When Brett Kavanaugh’s Supreme Court nomination was confirmed in October of 2018, many of my acquaintances speculated Americans would soon be traveling to Canada for their abortion care.

Progressive pundits have pointed out that Roe. V. Wade, the Supreme Court decision that made abortion legal in America, is in danger of being overturned by the court’s conservative majority. Given Kavanaugh’s track record of blocking women from terminating their pregnancies, I understand where the prediction that American women could end up crossing the border for abortions comes from. Many Americans view Canada as a liberal haven, the refrain of “Well, time to move to Canada” likely passing through every Democrat’s mind every time more conservative legislation is enacted. But is the idea of Canada as a hypothetical abortion tourism destination a realistic one? If you’re a feminist activist living in Canada, you know the answer is probably not.

Soon after Kavanaugh’s confirmation, my friend Kaley wrote on Facebook, “Now everyone will know Canada’s secret shame.” That secret shame being abortion isn’t so easily accessible here.

In Canada, abortion is theoretically considered “an essential healthcare service.” It is available at a mix of publicly funded hospitals and private clinics. However, each province has its own limitations, and in many parts of the country, hospitals will not provide abortions of any kind past the 12-week mark in many parts of the country. And, much like in America, access to terminations is uneven, with major urban areas enjoying the best resources. Frederique Chabot, the Director of Health Promotion for Action Canada For Sexual Health and Rights, explains Canada’s abortion access problem like this: “In the US, there are more regulatory policies to delay access or close down clinics. But when it comes to vast geography and being able to access that service in a timely manner, Canada is in a similar situation.”

Women in the Northern regions of the country typically must drive long distances – or sometimes fly – to have their procedures. For example, a woman living in Moosonee, a city in the far North of the province of Ontario, could find herself taking a 7.5 hour bus ride to the nearest provider. She’ll also be on the hook for travel expenses and hotel accommodations, which makes abortion a privilege only some can afford. A similar situation plagues people living in the Northern parts of other Canadian provinces, such as Manitoba, Quebec, Alberta, and Saskatchewan.

In Ontario, the most populous province, there are a mere 11 abortion clinics for approximately 14 million residents. That’s not even one facility for every million people! To make matters worse, all but one of these clinics is located in the two largest cities, Toronto and Ottawa. For a breakdown of abortion access by province, please see this chart. It does not paint a progressive picture.

Much like in America, access to terminations is uneven, with major urban areas enjoying the best resources.
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In 2015, medical abortion (the abortion pill) was finally approved by Health Canada after a long, drawn out process. At the time, it was touted as a way to help women in isolated communities take control of their reproductive destinies. However, the provinces of Manitoba and Saskatchewan still refuse to cover the cost of the drug. Add to this the issue that some doctors refuse to prescribe the it for religious reasons, and the fact it can only be used within the first ten weeks of pregnancy. Combined with the gestational limits, this is yet another hurdle for rural women who do not live in close proximity to the hospitals where the procedure is available. The abortion drug has not been a magic pill.

While I am lucky enough to live in Ontario, there are areas where abortions at private clinics are never reimbursed. In 2013, my friend Lily sought an abortion at a private clinic in Fredericton, New Brunswick. Already a mother of one, Lily and her husband conceived a second pregnancy by accident. They did not have the time or the money to devote to another child. While publicly funded abortions were in theory available to her at a local hospital, Lily discovered she would have to wait at least a month for the procedure. This was a scary prospect, because abortions in New Brunswick are only available for the first twelve weeks of pregnancy. Waiting for a free abortion would mean cutting the process down to the wire.

These long wait times at hospitals are common. In Nova Scotia, where the abortion pill is not provided by provincial healthcare, wait times for surgical abortions can easily be more than six weeks. This presents a significant obstacle, because the province does not provide abortions after the 15-week mark. Once an individual discovers they are pregnant, they have little time to weigh the options before scheduling a hospital abortion. And God help the person who doesn’t discover they’re pregnant until a couple months along!

Instead of waiting, Lily turned to a private clinic. However, the price of the procedure was around $700, a huge sum for Lily, who was paid per hour to work a part-time gig in publishing; her husband earned close to minimum wage as a day laborer. The nearest clinic only provided abortions one day a week, so Lily would be forced to take time off work. To make matters worse, it was Christmas time, and the couple did not want their young son to be deprived of presents. Remembering her experience, Lily told me, “It was a lot of money to pay, but I knew I couldn’t stay pregnant.” Fortunately, Lily’s father agreed to foot the bill her province would not pay.

The idea of Canada as a feminist utopia where getting an abortion is as easy as buying milk is a misconception built on good press and the belief that our country is cool. You know, because our Prime Minister donates money to Trevor Noah on Twitter.

As a Canadian feminist, it’s disconcerting—through admittedly flattering—when our neighbors to the South speculate my country has solved sexism, but we haven’t. Abortion access is not the only example of how Canada has failed women and non-binary people. For example, I could spill boundless ink discussing the crisis regarding missing and murdered indigenous women. Abortion access is one of many problems with which we’re still grappling.

It’s easy to see why people outside of Canada may be taken aback to hear we aren’t an abortion care paradise. In 2014, Justin Trudeau declared each candidate fielded by his political party was required to be pro-choice. Per his decree, Anti-choicers would be kicked out of his caucus and barred from running as Liberal candidates. At the time, Trudeau was a year away from becoming prime minister. Trudeau’s policy of zero tolerance for anti-choice politics was a splashy statement, one that set a feminist tone for his election campaign.

Trudeau’s declaration shocked many of our American cousins. On Fox and Friends, Jeanne Mancini, who organized the March for Life, contended Mr. Trudeau was “out of touch with mainstream America” (as if the Canadian PM should be primarily concerned with what Americans think). And despite pearl-clutching on the part of right-wing US pundits, you might be surprised to learn Trudeau talked the talk of promoting abortion rights without walking the walk.

Over three years after Trudeau became Canada’s self-identified “feminist prime minister,” women in much of Canada still do not have meaningful access to abortion. At present, we have no hope of becoming a reliable safe haven for Americans seeking abortion care. After all, we’re already failing people who live North of the 49th parallel.

When Prime Minister Trudeau was elected, I hoped no Canadian women would ever have the stressful abortion experience my friend Lily had again. It’s now been five years—and one federal election—since she had her abortion, and regrettably little has changed. There’s still only one abortion clinic in Fredericton, clinic 554. They are only allowed to provide terminations until the 15-week mark. And patients are still not reimbursed for the cost of their procedures.

Over three years after Trudeau became Canada’s self-identified 'feminist prime minister,' women in much of Canada still do not have meaningful access to abortion.
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So why, in a supposedly feminist country like Canada, do women and non-binary folks have wildly different access to reproductive healthcare depending on where they live? In 1988, the Supreme Court of Canada threw out the country’s laws criminalizing abortions in a landmark decision called R. v. Morgentaler. In accordance with this decision, the Federal government has no power to prevent a woman from obtaining an abortion at any point during her pregnancy. However, since healthcare is provided to Canadians by our provincial governments, those seeking terminations are at the mercy of the sort of care their provincial healthcare system offers. Most provinces do not provide this access past the 15-week mark.

