Friday, October 21, 2016

ANS -- Donald Trump Confuses Birth With Abortion. And No, There Are No Ninth Month Abortions.

In response to the part of the presidential debate that was about abortion, here is an abortion doctor's description of late term medical abortions.
As someone said on TV -- a ninth month "abortion" is called a C-section. Yes, apparently, Donald Trump and his cohorts want to make C-sections illegal.  (If they had been illegal when I was born, I and my mother would have both died.) I don't think they have realized that's what they are asking for.  

Donald Trump Confuses Birth With Abortion. And No, There Are No Ninth Month Abortions.

Trump's abortion stance is about punishment and control.

 10/20/2016 11:48 am ET | Updated 12 hours ago

The third and final presidential debate focused very quickly on abortion. Clinton defended choice, and Trump ― not one to be bothered with facts ― countered with this doozy of line:

I think it's terrible if you go with what Hillary is saying... in the ninth month you can take the baby and rip the baby out of the womb of the mother just prior to the birth of the baby. Now, you can say that that's okay, and Hillary can say that that's okay, but it's not okay with me. Because based on what she's saying and based on where she's going and where she's been, you can take the baby and rip the baby out of the womb in the ninth month, on the final day. And that's not acceptable.

First of all, we don't "rip" anything in OB/GYN. In surgery, we use sharp dissection and blunt dissection, but we don't rip. Some women do tear during a vaginal delivery, but that's not a doctor ripping the baby out. Even with a forceps delivery, I wouldn't call it ripping. We also don't rip tissues during c-sections.

Perhaps we can forgive Donald Trump for not knowing this as it is hard to believe that a man who bragged that he doesn't change diapers and said he wouldn't have had a baby if his wife had wanted him to actually physically participate in its care would have attended the birth of his own children. It's certainly not for the faint of heart as there is, after all, lots of blood coming out the "wherever."

Trump's statement, as incorrect as it may be, supports the fallacy of the due-date abortion. It is a common anti-choice narrative that women come in at 39 weeks and have some kind of abortion for fun or out of boredom and that we doctors are only to happy to comply. I'm sure some people think there are Groupons. The more graphic the description of the procedure, the better as it helps to distract from the facts.

Talking about abortion from a medical perspective is challenging when you are not a health care provider. Even someone familiar with the laws can get confused. For example, Mrs. Clinton made an error speaking about late-term abortion when she said it was a health of the mother issue. Typically, it is not (it's almost always fetal anomalies). However, this error on Clinton's part only underscores how important it is for politicians to not practice medicine.

To put it in perspective, 1.3 percent of abortions happen at or after 21 weeks and 80 percent are for birth defects. Put another way, 1 percent of abortions that are at or after 21 weeks and are for birth defects and 0.3 percent of abortions are at or after 21 weeks and are not for birth defects (some of these will be health of the mother and a very few will be for other indications). Let's take it situation by situation.


Birth Defects

This could range from Down syndrome to anomalies incompatible with life. The generally accepted limit of viability is 24 weeks. Before that, gestational age abortions can happen for any reason. After 18 or so weeks, the options are an induction of labor or a dilation or an evacuation (or D and E), which is a surgery.

With induction, it can take a few days as labor can be hard to trigger so early. If all goes well, the cervix dilates and the fetus delivers. Sometimes indictions fail because you can't always get such a premature uterus to contract. With a D and E, the cervix is dilated, with the help of medication, instruments or both, and the fetus is removed. The fetus is essentially taken apart with a D and E to fit through the dilated cervix (the cervix is dilated less with a D and E than for an induction). This is no secret to the women having the procedure. This is also no ripping; there is simply surgical technique. Women know they were pregnant before the procedure and that they were not after ― and trust me, they don't think their doctor waved a magic wand or had a time turner.

After 24 weeks, birth defects that lead to abortion are very severe and typically considered incompatible with life. These procedures are either a traditional induction, just like labor, or something that requires instrumentation. Because of the nonsensical partial birth abortion law women who wish to have a dilation and extraction (a modified technique for more advanced procedures) need to have fetal cardiac activity stopped with an injection into the uterus. Either way, it's a two or three (or even four) day process to get the cervix to dilate enough.

