We want to do evidence based care. We want to do things that work and avoid things that don’t work. This sounds simple. Let’s look at two very good natural experiments on unintended pregnancy rates:
- The Colorado Family Planning Initiative has increased health care provider education and training and reduced costs for more expensive contraceptive options, enabling more than 30,000 women in the state to choose long-acting reversible contraception….
- When contraception, particularly the long-acting methods, became more readily available in Colorado between 2009 and 2013, the abortion rate fell 42 percent among all women ages 15 to 19 and 18 percent among women ages 20 to 24.
-
Colorado is a national leader in the use of long-acting reversible contraception, and reducing teen pregnancy and repeat pregnancies.
- Teen birth rates in our state have declined more rapidly than in any other state or the nation as a whole.
- The birth rate for Medicaid-eligible women ages 15 to 24 dropped sharply from 2010 to 2012, resulting in an estimated $49 million to $111 million avoided expenses in Medicaid birth-related costs alone.
Since 2008, Colorado has successfully increased access to family planning services throughout the state, particularly for the most effective contraceptive methods, such as intrauterine devices (IUDs) and implants.
More reliable and effective contraception was made available to Colorado women who had the choice to elect Long Acting Reverisble Contraception (LARC) or do something else. A significant number of women elected to use LARC and the increased autonomy and reliability produced amazingly good results.
Texas
8c) When Texas defunded Planned Parenthood, births paid for by Medicaid rose 27%. Births are a lot more expensive than birth control. pic.twitter.com/VJgGvHVHro
— Caroline O. (@RVAwonk) January 5, 2017
Reducing contraceptive availability led to higher abortion rates and higher unplanned pregnancies. Earlier live births have massively negative multi-generational repercussions for both the parents and kids.
The evidence strong suggests that significant improvements in quality of life can be made and significant expenditures reduced if contraception is made readily available.
And guess what Congress will consider to be a high priority:
House Speaker Paul Ryan announced Thursday that Republicans will move to strip all federal funding for Planned Parenthood as part of the process they are using early this year to dismantle Obamacare.
Wahoo… the evidence will strongly support the hypothesis that this policy will lead to more unintended pregnancies, more abortions and far worse outcomes for far more Americans.
Evidence based policy making — Hoo Yaa
? Martin
Yeah, well, it’s been decades since the GOP backed any policy that was rooted in evidence. I’m sure somewhere in Congress there’s a group of Republicans planning on replacing Obamacare by just mailing everyone in the US a bible.
Yarrow
@? Martin: Yep. If the Republicans cared about babies, they’d be all for contraception. They aren’t. What they want is to control women. If women get pregnant with babies they are required to have and care for no matter what, then women have fewer choices and options in life. That’s what Republicans want.
Roger Moore
Which appears to be what Republicans actually want. They want to punish sluts with pregnancy, and they want “massively negative multi-generational repercussions for both the parents and kids”, because that’s where the next generation of serfs is going to come from. Republican policy makers are awful people.
? Martin
And on the bring manufacturing jobs back to America theme:
The nature of manufacturing in the US is changing and the workers need to change, yet voters and states and the educational systems are in denial of this need for change. Major universities aren’t interested in providing the kinds of educational programs that the manufacturing industry needs – even Industrial Engineering is a minor program at most universities and many don’t even offer the program. The US turns out approximately 5,000 industrial engineering degrees nationwide.
Obama asked how to bring manufacturing jobs back to the US, and the answer isn’t a simple soundbite like lower taxes or reduce regulation:
How do you hire 30,000 industrial engineers (most of which even only need an associates degree) when nationally we only educate 5,000 per year? And that’s just out of one company. Automakers need them as well, as does Carrier and Boeing and everyone else. If you want manufacturing in the US, you need a moonshot program to develop industrial engineering programs at 2 year and 4 year schools. You need trade school programs for advanced manufacturing and skill development. Apprenticeships are also needed nationally. But it’s a slow process. The results won’t be seen within an 8 year presidential term. But instead of all of that, we’re likely to get tax cuts which if anything will make it harder to make those kinds of educational investments.
Yarrow
Richard, thank you for highlighting Medicaid. Of all the moving parts in our patchwork health system, it’s probably the most vulnerable to cuts or destruction by the Republicans. It’s not just poor women who will be hurt. Our elderly depend on it. And, as Ohio Mom continues to point out, people with disabilities depend on Medicaid for accessing many of their services.
