment guarantees screening for breast cancer, yes, mammograms," Mikulski said. "We don't mandate that you have a mammogram at age 40. What we say is discuss this with your doctor, but if your doctor says you need one, my amendment says you are going to get one." • Zeituni Onyango, the half sister of President Obama's late father, gave an interview to the Associated Press in which she said she's anguished over not having contact with the family after it was revealed that she'd been illegally living in U.S. public housing for years. She isolated herself from the family after the inauguration because she didn't want her immigrations problems to hurt his presidency. "Before, we were family. But right now, there is a lot of politics, and me, I am not interested in any politics at all," she said. • South African President Jacob Zuma said today - on World AIDS Day - that the government will make sure that all HIV-positive babies receive treatment. There are also plans to expand testing and treatment for pregnant women. •  Sarah Palin's absurdist memoir Going Rogue has sold 1 million copies, a HarperCollins spokeswoman reveals. The publisher has increased the print run accordingly, to 2.8 million. • Asma Hanif, who runs a Baltimore domestic violence shelter for Muslim women says, "My biggest problem was that if you send a Muslim woman to be counseled in a shelter that's run by Christians, then what the people say is the reason why you're being beat is because of that religion. We do not want Islam to be the focal point of domestic violence." She added that in other shelters, "There may be situations - such as, there would be men that were there, or there wasn't any place for them to pray, or maybe there was an issue with the food." • An online poll of 1,027 people by the Tylenol Canadian Pain Survey found that women report experiencing headaches more often than men, and they experience somewhat more pain than men. "Pain doesn't discriminate against gender; however, with headache pain, women tend to be more expressive in reporting their pain than men, and tend to be more proactive in managing it," said Dr. Gary Shapero, a family physician who has studied headache and pain management. • Salon owner Cindy Vong is fighting the Arizona Board of Cosmetology's decision to ban flesh-eating fish foot treatments. "The board knows nothing about spa fish therapy, so its reaction is to shut it down," said her lawyer. "The board's action is more about protecting cosmetologists from competition than it is about protecting consumers against anything except wet feet and smooth skin." • On Thanksgiving, a woman and her brother were fighting over whether their parents are too old to be watching their children, when he allegedly threw extremely hot pecan pie at her after it was heated in the microwave. She was treated for first and second degree burns to her neck, face, and chest. Her brother is expected to be charged with aggravated assault. • 26-year-old Swedish father Ragnar Bengtsson has given up his months-long attempt to pump milk from his breasts. "All he got was sore breasts," said the host of a local show that was following the progress of the "Milkman." However, Bengtsson isn't walking away empty handed: He's flying to the U.S. to appear on - of course - The Tyra Banks Show. •

McArdle seems to have a low opinion of the various opinions put forth against Stupak, writing:

Most of them seem to come from feminists who blithely assume away concerns about the personhood of the fetus, and the staunch political opposition to subsidized abortion from those who lean towards the "person" side. This allows them to spend 1,000 words or so having a completely irrelevant discussion of the disparate effects of the Stupak amendment on poor women, arguing that women's reproductive health care is too real health care, and similarly unrelated side points.

Memo to authors: you could prove beyond a shadow of a doubt that women's health care is important, that this has a hugely disparate impact on women, that it will result in more women carrying unplanned pregnancies to term, etc . . . and that still wouldn't make a majority of the country want to pay for other peoples' abortions out of their tax dollars.

And once again, the majority of the country doesn't want a lot of shit. People didn't want to desegregate, or have their tax dollars fund schools and public services in minority areas. I don't want to pay for wars with my tax dollars. But the government doesn't work that way - did I miss the line-item veto form on my taxes?

McArdle then busies herself misusing the 13% statistic and making some really large assumptions:

The women who genuinely can't afford $500 bucks for an abortion are the women closest to the poverty line. Those women will be covered by Medicare, and they won't get abortion coverage anyway in most states. The women who will be buying insurance on the exchanges presumably mostly do not have health insurance now, and thus are losing nothing if their new insurance doesn't cover abortions. [...]

Obviously, I am not saying that feminists shouldn't worry whether women will be denied access to abortion if this passes. But the number of people who are going to lose access that they currently have, and therefore be forced to carry a pregnancy to term, is not likely to be all that large. We're mostly talking about a modest number of women who will have to hand over several hundred dollars that they would really rather spend elsewhere. The very small number of women who currently have access to abortion services, and will lose them, and cannot get together a few hundred dollars for an abortion in time—those women can easily be taken care of if everyone who is outraged by this makes a small donation to Planned Parenthood.

Exactly, because that takes care of all the problems, shifting a public health issue onto the plates of private donors. It also makes a huge assumption - that Planned Parenthood and other like-minded organizations are able to reach all the women impacted, particularly when one considers that it can be difficult to find access to these services outside of major urban areas. A donation to Planned Parenthood won't do much good if the person in need of an abortion is more than 250 miles from the nearest provider.

