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Daisy Wademan Dowling

Daisy Wademan Dowling

Daisy Wademan Dowling, executive director of leadership development at a Fortune 500 company, writes a regular column for the Harvard Business Review and is author of the 2004 book, "Remember Who You Are."

Stop the bleeding

"Get her to the emergency room. Now." The doctor's voice was urgent, commanding. My friend was bleeding, heavily - and no, not from an abortion. A simple though necessary surgery to remove a suspicious uterine polyp had somehow gone terribly, horribly wrong. The rest of that evening consisted of cold, sheer terror: the fearful calculation of what it might take to make the hemorrhage stop - and the dreadful prospect that perhaps nothing would. Two days in the hospital, massive quantities of drugs, an additional surgery and $100,000 in medical bills later, the problem resolved, and my friend is back in good health. She was lucky. And she had insurance that covered her bills.

But with the passage of the health-care reform bill, millions of women in this country won't. The deliberate and targeted withdrawal of gynecological care, especially from the poor, will make scenes like the one I witnessed more commonplace and more serious. Bad quality or inaccessible medical care will drive shocking - and shockingly expensive - medical outcomes, not to mention awful personal consequences for women, their families and yes, their children.

Let's get real. Restricting abortion coverage isn't about "compromise" or "achieving larger goals" or "protecting the needs of the many", as some of my fellow columnists have argued. It's both a simple political trade - the health and welfare of American women jettisoned in favor of victory laps and votes - and a disappointing display of leadership.

Great leaders don't make cynical transactions for the purposes of "getting things done," nor do they put their own interests ahead of the welfare of the people they're privileged to lead. Great leaders advocate passionately and effectively for what they believe. They strive towards truly positive outcomes. They work tirelessly to protect the needs of individuals even while managing towards the whole.

To those who salute congressional leadership for cutting this health-care deal, I'd like to ask: Do you still call a compromise a compromise when you're the one who's bleeding?

By Daisy Wademan Dowling

 |  November 13, 2009; 6:49 AM ET
Category:  Political leadership Save & Share:  Send E-mail   Facebook   Twitter   Digg   Yahoo Buzz   Del.icio.us   StumbleUpon   Technorati  
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Interesting how the Post removed some posted comments. What an institution of free expression.

I think you've misrepresented what the author wrote. She offers the example of her friend's emergency from "a suspicious uterine polyp," and then asserts, "She was lucky. And she had insurance that covered her bills. But with the passage of the health-care reform bill, millions of women in this country won't." She is asserting that the amendment prevents funding for such procedures.

The amendment will not limit a woman's access to this type of care, nor any other gynecological care unrelated to abortion. Yes, the amendment will prevent public funding for abortion (including subsidizing private insurance premiums for abortion policies). No one is arguing that point. What I am arguing against, is her assertion that the amendment will impact on the payment for procedures like her friend received. I cannot understand how you can read her first two paragraphs and conclude that she is not asserting that claim.

Posted by: BlueIguana | November 16, 2009 8:47 AM
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It's been a pleasure discussing this with you. You make your points without injecting insults and ad hominem attacks on those with whom you disagree.

I would like to correct one assertion in your last post and caution you on another. I did not create a non abortion related category. The amendment did. Ms. Dowling failed to make that distinction in her column, in fact asserting the opposite that non abortive procedures would be affected by the amendment.

In addition, your speculation about my never being pregnant didn't advance your argument at all. I never offered an opinion on the appropriateness of the amendment. My statements were directed at Ms. Dowling's and her unsupported assertions.


Posted by: BlueIguana | November 13, 2009 4:06 PM
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Blueiguana, I will no longer take issue with your initial claim.

I will note, however, that your comment completely exemplifies how the abortion discussion has been hijakced from the practice of medicine. Because many OBs would agree that gynecological care does unfortunately, include the termination of pregnancies. And unfortunately, often for women who actually want to bear children, the termination of a pregnancy in an expensive hospital setting is their only option. Thus your creation of a category called "non abortion related gynecological care" - a category to be enforced by the courts, is a bit ridiculous, and I must speculate it comes from someone who has never been pregnant. (My sincerest apologies if I am wrong).

The fact that the author of the column used a "suspicous uterine polyp" to make her case, rather than a uterine issue related to pregnancy really doesn't change the fact that coverage for women's health will be impacted.

Posted by: claudlaw | November 13, 2009 3:26 PM
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Your example is specific to abortion. But Dowling writes of "The deliberate and targeted withdrawal of gynecological care," not just on abortion related procedures. While there is evidence to support your assertion, there is no evidence, not in her column nor in the actual amendment, that non abortion related gynecological care will be affected by this amendment. I stand by my initial claim that her assertion is unsupported.

Posted by: BlueIguana | November 13, 2009 3:08 PM
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From the column: "The deliberate and targeted withdrawal of gynecological care, especially from the poor, will make scenes like the one I witnessed more commonplace and more serious."

I don't believe the author is asserting that any procedures are being OUTLAWED by the amendment. I DO believe the author is asserting that with this amendment, medical procedures related to abortion could be removed from insurance coverage. I will agree that the author should provide an example to back up her asserion. Since she has not done so, I will. Currently, if a woman were to discover the baby she is carrying suffers grave deformities that would leave it unable to survive at birth, she can choose to terminate the pregnancy. Yes, this is technically an elective procedure - if one believes that suffering the physical and psychological effects of carrying such a pregnancy to term is an "option." Under this Amendment, insurance companies who seek to be a prt of the public insurance exchanges, would have to remove coverage of abortion in this instance from their policies. This procedure, which currently is covered in many insurance policies, would likely now no longer be covered. What I have provided would be an example that falls outside the "life of the mother" exception.