Because tourists do not typically have access to pregnancy terminations in Canadian hospitals, hypothetical abortion tourists would be forced to use our private facilities. On average, over 650,000 abortions occur in the United States each year. It’s unlikely Canada, with a total of 55 clinics, could make a significant dent in that number, but it would increase wait times for people living in Canada. Next, there’s the matter of cost. In the province of Ontario, documented residents who have provincial health insurance will have the cost of their procedures covered by the government. Those who lack such documentation will pay anywhere from 450 to 900 Canadian dollars. However, out-of-country patients would likely have to pay around $2,000 for the procedure. That’s on top of the plane or bus ticket American patients would already be purchasing to get here, and we must not forget that those with criminal records and precarious immigration statuses would sadly not permitted to enter our country.

In 2019, Prime Minister Justin Trudeau will be up for reelection. There are certainly things he could do to improve abortion access across the country. He could provide additional funding to the provinces, funding that is earmarked specifically for reproductive healthcare. To bridge the access gap, he could also establish federal funding for women who do not live near abortion providers to travel for such treatment. It is time for our feminist prime minister to walk the feminist walk he talks so well.

Nearly two years ago I was diagnosed with a rare form of Acute Myeloid Leukemia—so rare, in fact, the doctors were not one-hundred percent certain with their diagnosis until it returned the second time. During most of my first rounds of treatment I had insurance through my place of employment—that is, until my six-month disability period expired, and I was fired.

My option was COBRA, an entirely overpriced insurance that would have left my husband and me with nothing on which to live. I was able to receive almost full financial assistance through the hospital where I was receiving treatment, and when I was declared in remission, we managed to squeeze in the tiny slot of the Affordable Care Act coverage that was actually affordable—mainly so my husband would have something “just in case.”

After a few months of remission, I learned that the disease had returned. My doctor gently informed me that I would have to undergo radiation, which was to prepare me for an allogeneic stem cell transplant, which is when the patient receives stem cells from a matched donor (as opposed to an autologous STC, where one’s own cells are used). However, due to sheer cost, the hospital’s financial assistance could not cover the STC—an estimate provided by the Leukemia and Lymphoma Society for an allogeneic STC is $500,000. My only options were to find affordable insurance in the Marketplace or to apply for Medicaid.

We did our research and weighed the pros and cons alongside our specific circumstances. While I had lived paycheck to paycheck throughout my professional career, my husband had managed to put away a significant “nest egg” while working during and after graduate school—but it was a drop in the bucket compared to the expense of the transplant I needed.

When we married, we acted as if his funds did not exist and lived off of what we made monthly. However, suddenly those funds for which he had worked and saved so diligently were keeping me from obtaining Medicaid, which we realized was the only viable option for my specific needs.  In order to qualify for Medicaid as a married couple, though I was the only one applying, we had to meet certain income limits as well as a spenddown before I could receive coverage.  

Since we could only have necessary assets, we had to provide copious amounts of documentation to prove we were under the financial need limit (i.e. one place to live, whether rented or owned, evidence of total income/assets under $3,000—less for us because we kept a second car, documentation for all bank accounts dating back three months, pay stubs, taxes, etc.).  They even ask on the application how much cash you have in your wallet.

My husband’s savings, along with our monthly income, would not cover long-term insurance premiums, co-pays, and meet required deductibles before our resources would run out, leaving us unable to cover basic living expenses—essentially all the reasons we had to turn down COBRA.  I felt angry, indignant, and sad that something totally unrelated to any of my own hard work was now in jeopardy because I had a life-threatening disease. We spoke with the Medicaid experts at the hospital, spent countless hours discussing and seeking wisdom from others, and finally made our decision. We would strategically and legally get rid of the money my husband had carefully set aside in order to save my life.

They even ask on the application how much cash you have in your wallet.
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Never had I imagined that spending money could be so stressful. There are countless stipulations of how you can and cannot dispose of your income, how many cars you’re allowed to have and at what values, and special boxes to check for earmarked monies. For instance, I was allowed to open a special “Burial Fund” account at my bank with $3,500 per person that is untouchable until after I am off Medicaid. We could, and did, pay a year’s worth of rent on our apartment. Then, we made sure our car and rental insurance was paid as far in advance as permitted by the insurance company.  However, we were not allowed to give or sell one of our vehicles to a family member for the duration of my time on Medicaid. We were also warned against giving away money when we considered donating funds to a non-profit cause, as it might look suspicious and could complicate the approval process.

The kicker was that, between the two of us, the government stated we could have one car and $3,000 total, in all assets. However, if we kept both of our cars, the one of lesser value would count against the $3,000 (an antiquated policy that ignores how many people are in two-job homes, requiring transportation for each). We both owned our old cars outright, but we decided to sell the car that got worse gas mileage and upgrade for the sake of my daily transportation comfort after my procedure (1.5 hours round-trip), since it wouldn’t count against us–part of strategic spending. After attempting to sell my car, we decided that based on its low worth in the Medicaid system, but personal value when I was again able to drive, we would keep it and take the financial cut. It was the best decision for us, because after 4-5 months I was again able to start driving short distances. But, it means we have to watch our bank account with a hawk eye.

The stress of making sure every detail was correct was excruciating. Nine months later, it is still a constant stress in our life. I worry what someone at the Medicaid office might say if I deposit a birthday check for $50. I anticipate the review every six months, knowing I have done everything I can, but am still concerned they will find something amiss that will cost me my coverage and therefore my ability to receive necessary treatments.

We were also warned against giving away money when we considered donating funds to a non-profit cause, as it might look suspicious and could complicate the approval process.
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The thing is, I know my story is a pretty good one compared to others. Like most people, I am on social media. I am familiar with people who are on welfare and Medicaid for many reasons. I hear comments people make about those who are truly less fortunate (I do not count myself in that category—my situation could be so much worse). The memes that are posted stating who should and should not qualify for assistance are appalling. The judgement cast by comfortable people who think “if I can do it, so can they” is sickening. The belief so many people have, that it is an easy system off of which people want to leech, is pure propaganda pushed by the greedy elite onto the masses for their own agendas.

Contrary to what many want to believe, my experience doesn’t show me people excitedly lining up to jump through rolls of red tape in order to receive state assistance. It is a painfully long and even degrading process. Humans are treated as a checklist and their personal experiences mean very little, if anything, to the person processing their file. When it takes so much effort to get on welfare (of any kind), is it little wonder that people are loath to get off before they know they can certainly survive without it? A single mother with children to feed and insure, working a job that barely covers rent and utilities, all without benefits will need help. A young couple who are struggling, while working full-time, to make ends meet because their job doesn’t actually pay a living wage may have to lower their pride and apply for food stamps.

These are just a few situations of thousands where the many who claim we need to “help our own first” want to turn a blind eye rather than actually seeing their tax dollars do good.

Personally, I have to consider various factors prior to getting my next job. I cannot wait to get back to work, but I am still officially disabled. I need Medicaid while I continue treatment and recovery. Before I can come off of Medicaid, I have to secure a position with benefits, a salary that will allow me to pay out of pocket fees until I’ve hit my insurance deductible, and the security that if I don’t qualify for much financial assistance, I’ll still be able to get the healthcare I need as a cancer survivor.