In the new New York magazine, Jennifer Senior provides disheartening facts and figures about support for abortion. While noting that even at the time of Roe vs. Wade, the Supreme Court decision was against the popular majority, Senior points out that over the years, our nation has swung closer and closer to the anti-choice side of the pendulum. More troubling appears to be the attitudes of the neo-lifers, which fall along these lines:

NARAL's Nancy Keenan likes to say that abortion's biggest defenders right now are a "menopausal militia"-a rueful, inspired little joke. These baby-boomers, whose young adulthoods were defined by the fight over the right to choose, will soon be numerically overtaken by a generation of twentysomethings who is more pro-life than any but our senior citizens. As GOP strategists Christopher Blunt and Fred Steeper have pointed out, this group came of age during the partial-birth debate and was the first to grow up with pictures of sonograms on their refrigerators. The major development in reproductive technology during their lifetimes wasn't something that prevented pregnancies but something that created them: IVF. These kids have no idea-none-what it was like to live in a world without abortion rights. ("This generation's knowledge of Roe is like, ‘Roe vs. what?' " says Keenan.) And they feel much more strongly about personal responsibility than the generations preceding them: Didn't use birth control? The burden's on you.

These anti-choice narratives are changing how women view abortion - and leaving less and less room for stories like this one:

The woman is 28 years old and ten-and-a-half-weeks pregnant. She wears false eyelashes, blue eyeliner, and a striped shirt of black and gray. The condition is: I can sit in on her counseling session if I do not know her name.

"I can see that you are stressed," starts Claire Keyes, her counselor.

"Yeah," the woman responds. "Always look stressed."

Keyes was particularly interested in counseling this woman because of the constellation of adjectives she'd checked off on her intake form: selfish, uncertain, guilty. If you listened only to pro-life cant, you'd think that women were unconflicted-cavalier, even-about their abortions, using them fungibly with birth control. Keyes can tell you this is seldom the case, especially in such a Catholic city as Pittsburgh, and especially among African-Americans, like this woman, who on national surveys are less inclined than whites to identify themselves as pro-choice.

"I see you're going to school," says Keyes. "Is it harder doing that or working?"

"Going to school."

"Because …?"

"Because I got to cram in homework; sometimes I don't do it," says the woman. "I got three kids: 13, 11, and 8. And I got to deal with them, and the household, and phone calls from school, 'cause they're cutting out. So it's just like … a whole lot of … everything." She reaches for a tissue. "Basically, I go to school, and as soon as I come home, I go straight to sleep."

Not all abortion clinics drill down and do this kind of work. But the Allegheny Reproductive Health Center in Pittsburgh, from which Keyes stepped down as director in January but still works as a counselor, has a national reputation for being psychologically oriented. If there's any place where the complexity and ambivalence surrounding abortion plays out, it's here.

Keyes opens the woman's folder. "The first thing I saw in your chart," she says, "is you're not sure about your decision. What do you want to tell me about that?"

"I don't know," says the woman. "In a sense, I got too much going on, and I can't afford to take on another child. But in a sense, I feel pressure from my boyfriend, because he don't want the kids … so it's like, I want to. I'm not into the whole abortion thing. I did it before"-twice, according to her chart, once last year at this very clinic-"and I really didn't like it. I think some things happen for a reason."

Worst still are how all of our discussions of "choice" and "life" can still be so woefully inadequate:

Keyes gestures toward the waiting room, where the patient's boyfriend is sitting. "Is he an important part of your life?"

The woman hesitates. "I guess. For now."

"He doesn't have kids?"

"He's got kids. He just don't want any more."

Keyes pauses. "I don't feel you in this decision, and that makes me sad." She thinks. "If you had to name a percentage-pick a number-what percentage of your decision to be here today is yours?"

The woman stares into space. "Basically, 99 percent of it is him." She looks listlessly at Keyes. "So. Get it done and over with."

Keyes gently returns her look. "We have a saying around here: We don't do abortions for boyfriends."

The woman is silent for several long, drawn-out seconds. Then, she offers something. "But see, that's where it comes down to my percent. I have three kids already. So, he leaves, and now I have four children and no dads."

Often, the default pro-choice discussions shy away from these moments, while anti-choicers relish them. To some, this woman is exactly why the government should not assist anyone in paying for abortion. Her story plays neatly into existing stereotypes about black women, promiscuity, and parental responsibility that seems pulled straight out of the pages of the Moyinahan report. And yet, this woman's story is true, and it is one of the many different circumstances that lead to why women seek abortions in the first place.

What generally isn't applied to this type of analysis is a look at the larger factors surrounding choice. Race and racism loom large in various aspects of the debate, but are rarely discussed. African American children are disproportionately placed in the foster care system, and it is often difficult to find these children homes - the GAO even commissioned a study in 2007 to analyze the problem and propose solutions. Poorer women are already banned from receiving abortion coverage, but this is not a fight that has been taken up. Many mainstream feminist organizations are just concerned with maintaining what American women have, and lack the resources and support to push for more equality.