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The further along in the pregnancy, the more likely the procedure will be an induction of labor. But a skilled practitioner can do a dilation and extraction at 32 or 34 weeks. I've never heard of a dilation and extraction for any other reason than severe birth defects, and often, it is for a woman who has had two or three c-sections for whom inducing labor might pose other health hazards, like uterine rupture. Are we to force women to have c-sections for a pregnancy that is not compatible with life?

Why do some women end up with these procedures later on in their pregnancy? Sometimes it can take weeks or even longer to fully understand what is going on with the fetus. Some patients might think they can make it to term and then at 34 weeks cave and ask to be delivered because they just can't bear one more person asking them about their baby. Do they just smile and walk away or say, "Well, actually, my baby has no brain and will die at birth"? Some women go to term and others can't. To judge these women for requesting an early delivery is cruel on so many levels. I wrote more about it here if you are interested.  

Regardless, terminations for birth defects isn't ripping "the baby out of the womb in the ninth month." At 38 or 39 weeks, it's always an induction and is simply called a delivery.

Health of the Mother

This definitely happens between 20 and 24 weeks. The most likely scenario is ruptured membranes and an infection in the uterus. The treatment of this is delivery or the infection will spread and kill the mother; however, someone with lupus or renal disease or heart disease (for example) could have a deterioration of their health and with their providers make the decision to have a termination.

After 25 weeks, this would simply be a c-section or an induction of labor and the baby would go to the neonatal intensive care unit. Between 24-25 weeks, there could be some leeway as conditions that are serious enough to require delivery at 24 weeks often also have devastating effects on the fetus. For example, the fetus could be so severely growth restricted making viability at 24 weeks unlikely and a woman with a severe heart condition may not elect to risk her health with a c-section for a likely non viable pregnancy and choose a termination.

These are difficult and nuanced decisions, and everyone is simply working together to make the best decision for the pregnant person. I don't know where Mrs. Clinton got this "bad news at the end" of the pregnancy being about maternal health. I have only ever heard of one very late abortion for maternal health and that was for the rape of a minor by her brother and that was still not at term.

So no one is performing health of the mother abortions at 38 or 39 weeks/ We just do deliveries. It's called obstetrics.


Some of the 0.3 percent of abortions after 21 weeks will be for personal reasons. Often these are called elective abortions, but I don't like that term. Usually this happens when it took too long to find a clinic and raise the money. These abortions happen before 24 weeks. There is no ninth month action here either.

The Facts

There are no ninth month abortions. Really. A ninth month abortion is a unicorn and so it's ridiculous to even discuss it. Terminations after 24 weeks are for severe fetal anomalies.

If it's a unicorn, why not legislate it? Introducing a gestational age limit is introducing the thin edge of the wedge. Once you say abortion is illegal at say 37 weeks then you have agreed the subject is up for negotiation and more legislation.

If someone were truly interested in reducing abortion, they wouldn't start with the 1.3 percent. More reductions can be made in the first trimester where most terminations are due to unplanned pregnancies. These abortions could be reduced dramatically with access to free and accessible long-acting reversible contraception. To dismiss these abortions and focus on the later procedures means it is not about reducing abortion at all, so it can only be about punishment and control.

A version of this post originally appeared on

Tuesday, October 18, 2016

ANS -- Paul Ryan: If Republicans Lose the Senate, Bernie Sanders Wins

This is an exciting prospect -- if Democrats regain the Senate, Bernie Sanders is in line to become chair of one of the most important committees -- Either the Budget Committee or Health, Education, Labor, and Pensions.  Please be sure to vote!

Paul Ryan: If Republicans Lose the Senate, Bernie Sanders Wins

The house speaker knows that if the GOP loses seats in Congress, Bernie Sanders could become the Senate Budget Committee Chairperson.