I know you’re busy with your new job and move, but a post on the value of Medicaid, or reposting one you’ve already done, might be timely right now.
Neech
@Richard Mayhew
Not sure if you saw my comment in the previous thread, so I’m posting it again. I sent you an email with my realtor friend’s contact information. When you have a chance, drop me a line to let me know if you received it.
BGinCHI
The old adage, “work smarter, not harder,” comes to mind.
I guess the TX state motto is “work stupider, stick it to the ladies, and bilk the feds.”
japa21
Richard, or may I call you David, as pointed out above, this is all part of the plan. After all, contraception is a tool of the Devil.
Major Major Major Major
@? Martin: tax cuts decrease the deficit! Greeted as liberators!
Villago Delenda Est
Richard, David, whoever, keep speaking truth to the utter stupidity of the forced birth fuckheads.
Villago Delenda Est
@? Martin: The cheeto faced shitgibbon knows NOTHING about the details of how anything works.
mai naem mobile
This stupid stupid country voting for these stupid stupid people. I want to go up to every Trump voter and shake them and slap them silly. If you told these morons two plus two is four they would argue with you and say its 5. Obstinately argue that its 5.
Thoroughly Pizzled
@? Martin: I went to one of Hillary’s speeches in Macomb County, one of the three counties everyone’s pointing to as deciding the election. It was at an advanced manufacturing plant. She gave a great speech about jobs and training and economics. What could have been…
Villago Delenda Est
@Thoroughly Pizzled: Lickspittles of the MSM were too busy covering some Drumpf Rally in Nowhere, Alabama.
Thoroughly Pizzled
@Villago Delenda Est: Yeah, all the “Why didn’t she talk about economics?” bullshit is either the MSM covering its ass or Hillary-haters being deliberately misrepresentative.
StringOnAStick
Colorado resident here. We’re lucky to have a reasonable Democratic governor and lateky the state house and Senate have been within 1 vote either direction, so we get good stuff like this program. As fired up as I’ve seen people are now, I’m hoping we pull off a much bigger margin next election.
Shakti
This is a feature, not a bug of cheap labor conservatism. It’s un/consciously Malthusian as well.
Mike J
One problem with this is the anti-choice people claim that IUDs are actually a form of abortion.They aren’t really concerned that it isn’t true.
TriassicSands
I just went to Mitch McConnell’s contact page to send him an email and found this at the top of the page:
No authority to “intervene?” No, you have authority to eliminate food stamps or drop millions from eligibility, but no power to intervene. You have the power to block grant Medicaid and cause millions to lose coverage, but no power to intervene.
The man is an unbelievable liar.
JPL
Planned Parenthood is reimbursed by Medicaid. They do not receive other money from the government. What the republican plan does, is close valuable clinics in poorer areas. This is what Alan Grayson spoke about it, when he said the republican plan was to just die.
Spider-Dan
There is one issue I’ve been wrestling with that mostly applies to healthcare, but partially to everything else policy related, too.
I’m generally inclined to agree with the idea that Democrats should sit on their hands and vote No on any/every attempt by the Republicans to repeal/replace the ACA; let the GOP own it. The theory is that even though more people will suffer in the short-term by the lack of Democrats negotiating a less-terrible outcome, when everyone figures out what Obamacare actually did, the GOP will get kicked out of office in outrage.
Let us suppose this political strategy goes perfectly according to plan and in 2020, we have a Congress with overwhelming Democratic majorities (again), and we repeat 2009 word-for-word: Dems pass a new, more progressive (but not perfect) program, GOP obstructs and demagogues, Dems get thrown out in the midterms by a combination of dissatisfied liberals and enraged conservatives.
Is this our destiny going forward? Can the politics of obstruction result in anything but passing a bunch of laws, then watching the other side repeal them all a few years later? At what point does governance – trying to secure the best long-term outcome for your constituents – win out over political gamesmanship?
I’m not asking this as a veiled plea for capitulation; I’m not even sure capitulation would work. I sincerely want to know the answer: what is our endgame?