This may be partially an issue of our own making. As Kimala Price writes in Homegirls Make Some Noise:

From the 1980s to the present, women of color have continued this activist legacy in reproductive rights and justice. In the late 1980s, a group of thirty-five prominent African-American women, including political activists and members of Congress, issued the statement "We Remember." The statement connected reproductive health with other issues such as economic and social justice issues:

We understand why African American women risked their lives then, and why they seek safe legal abortion now. It's been a matter of survival. Hunger and homelessness. Inadequate housing and income to properly provide for themselves and their children. Family instability. Rape. Incest. Abuse. Too young, too old, too sick, too tired. Emotional, physical, mental, economic, social – the reason for not carrying a pregnancy to term are endless and varied, personal, urgent and private. And for all these pressing reasons, African American women once again will be among the first forced to risk their lives if abortion is made illegal (African American Women Are for Reproductive Freedom 1999, p. 39)

This re-articulation is in light of the U.S. government's ugly history of determining who can and cannot be mothers, who has the right to bear and raise children, through coercive policies. In the past, the federal government had sterilization campaigns targeting African America, Puerto Rican, Mexican American and Native American women. Today it uses more insidious ways of accomplishing the same end, such as family cap policies in the "reformed" welfare system in which mothers may lose benefits if the number of children they bear exceeds the limit set by state governments. Thanks to the 1976 Hyde Amendment, which banned federal funding of abortions, most state Medicaid programs will not cover abortions, and women who serve in our nation's armed forces cannot obtain abortions on military bases or through the military's health plan. Women in federal prisons and most state prisons don't have access to abortions as well.

The problem has been that the mainstream reproductive rights movement has not paid that much attention to these and other related issues. Out of their frustration with this, women of color activists are busy building our own movement. [...]

Drawing from human rights and social justice principles, women of color activists have re-defined "reproductive rights" into what they now call "reproductive justice." Reproductive justice is not just about the individualistic right to have an abortion (i.e., the right not to have children) but to include the right to have children and to raise them in healthy and stable families. Accordingly, these activists have broadened reproductive rights and freedom beyond abortion rights, the rights to privacy and "choice" which are normally associated with the movement. In sum, reproductive justice encompasses many other issues such as economic justice, immigration rights, housing rights, and access to health care.

This is the reason that Stupak-Pitts has become an important dividing line for the pro-choice movement. The amendment is horrid enough on its own - however, as a symbol, it continues to show the quiet erosion of women's right to choose and a painful reminder of all that progressives have failed to accomplish.

Interested in helping to Stop Stupak and expressing support for the right to choose? There are events scheduled this week that you may be interested in. There is a National Day of Action (that's this Wednesday, December 2) where coalitions from different Reproductive Rights Organizations will lobby their congresspeople as well as rally. Supporters are welcome, and Planned Parenthood is asking for people to RSVP. NOW has more details on the basic schedule for the day. There are also rallies planned in Illinois (Dec. 2) and New York (December 4) with more details here.

The Abortion Wars Heat Up [The Atlantic]
The Abortion Distortion [New York Magazine]
The Moynihan Report (1965) [The Black Past]
African-American Children In Foster Care [GAO]
Quoted: Kimala Price On Hip-Hop Feminism and Choice [Racialicious]
National Day Of Action [Planned Parenthood]
National Lobby Day And Rally [NOW]

Earlier: Nancy Pelosi: "This Is Not A Bill About Abortion"

"We have a lot of people … [who have] lost their jobs, who don't have health care, even children that are in homes don't get three square meals a day. But this man sits with guards protecting him, he's receiving free medical, free meals." •  A recently freed Spanish skipper claims that Somali pirates are holding a 12-year-old Ukrainian girl hostage aboard another hijacked ship. Ricardo Black says he met both the girl and her parents. "Her mother begged me to take [her daughter] with me," he told a Spanish paper. • A New York teacher is suing the Department of Education because she claims she suffered injuries after she slipped on garbage, including condoms, that had been left on the floor. She's particularly mad about the condom bit (although there is no news about whether or not they were used): "They caused, allowed and permitted condoms to be distributed by school personnel to the students, many of which were opened during the school lunch period and thrown on the floor," she said in the suit. • Five high school freshmen were arrested in California for the sexual assault of two ninth-grade girls. Police say that the boys accosted the girls at school and groped them during a lunch break. • Forbes has compiled a list of the top earning states for women. Washington D.C. is at the top of the list, with women making an average of $866 a week, only 7.8% less than men. Also high on the list are Maryland, Connecticut, and Massachusetts. • Rusty Kanokogi, advocate for women's judo, has died at the age of 74. Kanokogi devoted the past twenty years to making women's judo an Olympic sport, an effort that was recognized by the Japanese government, who awarded her the Order of the Rising Sun last year. • The Virginia Military Institute is facing charges of sex discrimination. The Education Department first brought the complaint against the Military school in 2008, claiming that the "climate and culture" of the school was derogatory and discriminatory towards women.  • According to FBI data released today, reports of hate crimes against gays and religious groups increased sharply in 2008. The number of racially motivated hate crimes fell less than 1 percent, but there was an 11 percent increase in hate crimes against homosexuals and a 9 percent increase in crimes against religious groups. • Dr. Bernadine Healy, the former director of the National Institutes of Health, says women should ignore the new breast cancer screening guidelines that delay the start of routine mammograms until 50, because it would save money but not lives. • Senator Harry Reid says that right after the Senate's vote to begin debating health care legislation on Saturday, he got a call from Ted Kennedy's widow, Victoria Reggie Kennedy. "She believes that Ted was watching," said Reid. "I'll remember the call always. She of course was crying pretty hard. We both felt that he's watching us tonight." • Today President Obama announced "Educate to Innovate," a 10-year campaign to increase American students' achievement in math and science. It involves $260 million in corporate donations, a National Lab Day, and an annual national science fair at the White House "to show young people how cool science people can be." • A reporter for The Guardian visited an Iraqi jail to talk to women who have attempted to commit a suicide bombing. She found many have lost close male relatives, lived in isolated communities dominated by extremists, and felt choosing to be a suicide bomber made them special, even though they couldn't control much else in their lives. But, one detective investigating the women cautioned not to generalize because, "All the cases are different. Some are old; some are young; some are just criminals; some are believers. They have different reasons." • The late Sister Maria Alfonsina Danil Ghattas is one step closer to becoming a saint after thousands of worshipers gathered in Nazareth for her beatification yesterday. She helped found the Sisters of the Most Holy Rosary of Jerusalem in the 1880s, which continues to run schools for Palestinian girls in Israel, the West Bank and the Gaza Strip. • Libby Longino is one of only 32 students to win a Rhodes Scholarship this year, but she won't be lonely at Oxford University: her boyfriend Henry Spelman was also selected. They are both seniors at the University of North Carolina at Chapel Hill. Longino said, "I could barely hope it would turn out this way." •

