Women’s Health in the Climate of Democracy in Chains

By Nancy Worcester and Mariamne Whatley

What happened? What’s happening? What can we do about it?

Like many women’s health activists, educators, and practitioners, we’ve spent the last two years agonizing over these questions. There have been too many moments when everything we care about and worked for seems to be under attack and each presidential appointment/nomination brings news of someone perfectly chosen to dismantle rather than promote and protect their portfolios of responsibilities. But how could it be that a president known for his inconsistencies and unpredictability and for not reading, thinking, or listening to advisors could so effectively and systematically sabotage the very basic things that the majority of Americans value?

Nancy MacLean’s Democracy in Chains: The Deep History of the Radical Right’s Stealth Plan for America  provides a useful framework to make sense of what is happening today through the history of one man’s (James McGill Buchanan, 1986 Nobel prizewinner in Economic Science) masterplan for dismantling democracy. MacLean shows how the Radical Right (now often called conservatives, Tea Partiers, neoliberals, Libertarians, or pro-market liberals) influenced people like Charles Koch and Mike Pence, took “control over the machinery of the Republican Party,” and planted the groundwork for much of what is happening today. MacLean outlines the Radical Right’s clear ideology that in order for property-owning men to continue to have power and the way of life they want they must change the fundamental rules so that there are “few constraints on how a man might get wealthy, and great restraints on government in asking for some part of that wealth, other than for the maintenance of order and military defense.”  

The Radical Right’s agenda includes gerrymandering on a scale never seen before, restricting voting rights, eliminating Social Security, safety nets, and the U.S. Postal Service, eliminating funding for health care and public education, dismantling unions, workers’ rights, and environmental protections, creating distrust of science including climate change, and “making the protection of corporate profits and private wealth the cornerstone of the legal system.” Because this vision benefits a relatively few rich people (mostly white men) and hurts the majority (including most women, people of color, LGBTQ people, people with disabilities, and absolutely all poor people), the Radical Right always knew they needed to “carry out a revolution below the radar of prying eyes,”  develop a secretive long term strategy, shape the language of “makers” versus “takers” (tax producers versus tax consumers), and develop multi-prong messaging to divide and erode support for popular public programs like Social Security and health care.

There is a direct link between MacLean’s historical analysis, Jane Mayer’s important Dark Money’s analysis of “The Hidden History of the Billionaires Behind the Rise of the Radical Right” and how conservative think-tanks now use Trump to carry out their long planned agenda. Although there was initially skepticism about Trump having “no track record of allegiance to conservative causes,”  it turns out that conservative groups like the Heritage Foundation and Trump “were uniquely positioned to help each other.”  Trump may have had no idea how to staff a government but the Heritage Foundation did! Even before Trump declared his candidacy, the right-wing think tank assembled long lists of conservatives eager to serve in a post-Obama administration. Now, with nearly 70 Heritage employees and alumni in the Trump administration and hundreds of their recommended people in nearly every government agency and the Cabinet, the Heritage Foundation has “the kind of critical mass it has been working toward for nearly half a century.” Similarly, the Federalist Society, the Heritage Foundation, the Judicial Crisis Network, the Judicial Action Group, and the Committee for Justice have planned for decades how to grow a new generation of young legal conservatives to go into government and fill the courts, starting with lower judiciary levels. Trump understands that he must fill the courts with judges trusted by legal conservatives and pick Supreme Court nominations presented to him by these think tanks because “for Trump, it is an implicit bargain, a way of keeping his political base in his corner despite misgivings that many conservatives harbor over his policies or various scandals.” “Never before has an entire political apparatus arisen to systematically engineer a more dependable Supreme Court over the course of a generation.”

Radical Right Health Plan: Let Them Die

“Let them die,” seems like the simplest yet most accurate way to summarize MacLean’s analysis of what the Radical Right envisions for health care policy. One is reminded of that awful September 2011 Tea Party debate when Ron Paul was asked a question about what should happen to an uninsured young man in a coma and many in the audience shouted, “Let him die.” None of the Republican candidates on stage expressed a word of disapproval as the Tea Party audience literally clapped for blood.”  MacLean clarifies that in addition to being long term opponents of Medicare, Medicaid, or any government health care provisions/requirements, the Radical Right “zealots do not believe that government should be involved in trying to promote public health period. We are not talking about subsidized hip replacements and birth control. We are talking about things like basic sanitation.”  