Brachiator
@Spider-Dan:
I wouldn’t count on public outrage as coming to the rescue. The Republicans could cobble together some makeshift crap that pretended to solve the problem, and a chunk of the public might eat it up.
This is not to say that I know what the Democratic leadership should do. But that’s the problem. There is no best set of options.
Another Scott
@? Martin: You raise a lot of good points, but I have to take issue with the framing.
How did Henry Ford make millions of Model Ts when his starting workforce was used to following horses around in a field?
He offered a wage that people were willing to leave their present employment to get.
As you know, most people don’t go to college and pick a degree without having some idea of where they want to work when they’re done.
Apple and all the other companies out there want to pretend that “supply and demand” doesn’t apply to their workforce, but it does.
Apple could raise the wages of new hires to attract more people. They could have not entered into anti-poaching and other wage-suppressing agreements with their industry-mates. They could train people in-house, or they could spend a lot more on scholarships, endowed chairs, or work to create a industry-wide system of education to train more people and spread the costs, etc.
I know what it’s like to want to hire new people that one doesn’t need to train. Someone who can bring their new, up-to-the-minute knowledge to a job and start working immediately. And do it cheaply. But if you can’t do that in the US, it’s not because something is broken about the US economy or US education, it’s the employer not paying enough.
It doesn’t matter what the wage is compared to all of the US. If Apple wants to hire tens of thousands engineers in Silicon Valley, it can do it if it is willing to pay the price. They aren’t, so they whine and say they’re “forced” to be in China. It’s BS. With a high enough wage, they’d be able to hire from other companies, they’d be able to get good people who can be trained quickly, they’d be able to increase enrollment in universities and trade schools (or help create new ones).
There are plenty of people in engineering grad schools who don’t get multiple offers, and engineers who had to take early retirement or were forced out of their jobs, who would love to live in Cupertino, but can’t do it because of the costs and the comparatively low wage.
I know you can give counter-examples, but I think the general point stands. These huge companies with hundreds of billions in the bank are just whining. They don’t want to pay the market price to fill their openings.
My $0.02.
Cheers,
Scott.
Soprano2
I have come to believe that Republican opposition to abortion is actually an attempt to control the sex lives of young women, because as far as I can tell there isn’t one anti-abortion advocacy group that also advocates medically-accurate sex education and safe, effective birth control for everyone. No, they all advocate the failed policy of abstinence-only sex education and abstinence until marriage, which is bound to fail when the age of first marriage is in the late 20’s. I hate to break it to the anti-abortion folks, but most young people aren’t going to wait until their late 20’s to have sex. It’s indeed too bad that we can’t have more policy based on real evidence, rather than religious belief. I’ve always believed that the best way to reduce abortions is to reduce unintended pregnancies. Of course, having control over their fertility gives women more agency over their lives, and conservatives think we just can’t have that. Ggggrrrr……
low-tech cyclist
What I told my (all Dem) Congresscritters this morning was, “If I had a Republican Congressman, I’d tell him:
‘What a great idea! Cause more poor women to have more babies that you will refuse to help because to you, they’ll be nothing more than a bunch of little moochers and takers.’
“So feel free to express this sentiment to your Republican colleagues on my behalf.”
Yeah, I’m really pretty pissed about this one.
Roger Moore
@Thoroughly Pizzled:
Or people who don’t know what she spent her time talking about because the media thought it was more important to report on emails than policy.
? Martin
@Another Scott:
Starting salary for an industrial engineer is about $60K. How does that relate to whether or not Duke offers an Industrial Engineering degree program. They don’t. The main reason why they don’t is likely because they have a lack of industrial engineer PhDs on faculty to create such a program and there’s no windfall of cash being handed to them to hire an entire department’s worth. It’s a risky strategy for a university to develop a new program with no existing faculty. It’s a big investment and universities are extremely risk-adverse.
So, yes, supply and demand does work, but in education you have a layer in the middle that isn’t part of that equation. US universities don’t benefit from that dynamic. Now, Henry Ford didn’t have an intermediate layer to deal with – he took workers straight off of the farm. That’s what free market people miss in an advanced economy – that you need these infrastructure layers to be included in the benefits in order for the endpoints to ever get connected. That’s where government needs to play a role. Industry can and does as well, but if China is willing to make the strategic investment, then why should Ford or Apple make it? Apple has been saying for a decade now that the US needs to make strategic investments in universities – and they’re far from the only one, they’re just a higher profile than others. Why does nobody listen?
