Nuking The Thieves

This week, two carjackers in Mexico made off with a truck full of cobalt-60, a radioactive isotope with medical applications. But it seems they didn’t know what they were dealing with:

While Mexican officials initially feared that the material could have been stolen as part of a plot to build a dirty bomb, the material itself has since been recovered. What hasn’t been found are the two carjackers, but they won’t get far: authorities say the thieves will almost certainly [die] of exposure if they haven’t already … It wasn’t initially clear if the thieves knew what they were stealing. But when a small amount (a few dozen grams) of the cobalt-60 was found removed from its casing, authorities figured the duo had no idea what they had, as a thief deliberately targeting radioactive material probably wouldn’t have exposed himself to a deadly dose of radiation.

Julia Fisher details what that level of radiation exposure does to a human body:

Cobalt-60 is produced commercially for use in industrial plants and for cancer radiotherapy. Like any radioactive material, it can also cause cancer if you’re exposed to low amount over a long period of time. But how cobalt-60 will exact its punishment on the thieves is a different, gruesome matter. …

Thus, the thieves in Mexico are probably in great pain. They may have burns and blisters on their skin. They could have diarrhea, a headache, and a fever. They may be vomiting—perhaps even vomiting blood. Their stomachs and intestines could be bleeding. The radiation has probably depleted their supply of red and white blood cells. Lack of the former will reduce their bodies’ access to oxygen, making them tired; lack of the latter will lower their resistance to infections, making it easier for them to get even sicker. They may be suffering from seizures, or even in be in a coma by now.

Fisher talks to Mark Hibbs, who says the risk of criminals making a dirty bomb from such materials is lower than we think. He’s still plenty concerned, though:

The scenario Hibbs seems most worried about isn’t a TV-ready plot about a dirty bomb or other large-scale attack. It’s an accident borne of poor safety practices and too-scant public awareness of the dangers of nuclear materials.

It may not sound as scary as terrorism, but Hibbs warned that the real risk here may be when countries such as Mexico falter in safely and securely moving around nuclear materials in a way that risks exposing small numbers of innocent people. “The biggest threat is the environment where a source like this would get lost,” he said, comparing Mexico to Thailand, which experienced a similar incident in 2000.

“In Thailand, the perpetrators were the victims. Someone found a source [of radioactive material] in a scrap pile, gathered that what was inside the locked box must be valuable, and cut it open,” Hibbs recounted of the 2000 incident. “The cobalt was so hot that a couple of people got fatal doses after they handled the cobalt for a short period of time. Others had bad radiation burns. They had no idea that what was in that box could kill them.”

Meep Meep Watch

It’s worth recalling the glee with which many hacks determined that the Obama presidency was over before the second term had really kicked in, well, only a month ago. The Healthcare.gov fiasco was Katrina; the Syrian pivot was a disastrous wobble; the Iran negotiations were abject roadrunner-midairsurrender; the economy was going nowhere. And it’s not as if there weren’t good reasons for the punditocracy’s sudden lunge for the presidential jugular. The botched website launch remains a pretty unforgivable product of presidential negligence.

But it’s worth digesting how all these alleged disasters have settled down. Obama’s alleged surrender to Putin on Syria … has led to something no one really believed possible: a potential shut-down of Syria’s WMD potential. What Bush failed to do in Iraq (because Saddam’s WMDs were a fantasy), Obama has almost succeeded in doing in Syria – with Putin’s help. The Iran negotiations – far from being a surrender – have set the stage for a real rapprochement. Les Gelb notes:

The Obama team has won the first round on the six-month agreement with Iran by a knockout. The phony, misleading, and dishonest arguments against the pact just didn’t hold up to the reality of the text. As night follows day, the mob of opponents didn’t consider surrender, not for a second. Instead, they trained their media howitzers on the future, the next and more permanent agreement, you know, the one that has yet to be negotiated.

Even George Will has conceded as much. There is a chance that the Middle East, far from exploding in another spasm, is actually safer today than in recent times. Netanyahu’s worst instincts have been rather coolly checked. The reactionary forces in Iran are on the defensive. Kerry has in no way given up on a two-state solution on his watch. And today, we got a glimpse of a much stronger economy than most were expecting, and the disastrous website … has been patched up as promised (with, of course, some ways to go). Alec McGillis sums it up:

The bungled healthcare.gov Web site emerged vastly improved following an intensive fix-it push, allowing some 25,000 to sign up per day, as many as signed up in all of October.