The two bills do have some common ground:

Both bills would require all Americans to carry health insurance, with government help to make premiums more affordable. They would ban insurance companies from denying coverage or charging more to people with health problems. They would set up new insurance markets for those who now have the hardest time finding and keeping coverage - self-employed people and small businesses. Americans insured through big employer plans would gain new consumer protections but wouldn't face major changes. Seniors would get better prescription coverage.

Thing is, the battles are getting increasingly more contentious as the debate continues. For Representative Patrick Kennedy, the national mud-wrestling match over abortion rights has turned personal:

A bitter dispute over abortion that prompted Rhode Island's Roman Catholic bishop to ask Rep. Patrick Kennedy not to receive Holy Communion has revealed the depth of the divide among Catholics over how politicians should reconcile their faith with their public duties.

Bishop Thomas Tobin on Sunday said he made the request because of the Democratic lawmaker's support for abortion rights. The news prompted debate among Catholics around the country and within the bishop's flock in the nation's most Catholic state about whether it was right for Tobin to publicly shame Kennedy for breaking with the church on what its leaders consider a paramount moral issue. [...]

Their dispute began in October when Kennedy criticized Catholic bishops for threatening to oppose an overhaul of the nation's health care system unless lawmakers included tighter restrictions on abortion, which have since been added to the House version of the bill. Tobin said he felt Kennedy made an unprovoked attack on the church and demanded an apology.

Since then, their feud has played out in public. Tobin, who has said he might have gone into politics were he not ordained, has written sharp public letters questioning Kennedy's faith and saying his position is scandalous and unacceptable to the church. Kennedy has said his disagreement with the church hierarchy does not make him any less of a Catholic.

This isn't the first time a question of Catholicism and politics made waves in public:

In 1984, former Democratic New York Gov. Mario Cuomo, a Catholic who supported abortion rights and was at the time a potential presidential candidate, delivered a speech at the University of Notre Dame explaining that Catholic lawmakers shouldn't be pressured by church leaders to work for anti-abortion legislation. He said Sunday it's dangerous for the church to pressure politicians because of the potential for unintended consequences.

"If you're required (by the church) to make everybody follow your Catholic role, then nobody would vote for Catholics because it's clear that when you get the authority, you're going to be guided by your faith," the former governor told The Associated Press.

Cuomo said there are two positions a politician can take: They can oppose church doctrine outright or, as he did, accept church teachings personally but refuse to carry them into the public arena where they would affect people of every faith.

"Don't ask me to make everybody live by it because they are not members of the church," Cuomo said. "If that were the operative rule, how could you get any Catholic politician in office? And would that be better for the Catholic church?"

Outside of religion, party politics are looming large over the horizon. Lawmakers are feeling major breaks between the Dems and the GOP, as well as splintering within their own parties:

A leading Senate Democrat said Monday his party is determined to push through a health care overhaul bill with or without Republican support because the "system is broken."

"We prefer to go at it with Republicans if we can reach compromises in some areas," said Sen. Charles Schumer, D-N.Y. "But we're not going to not pass a bill."

Schumer dueled with Republican Sen. Kay Bailey Hutchison on a network morning news show in the wake of a key Senate vote Saturday night that advanced a 10-year, $959 billion health bill to full debate. Hutchison argued that "you're going to put taxes and mandates on business" that would be a drag on an economy still struggling to recover from recession.

Accusations around the political use of the task force recommendations on breast cancer screening have also become a dividing line between Democrats and Republicans:

Rep. Debbie Wasserman Schultz (D-Fla.), a breast cancer survivor, slammed Republicans on Sunday for trying to use controversial new mammogram guidelines as an argument against Democrats' health care legislation.

"The Republicans, and Ms. [Marsha] Blackburn, have for the first time politicized breast cancer," Wasserman Schultz said on ABC's "This Week," where Blackburn (R-Tenn.) was also a guest.

Obviously, an orderly fight ensued.