The belief so many people have, that it is an easy system off of which people want to leech, is pure propaganda pushed by the greedy elite onto the masses for their own agendas.
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I don’t fit the “stereotypical” role of a welfare recipient. I am a professional, young adult who was diagnosed with a deadly disease and has had to make painfully stressful decisions in order to give myself the best shot at living. But because I don’t fit the bill, I can use the general public’s false assumptions to expose the fallacy of their definition of poverty, what material possessions someone receiving government assistance can have, and what their lifestyle can look like.  

For instance, we drive a used Prius and an old Civic. We shop at Aldi. We use iPhones we bought before my diagnosis (over two years old) and maintain them well. I strive to make my home cozy and a place where my husband and I can work and relax, since we are here practically 24/7. But many would want us to be car-less or in a junker, using a flip phone (nothing against those), and living in a dilapidated house if they knew I was receiving Medicaid.

When I go into the doctor’s office or call my case worker at social services, I cannot help but feel like I’m viewed as slightly less worthy simply because I need help from “the system.” I speak extra clearly and efficiently to communicate that I am aware of the process and want to know what they need me to do. I refuse to be one more person they think they can railroad over because of a complex and confusing system. They will acknowledge my humanity.

Our society wants to see the poor look impoverished, and if they don’t, society lacks the desire and drive to help. After all, if you don’t look pathetic, how can they judge you? The “older” generations cannot comprehend that holding a full-time job is often not enough in the current economy and job market. Thousands of college graduates wind up serving you your morning latte, and I can guarantee that, for most, that is not their passion. Families where one adult is a caregiver and the other is disabled face losing their food stamps when their teenage, but not yet adult, children get high school jobs—like society says they should. The state counts that as household income, even though most families would consider that simple spending cash, not grocery money.

The system is flawed.  Currently, the Trump administration wants to cut assistance to “the three big entitlement programs,” as Senator Mitch McConnell stated in an interview with Bloomberg, as a solution to lowering the national debt.  This comes on the heels of approval of a $675 billion budget for the Department of Defense—only furthering unending, pointless, greed-driven wars, death, and destruction.

We say we want to help the poor in our nation, but do we really? The proof is in the policies—policies that oppress, stress, and even kill.

What if you could get a medical diagnosis for free? No confusing copays, no being put on hold trying to argue an unexpected bill with your insurance company. A first, and second, and third opinion, all at once. Do we have the government to thank? Nope, just TV. TNT has announced it’s prepping for M.D. Live, a show where patients can apply to get their illnesses diagnosed by a panel of doctors—and a live audience.

During an episode, a panel of doctors will reportedly discuss the patient’s symptoms and possible diagnoses, before “crowdsourcing” with the audience, which seems perfectly healthy. Speaking to the Hollywood Reporter, Michael Bloom, TNT’s Senior VP of unscripted and live programming, said, “We want this show to inspire action and give hope to real people struggling with medical problems to get answers, proper treatment, and ultimately, improve their quality of life.” But responses from disabled and chronically ill people online suggest that this new breed of entertainment is hiding a far darker reality.

Chronic illness affects approximately 133 million Americans, and an estimated 30 million sufferers remain undiagnosed. It takes an average of 7.6 years to diagnose a rare disease in the U.S., and undiagnosed illnesses are associated with higher mortality rates, and lower quality of life for the people affected.

But because of the high costs involved in accessing care, many patients are forced to abandon their search for answers for years at a time. Last year, The Guardian reported that medical expenses were the most popular category of fundraising on crowdfunding site YouCaring, and that medical fundraisers on GoFundMe had increased from $6 million in 2012, to $147 million in 2014.

Unsurprisingly, women, particularly black women, and people living in poverty, face additional barriers to diagnosis. In Maya Dusenberry’s ground-breaking book, Doing Harm, she reveals that of the 100 million Americans who live with chronic pain, the majority are women. Yet research released in the study Women With Pain shows that women with chronic pain are more likely to be wrongly diagnosed with mental health conditions than men, and are frequently prescribed antidepressants and psychotropic drugs instead of pain relief.

Similarly, a study by the British Heart Foundation found that women have a 50% higher chance of receiving a false diagnosis following a heart attack, because the severity of our symptoms is not immediately believed, and we are more likely to be told we are having a panic attack.

But hidden biases in the medical system don’t stop there. Obese men and women are more likely to suffer with undiagnosed conditions, often because doctors blame their symptoms erroneously on their weight. This leads to a lack of diagnostic testing, and frequent fat-shaming may mean that sick patients stop going to the doctor altogether.

And these problems are compounded for black women, who often experience implicit racism in medical settings. Black women are three to four times more likely than white women to die from pregnancy-related complications, as illustrated recently when Serena Williams had to fight for medical intervention following the birth of her daughter. Black women also face a significantly higher risk of delayed breast cancer diagnosis than white women, and are frequently under-diagnosed generally.

It takes an average of 7.6 years to diagnose a rare disease in the U.S., and undiagnosed illnesses are associated with higher mortality rates, and lower quality of life for the people affected.
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Under a medical system that so often struggles to provide equal, affordable treatment to its patients, it’s no wonder that those with undiagnosed chronic illnesses might be tempted to prostrate themselves across our TV screens, in the hope of finding answers. But the trend of producing television that depicts suffering as entertainment, is one that does real-world harm to disabled and chronically ill people worldwide.

Most recently, Netflix came under fire for its show Afflicted. Billed as a documentary portraying “baffling symptoms and controversial diagnoses,” it was alleged in an article by the LA Times that producers edited the footage unethically, to falsely suggest that the participants’ medical conditions were psychosomatic in origin.

In a joint post on Medium, entitled ‘The Truth Behind Netflix’s ‘Afflicted,’ participants in the show say they were told they would be taking part in a project that would show their lives and struggles through a “compassionate lens.” Instead, they say, footage of their concrete diagnoses and tests results was excluded, and conventional medical doctors were either not consulted during filming, or their interviews were left on the cutting room floor.

The result of this was that many of the participants were harassed online, and some were even sent death threats by viewers who believed they were either faking it, or mentally ill. But such poor depictions on screen aren’t just damaging for the patients involved. They also have a far-reaching negative impact on the millions of other people struggling just like them.

Netflix reaches 300 million viewers worldwide. When a program with that kind of impact misrepresents medical conditions that are already under-funded and under-studied, it has a direct effect on whether patients facing similar problems can access appropriate care, or whether governments choose to support research funding.

And this is the core of the problem with M.D. Live.

The trend of producing television that depicts suffering as entertainment is one that does real-world harm to disabled and chronically ill people worldwide.
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It’s likely that many undiagnosed patients will be from social groups that already experience prejudice from the medical profession, and these prejudices may be replicated by the producers, unknowingly, on-screen. It’s easy to imagine a panel of doctors telling a fat white woman she just needs to lose weight to solve her problems, or insist that a black woman’s pain can’t be as bad as she says it is. While it’s easy to see why desperate patients might approach the show to help them when they’ve exhausted all other options, it’s also all too easy to see how exploitative this could become.