Paul Ryan and Patty Murray inched toward a modest budget agreement. This morning came a remarkably solid jobs report, showing 203,000 new positions created in November, the unemployment rate falling to 7 percent for the first time in five years, and the labor force participation rate ticking back upward. Meanwhile, the administration’s push for a historic nuclear settlement with Iran continued apace.

All of these developments are tenuous. The Web site’s back-end troubles could still pose big problems (though word is they are rapidly improving, too) and the delay in getting the site up working leaves little time to meet enrollment goals. Job growth could easily stutter out again. The Iran deal could founder amid resistance from Congress or our allies. Still, it seems safe to say that the Obama presidency is not, in fact, over and done with.

Far from it. The filibuster has been tamed, and the courts freed from total obstruction. The GOP remains utterly devoid of any constructive alternative to Obamacare, whose losers have been far less vocal – so far – than the winners. The president is on the offensive – on economic inequality and healthcare. It’s far too soon to project anything certain. But what we sure can say is that a huge amount is still to play for.

Stop-And-Frisk Lives On

Joe Lhota’s prognostications of doom (seen above) are looking ever more unfounded. NYC mayor-elect Bill de Blasio appointed William Bratton as his new police commissioner on Thursday. Bratton, who led the NYPD under Giuliani in the ’90s, was the architect of the very same stop-and-frisk program de Blasio ran against during campaign season. Mychal Denzel Smith is disappointed, but not surprised, at the choice:

While he criticized outgoing commissioner Ray Kelly for the “overuse-and-abuse of stop-and-frisk,” de Blasio has stopped short of calling for an end to the policy altogether. He has been in favor a “mend, don’t end” approach, supporting the reforms as handed down by US district court judge Shira Scheindlin as a result of the Floyd v. City of New York case. His choice of Bratton for police commissioner is consistent with his previously stated positions … The mayor-elect had an opportunity to signal a fundamentally new approach to the way policing would be done in NYC, but chose instead the safe and familiar, which has never benefited the communities that elected him to office. De Blasio has always been the most progressive candidate with a chance of winning, not the most progressive.

Heather Mac Donald declares Bratton’s appointment proof of “the limits that now constrain even the most left-leaning urban politicians”:

Though de Blasio demagogued against the NYPD during the election campaign, his selection of Bratton shows that he understands that his mayoralty will be judged first and foremost on whether he maintains New York’s status as the safest big city in America …

Thanks in part to de Blasio himself, the NYPD has been plagued in recent years by specious allegations that it was deliberately targeting blacks and Hispanics for racially biased pedestrian stops. Bratton understands as well as Kelly, however, that effective, unbiased policing will inevitably produce racially disparate enforcement data, given the vast disparities in crime commission and victimization. In 2012, according to NYPD figures, blacks in New York City committed over 78% of all shootings, for example, though they are only 23% of the city’s population. Whites committed 2.4% of all shootings, though they are nearly 35% of the city’s population. At the same time, blacks were 74% of all shooting victims; whites just under 3%. The ratios of stops to arrests and to population data were virtually identical in the Los Angeles Police Department under Bratton and in Kelly’s NYPD.

Drawing on an interview of Bratton from this May, Jeffrey Toobin suggests that his understanding of stop-and-frisk differs both from de Blasio’s and from that of Bloomberg’s commissioner Ray Kelly:

Bratton emphatically endorsed stop-and-frisk as a police tactic. “First off, stop-question-and-frisk has been around forever,” he told me. “It is known by stop-and-frisk in New York, but other cities describe it other ways, like stop-question-and-frisk or Terry stops. It’s based on a Supreme Court case from 1968, Terry v. Ohio, which focused very significantly on it. Stop-and-frisk is such a basic tool of policing. It’s one of the most fundamental practices in American policing. If cops are not doing stop-and-frisk, they are not doing their jobs. It is a basic, fundamental tool of police work in the whole country. If you do away with stop-and-frisk, this city will go down the chute as fast as anything you can imagine.”