Paul Ryan is famously described as what Republicans think a smart person sounds like. But sometimes the speaker of the House outsmarts himself.


Ryan lectured Young Republicans in his native Wisconsin last Friday, and the national news media were invited to listen along. The speaker wanted to make the case for Republican voters to turn out and back GOP congressional candidates, even if they can't stomach their party's scandal-plagued presidential ticket. Implicit in Ryan's argument was the suggestion that a Republican-controlled House of Representatives and Senate could be counted on to obstruct Hillary Clinton's supposedly "liberal progressive" agenda.

But in a question-and-answer session following his unremarkable speech, Ryan inadvertently made a case for liberals and progressives to turn out in big numbers in order to elect Democratic candidates in the fight for control of the Senate.

As he outlined his Wall Street–friendly proposals for tax reforms that would more rapidly redistribute wealth upward, and for budgets that would put vulnerable Americans at greater risk while increasing burdens for middle-class families, the speaker explained that his agenda can advance only if Republicans control both the House and Senate. "If we keep control of the Senate in the Republican hands…a nice guy named Mike Enzi from Wyoming is the Senate budget chair and he helps us get these budgets to the president's desk, gets these tax bills through," he said.

On the other hand, Ryan warned, "If we lose the Senate, do you know who becomes chair of the Senate Budget Committee? A guy named Bernie Sanders. You ever heard of him?"

Ryan's comment drew a tepid response from the Young Republicans he was lecturing. No surprise there. Polling suggests that Bernie Sanders is among the most well-regarded political figures in the country, especially among younger voters, and the long-time independent generates far less partisan antipathy than veteran Democrats.

But when word got out that Ryan was rattled by Sanders, the response from around the country was electric. People who might have been having a hard time getting excited about the presidential race were most intrigued by the possibility that Sanders might become a powerhouse in the Senate.

The possibility is real enough.

The senator from Vermont is the ranking member of the budget committee, and if Democrats gain control of the chamber on November 8, he would be in line to chair it. But Sanders could also end up chairing then powerful Senate Health, Education, Labor, and Pensions (HELP) Committee, which he could use to advance many of the proposals (for affordable college, empowering unions, and investing in public-health programs) that made his bid for the Democratic presidential nomination so popular.

The final list of committee assignments will be influenced by the choices of senior senators, such as Washington's Patty Murray. "There's lots of individual choices ahead, of people who are senior to Bernie," says Senator Charles Schumer of New York, who is set to replace retiring Senate Democratic leader Harry Reid of Nevada. Yet Schumer says of Sanders, "He will chair a significant committee if we win the majority.''

That prospect scares Paul Ryan.

But it excites a lot of other people.

Because Ryan's Friday event—at which he avoided mentioning the candidate he has endorsed for the presidency—was otherwise devoid of news, the speaker's reference to Sanders got a good deal of attention. Reporters tweeted about Ryan's comments regarding the Vermonter, and made mention of them in articles on an otherwise inconsequential event.

The response was immediate—and enthusiastic.

The news that Sanders might end up in a top position in the Senate, and that he might be positioned to thwart Ryan's plans, became a digital sensation. Twitter and Facebook exploded—with messages like "Awesome!" and "Sounds like a plan!" and "Too bad for Ryan, that's a scenario millions of millennials would welcome."

Sanders fans created images of the Vermont senator with the Ryan quote superimposed on it, and bloggers mocked the speaker's "doomsday scenario" with assessments like this Daily Kos observation: "Good god, people! Sanders might try to expand Social Security. He might look for ways to ease the burden of college debt. By god, he had a 'Medicare for All' platform. Just think of it: Insured people everywhere! Talk about an apocalypse!"

Of course, liberals and progressives understand that an empowered Bernie Sanders is no doomsday scenario, no apocalypse. For them, it's a thrilling prospect that builds enthusiasm for voting—and perhaps for volunteering. Even among young voters are not all that thrilled with the prospect of a Hillary Clinton presidency, the prospect of Bernie Sanders writing budgets and setting national priorities is, well, "awesome."