Susan Berke Fogel, National Health Law Program Director of Reproductive Health, observed “Trump is blatantly attacking basic rights of women, to rally his anti-woman base.” (Similar to how Trump plays on racism, homophobia, and other forms of discrimination to hang on to a base that would not be his without such tactics.) Pence actually brags about the number of anti-abortion people now serving in key positions, “For the first time in a long time, America has an administration that’s filled top to bottom with people who stand without apology for life.” The NWHN, other feminist organizations, and sometimes even the mainstream media  have done a good job of highlighting the on-going attack on the health of American women and women around the world through national and global gag rules, cutting, abolishing, or adding political strings to funding for the widest range of women’s health care, procedures, screenings, education and information, supplies, and organizations.

Perhaps best known is the administration’s defunding of basic preventive healthcare under Title X (e.g., birth control, STI/HIV services, cancer screenings). Vice-President Mike Pence cast “the tie-breaking vote in the Senate to dismantle President Barack Obama’s rule protecting basic health care services through Title X” and “ President Donald Trump signed the bill into law behind closed doors.” Symbolizing what the Guttmacher Institute’s senior policy manager describes as the Trump administration’s “ideologically motivated and aggressive campaign against women’s sexual and reproductive rights” is the Trump administration’s plans 2018-22 for Health and Human Services (HHS) “expanding protections for doctors, nurses and other health workers who have moral or religious objection to performing services like abortion, euthanasia or gender reassignment surgery.” Language stating HHS will now be “serving and protecting Americans at every stage of life, beginning at conception” is the language of religious and anti-abortion groups (not federal policy) and demonstrates the religious right’s growing influence at the highest level of government. The Women’s Health Activist readers will all have their own long list of health programs and health and safety regulations that have been hurt, cut, or threatened by conservatives.

It is also important to introduce ways the Radical Right has dismissed science, especially related to climate change and other environmental issues. Illustrating success of this strategy is this example of views about climate change: “By 2014, only 8 out of 278 Republicans in Congress were willing to acknowledge that man-made climate change is real. Economist and columnist Paul Krugman rightly points out, ‘We’re looking at a party that has turned its back on science at a time when doing so puts the very future of civilization at risk’”  “Just as the property supremacists would rather let people die than receive health care assistance or anti-smoking counsel from government, so they would rather invite global ecological and social catastrophe than allow regulatory restrictions on economic liberty.”  

The outcome of the conservative approach “to combat science” and “to replace evidence-based conclusions with ideological misinformation” is seen in many policies and proposals related to health care, public health, and the environment. HHS banned the Centers for Disease Control and Prevention (CDC) from even using the terms evidence-based and science-based,  as if to signal that the use of scientifically sound “gold standard” research would no longer be used in making decisions. Simply, the goal is to undermine science so that it will be difficult to use research in ways that could keep rich people and corporations from becoming richer.

Undermining, attacking, or ignoring scientific research are strategies to deter or reduce government regulation. Such approaches are not new, having been used, for example, to protect the tobacco industry from health-related regulation. The goal of reducing/eliminating government regulation is well served by anti-science rhetoric and attacks. Research that supports possible regulations that might reduce the wealth of the “makers” (e.g., warnings, labels, restrictions, bans) or transfer funds to the “takers” (e.g., lawsuits, reparations) are prime targets.

Of course, not all science is under attack since corporate-influenced research can be designed to produce results favorable to industry. Also, industry’s influence at the Federal level affects which research can or cannot be used in rule-making. In turn, Federal agencies use many strategies to control information related to science and policies, including:  Declining to collect important information; deleting publications that contradict policy goals; silencing views of some scientists; removing information from Federal websites; politicizing the scientific grant-making process; prohibiting experts from using common words.

NWHN members are probably familiar with many examples of ideological (mis-)information displacing scientific research in decision making. Sexuality education and family planning programs often fall into this category. For many years sexuality education has been an area of contention, though, in the United States, the majority of adults — including parents — have supported sexuality education in the schools. Debates have focused on whether it should be required/state-mandated and what form it should take. The overwhelming evidence through years of study has been that “abstinence-only” does not work and that comprehensive programs have been much more effective. The latter can be partially credited with the impressive national 30 year low in the rate of unintended pregnancies and the all-time low rate of unintended teen pregnancies. When a public health program has shown success, an expectation is that funding would continue and possibly increase. However, the administration has attacked the successful evidence-based Teen Pregnancy Prevention Program (TPPP). Instead they strongly support discredited abstinence-only programs, shifting away from evidence-based, evaluation-focused programs, as demonstrated by: Appointing a leader in the abstinence-only-until-marriage movement to a high position in HHS in the office overseeing TPPP; abruptly terminating funding to TPPP grantees two years earlier than expected; creating new funding opportunities requiring use of abstinence-only approaches; proposing budgets eliminating TPPP completely.