Health Care Hurdles [ABC News]
Schumer: Dems ready to go-it-alone on health care [AP]
Kennedy Abortion Flap Shows Catholic Rift [CBS News]
Dem: GOP has 'politicized breast cancer' [Politico]

Earlier: New Breast Cancer Screening Guidelines Spark Confusion, Criticism

Update: Senator Blanche Lincoln of Arkansas has also stated that she, too, will vote to push the bill forward, which gives the Democrats the 60 votes they need to avoid a Republican filibuster. [CNN]

Things to watch out for during the Saturday vote which will determine if the health care debate moves forward:

Major Differences

The Politico summarizes:

Senate Majority Leader Harry Reid introduced his health care reform bill yesterday and moved the debate into its final stage. After a year of multiple plans, proposals and programs we're down to two final, and very different, versions of reform. The House bill costs just over $1 trillion. The Senate bill weighs in at $848 billion. The Senate cuts Medicare spending by $491 billion and the House slashes it $571 billion. The Senate's public insurance option allows states to opt out of the program while the House has a more robust plan. And to fund reform, the Senate relies primarily on taxing high-end health plans while the House taxes the rich. And the gulf between the two bills is not likely to shrink as the bill moves through the Senate. If anything, the gap may widen if Senate moderates force Reid to make the bill more conservative. Besides the daily speculation about whether Reid has 60 votes to move a bill forward, which has been going on for weeks, the next power play to watch will be how Reid, Pelosi and the White House begin to move toward a bill that can pass both chambers and land with a victorious thud on the president's desk. Getting a bill passed through the Senate is difficult, but many insiders think reconciling the differences between the two bills could be hellacious.

Abortion

Now that Pelosi has reversed her stance on Stupak-Pitts, saying the amendment goes too far and embracing Reid's version, Catholic leaders and the GOP have come out swinging.

Catholic bishops are displeased:

A top Obama administration official on Thursday praised the new Senate health care bill's attempt to find a compromise on abortion coverage - even as an official of the U.S. Conference of Catholic Bishops said Sen. Harry Reid's bill is the worst he's seen so far on the divisive issue.

The bishops were instrumental in getting tough anti-abortion language adopted by the House, forcing Speaker Nancy Pelosi, D-Calif., to accept restrictions that outraged liberals as the price for passing the Democratic health care bill. [...]

Richard Doerflinger, associate director of the bishops' conference Secretariat of Pro-Life Activities, said Reid's "is actually the worst bill we've seen so far on the life issues."

He called it "completely unacceptable," adding that "to say this reflects current law is ridiculous."

Meanwhile, the Republicans found a new talking point:

House Minority Leader John Boehner's office has posted a long statement blasting the Senate health care plan, specifically targeting the abortion provisions with an accusation it levies an "abortion premium fee."

A Senate Democratic aide came back with the facts, pointing out that the prevision that Boehner refers to is for something else, and points to all the language in the bill that prohibits the use of public funds for abortion.

But Melissa over at Shakesville points out that Reid's additions are more of a Pyrrhic victory than anything else.

When Boxer's petition against the Stupak Amendment noted it "discriminates against women by taking away health coverage they already have-and tells women who participate in the new health insurance exchange that they can't even use their own funds to buy a policy that includes abortion coverage," I didn't imagine "let them use their own funds!" was going to be regarded as the best solution.

Silly me.

Meanwhile, D-Day notes that this compromise depends heavily on decisions made by the Secretary of Health and Human Services, as s/he "determines whether or not abortion services are being paid for with federal dollars" and "can choose whether or not abortion services are covered in the public option."

Not only are those wildly enormous decisions to leave in the hands of one person, but, as D-Day points out, "the executive branch may indeed be controlled by a Republican at some point in the future."

Cost

One of the major differences in the two plans is how it will be funded. The House wants to tax millionaires - the Senate bill wants to tax "Cadillac plans." However, taxing these so called plans may not be a good strategy. Politifact delves into the details of the Senate plan:

Under the Senate Finance proposal from Sen. Max Baucus, insurance companies would have to pay a 40 percent excise tax on health insurance policies that exceed $8,000 for individuals and $21,000 for families; they would pay taxes on the amount that exceeds those thresholds. We spoke with three economists on both the left and the right, and they all agreed that insurance companies will not simply absorb the new tax; they will pass it along in the form of even higher premiums. Employers will then try to avoid the new higher costs by buying cheaper health plans.

Finally, the economists agreed that if employers have to scale back on health plans, they will eventually pay higher wages as they seek to retain workers. At this point, disgruntled workers may say "Yeah, right," but the economists were adamant that it is the case. There are data that we won't get into now that back up their point.

Here's where the analysis that Palin mentioned by the Joint Committee, which is nonpartisan and advises Congress on tax policy, comes in: At the Senate's request, it tried to figure out the effect of the excise tax on federal taxes collected. Like the economists we talked to, the Joint Committee also believes that wages will rise if employers select lower-priced health insurance, and the government gets to tax those higher wages. So the Joint Committee created a series of tables projecting how much additional income tax would be collected over the next 10 years. By 2019, about 87 percent of those people paying higher taxes would make less than $200,000, according to an analysis of the preliminary Senate Finance proposal.