So Democrats will undoubtedly be pleased if the speaker keeps talking about the Sanders "threat."

Paul Ryan is making a muscular case for why control of the Senate should be grabbed away from right-wing Republicans and handed over to a party that plans to put Bernie Sanders in a position of power.

Monday, October 17, 2016

ANS -- Time to Implement a Fixed Minimum Tax Rate on the Wealthy

This is a short, not very deep article, but it is about the idea of a minimum income tax for the wealthy. (30% is one suggestion) What do you think of that idea? Would it be possible to get it passed?  Even if we had a Democratic majority in the Senate?  Senate and House?

Time to Implement a Fixed Minimum Tax Rate on the Wealthy

Monday, 17 October 2016 00:00By Sam | Op-Ed

Warren Buffett, the third-richest man in America, has always been a bit of a traitor to his class. The super rich, Buffett holds, ought to pay income taxes at a higher rate than average Americans because they have the capacity -- and good fortune -- to contribute significantly more to our national well-being.

Current tax law, Buffett goes on to explain, lets the really rich routinely avoid that responsibility. In fact, as Buffett has famously declared, his secretary pays taxes at a higher rate than he does.

Buffett believes in tax fairness. Donald Trump, on the other hand, most certainly does not.

The Donald has personally lobbied Congress for tax breaks that ease the tax bite on wealthy real estate developers like himself. And his latest White House campaign tax proposal, the Center for Budget and Policy Priorities points out, would if adopted "raise after-tax income for those with annual incomes of over $1 million by 14.3 percent."

White House hopeful Trump doesn't just pay taxes at a lower rate than his secretary. At the second presidential debate with Hillary Clinton in St. Louis, he essentially acknowledged he regularly pays no federal income taxes at all.

Trump's brand of in-your-face tax dodging simply -- on philosophical grounds -- outrages Warren Buffett. But at the St. Louis debate Trump gave Buffett's outrage a personal twist. The GOP nominee publicly charged that the Omaha billionaire has claimed even "bigger deductions" than he has.

Buffett shot back at Trump the next day. He released his latest tax return and denied he had ever exploited the tax break that has enabled Trump to zero out his entire federal income tax liability.

The tax return Buffett released showed he had paid $1,845,557 million in taxes for 2014, 16 percent of his income. Buffett also noted that he's been paying taxes "of a similar nature" for years.

But Buffett's rebuttal to Trump did admit that he hasn't always paid taxes in the millions. As a 13-year-old in 1944, the billionaire quipped, he did pay only $7 in federal income tax.

That 1944 tax year actually has a much higher claim to fame than experiencing the first of Warren Buffett's 72 federal income tax returns. That year, history tells us, climaxed the most ambitious stretch of "soaking the rich" in U.S. tax history.

Over the three-year period that ended with 1944, America' richest -- those taxpayers averaging over $2 million, in today's dollars -- on average annually paid between 68 and 78 percent of their total incomes in federal income tax.

How do those overall tax rates compare to tax rates on the rich today? In 2013, the most recent year with IRS stats that single out the super rich, the 400 Americans with the nation's highest reported incomes paid on average just 22.89 percent of their total incomes in federal income tax.

Many tax reformers, in response to stats like these, are calling for a fixed minimum tax rate on America's wealthy. No one taking in millions a year, they argue, ought to be paying less than 30 percent of their income in federal income taxes.

This "Buffett rule" has won the support of a number of political leaders, including Donald Trump's chief rival for the White House. But the tax experience of the 1940s suggests we can tax the rich at a much higher minimum rate and, in the process, accomplish amazing things as a nation.

And what did we accomplish back in the 1940s? Not much. We just thumped the Nazis and began an epic sharing of the wealth that turned the United States into the first mass middle class nation in world history, the first nation ever to have a majority of its people not living in poverty.

So, yes, let's put a 30 percent Buffett rule in place. But let's do our best to not -- for a moment -- stop there.

This piece was reprinted by Truthout with permission or license. It may not be reproduced in any form without permission or license from the source.