Disabled and chronically ill patients often experience harmful advice from the medical profession, as well as from friends, family, and the public, if a simple cause for their symptoms isn’t easily identified. It’s difficult to see how a show in which doctors discuss potential diagnoses, before “throwing live to the crowd for additional feedback”, will do anything other than encourage dangerous speculation from unqualified viewers, and lead to damaging, pseudo-scientific suggestions in the pursuit of interactive entertainment.

Michael Bloom says TNT’s “professional team of studio and field crews will lead our charge crowdsourcing hope to help our patients solve the medical mysteries we present in the series,” but even more so than a documentary like Afflicted, as live entertainment, it’s unlikely that TNT will succeed in helping patients long-term.

M.D. Live is the direct result of a government that considers medical care as a product, not as a basic right. In a show which allows a live audience to share their opinions, while people with undiagnosed illnesses are forced to waive their right to privacy in the hope that television will succeed where their doctors have not, the potential for misrepresentation and exploitation is staggering. TNT claims to be “crowdsourcing hope,” but I don’t find much hope in a world that relies on television to heal the wounds that the medical system leaves gaping open.

The ACA Has Been A Lifesaver For Those With Eating Disorders — What Happens If It Goes Away?

Millions could be hurt by the GOP’s health-care plans. But one group in particular is often overlooked.

flickr / daniellehelm

This week, the United States Senate again failed to collect enough votes to complete one of President Donald Trump’s cornerstone campaign promises: repealing and replacing the Affordable Care Act. Senate Majority Leader Mitch McConnell has since proposed a vote to simply repeal the ACA without a plan for replacement (he promised a two-year “pause” without more specifics), though that plan doesn’t appear to have the votes required to pass, either. Meanwhile, the President stated that he’d be more inclined to just “let Obamacare fail,” an ominous threat without much substance or policy behind it.

This constant changing of the currents — an uncertain future that has left insurers skittish, local governments scrambling, and patients in fear — is largely due to political disagreements and power struggles between wealthy white men, but its impact is much greater and more deadly than they seem to realize.

The constant changing of the currents on health care is largely due to power struggles between wealthy white men.

Justly, more visible diseases, like diabetes and cancer, receive the lion’s share of the attention in discussions about the devastating impacts of the ACA. But there’s another, less talked-about group who may also die as a result of this politicking — those who are struggling with, and unable to get help for, their eating disorders.

The National Eating Disorder Association (NEDA) estimates that about 30 million people in the United States live with an eating disorder at some point in their life. Eating disorders are not fatal for the majority of those who get help — about 97% of patients who are treated survive — but when treatment is not available, the mortality rate jumps as high as 20%.

The fact is, despite targeted rhetoric about its costliness and general failure, the ACA has substantially increased access to treatment for many patients — and without it, many people with eating disorders would die.

Eating Disorders Before The Affordable Care Act

Though Netflix’s To The Bone made it look easy to get into a cushy in-patient program and stay for months at a time, the reality of eating-disorder treatment is much more bleak for many patients — and was even moreso prior to the adoption of the ACA.

In 2011, a court case in California pushed back on the idea that insurers don’t need to cover in-patient treatment, one of the most aggressive methods of treating eating disorders. The case stemmed from a perception that mental-health issues and physical ailments weren’t being treated equally, a violation of the state’s mental-health parity law and its federal counterpart, The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008.

For years, insurers would cover only a limited number of days — a week, a month — in residential treatment, typically citing the cost; a week at Renfrew, the gold standard of eating disorder treatment, costs over $8,000 per week out-of-pocket. Other insurers flat-out wouldn’t cover any kind of residential treatment, despite recommendations from health-care providers.

Whether residential treatment is the most effective method is up for dispute — and there’s plenty of debate on that exact subject — the fact remains that in-patient treatment is still highly recommended by many doctors and therapists, and can be a lifeline for families who need help.

When You Include Your Eating Disorder On A Medical Intake Form

The ruling, which stated that insurers must strive toward parity of care between mental and physical ailments and thus, provide coverage for residential treatment programs, came down in 2012. NEDA CEO Lynn Grefe called it “a significant victory in the battle against eating disorders that we hope will have repercussions throughout the health insurance industries.”

It did not, however, help establish how patients would be able to access these resources if they couldn’t afford or obtain insurance in the first place. Crucially, despite the significance of the ruling, insurers could still find ways to avoid picking up the tab. Prior to the passage of the Affordable Care Act, they had one very handy tool: pre-existing conditions.

Though “being a woman” is not, in fact, a pre-existing condition, being a woman (or a person of any gender) with an eating disorder is — which means even if a person got coverage once, they could be denied it in the future. That’s challenging when dealing with a disease which tends to take multiple attempts at treatment (and many years) to fully recover from.

Thanks to Obamacare, insurers could no longer turn people away for trying again, and accessing health care was easier than ever.

Eating Disorders Are Expensive For Everyone

Even after the passage of the ACA, though, treatment for eating disorders was difficult to access — making the President’s threat of just “letting it fail” even more frightening.

At the time of the law’s passage, treatment of eating disorders had not qualified as an “essential health benefit” under the new law, despite lobbying from industry professionals. In a letter to then-Secretary of Health and Human Services Kathleen Sebelius, an organization of “more than 35 organizations in the eating disorders education, prevention, and treatment communities” stated their case:

“People with eating disorders experience discrimination in accessing proper treatment and this is a serious obstacle to recovery…According to a 2003 epidemiological study of more than 2000 women, only 1 in 4 white women and 1 in 20 black women who had a diagnosable eating disorder ever received any treatment for their eating disorder.”

Protecting benefits and Medicaid coverage is a matter of social justice. A lack of treatment options and funding methods means that the lethality of eating disorders can be extremely discriminating; if only one in 20 Black women receives treatment, the other 19 are at a much higher risk of death.

Protecting benefits and Medicaid coverage is a matter of social justice.

Reducing access to treatment may also skew research and perpetuate the myriad stereotypes about eating disorders — what they look like, who gets them, and how old they are. One of the most comprehensive ways to collect data about who suffers from eating disorders is to survey those who are getting help. However, when people from marginalized groups — LGBTQ individuals (particularly trans youths), people of color, immigrants, and the very poor, to name a few — don’t have access to treatment, they can’t be counted. The prevalence of eating disorders in poor, rural, and immigrant communities is fairly unknown because they just aren’t getting treatment. Additionally, because these stereotypes persist, primary-care physicians working with these populations may not know the signs or know when to refer someone to care.

The common perception is that eating disorders are private battles fought by thin white women (again, thanks a bundle, To the Bone), but the truth is that they frequently intersect with a whole lot of other issues.

Many eating disorders have nothing to do with restricting and may be masked by other behaviors, substance abuse issues, or trauma. It’s impossible to have conversations about obesity, diabetes, the opiate crisis, or the cost of health care in the United States without mentioning the fact that many of these issues impact and are impacted by the millions of Americans who are living with some kind of eating disorder.