The good news is that, although this story continues with attacks on TPPP, these are countered by strong resistance. Lawsuits have been filed in support of continuing TPPP and on behalf of grantees. As of September 2018, there were seven court decisions against the administration’s attempts to dismantle TPPP.

Paying Attention to the Radical Right Agenda at the State Level

The 2018 elections provide the perfect opportunity for making it a priority to understand how effective the Right has been for a long time at the state level, knowing that changing key players holds potential for enormous change. If we are honest with ourselves we might find that we pay more attention to what is happening at the local and national levels than we do to what happens at the state level. It turns out we aren’t alone in this: “Virtually every state government, according to a recent study by the nonpartisan Center for Public Integrity, kowtows to business and the wealthy, underrepresents citizens of lesser means, lacks transparency, and does a poor job of enforcing ethics laws… Corporate and conservative interests can make their will felt more easily in state government… partly because state affairs are less well monitored by people and the press.”

Gridlock at the federal level often distracts attention from the Right’s stunning success at the state level due to the election of “fire breathing conservatives” as Governors, “doctrinaire ideologues” winning many down-ballot positions of attorney general, secretary of state, and state legislators, the fact that Republicans control all three parts of government in many states, and the powerful role of the Koch supported American Legislative Exchange Council’s (ALEC’s) model legislation. For example, 334 abortion restrictions were enacted in state legislatures between January 2011 and July 2016.

ALEC’s impact on state legislation is widely acknowledged. Behind closed doors, state legislators and corporate representatives, whose interests span the range of conservative issues, meet in national task forces to write model legislation that can be used as is or modified to meet specific “needs” of a state. A Brookings  report tracking the secretive ALEC process for the 2011-2012 legislative session found that “bills based on ALEC policies have a survival rate nearly five times that of the average bill in Congress” and summarized that “ALEC model bills are word for word introduced into state legislatures at a non-trivial rate, have a good chance – better than most legislation – of being enacted into law, and that the bills are most often linked to controversial social and economic issues.” There have been rumors that in fast-tracking ALEC model legislation through their own state legislatures, some politicians have even forgotten to print it on appropriate letterhead and have sent it through on ALEC letterhead! Wisconsin Senate Minority (Democratic) Leader Jennifer Shilling observed, “It’s become standard practice now for Republicans to meet with donors and corporate lobbyists behind closed doors, write a bill in secret, and then pass it in a matter of days without public input. It’s a major shift away from the level of transparency and accountability that citizens and taxpayers expect from their government.”  

In examining ALEC’s influence on health legislation, former health insurance executive Wendell Potter found archival records from the early 2000s revealing that ALEC had been working with the health insurance industry to develop model legislation that was “a comprehensive wish list for insurers.”As soon as 2008 elections signaled the possibility of some sort of federal healthcare reform, ALEC’s model health bills show that “insurers realized early on that the best way to block the profit threatening provisions of any federal reform would be to attack them at the state level.” Readers are encouraged to look at both ALEC’s Legislative Agenda on Health Care, which the Center for Media and Democracy summarized as “proposals to weaken the regulation of medicine by the Food and Drug Administration, privatize Medicare and Medicare, repeal important laws that expand public access to healthcare, and bar the families of Americans injured or killed by drugs that are recalled from holding drug companies accountable,” and ALEC’s Legislative Agenda on Women and Children that “harms women and families in numerous ways, including proposals that would roll back no fault divorce laws, limit regulation of day care centers, make it more difficult for impoverished children to receive the benefits of welfare, limit regulation of toxic and hazardous substances, bar lawsuits for injuries due to recalled drugs, and outsource to for-profit companies the collection of child support.” (See Center for Media and Democracy Fact Sheets on key topics at www.alecexposed.org or check out ALEC proposals themselves at www.alec.org)

Many activists have long enjoyed victories at the most local level where they knew the players and the issues so could effectively influence specific regulations or policies they hoped would improve their own communities and serve as models for others. This powerful grassroots activism seems an example of democracy at its best. Looking at the increasing ways Republican-controlled states put “democracy in chains,” it shouldn’t be surprising to discover that pre-emptive laws (state legislatures passing laws that prevent all cities, towns, and counties in that state from passing laws about specific issues or enacting regulations that hold a city to higher or safer standards) have become “the most powerful statehouse tactic of our time.” The National League of Cities’ 2018 City Rights in an Era of Preemption “shows how recent preemption has pitted rural- and suburban-dominated state legislatures against cities with large populations of low wage earners and ethnic minorities” and gives many examples including: laws preventing minimum wage ordinances (28 states); prohibiting paid sick, family and medical leave (23 states);  not allowing local firearm and ammunition regulation more stringent than state laws (43 states); preventing localities from passing nutrition regulations (9 states); even stopping towns from regulation of plastic bags (5 states). Because these pre-emptions have often been passed when no jurisdiction has even passed any such law, they are getting labeled as “pre-emptive pre-emption… the state equivalent to “don’t even think about it.”  