Wednesday, October 05, 2016

ANS -- Pence Gave Away Trump’s Biggest Policy Advantage and Kaine Didn’t Even Notice

This is a completely different take on the VP debate than any other I've seen.  I don't like how he sneers at Kaine, but the viewpoint is worth thinking about.  


Yet Another Attempt to Make the World a Better Place by Writing Things

Pence Gave Away Trump's Biggest Policy Advantage and Kaine Didn't Even Notice

by Benjamin Studebaker

The Vice Presidential debate last night between Tim Kaine and Mike Pence was a sad affair–Pence was able to "win" the debate without knowing any policy by repeatedly attacking Clinton's record while only vaguely referencing policy issues. Rather than force Pence to defend his vague policy assertions, Kaine relied on a variety of canned talking points, many of which were personal attacks on Trump that moved the conversation away from the issues (Kaine repeatedly referenced my 5 bad anti-Trump arguments instead of my 5 good ones). This made Kaine look like he was running from policy, allowing Pence's assertions to go unchallenged and giving Pence command of the room. Pence was able to accuse Kaine of running an insult-driven campaign, and Kaine's response to that was to petulantly interrupt, get defensive, and resort to more insult-driven talking points, all of which reinforced Pence's point. There were many claims Pence made that were open to attack, but I want to focus on one in particular today–Pence eliminated the major policy difference between his campaign's and Kaine's on Syria, and in so doing he eliminated the foreign policy case for Trump.


When it comes to Syria, there are really only three core approaches that you'll see different American politicians favor:

  1. The Lindsey Graham Plan
  2. The Hillary Clinton Plan
  3. The Jimmy Carter Plan

Most American politicians have two core objectives in Syria–they want to remove President Assad, a strong ally of Iran, and they want to defeat ISIS. The priority you give to these two objectives and the means you're willing to use to achieve them determine which approach you favor.

The Graham Plan

Remember Lindsey Graham, the former Republican presidential candidate? Here he is with his good friend John McCain:

He wants to get rid of Assad and ISIS at the same time, and he wants to do that by sending an Arab coalition into Syria with at least 20,000 American ground troops. He wants a no-fly zone in Syria, even though the Russians object to that and are currently flying bombing missions there to help Assad. There are big risks with a no-fly zone because if the United States imposes it without Russian cooperation the Russians might refuse to respect it. If they defy the no-fly zone and we shoot down Russian planes, that could lead to war. The Russians categorically oppose a no-fly zone, because they believe it will be used to oust Assad in the same way the no-fly zone in Libya was used to oust Gaddafi). However Graham's plan does have one key advantage, which is that it provides for a ground army to take and hold the territory we pry lose from ISIS. The trouble is that Graham's plan calls for 90% of the troops in this army to come from other countries in the region, and so far regional powers have been immensely reluctant to agree to that kind of commitment. So in practice Graham's plan might result in a much larger American troop commitment than he readily admits, which would be expensive and could lead to a prolonged occupation, similar to what happened in Iraq. Nevertheless, this plan has a lot of support from Republican hawks and neoconservatives from the Bush era.

The Clinton Plan

Clinton also wants to remove Assad and defeat ISIS at the same time, and she also supports a no-fly zone that raises the risk of a war with Russia. The difference between her plan and Graham's is that Clinton does not support an American troop commitment. Instead she wants to arm and supply Syrian and Kurdish rebel groups. Some of these groups are themselves hostile to the United States and there is little evidence to suggest they are prepared to take and hold sufficient territory for this plan to work. The most powerful rebel groups are not moderate by any stretch of the imagination, and the plan could replace both Assad and ISIS with some other radical group, like the Al-Nusra Front. As was the case in Libya, where Clinton pushed for the elimination of Colonel Gaddafi through a no-fly zone (which the Russians regarded as illegal), Clinton wants to eliminate major players in the region without a clear plan for what comes next. This is very likely to result in a new power vacuum and more violence (Libya's per capita GDP has collapsed and it's been mired in civil war for years–when criticized about this, Clinton responds by blaming the Libyan people). It's a weak plan, but it appeals to Americans who don't like the Graham plan because Clinton's plan doesn't require any American troops and Graham's does. President Obama has repeatedly refused to go along with Clinton on this–while he has armed some rebel groups, he has kept his commitment relatively small and he has declined to impose a no-fly zone. It's sometimes forgotten, but Clinton is much more of a hawk than Obama, which is why she supported the Iraq War at the time and he did not.