Why We Need More ‘Hunger’ And Less ‘To The Bone’

Offering treatment, then, has far-reaching effects. But the case for offering it goes beyond being the right thing to do. Footing the bill for treatment also does what conservatives have claimed as their goal: saving money.

The sticker shock of a $30,000 per month tab for residential treatment may seem like a lot to a lawmaker looking to make cuts, but consider the cost of not treating those struggling. Again, from the provider letter sent to Secretary Sebelius:

“Consequences of not receiving necessary health insurance coverage include financial ruin for families paying out of pocket, a lack of life saving care, which leads to the worsening of symptoms and in some cases death. Anorexia has the highest mortality rate of all mental illnesses, upwards of 20%. Individuals with anorexia nervosa are 11 times more likely to die than their peers and they are 57 times more likely to die of suicide. Mortality rates are also higher for people with bulimia nervosa (3.9%), and eating disorder not otherwise specified (5.2%).”

Unlike many other ailments, which land sufferers in the emergency room for a round of antibiotics if they’re uninsured, eating disorders are an ongoing, deeply damaging experience that impacts both a person’s physical and mental health. It hinders lifetime productivity, can reduce earning power, and generally perpetuates the gender wage gap. Mental-health issues, particularly those with physical impacts, cost billions in unearned income, creating a cycle of economic despair and expense. They literally make people more poor, thus making them more reliant on social services.

The absence of a functional health-care system — whether that’s single-payer, an improved Obamacare, or something else — is also necessary for the ever-increasing number of children who develop eating disorders.

Yes, many eating-disorder patients are children — between 1999 and 2006, the number of children under 12 who were hospitalized for eating disorders increased 119%. These kids are unable to “go get jobs,” and may be reliant on their parents’ Medicaid, which is also in peril under the GOP’s health-care plan.

The Medicaid expansion portion of the ACA has been monumental for families; in some states, children are the single largest dependents on Medicaid. Meanwhile, children as young as 4 years old report disordered eating patterns that often go undiagnosed because they don’t have access to competent care. The younger these patterns are caught, the better a child’s chance of recovering early.

Repeal, Replace, Fail

There are necessary improvements to the ACA that must be made, but none of them are contained in the proposals coming from Republicans in the House, Senate, or Executive branches.

Each plan put forth by the GOP — from the AHCA to the BRCA to the plan to just plain old repeal — would put people with eating disorders at risk. Cuts to Medicaid spending, reduced coverage for pre-existing conditions, and trimmed mental-health-care coverage would all directly impact the millions of Americans seeking help.

They won’t help bring down the cost of treatment, either; with less insurance or Medicaid funding for eating disorder centers and recovery options, the patients will be expected to pony up. And in the absence of funding, many, many patients will opt not to get help, deferring the cost of treatment to a later date, and potentially dying while they do.

Each health-care plan put forth by the GOP would put people with eating disorders at risk.

McConnell’s two-year pause could also be lethal for patients; recovery is a long road, and many patients who are fortunate enough to be able to afford residential treatment, either through insurance or their own financial stockpile, will need ongoing aftercare. Putting a pause on coverage or temporarily cutting Medicaid will ensure that the long-term care is not an option — significantly increasing a patient’s risk of death.

And as for the President’s promise to “let it fail,” he may be waiting for a while. The ACA is far from perfect and there are still many reasons why treatment is just beyond reach for a lot of individuals, but it is not, as claimed, collapsing — despite concerted efforts from the President to make it so.

Regardless, this is a fight that’s being waged in Washington but fought with the weaponized bodies of people who are disproportionately young, disproportionately marginalized, and disproportionately struggling with other issues. Though the men in ties in the Beltway may view this as a high-level game of chess, the fact of the matter is that the future of the ACA is intimately tied to the future of many Americans who’ve only just got some semblance of hope.

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]]> https://theestablishment.co/the-gops-health-care-bill-would-push-more-disabled-people-into-poverty-e2b962f4160c/ Wed, 28 Jun 2017 23:35:34 +0000 https://theestablishment.co/?p=3334 Read more]]>

The GOP’s Health-Care Bill Would Push More Disabled People Into Poverty

The system around disability benefits is already broken — and it could soon get exponentially worse.

Adapted from flickr/Wally Gobetz

Over the last few months, Trump’s Budget Director, Mick Mulvaney, has frequently turned Social Security disability insurance into a punching bag. In March, he called it “a very wasteful program.” In May, he declared, “If you’re on disability insurance and you’re not supposed to be, you’re not truly disabled, we need you to go back to work.” A day later, presenting Trump’s budget proposal, he stated he is “a lot less comfortable” with telling taxpayers “look, I need to take this money from you to give to this person over here who really isn’t disabled but is getting a disability benefit.”

Mulvaney’s language surrounding disability insurance, though perhaps particularly sharp, is not unusual. The GOP has long suggested that the system is ruinous and routinely abused by lecherous fraudsters. The problem? Such claims do not hold up to factual scrutiny — statistics show that abuse is, in reality, extremely rare. The disability error rate, which counts both overpayments and underpayments to beneficiaries, is well below 1% of all benefits, as then-Acting Social Security Commissioner Carolyn Colvin testified to Congress in 2012. If anything, in fact, the program is so strict that it makes it too difficult to secure disability insurance in the first place — only 40% of applicants are awarded benefits.

Meanwhile, while Republican leaders crow about a problem that hardly exists, a real issue is often ignored: Disabled people are frequently pushed into poverty, or further into poverty, as a direct result of their efforts to secure financial assistance.

The situation has been dire for a while. And if Trump’s draconian budget is signed, and the Senate’s health-care bill passes, it could get even worse.

Many people are unaware that Social Security disability actually takes two forms: Social Security Disability Insurance (SSDI) is granted to disabled people who have worked in the past but are currently unable to do so, while Supplemental Security Income (SSI) is reserved for those who have never worked or only worked a small amount. While SSI is a welfare program, SSDI is insurance — a payroll-tax-funded program the recipient has paid into throughout their adult life.

Award benefits for both programs are meager. For an individual, annual SSI payments top out at about $3,000 less than the federal poverty line. SSDI awards, which are based on the claimant’s previous income rather than on financial need, end up being about $2,000 above the annual poverty line for a one-person household.

Meanwhile, the time between application and approval is, for both programs, prohibitively long: The process can span years, often requiring numerous appeals. And this wait, in turn, can have dire impacts.

Health-Care Activism Is Failing The Disabled Community

Take the case of Courtney, an SSI applicant who shared their experience with me. Since age 11, they have been diagnosed with 13 disorders, the most severe of which are POTS, which causes fainting, lightheadedness, and fatigue, and Myasthenia Gravis (MG), an autoimmune neuromuscular disorder which causes the major muscles to fatigue and stop working. Every five weeks Courtney, now 26, receives treatments to boost immunity and minimize MG symptoms. Treatment and recovery take five days — and without these treatments, Courtney says, they could go into myasthenic crisis, which could cause stop them to stop breathing and halt their heartbeat. Yet even with these treatments, Courtney is unable to meet the physical requirements for available jobs in their area.