So here's what that means: If workers end up getting paid more, they'll also be taxed more.

Communications Workers of America also ran a separate analysis on what the 'Cadillac' plan tax would mean for workers:

"The Senate Finance Committee excise tax is not a tax on 'Cadillac' plans; it's a pick-up truck tax. It taxes plans that are of great utility to millions of working Americans, but it is bad policy based on wrong assumptions," said CWA President Larry Cohen. "Health care reform should be paid for by making employers who don't pay, pay. The House bill does it with an 8 percent payroll tax on employers who don't provide coverage."

CWA recommends the following strategies to avoid penalizing people who fought for better coverage, but are being lumped in with CEO packages:

Rather than impose a new tax on the middle class, CWA supports other revenue sources:

* Require most employers to provide coverage or pay an 8 percent penalty if they do not, as proposed under H.R. 3200 in the House of Representatives. This would raise $163 billion over ten years, according to the Congressional Budget Office (CBO). The Senate Finance Committee bill has no employer mandate.
* Levy a modest surtax on the wealthiest Americans – 1.2 percent of U.S. taxpayers – as proposed in H.R. 3200, raising $544 billion over ten years according to JCT.
* Limit the charitable deductions for individuals earning more than $250,000 and families earning more than $500,000, as proposed by President Obama, which would raise $318 billion over ten years.
* Enact a strong public health insurance plan option to compete with private insurers, as proposed under H.R. 3200, which would lower costs by about $110 billion. The Senate Finance Committee bill has no public option.

Of course, the real party starts Saturday night. Seeing that the last Saturday evening health care announcement brought us Stupak-Pitts, let's hope nothing new comes out of left field.

Live Pulse [Politico]
Pelosi Says Stupak 'Goes Beyond Status Quo', 'Optimistic' It Won't Stop Reform [TPM]
White House at odds with bishops over abortion [AP]
GOP Claims Senate Bill Forces Taxpayers To Pay 'Abortion Fee' [TPM]
Senate Health Bill Answer to Stupak [Shakesville]
Sarah Palin says health care reform will raise taxes on the middle class [Politifact]
CWA Excise Tax Study Finds that One-Third of Health Care Plans Still Will Be Affected By Senate Finance Committee Approach [CWA]

Related: Why the Health Insurance Excise Tax Is a Bad Idea [The Nation]

The report made waves by advising against home screening for breast cancer and against annual mammograms:

The task force, a federal advisory board, said this week that women should not begin routine mammograms until age 50, contradicting the well-established advice that women 40 and older should be screened.

Groups such as the American Cancer Society and Susan G. Komen for the Cure have opposed the new guidance.

The backlash was swift and merciless, forcing Health and Human Services Secretary Kathleen Sebelius to issue a statement saying that the recommendations of the task force are not guaranteeing a change in government policy:

In a written statement, Sebelius said the guidelines had "caused a great deal of confusion and worry among women and their families across this country" and stressed that they were issued by "an outside independent panel of doctors and scientists who . . . do not set federal policy and . . . don't determine what services are covered by the federal government." [...]

The task force on Monday recommended that women in their 40s stop having routine mammograms and instead individually discuss whether to get the exams with their doctors.

The panel also recommended that women in their 50s get mammograms routinely every two years, instead of annually. The panel argued that the benefits of more frequent exams were outweighed by the harms caused by false alarms, which can lead to anxiety and unneeded treatment.

While hailed by many patient advocates and breast cancer experts, the new guidelines have been harshly criticized by the American Cancer Society, the American College of Radiology and others, including some members of Congress.

Two of the women over at Time's Swampland blog are up in arms, noting that the recommendation seems more like a cost-saving measure rather than anything that will benefit women. Kate Pickert points out the numbers:

The panel also said a review of clinical data showed that yearly mammograms for women 40-49 reduced the risk of breast cancer death by 15%, but under a section titled "Balance of Harms and Benefits," said this:

• Harms of screening include psychological harms, additional medical visits, imaging, and biopsies in women without cancer, inconvenience due to false-positive screening results, harms of unnecessary treatment, and radiation exposure. Harms seem moderate for each age group.

  False-positive results are a greater concern for younger women; treatment of cancer that would not become clinically apparent during a woman's life (overdiagnosis) is an increasing problem as women age.

These new guidelines - which while influential, are not binding - have caused no small amount of consternation. Women are incensed that some faraway task force has decided a 15% risk reduction – i.e. actual lives saved – is not enough to warrant mass screenings. I asked a number of female colleagues here at TIME what they thought of the new guidelines and all said they found the new recommendations to be disturbing. One even said the news set off "a giant pink bell ringing in my head."

After pointing out how Congresswoman Debbie Wasserman-Schultz, a breast cancer survivor, freaked out at the proposal, Pickert concludes:

For instance, a small number of women get diagnosed with breast cancer in their 20s and 30s. Does this mean mammograms should be routine during these years too? At what point do lives saved outweigh "psychological harms, additional medical visits, imaging, and biopsies in women without cancer, inconvenience due to false-positive screening results, harms of unnecessary treatment, and radiation exposure." Will private insurance companies, which pay close attention to guidelines from the U.S. Preventive Task Force and other groups, stop covering mammograms for women under 50? Wouldn't insurers rather catch cancers early when they are easy (and cheap) to treat? And what about the oft-touted U.S. breast cancer five-year survival rate, which is 83.9%, compared to England, where it's 69.7%?

