The boosters, of whom Krugman is a lucid example, have been talking up new health care law, generally called the Affordable Care Act (ACA). They make good points. Some people with pre-existing conditions are covered who weren’t before. Those under-26 year-olds whose parents are insured are able to retain coverage on their parents’ policies. These are good things.

They are also drops in the bucket. After two years of weeping, wailing, and gnashing teeth, the richest country on earth managed to extend a bit of expensive complicated coverage to a fraction of its population. And that’s the good news. The point at which we all become captive customers of the insurance industry is still two years down the road. That’s when we find out what the tiny expansion of coverage is going to cost us.

The indications so far are not good. For instance, in the case of honest — or strictly regulated — insurance, providing it to everyone is cheaper because healthy people are in the pool as well as sick people. That should lower the currently stratospheric US premiums. In addition, the law has a number of stipulations that would limit insurance companies’ ability to raise premiums at will once the law goes into full effect in 2014. So what do they do? Raise premiums at utterly absurd rates before that. That way they can have high rates and captive customers after 2014. Wheee!

We are also reassuringly told that everything will continue as before, except the uninsured will be covered. It’s to be expected that some employers near the financial edge will drop their current coverage and their workers will have to use the ACA pools. The Congressional Budget Office estimated how many might do that. Initially it was around 2%, later updated to be slightly higher. A year later, a poll by IPSOS asked employers what they planned to do. The numbers came back: 30%-50% of employers said they planned to drop coverage.

That number was disputed. Some commissioned their own survey from a company called Avalere. They said a more realistic number was -0.3% to 8.5%.

“Avalere offers three reasons for why employers will continue providing insurance: 1) to recruit and retain employees, 2) historically there has been no viable alternative for employees to obtain comprehensive coverage on their own, and 3) boost worker productivity. “

Yes. And the Tooth Fairy leaves you silver dollars these days. I’ll take the points in turn.

• 1) Attracting or retaining workers is not a factor I’ve ever noticed except in high-paying private-sector jobs. Restaurant workers, academic temps (well over half the faculty at most institutions), baggage handlers, truck drivers, don’t have the problem of choosing between job offers with enticing benefit packages.
• 2) The whole point of ACA is that now there will be an alternative. Officially. “Affordable” really needs quotes around it, but, officially, there’s an alternative. So I’m not sure what kind of sense it makes to say employers won’t dump workers into alternative insurance plans because there aren’t any when you’re talking about an alternative insurance plan.
• 3) Boost worker productivity. Indeed, good health benefits are proven to boost productivity, as are shorter work weeks, on-site day care, and flexible leave policies. Have you noticed all the employers vying to provide them? Give me a minute to stop laughing uncontrollably.

Okay. I’m back.

Then, just today, I saw yet another scam in the making which I’d never imagined. “[H]ealth insurers offering new type of self-insurance for firms with as few as 25 workers are gaming the system and may undermine a key goal of the federal Affordable Care Act.” More quotes from the LATimes article:

Self-insurance is attractive for many reasons, particularly the prospect of lower costs. It’s exempt from state insurance regulations such as mandated benefits….

Self-insured plans have an immediate cost advantage since there’s no state tax on insurance premiums being passed along by an insurer. Starting in 2014, they will also avoid additional fees levied on health insurers to help pay for the federal healthcare law.

Small businesses switching to self-insurance do gain more insight into why their medical costs might be rising so fast because they have access to detailed claims data. … [C]ompanies like the ability to see whether their employees’ use of healthcare is above average and to make changes in the benefit package to bring those costs in line.

What could possibly go wrong?

None of this even gets into the whole individual mandate rat’s nest, which the Supremes will start to address on Monday. I’m a liberal with a head so pointy you could hurt yourself on it. I believe the government must regulate and support lots of things. I have no problem with paying taxes that go to Medicare or Medicaid. But even I have a problem being told to fork over money to private companies over whom I have zero control. Not even the miniscule control of not buying their product, after ACA goes into effect. And that for the same industry imposing 60% price increases when it thinks it can get away with them.

That health law mess was the “realistic,” “politically feasible,” “doable” path. Not like Medicare for All. That would simply cover everybody at half the price. That’s just Not Done.

Seriously. It’s time. The whole Republican birth control bullshit (and I do mean bull) has brought the issue to levels of absurdity that require action.

First, notice one thing about the sex issues of the last few decades. They’ve been about birth control (1950s), then abortion (1980s onward), now, God help us, birth control again. Supposedly, it’s all about life, but there are also plenty of outbursts that sex is irresponsible, thoughtless, and no longer “special” when there are no “consequences.”

But sex has always been that way. For men. They’re famous for it, or at least they try to be.

The problem isn’t thoughtless sex. Only thoughtless sex by women. That was the only thing that changed. Women could have sex without terror.

It’s also the only case where a reduction in terror is supposed to usher in the end of civilization as we know it. Antibiotics interfere with God’s will, but nobody complains. Superpower nuclear war is less likely these days, but we don’t get lectures on the lamentable loss of character-building fear.

There has to be a reason why women, specifically, are best terrified.