Courtney first applied for SSI in February 2016, and has been denied three times. Initially, their disabilities were deemed insufficiently severe. Later Courtney was told that their ability to fill out the appeals paperwork indicated they could work a sedentary job. This kind of justification for denial is not uncommon. Dana Duncan, a Wisconsin attorney who has worked on behalf of disability claimants for 27 years, says that while he doesn’t “want to seem too cynical,” some decision-makers “have gotten jaded, and they’ll put anything down if they want to deny the case.”

Some decision-makers ‘have gotten jaded.’

The success of Social Security claims is further complicated by vocational experts, witnesses who testify for the Social Security Administration (SSA) regarding the availability of jobs that claimants can perform. But as Duncan points out, these experts work with outdated and inaccurate data. Some formerly “unskilled” jobs, for example, now require limited computer knowledge, classifying them as “semi-skilled” — but this change is not reflected in the Dictionary of Occupational Titles (DOT), the reference text used by vocational experts. Despite this, disability claims are often denied on the basis of vocational expert testimony. (The SSA is in the process of replacing the DOT, which was last updated in 1991, with a new Occupational Information System that will more accurately represent job descriptions and requirements. However, this system will not be complete until 2019.)

The resulting appeals process may further intensify financial difficulties. According to Duncan, “Most of my clients, by the time they get to a point where they realize they’re going to be disabled, they don’t have any money. They’re already missing a lot of work, usually before they ever lose their jobs. They have a huge amount of hospital or medical expenses, because even if they were having coverage, between deductibles and co-pays, they have thousands of dollars a lot of times in medical bills.” So even if these clients are approved, by the time they start receiving benefits they “are so far in debt that they can’t even dig their way out.”

‘Most of my clients, by the time they get to a point where they realize they’re going to be disabled, they don’t have any money.’

The financial burdens of medical care and loss of employment are so significant that some disabled people, particularly those lacking strong personal safety nets, become homeless. Though non-institutionalized disabled people account for only 16% of the U.S. population, over 40% of the country’s homeless is disabled. Duncan has had clients who lose their homes during the appeals process and move “from family member to family member,” live in unheated cabins in the woods, or are forced to stay with their ex-spouses. As a result, not only are applicants stripped of their independence, they can be difficult to locate — which, in turn, affects the success of their claims. In fact, disability and homelessness are so entwined that there is government-funded outreach to help the homeless acquire disability benefits.

Successful applicants typically receive back payments for the time they were unable to work and not receiving benefits. However, debt and interest can accumulate quickly. Simone, a 30-year-old SSI recipient I interviewed over email, waited over two years before receiving benefits. According to Duncan, it is common for applicants to wait three to four years, making Simone’s wait relatively short. Even so, most of Simone’s over $13,000 in “back pay” went toward credit card debt and stopping foreclosure proceedings on her home. By the time she received her benefits, one $1,500 credit card payment had ballooned to $6,000. And although she and her husband only owed about $900 on their home, they ended up paying an additional $6,000 in lawyer’s fees, which, Simone says, would not have happened if they had been able to pay sooner. After quickly depleting thousands in back pay, Simone had only her husband’s income of under $5,000 per year and her monthly SSI payments of $698 to live on.

Simone’s situation has stabilized somewhat. Last year, between her SSI and her husband’s job, her household income exceeded $30,000. This is enough to provide for Simone, her husband, and their young child, but, she says, “We’re still scared.” When determining SSI eligibility and award amounts, the SSA accounts for spousal income and family size, which can result in reduced payments or loss of benefits entirely. If Simone’s husband makes more than $31,000 a year, Simone says, she will lose her SSI, “so we are nervous that right when things look up we could end up stuck again, before I have a chance […] to help the household somehow.”

As for Courtney, their second appeal was denied in September 2016, and they have been waiting on a hearing for nine months. If approved, Courtney says, “I would like to move in with my fiancée and start an actual life.” But they still worry about life on disability, saying that even with benefits, “I have no idea if we can ever get married for real, because I will probably lose my Medicaid if we do and without that I can’t afford to live.” And while Courtney would like to have children one day, they are concerned about the expense. Because SSI award amounts are need-based, Courtney’s benefits will be restricted to less than $400 a month as long as they live with their mother. If they move out and support themselves, they can expect around $730.

‘We are nervous that right when things look up we could end up stuck again.’

Such financial struggles would only worsen under the GOP agenda, especially the proposed budget and the new Senate health bill. The budget would cut $72 billion from Social Security disability programs, further restricting the number of people who can access benefits. It would also slash $616 billion from Medicaid and the Children’s Health Insurance Program, which would result in loss of insurance for the poor and sick and lead to incomplete documentation of disability and worse health outcomes.

Changes to the Affordable Care Act would only compound these issues. According to a CBO report released on Monday, the Better Care Reconciliation Act — the Senate’s rushed version of a health-care bill — could result in loss of insurance for an additional 22 million people by 2026, raising the total number of uninsured Americans to 49 million. And while the bill does not let insurance companies deny coverage to people with preexisting conditions, it does allow states to alter essential health benefits, meaning that sick people can be forced to settle for worse coverage. These changes would reduce quality of care and increase medical debt — and these gaps in health care would make disability claims even harder to win.

Limited health-care access also increases the number of people who need disability benefits in the first place. Duncan points out that many disability recipients are only sick because “they don’t get the medical care they need.” For example, someone with heart palpitations or high blood pressure might not go to a doctor until they suffer a heart attack. “If they would have been treated for it when it first started, they probably wouldn’t need to be on disability,” he says. “But no one thinks of that.”

As A Disabled Woman, I Am Terrified By A Trump Presidency

This is not to suggest that the current system needs no reform. Currently, an applicant who tries to work while their case is pending is often penalized with denial of benefits. As a result, it can be easier for people to “sit around […] and wait for [their] benefits to start.” Duncan suggests reforms in this area, as well as the option of a “partial disability benefit,” where the recipient is covered under Medicare and can work part-time. These changes could ease recipients’ financial struggles.

Mulvaney has promised that “We’re not going to measure compassion by the amount of money we spend, but by the number of people that we help.” But this reluctance to spend is the problem — with wait times spanning years, and benefits so meager, it is often impossible for disability recipients to rise above the level of survival.

And as for the implied epidemic of abled people exploiting the system? It “doesn’t happen,” Duncan says. Not only is the process of acquiring disability complicated and long, the payout isn’t worth it.

The Trump administration’s agenda for health care and social programs, he adds, “isn’t making America great again. It’s taking away the basics of what we should have as a country.”

“It feels like the government sees my existence as a burden,” Courtney says, “and so does everyone else.”

]]> https://theestablishment.co/horror-scripts-about-reproductive-health-care-9629749ffcc0/ Wed, 19 Oct 2016 01:53:46 +0000 https://theestablishment.co/?p=6786 Read more]]> You want scary? This is scary.

‘The Congress Planned Parenthood Massacre’

FADE IN.

INT. BREAK ROOM, GOVERNMENT BUILDING — EARLY EVENING

Cecile Richards begins to regain consciousness, stirring in the chair to which she is bound. For a few blissful seconds, she is able to believe that the past few hours were nothing but a bad dream — that her idyllic fall afternoon drive through Washington D.C. went off without a hitch, that she was never captured and dragged back to the hulking government building in which she now sits, trapped and terrified. Her eyes snap open — Cecile is forced to confront her reality. Her captors pore over book-length documents and argue. Cecile screams. The captors scream back.