Time's Karen Tumulty doesn't pull any punches - she thinks the task force is composed of "pinheads:"

[A]t age 19, when I discovered lumps in both my breasts that didn't go away after a couple of menstrual cycles.

That's when I had my first mammogram. Back in those days, the technology wasn't what it is today, and it was inconclusive. My doctor decided he wanted to do a biopsy. That wasn't what it is today, either. A simple breast biopsy in 1975 required me to check in for an overnight stay in a hospital, and to sign forms before the surgery authorizing a mastectomy on the spot if it turned out to be cancer. I remember vividly waking up from the general anesthesia terrified, feeling the heavy layers of bandages trying to figure out what they had done. It was benign—thank God—but it turned out to be the first of several times I would go through this drill, because I have lumpy breasts. The fancy name for that is fibrocystic disease.

At the time of my first breast biopsy, I had no family history of the disease. I subsequently developed one. Over the years, my mom was diagnosed with breast cancer (and survived it); my aunt was too (and didn't). I've had a number of scares, but none, thus far, has turned out to be cancer.

So it would seem I'm the perfect example of a person who shouldn't have had mammograms, or even examined my own breasts. But am I sorry I've had the information I've had through mammograms and self-exams? Not for a second.

That's why I think these scientists are pinheads. Pink ribbons are lovely, but women who want information should have it. And I would remind Swampland readers of the important lesson we all learned from Carly Fiorina. Information is power, ladies, and don't let some scientific panel tell you it isn't.

But the NY Times' Gail Collins begs to differ:

Somewhere between the reports that Pap smears and tests for prostate cancer aren't all they were cracked up to be and the news that a high fiber diet doesn't do anything to prevent cancer, the health establishment began looking decidedly nonomniscient. Then this week, a federal task force reported that most women don't need annual mammograms.

Even more fascinating, they suggested that doctors stop telling their female patients to self-examine their breasts for lumps. [...]

The report triggered two immediate and inevitable responses. Doctors and patients began an animated discussion. And Republicans declared it was all a Democratic plot.

"I mean, let the rationing begin. This is what happens when bureaucrats make your health care decisions," said Representative David Camp, the ranking Republican on the House Ways and Means Committee.

Representative Camp is definitely on to something. Whatever happens, we do not want the government conducting any studies on whether current health practices actually do any good. Let this continue and soon you will not be able to get your hands on a good leech when you need one.

There is no possible political advantage in coming out against medical testing, so the Obama administration scurried away from the report. The task force did not consider the matter of cost, but, of course, people like Representative Camp depicted it as the first step toward rationing. The current position of the Republican Party seems to be that it is not possible to spend too much money on medicine. Party on.

(Has anybody noticed that the people who darkly warn about government bureaucrats forcing insurance companies to cut back our coverage appear to be the same ones who just voted to force insurance companies to stop covering abortions? Where's the sanctity of the marketplace when we really need it?)

Collins, also a breast cancer survivor, is remarkably glib about the whole business, explaining:

I had mammograms every year like clockwork, and I had just gotten a clean bill of health from my latest one when I found a lump on my left breast while watching a rerun of "Buffy the Vampire Slayer," multitasker that I am.

It turned out to be cancer, of a fairly low-grade variety. My oncologist felt strongly that it never would have developed if I hadn't taken estrogen replacement therapy - another one of the medical marvels that has now been consigned to the Seemed Like a Good Idea at the Time category.

So, in summary, the cutting-edge of medical thinking of the 1990s may have induced my cancer, and then the universally recommended testing protocol failed to detect it.

So who's correct? Only time will tell, but in terms of personal health, most of us would prefer to side with the old adage "an ounce of prevention is worth a pound of cure."

Who decides about mammograms? Inside the task force [CNN]
Sebelius distances herself from new mammogram guidelines [LA Times]
Are Mammograms the New Political Football? [Time]
A Word About My Breasts [Time]
The Breast Brouhaha [NY Times]

Earlier: New Breast Cancer Screening Guidelines Spark Confusion, Criticism

Senator Reid unveiled his plan last night with both fanfare and steely resolve:

Reid's plan would expand coverage to 94 percent of Americans through a government-run health insurance option - allowing states to opt out - and other features, all while reducing future federal deficits by $130 billion over the next 10 years, according to a Congressional Budget Office report released late Wednesday. [...]

But Reid's plan contains considerable differences from House legislation passed earlier this month - with a more limited public option and different ways to pay for the bill. Reid included an excise tax on insurers who offer "Cadillac" health plans, not the "millionaire's tax" that's in the House bill.

And one of the biggest differences between the bills – on language restricting federal funding for abortion – could prove problematic for Reid. His bill doesn't include as many limits as the House bill and already is drawing fire from anti-abortion activists.

On the issue of abortion, the bill makes the following provisions:

The bill grants the secretary of Health and Human Services the authority to determine whether federal money is being used to fund abortions under the public plans, but doesn't ban those plans from offering the coverage. Reid's bill also explicitly requires insurers to separate private premiums from any public subsidies used to pay for that coverage to assure taxpayer dollars aren't used to fund the procedure - which is prohibited by the Hyde Amendment. [...]