The Carter Plan

Unlike Clinton and Graham, Carter thinks it's much more important to stop ISIS than it is to immediately remove Assad, and that means he's much more willing to cooperate with the Russians. Carter wants us to pursue a lasting ceasefire between Assad and the non-ISIS rebel groups. By putting a stop to the instability in the country, Carter would enable all factions in Syria to focus on eliminating ISIS and negotiate a sustainable long-term plan for political transition that all the players are comfortable with.

Bernie Sanders and Donald Trump both supported this kind of plan during the primary campaign. Sanders said:

I think we do have an honest disagreement: in the incredible quagmire of Syria, where it's hard to know who's fighting who and if you give arms to this guy, it may end up in ISIS' hand the next day. And we all know–the secretary is absolutely right–Assad is a butcher of his own people, a man using chemical weapons against his own people. But I think in terms of our priorities in the region, our first priority must be the destruction of ISIS. Our second priority must be getting rid of Assad, through some political settlement, working with Iran, working with Russia. But the immediate task is to bring all interests together who want to destroy ISIS, including Russia, including Iran, including our Muslim allies to make that the major priority.

Trump put it more bluntly:

So, I don't like Assad. Who's going to like Assad? But, we have no idea who these people, and what they're going to be, and what they're going to represent. They may be far worse than Assad. Look at Libya. Look at Iraq. Look at the mess we have after spending $2 trillion dollars, thousands of lives, wounded warriors all over the place–we have nothing.

But during the debate, Pence effectively adopted Clinton's position. Pence said:

The United States of America needs to be prepared to work with our allies in the region to create a route for safe passage and then to protect people in those areas, including with a no-fly zone.

Once you're for a no-fly zone, you are totally rejecting dealing with the Russians, and that takes the Carter plan off the table. Trump and Pence have not committed to ground troops in Syria, which means we have no reason to believe they've embraced the Graham plan. That leaves the Clinton plan–Pence gave every indication last night that the Trump solution to the Syrian conflict is identical to Clinton's.

Tim Kaine could have pounced on this tremendous concession, but in his incompetence he responded with a series of canned talking points that had nothing whatsoever to do with the issue at hand:

Well, let me — let me come back and talk about — let me talk about the things that Governor Pence doesn't want to acknowledge, Elaine. He doesn't want to acknowledge that we stopped the Iranian nuclear weapons program. He doesn't want to acknowledge that Hillary was part of a team that got bin Laden. He doesn't want to acknowledge that it's a good thing, not a bad thing, that it's a good thing — not a bad thing — that we're down from 175,000 troops deployed overseas to 15,000. But let me tell you what will really make the Middle East dangerous. Donald Trump's idea that more nations should get nuclear weapons, Saudi Arabia, Japan, South Korea. Ronald Reagan said something really interesting about nuclear proliferation back in the 1980s. He said the problem with nuclear proliferation is that some fool or maniac could trigger a catastrophic event. And I think that's who Governor Pence's running mate is, exactly who Governor Reagan warned us about.

I'll close with a little chart that helps break down how the different Syrian strategies work:

Priority (Assad vs ISIS)ISISBothBoth
No-Fly ZoneNoYesYes
Work with RussiaYesNoNo
Arm RebelsNoYesYes
American TroopsNoNoYes
Who Takes TerritoryRebels + AssadRebelsUS Coalition
ProponentsDem Doves, Sanders, Primary Trump, Rand Paul, GOP Anti-EstablishmentDem Hawks, General Election Trump & Pence (apparently)McCain, Neocons, Ex-Bush Administration