CECILE
Why are you screaming at me?! I’m the one tied up here!

DESICCATED OLD MAN
Oh, that’s just what we do! We protect innocent baby lives by screaming at scared women outside of clinics. You know, calling them murderers and whores and stuff. Classic good guy behavior. Besides, we’re men and our voices should be heard over a woman’s at all times.

Cecile glances around the room and screams again.

CECILE
What are those?! What is wrong with you?!

She motions with her head to a pile of posters and signs covered with graphic pictures of dead fetuses.

ANOTHER DESICCATED OLD MAN
Those are our protesting placards. We use them to stop all you evil women from aborting.

CECILE
So you collect and surround yourself with gruesome high-resolution pictures of dead fetuses and somehow women who get abortions are the evil ones? . . . That’s not even what an aborted fetus looks like!

DESICCATED OLD MAN #1
Shut your mouth! What do you know?! You’re just a dumb woman. Now quit yer screaming — you’re distracting us from our important work.

‘Those are our protesting placards. We use them to stop all you evil women from aborting.’

CECILE
What work!? What are you going to do to me?! Let me go!

DESICCATED OLD MAN #2
Well, we’ve downloaded some new fonts that make words look like they were written in dripping blood, and then we wrote a pro-life parody of Lady GaGa’s “Bad Romance” called “Bad Abortion (Abortion Is Bad).”

He makes a deliberate check mark on his clipboard.

Now we’re onto the next task on our agenda — we’re coming up with new ways to restrict abortions.

CECILE
But abortion is legal! Whether or not a woman aborts shouldn’t be up to you — the decision should be made solely by the woman whose body is in question, not lobbyists or politicians!

DESICCATED OLD MAN #1
(disregarding Cecile)
Remember when we talked about “legitimate rape” and how females’ bodies can shut down pregnancies if they want to?

CECILE
Oh god, please, no! Don’t say “females!” Please! Please! Anything but that!

DESICCATED OLD MAN #2
(ignoring Cecile)
This is a graph my kids helped me create on Excel. See, there are numbers and lines — which means it’s science, which means it’s basically fact which means . . . we’re right. That line going up is the number of abortions . . . I think. I don’t know — I got caught up in choosing the right colors for my graph lines and forgot to label the axes.

CECILE
What gives you the right to weigh in on women’s reproductive healthcare?!
You’re all just a bunch of cisgender old men!

DESICCATED OLD MAN #2
Cisgender old men with a lot of money, baby!

DESICCATED OLD MAN #1
Who better to determine what a woman can do with her body?

DESICCATED OLD MAN #2
Don’t you understand — we have to protect human life, so we cut funding for food stamps and Medicaid in order to pay for more investigations into legitimate medical organizations like Planned Parenthood! How doesn’t that make sense?

DESICCATED OLD MAN #1
Speaking of . . .

Off-camera, a grinding mechanical sound grows louder and closer. Cecile fights against her restraints and spasms with terror when the source of the noise is revealed to be a maniacal hulk of a man wielding a chainsaw in one hand and a reel of footage in the other. As Cecile screams, the man guides his weapon through the film, unabashedly splitting scenes.

DESICCATED OLD MAN #1
Yes! With that video, we will surely rile everyone up and come close to defunding Planned Parenthood! Good work, Fetaltissueface! . . . You know, we should probably work on your name. It’s not exactly catchy. Kinda sounds a bit foreign too, which you know the family doesn’t like.

CECILE
That footage is blatantly manipulated! You’ll waste millions of dollars probing into claims that have been proven false time and time again!

DESICCATED OLD MAN #2
Yeah, pretty scary, isn’t it? Just be thankful that we’re not talking about your emails. Now back to this graph — do you think the red I chose for the word “abortions” needs to be redder? Should I use the new blood-dripping font?

‘The Village Pharmacy’

FADE IN.

EXT. HIGHWAY — AFTERNOON

A girl in a dirty 19th-century-style dress emerges from a thick forest. Her hands and face are covered in fine scratches and leaves are tangled in her disheveled hair. She boldly steps forward into the middle of the highway, forcing a SUV to quickly swerve left to avoid hitting her. The truck comes to an abrupt stop mere feet from the girl, who appears confused but not entirely fearful. After a few moments, we hear the truck’s door open.

DRIVER
Are you okay?

GIRL
I’m not hurt. But please — bring me to the town. I seek tools of medicine.

GUY IN BACKSEAT OF SUV
(sticks head out of his window)
Uh, if she gets in the car, that makes this an UberPool, not an Uber — I’m gonna need the charges to reflect that. Also, not to be a dick, but I think I should be dropped off first since I got in first and happy hour ends soon and I’m not paying $12 for a whiskey ginger, you know?

INT. WALMART — LATE AFTERNOON

The girl stands before the store’s pharmacy counter, bewildered and blinking rapidly in the florescent light.

PHARMACIST
Can I help you?

GIRL
(hushed voice)
Please, tell me — I heard whispers in my village, in the meeting hall, amongst the women. They spoke of a certain medicine that —
(her voice drops to a hoarse whisper)
— that stops a woman from being with child. I thought it was surely a farce but . . .

Her voice trails off but she continues to lean eagerly over the counter, eyes locked on the pharmacist, and hopeful.

PHARMACIST
Oh. You mean birth control?

GIRL
Yes. Yes, please. One of that. One birth control for me.

PHARMACIST
I’m sorry, ma’am, but I cannot give that to you.

The girl’s face falls and her voice takes on a trembling quality.

GIRL
But please! I must have it!

PHARMACIST
I’m sorry, ma’am, but first of all, you do not have a valid prescription from your doctor for any sort of birth control. Second of all, even if you did, I wouldn’t be able to give that to you. It’s against my religion.
(in a deliberate whisper)
You see, birth control encourages sexual activity.

GIRL
But my village doesn’t carry this medicine and I have been encouraged to be sexually active! Do you know what really encourages sexual activity? Being locked in a tiny meeting hall with the village’s eldest boys after they have returned from a day’s work in the fields, their chests glistening with sweat, faces flushed with hot blood, breath forceful and uneven like that of a stallion mounting the broodmare, and —

The girl breaks out of her fantasy and notices that the pharmacist is holding something shiny and sleek in her palm.

GIRL
What is that?

PHARMACIST
My cell phone. I was just taking some notes for my fanfiction, don’t worry about it.

GIRL
Cell phone? Fanfiction?

PHARMACIST
Never mind. Ma’am, I appreciate your story but there is nothing I can do for you.

GIRL
But what of the hideous pain that comes with my monthly bleeding? Or the fact that the bleeding is irregular and unusually heavy? Doesn’t this medicine also treat those issues?

PHARMACIST
Well, yeah . . . but the sex stuff, like I said before, it’s bad. Thanks to conscience clauses, I don’t have to give you this pill, so I won’t. Now if you’ll excuse me . . . Ugh, god.