Stan
@BGinCHI:
It was always thus. I happen to be reading a lot of pre-Civil war history right now….it seems that Texas has *always* been the place white people went to escape responsibility and education, and then expect the taxpayers of other states to bail them out.
Stan
@Another Scott:
Absolutely correct, I know a bunch of them. They are all working their asses off, some of them not even in engineering, but they’d love those Apple jobs.
Another Scott
@? Martin:
We’re talking past each other a little.
I’m a big fan of investment in education, free tuition for college, all the rest. You’ve had good posts on this.
My beef is with Apple and other companies that have billions in the bank, who had anti-poaching agreements with their nominal competitors, who whine and whine about how there is a huge shortage of STEM people (there isn’t or wages would be much higher than they are), yet who demand property tax breaks (cutting the feet out of school boards) and other tax incentives (which make it harder for state and local governments to support the schools as well), who argue that supply and demand doesn’t apply to wages. It’s infuriating.
Universities develop new programs all the time, as you know. If Apple wants Duke to start a new Industrial Engineering program, they can make it happen by raining money down on Duke and they’d be happy to take it. And they would make it work, in a lot less than 10 years. And if there were good wages to be had (and $60k isn’t all that much these days, especially in Cupertino), then students will be beating down their door to get in – especially if the tuition is free. ;-) Yes, it would take time to graduate huge numbers of new students, but in the meantime they could poach from other companies the way silicon foundries did in the ’70s and ’80s.
Saying that China has compelling advantages as a developing economy is certainly true. But them saying they “can’t find people” in the US is just nonsense. They don’t want to pay the price, even though they’ve got more money than god.
My $0.02.
Cheers,
Scott.
Stan
Scott: Right On !!!!
To cite a great example: Carnegie Mellon University is one of the top computer engineering schools. Microsoft recruits there. A couple years ago, MS gave them a building so they could expand their program. The place cost somewhere in the neighborhood of $200M.
If firms want trained staff, this is a way to pay for them. I am no fan of microsoft but in this case they did the right thing.
Miss Bianca
@StringOnAStick: We have to keep our hands on the wheel to make it so!
Roger Moore
@Another Scott:
I think the point you’re missing is that China is already doing a lot of the kinds of things you’re talking about for Apple. If they’re given a choice between spending a bunch of money upgrading university engineering departments here or going to China and having plenty of trained people available, you know which way they’re most likely to go. From that perspective, asking to bring people here on H1 visas or saying we need to improve our education rather than just moving everything from China is giving us an extra chance to keep things here.
Ruckus
@? Martin:
This. A bazillion times this.
I’ve worked in mfg for 55 yrs, with the exception of 11, when I took a break and worked in professional sports. I’m working back in mfg now. I just spent the morning at a customers plant, where they make hyd actuators for planes. Yes there is starting work for unskilled workers. Maybe 1 or 2 percent of the workforce at this plant. At best. Where I work we have 2 unskilled workers. One is learning fast and will go as far as he can until he understands that education is his friend. The other will probably not be there in a year, I’d imagine. Two of the long term workers are pursuing higher education on their own, as they realize that is the only way to get ahead in this day and age. A blanket statement that unskilled workers in mfg is wrong, like most blanket statements, but it is very much less wrong today than it was even 20 yrs ago.
Ruckus
@mai naem mobile:
I think you are giving them too much credit. To find an answer that is only off by 20% would be beyond most of their capabilities.
Another Scott
@Roger Moore: As I said, there are compelling advantages that China has. And I’m a big supporter of investing in education.
But whether or not it makes sense for Apple to do things in China, it doesn’t mean that the argument they are using with respect to the “shortage” of STEM people in the USA has merit. Apple could hire more people here in the US, and it could do lots of other things. It makes a choice not to, but tells us it can’t do otherwise.
It’s hundreds of billions of dollars in the bank says otherwise. Supply and Demand says otherwise.
Rather than repeat and rephrase what I’ve said above, I’ll just say, “That is all.”
:-)
Cheers,
Scott.
Elie
Actually there is an IUD (paraguard) that can be used as emergency contraception In general tho you are correct