And to those who believe that the exception is carved out, "to protect the mother's life", I will repeat: the Hyde language has had many varying interpretaions around the country. Some state courts have held that unless a woman is at death's door the language does not apply. Not all pregnancy complications may actualy KILL a woman, but many could render her ill or infertile. "Health of the Mother" superior language as far as breadth is concerned, is not the language being used in the Stupak Amendment.

Again, all I am suggesting is that we have once again placed gynecological medical decisions that should remain in the hands of actual doctors into the hands of politicians.

Posted by: claudlaw | November 13, 2009 2:45 PM
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Read the darn column. You rebuttal had nothing to do with my critique of this assertion.

Dowling asserts that the non abortion procedure her friend had and other non abortion procedures would be outlawed by the amendment. She offers no evidence (e.g., language in the bill) to support this assertion. It is, therefore, and unsupported assertion. Simple enough?

Posted by: BlueIguana | November 13, 2009 2:00 PM
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to clarify my previous post, if most women who have abortions now are uninsured for anything (including abortion), then extending insurance to maybe 10 million more women of child bearing age but not including abortion in that coverage, the coverage of abortion by insurance does not change. most women who have abortion STILL wont have it covered by medical insurance.

Posted by: dummypants | November 13, 2009 1:13 PM
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Because the majority of women who end up in situations that lead to an abortion also fall into the categories that leave them uninsured.

so, what you are saying is that the stupak amendment effectively preserves the status qou. which is exactly what pres. obama says the goal should be, and which happens to be essentially what i was arguing in my original post ("changing the percentages at the margins").

so, i dont know what all the fuss was about in your response to my post. maybe you're confused.

Posted by: dummypants | November 13, 2009 1:05 PM
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The 13% of abortions covered by insurance is a VERY misleading number. First, it only takes into consideration those that are billed directly to isnurance. Many women actually submit the claims to the insurance company themsleves and are reimbursed for it. Second, why does it matter that only 13% are directly billed to the insurance company? This in fact has no relevance. Why? Because the majority of women who end up in situations that lead to an abortion also fall into the categories that leave them uninsured. So the more important thing to look at, is how many employer provided plans cover abortion? Thats where your 45% comes in. However, that is also misleading as it asks people. Most people don't know exactly what their insurance plans cover until they need it. Check out this link that shows that up to 87% of employer provided plans cover abortion. http://www.guttmacher.org/media/inthenews/2009/07/22/index.html

So, yeah, its a HUGE deal.

Pepperjade - First of all, my understanding of the amendment is it wouldn't allow coverage in any case. Not only that, it infringes on private insurance plans' right to offer coverage, which goes beyond the current anti woman situation we already have. So maybe you don't think the public should have to pay for it, but why should the burden fall on the woman? We certainly didn't choose to be women. So if you support this plan, fine, then figure out a way to make men pay for it, since they share equal responsibility. It is NOT only a woman's "mistake" so why is she the only one getting a bill? Thats my problem with this, there is no equivalent for men to have to cover out of pocket.

Posted by: EAR0614 | November 13, 2009 12:54 PM
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No more disengenuous and amateurish than those elected officials who would throw OUT all types of abortions, elective or otherwise, for the sake of deals with people who will brook no compromise whatsoever. The latter have held sway of this argument long enough. It is not their lives or their bodies on the line, and hence it is NONE OF THEIR BUSINESS!

Posted by: dewdrop2 | November 13, 2009 12:25 PM
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The public should not be forced to pay for elective abortions (I am pro-choice, but many people are not; this is a divisive issue). If a woman's life is at risk, that is a different story. Those are not elective abortions. It's a medical procedure to save a woman's life. And yes, it is very disengenuous and amateur for the blogger to throw all OBGYN care into the same mix.

Posted by: pepperjade | November 13, 2009 11:58 AM
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It's not poorly-reasoned at all, it's all too accurate. And the architects of this "compromise" deserve a place in the hall of shame for kowtowing to a group of antiabortion extremists who wouldn't know the value of human life if it stared them in the face.

Posted by: dewdrop2 | November 13, 2009 11:18 AM
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i have to agree with the first poster. its not just that there is no apparent reason that the blogger's example has consequences for the abortion issue. rather, the fact that a majority of abortions are not covered by insurance at current would seem to affirmatively shed doubt on the blogger's argument.

estimates of the percentage of abortions covered by insurance range from 13% to 45%. thats 55% to 87% which are not. if its not national crisis already its hard to see how changing percentages at the margins will suddenly transform it into one.

also, the blogger's writing style is nauseating.

Posted by: dummypants | November 13, 2009 11:14 AM
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Blueiguana, here's an assertion that has yet to be rendered unsubstantiated. There are a host of medical conditions that could render a woman in need to a hospital-based abortion, and should this amendment pass, have to pay out of pocket in the range of tens of thousands of dollars. Ectopic pregnancies and ruptured placentas come to mind. The Hyde Amendment language that the amendment is based on has been interpreted quite broadly by courts in many states, meaning this: protecting the "life of the mother" does not always mean protecting the HEALTH of the mother.

Do I think that an OBGYN will let a woman face future infertility with an ectopic pregnancy due to the Stupak Amendment language? No. But I do suspect that a woman would face a 50,000 hospital bill since the abortion would not be covered under her plan? No one has seemed to qualch this concern of many in the medical community.

Posted by: claudlaw | November 13, 2009 10:35 AM
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Huh? What do restrictions on federal funding for abortion have to do with the procedure performed on Ms. Wademan's friend? What evidence is there that this restriction will apply to that procedure, or procedures like it? Seriously?!

It's not uncommon to read poorly reasoned arguments and unsubstantiated assertions in Post opinion columns, but this one might take the cake.

Posted by: BlueIguana | November 13, 2009 9:21 AM
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