There is a conscience clause that makes it perfectly acceptable for insurance companies to deny that coverage or health care providers to refuse carrying out the procedure. But the bill also requires each exchange to offer one plan that provides abortion coverage and one that doesn't - a major sticking point for critics of the original House language.

California Rep. Lois Capps, who tried to hatch a compromise on the Energy and Commerce Committee, commended Reid's language, saying, "I am pleased that the Senate has adopted a reasonable, common ground approach on this difficult question. It appears that their approach closely mirrors my language which was originally included in the House bill."

In a statement, she went on to point out that the bill "ensures that federal funds do not pay for abortions but allows continued access to this legal medical procedure."

We also have a date: Reid's version of the bill would start exchanges in 2014.

Reid, it should be noted, isn't fucking around with party holdouts.

At a special evening meeting of the Democratic caucus tonight, Senate Majority Leader Harry Reid outlined, in broad strokes, the details of his health care bill, which the CBO has found, in a preliminary analysis, will expand coverage to 94 percent of Americans while reducing the deficit. And earlier in the day, during a separate meeting about floor procedure, Reid let three of his party's key skeptics know that if they join Republicans at any stage of the process to block the bill, he still retains the option of passing major parts of it through the filibuster proof budget reconciliation process.

In response to a question from TPMDC Nelson told reporters that, at a meeting this afternoon with Sens. Mary Landrieu (D-LA) and Blanche Lincoln (D-AR), Reid "talked about process, procedure, discussion about reconciliation and a whole host of issues of that sort."

"Nobody's really jumping up and down to push for reconciliation," Nelson said, "he's not threatening that, but anybody can conclude that if you don't move something on to the floor, that is one of the possibilities."

National Right to Life-rs are, of course, talking shit, but I'm going to ignore them in favor of reason and sanity. The real battle begins on Saturday.

Reid plan ups pressure on moderates [Politico]
Reid's restrictions on abortion [Politico]
Reid Outlines Bill For Caucus, Warns Conservative Dems That Reconciliation Is Still An Option [TPM]
National Right to Life blasts the Reid bill [Politico]

NBC's Andrea Mitchell and Rep. Debbie Wasserman Schultz, herself a breast cancer survivor, talk above about one of the biggest concerns sparked by the new guidelines: that insurance companies will now choose not to cover mammograms for women under 50. Doctors say this won't happen immediately, but is certainly possible, and the National Committee for Quality Assurance is already changing its system for grading health plans to reflect the new recommendations. Because of this, many worry that the change is motivated by a desire for cost-cutting, and not a concern for women's health. Carol H. Lee of the American College of Radiology says,

The only conclusion I can come to is it's economically motivated. In this climate, when we are all paying attention to how we can decrease the cost of health care, in my opinion that's the primary motivation.

But the United States Preventive Services Task Force, which not only recommended the change in mammogram ages but also said breast self exams have little benefit, says the real issue is unnecessary screening and even treatment. Women in their 40s are 60% more likely to experience false positives from mammograms, leading to unnecessary follow-up tests and anxiety. While these risks may seem relatively minor, early screening also increases the odds that a woman will be treated for cancer that never would have sickened her — and unnecessary cancer treatment is a much more serious proposition than a biopsy. Some women, in fact, seem relieved by the new guidelines. 51-year-old Nancy Moylan told the New York Times,

Sure, I know plenty of women who have breast cancer. And I know many, many women who've received false-positives. It always struck me that most women seemed so relieved to know that they don't have cancer that they never took the next step and said, ‘Hey, why was I just put through that anxiety? I've had all these invasive tests and worry only to find out that the mammogram isn't all it's cracked up to be?'

What's frustrating for many women may be the uncertainty of breast cancer screening, uncertainty only further compounded by the new guidelines, which have already been criticized by the American Cancer Society. Liesl Schillinger writes in The Daily Beast,

The only consistent message from the scientific community to women is to be afraid. How can issues of such life-and-death importance to women-more than half the population-be so murkily understood, and so conflictingly explained? Are medical authorities playing a guessing game with women's health?

Unfortunately, when it comes to breast cancer, a guessing game still seems to be the only game in town. Dr. Donald A. Berry, a statistician on the task force, says the money spent on regular mammograms for women under 50 "was buying something of net negative value," and that with the new guidelines, "the economy benefits, but women are the major beneficiaries." And in fact, many women have long forgone mammograms because they personally feel the risks outweigh the benefits. Unfortunately, mammograms only reduce the breast cancer death rate by 15% — a big deal if you are one of the ones saved, but still a relatively small fraction of all sufferers. This statistic — and the high number of false positives associated with mammograms — shows that what women really need are better screening tools. But for now, we have to decide what to do with the tools we have, and this decision has just become a lot more complicated.

Mammograms And Politics: Task force Stirs Up A Tempest [Washington Post]
Many Doctors To Stay Course On Breast Exams For Now [NYT]
New Mammogram Advice Finds A Skeptical Audience [NYT]
Panel Urges Mammograms At 50, Not 40 [NYT]
The Great Mammogram Debate [Daily Beast]