The pharmacist begins to pull and tug at her shirt, leaning forward and shifting it around, clearly trying to alleviate some pain.

‘Thanks to conscience clauses, I don’t have to give you this pill, so I won’t.’

GIRL
What’s wrong?

PHARMACIST
Nothing, it’s just my bra; the underwire broke so it’s poking into my side.

GIRL
You know, the whole point of this movie is the shocking plot twist at the end when it’s revealed that I actually live in the 21st century and that my village is just some strange secluded social experiment. But this interaction kinda has me questioning that whole premise. Like, it’s not the 1850s, but women still struggle to easily obtain low-cost and long-acting birth control? A woman’s sexuality is still a source of shame, condemnation, and criminality? And through some black magic, you have the power to write words on this “cell phone” without a dip pen and paper, and yet you people still haven’t invented a way to hold up a woman’s breasts that doesn’t involve sharp metal shards that eventually poke out and impale the very bosom they are supposed to be protecting?

PHARMACIST
Uh . . . yes? Wait — no? I don’t . . . what was the question?

GIRL
Forget it. My Elders also wanted me to procure some firearms, but surely there’s no way that a device created to take life is easier to obtain than some pill —

PHARMACIST
Aisle 11. Unless you want youth rifles, then that’s Aisle 15, next to the Minions toys.

‘The Sexistorcist’

FADE IN

INT. MEEGAN’S BEDROOM — NIGHT

Barely concealing his revulsion, Father Yesallmen enters slowly, picking his way across a floor littered with crusty tights, underpants, and empty jars of Nutella. His eyes flit across the dimly-lit room, then widen in horror. Arms held down by a double set of restraining straps, Meegan appears barely alive. Her hair is tangled and thickly matted — and we’re not talking about in a cute beach waves or Kylie-Jenner-culturally-appropriative-Teen-Vogue-spread kind of way. Her shoulders are shrunken and festooned with sheets stained with either human blood or red wine, depending on whether murder or squandered alcohol scares you more. A laptop sits on her withered lap; we can’t see the screen, but from the noises we know she’s watching the Entourage movie. Clearly something is wrong. Meegan lolls her head toward Yesallmen, who struggles to maintain some semblance of control.

YESALLMEN
Hello, Meegan.
(dragging a chair to her bedside)
I was told you wished to see me. How can I help you?

Meegan’s features recompose into a horrific demonic visage. Her throat swells and a nightmarish growl shudders through her body. Yesallmen remains silent, observing uneasily, until life returns to the girl’s face. It is the old Meegan once more, except her countenance is twisted with embarrassment and pain, a suggestion of an apology.

MEEGAN
(whispering)
I think it’s clear, Father — I need an exorcism.

YESALLMEN
An exorcism?

Yesallmen gathers one of Meegan’s hands in his own, careful to not pull on the restraining straps.

YESALLMEN
You want to get rid of this demon, this life, growing inside of you?

MEEGAN
Well, Father, I —

Sweat dots Meegan’s brow and some sort of wild electricity causes her frail body to seize. A foreign voice — thick, rasping, and filled with hate — passes through her lips.

‘You want to get rid of this demon, this life, growing inside of you?’

MEEGAN
Foolish man! She is ours! There is no god! Your world is scum! Beyoncé is overrated and her last album only had three decent tracks!

Meegan regains control. Her voice returns, frayed and tired.

MEEGAN
Yes, yes, I’m sure. Please cast this wretched monster out, Father.

YESALLMEN
Oooh, yeah, I don’t know if I can do that for you, Meegan.

MEEGAN
(baffled)
What?

YESALLMEN
This is a living demon that can feel pain. It probably has 12 long, poison-tipped demon fingernails already. You want me to cast something with fingernails out?

MEEGAN
Yes, I do — it keeps scratching “666” and “DEMON WUZ HERE” with a poor facsimile of the nail painting emoji into my chest. Besides, I’ve only been possessed for a few weeks. I can still talk to you as myself, so clearly the demon isn’t that strong.

YESALLMEN
Life begins at possession, Meegan. Besides, you engaged in the risky behavior; you should’ve been ready to accept the consequences.

MEEGAN
I got possessed by mistake! The Ouija board is produced by the Parker Brothers — how was I supposed to know that the creators of Monopoly unlocked a portal to hell?! I thought I was being safe; I mean, I only touched the tip of the planchette. I even faked it for awhile so it would end faster!

YESALLMEN
Meegan, I urge you to rethink your possession. This is a gift —

As YESALLMEN talks, a stream of thick greenish vomit shoots from Meegan’s mouth, soaking the bedding and the Father’s robe.

YESALLMEN
 — from God. You have to make the best out of a bad situation.

MEEGAN
How am I supposed to support myself? My savings are pretty much drained; I keep having to buy new beds to replace the ones I break after levitating.

YESALLMEN
Life is a miracle, Meegan.

MEEGAN
Considering that my flesh burns whenever I come into contact with holy water, I think this might be the exact opposite of a miracle. Father, please listen, this is my body. I alone should have autonomy over it. It is my right to decide what I want to do with it.

(dramatic pause)
And I want an exorcism.

Unable to reign back his disdain, Yesallmen glowers at Meegan. He lets go of her sweating hand and leans back in his chair, contemplating the girl’s case.

YESALLMEN
I suppose this is what you really want, Meegan. Before I can perform the exorcism, there are a few things I’m required to do by law. Firstly, I’m going to need your parents’ signatures on a consent form . . .

Meegan attempts to roll her eyes, but they go all the way into her head, leaving only the whites exposed.

MEEGAN
(hoarsely)
My parents are currently in the hospital. They were inadvertently crushed by a piece of furniture that I sent flying around my room with the new telekinetic powers I developed after a demon possessed me.

YESALLMEN
Hm, well, possessed women are known to be moody, heh heh. Hormones and all. I’d like you to look at this sonogram of the demon.

(Types on the laptop and turns it so the screen faces Meegan.)

Footage from the 1995 film “Casper” plays on the laptop screen. The bed begins to buck and fall as the Father snuggles up with Meegan in order to watch the movie.

YESALLMEN
Look at how adorable that spirit is! Do you really want to exorcise a spirit like that? Ugh, this is my favorite part — “Can I keep you?” I get the chills every time!

Yesallmen turns to Meegan for solidarity but she is motionless, the whites of her eyes glowing eerily in the dark room.

YESALLMEN
Ah, yes. Well. One last thing: just listen to the demon’s heart.

Yesallmen pulls a stethoscope out of his pocket and presses the diaphragm to Meegan’s stomach. A deafening hellish noise screeches from the ear tips, filling the whole room. The sound is unlike any other; it is multitudinous and deep, as if every soul in hell were howling for help. It is the aural equivalent of loneliness and fear and blinding rage and stubbing your toe on the corner of a desk while simultaneously biting your tongue and shattering your iPhone screen. The cacophony ruptures Yesallmen’s eardrums and he tumbles off the bed, pulling the stethoscope with him. As quickly as the noise exploded, it stops. After a few minutes of silence, Yesallmen pulls himself up to his feet. Blood trickles from both ears and his body noticeably trembles.

YESALLMEN
(shouting)
So, is adoption out of the question?