Paying attention to all that is happening at the state level is exactly the prescription needed for feeling positive about voting in November. Thirty-six out of fifty governorships will be decided, eighty-seven of ninety state legislative chambers will be determined, and thirty states plus the District of Columbia have attorney general races. State attorneys general have been called “the sleeping giants of the 2018 midterms” and there is “good argument that the fate of much of President Trump’s agenda will rest on the fate of a key handful of races for state attorneys general.”  It is predicted that in some states that are already Democratic, more progressive Democrats (rejecting austerity, addressing climate change, aligning with labor and workers’ rights and civil rights) will win in November and make it possible for new progressive state-based campaigns in spring 2019. States could take increasing responsibility for protecting women’s contraceptive and abortion rights in case Congress or the Supreme Court take away those rights. For example, Massachusetts has already passed new laws insuring women access to no cost birth control (in November, 2017) and repealing antiquated bans on abortion, adultery, and fornication (in July 2018 in a delightfully named NASTY Woman Act – short for Negating Archaic States Targeting Young Women.)  

Prescription for Change – Be Hopeful

The title of Dr. Mona Hanna-Attisha’s highly recommended insightful and inspiring book about the Flint, Michigan community’s success in fighting its water crisis, What the Eyes Don’t See: The Story of Crisis, Resistance, and Hope in an American City, highlights the components needed to identify and resist the Right’s plans that hurt the health and healthcare of Americans. We literally need to learn to see what is happening! Then, keep up the resistance and support each other in finding ways to stay hopeful. Hanna-Attisha tells the story of Flint, a struggling, poor, majority African-American community. Michigan’s Tea Party-inspired Governor replaced the democratically elected government with an emergency manager (EM), appointed very specifically to take all power away from local leaders and implement extreme budget cuts. (Residents of cities taken over by EM claim EM violate the Voting Rights Act because more than half of African-Americans in Michigan have EM controlling their cities or schools.)  Simply to save money, Flint’s EM changed the source of the city’s water supply to a polluted source, did nothing to test and ensure that the water was safe, and foolishly even saved the mere $80 per day it would have cost to control the new water’s corrosive impact on old pipes as regulations required.  

Hanna-Attisha provides a most moving public health thriller as she recounts the wrong-doing of many officials who ignored or hid the dangers of the polluted water, causing Legionnaire’s disease and high lead levels in children’s blood while “General Motors had stopped using the water a year before because it was corroding engine parts”  and “state officials, while telling Flint residents that their water was safe to drink, were arranging for water coolers to be delivered to the Flint State Office Building so state employees wouldn’t have to drink from the tap.”  This contrasts with the incredible local activism by many mothers, scientists, and public health personnel determined to identify and stop the health-wrecking contaminants in the water supply. As the Flint community now moves on to long term plans for their “tomorrow fund” to counteract the lifelong effects of lead in their children’s water, Dr. Hanna-Attisha concludes with what she calls her prescription for hope. “The most important medication I can prescribe is hope.”  “I hope that somehow what happened (in Flint) – the resistance, the science advocacy, and the coalition building – inspires others to fight the injustices around them”

Her words complement the inspiration from Bryan Stevenson, author of Just Mercy, Executive Director of the Equal Justice Institute (founder of the new anti-lynching museum in Montgomery) on how to face today’s political challenges, “You don’t have the choice to be hopeless. Hopelessness is the enemy of justice. When you are fighting for justice you are fighting hopelessness…And the truth is, you’re either hopeful working toward justice, or you’re the problem. There’s nothing in between.”

The Prescription for Change

  • Vote and protect all voting rights. In a climate where voting rights are under attack, voting has to be defined as a social justice and women’s health issue.
  • Take new interest in watching and working on politics at the state level. State elections in November are places where positive changes are possible.
  • Identify and support the organizations that do their work within the context of the threats to democracy.
  • Look for and work for the interconnectedness of women’s health with all social justice issues.

Nancy Worcester and Mariamne Whatley are Professors Emeritae of Gender and Women’s Studies at the University of Wisconsin-Madison. They are long-time women’s health educators, writers, and activists. Both served on the NWHN Board.

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