Terrorized people don’t talk. They do their best to be invisible. So women are silenced, out of the public square, out of public life. And should a few of them forget their place and make a public mark, the Great Forgetting disappears it. Their concerns are unheard, individual, unimportant, personal, private, something for them to deal with on their own, without help.

Which is especially ironic when it concerns something like birth control. If that’s a “women’s issue,” virgin birth must be more common than I realized.

(While I’ve been working on this post, off and on, I see Zunguzungu has made some of the same points. “He is defending his [privilege] for that to be a woman’s problem, one [with] which he … doesn’t need to be concerned.” “[By] making it about her, personally — [he] changes the subject from a generalizable woman’s public concern” to a personal one. “[P]olicing the boundaries … of whose concern gets to be publicly voiced and heard….)

Sara Robinson put it very clearly: control over reproduction brings “a louder and prouder female voice into the running of the world’s affairs at every level, creating new conversations and new priorities.”

But female voices and their new conversations and new priorities and the subsequent unavoidability of acknowledging sex and reproduction and children in public are exactly what people in the patriarchy have been desperate to silence.

The goal of the whole blob of sex-related issues, whether they’re called “pro-life” or “personhood” or “traditional values,” is to deny women their rights. It’s never explicit (at least not in the West), but that would be the effect if the legislative or cultural goals were achieved.

That back door approach is essential because equal rights in law have become dogma. Nobody could suggest women should be unable to speak by law. The repressives can only do their best to get women to disappear in fact. The tried and tested method of silencing women is terror, so they’re desperate to go back to the days when women had “consequences.”

Those of us on the other side need to address the real subject, the denial of rights. We need to stop being polite about taking the con job on its own terms. None of this is about “life” or “values.” It’s about denying women their rights.

We have to aim at the real subject every time. When girls are deprived of Plan B because ‘what about the children!?’ it’s tangential that the medical evidence supports its use. The real point is the fundamental right to control your body. When birth control for women is attacked because it enables female sluthood, the real defense is not the specifics of hormonal treatment for polycystic ovarian syndrome. The point is that women’s sex is nobody’s business but their own. When abortion opponents are upset over the loss of “life,” it is irrelevant that there are no cellular markers indicative of personhood or soul. The point is that nobody’s body can be requisitioned against that person’s will. Forced pregnancy is a loss of rights exactly equal to forced kidney donation.

Separation of sex and state makes it simple to see when the state should be involved. Sex, like religion, is a private matter. Same as with religion, when nobody is hurt or coerced or exploited or bamboozled, it’s nobody’s business except the people involved. (The presence of embryos changes nothing, because their status is a matter of personal belief that can guide only personal actions.) On the other hand, if anyone is harmed, then whatever happened is a crime and is neither sex nor religion. It’s very much the state’s business to stop and punish crimes. And the state also has a legitimate function in ensuring children are cared for. But that’s where it ends if the need to separate sex and state is understood. The state does not actually need to tell people how or when to have sex. Really. It doesn’t. People can have sex without any input from the state. It is possible to separate sex and state. It is possible to mind one’s own business.

Separation of sex and state does not mean that people must change their attitudes any more than it does in the parallel case of religion. A Christian can go on being a Christian. They just can’t make anyone else be a Christian. If you’re against gay marriage, you can go on avoiding a same-sex partnership. If you’re anti-abortion, you can avoid having an abortion.

If we want to have actual democracies with equal rights, we have to start insisting on the broad principle that people’s private business is no business of government. There was a time when we’d figured that out for religion, although we seem to be losing the insight now. It was great while it lasted. The holy wars collapsed and boatloads of blood did not get spilled in many places for many years.

If we separated sex and state, we’d get the same massive release of energy for useful purposes as when the holy wars stopped. We’d get the same reduction in casualties, too, when women stopped dying from botched abortions, pregnancy-related suicides, unwanted childbirths, and caring for too many children, and when everybody’s lives improved as population pressures let up. Even children and men would not die as often before their time.

And the separation of sex and state means women can be citizens in fact as well as on paper. That is what is at stake here. If the two are separate, women are citizens. If not, they are for all practical purposes incubators. Never lose sight of that. Anyone who waffles on it, even if they make polite noises while doing it, even if they make polite noises while being President of the United States, is on the side of the Dark Ages and against human rights. No, that is not hyperbole. Not if you understand that women are, in fact, humans.

Sex and state must be separate.

I wrote on that topic several times, but now it’s everywhere.

Chatblu makes the point that “this whole ‘person’ thing is becoming a wildly overpopulated ‘hood.’ … A person can be as tiny as a sperm or as large as Microsoft.”

However, the membership of women in the category remains unclear, although they are within the size range.

The most lucid explanation to date came just recently. Jessica Winter finally answers the question for us.

All my adult life, I’ve been pretty sure I’m a sentient, even semi-competent human being. I have a job and an apartment; I know how to read and vote; I make regular, mostly autonomous decisions about what to eat for lunch and which cat videos I will watch whilst eating my lunch. But in the past couple of months, certain powerful figures in media and politics have cracked open that certitude.

Read on for the thrilling conclusion!