We also discussed the current controversy over stop-and-frisk under Raymond Kelly, Bloomberg’s Police Commissioner. “What you have right now is a controversy in which nobody really understands what they are fighting about,” Bratton said. “Stop-and-frisk is not a tool solely to look for guns. Unfortunately, both the Mayor and the Police Commissioner refer to it that way, and that’s a problem because so few guns are recovered. But so what? The vast majority of stops are for a wide variety of things. Is someone drinking a can of beer on the corner? You want to stop that behavior. If somebody is aggressively panhandling on the street, urinating against a building. Is there somebody that you suspect is casing a building? Or is that two guys just locked out of their apartment? Police officers notice what may be a burglary. Of course they should be noticing and investigating. There are countless examples of what you want police to do.”

Brad Knickerbocker unearths another Bratton interview in which he emphasized the importance of consistency and public trust in police work:

“I’ve spent my life in the police profession, and I’m proud of that,” he said. “But I am also very cognizant of the profession’s limitations, its potential for abuse, and its potential negative impact.”

“Policing has to be done compassionately and consistently,” Bratton continued. “You cannot police differently in Harlem than you’re policing downtown. The same laws must apply. The same procedures must be employed. Certain areas at certain times may have more significant crime and require more police presence, or more assertiveness, but it has to be balanced. If an African-American or a recent immigrant – or anyone else, for that matter – can’t feel secure walking into a police station or up to a police officer to report a crime, because of a fear that they’re not going to be treated well, then everything else that we promise is on a shaky foundation.”

Adam Serwer is cautiously optimistic about Bratton:

Despite his ties to Giuliani, Bratton may be better prepared to handle an overhaul of the NYPD than he might appear. After running the NYPD, Bratton led the Los Angeles Police Department through court-ordered reforms monitored by the Justice Department. The LAPD had its own toxic relationship with racial minorities in the city, but a 2009 study showed that crime continued to decline even as police abuses were reined in and relations with city residents were improved.

Mike Riggs highlights Bratton’s support for putting cameras on cops:

Even though it’s unclear what will happen with stop-and-frisk, there is one policy on which Bratton has made his opinion known, and that’s on-body cameras for officers. “So much of what goes on in the field is ‘he-said-she-said,’ and the camera offers an objective perspective,” Bratton told The New York Times earlier this year. “Officers not familiar with the technology may see it as something harmful. But the irony is, officers actually tend to benefit. Very often, the officer’s version of events is the accurate version.”

Ronald Bailey recently made the case for to equipping cops with cameras:

Won’t police officers resist wearing video cameras? Initially, perhaps. But most patrol officers are now becoming comfortable with dashboard cameras in their cruisers. A 2004 study for the International Association of Chiefs of Police found that in cases where police misconduct was alleged, in-car video evidence exonerated officers 93 percent of the time.

The same report further noted that dashboard cameras enhanced officer safety, improved agency accountability, reduced liability, simplified incident review, enhanced new recruit training, improved community perceptions, helped advance case resolution, and enhanced officer performance and professionalism. … Body-worn cameras will clearly augment all of those objectives. And it will accomplish an important democratic task as well: turning the tables on the functionaries of the surveillance state. It gives citizens better protection against police misconduct and against violations of their constitutional rights. And it protects good cops against unfair accusations, too.

Bailey also discussed this issue earlier in the year.

Will The GOP Make A Deal?

Earlier this week, Suzy Khimm outlined a possible budget deal:

Sen. Patty Murray and Rep. Paul Ryan, Congress’s budget leaders, are currently aiming for a deal that would undo somewhere between $60 and $80 billion of sequestration cuts over the next two years, according to Congressional aides and others familiar with the talks. Overall, the deal would raise 2014’s discretionary spending levels from $968 billion to $1 trillion, and Republicans are insisting on additional deficit reduction.

The basic outlines of the deal are still in flux, and those figures could change in the coming days. “The actual numbers are very fluid. I wouldn’t take them as certain by any means,” said one Republican aide, who spoke on the condition of anonymity.

Barro discounts such reports:

I can buy the idea that Rep. Paul Ryan (Wis.), who is leading negotiations for House Republicans, will reach a spending deal with Sen. Patty Murray (D-Wash.) I remain skeptical that such a deal can pass the House of Representatives with a majority of Republican votes, and without making outside conservative groups go insane, before the government shutdown deadline of Jan. 15.

Josh Green throws more cold water:

What appears to have happened here is that Republican leaders who’d like very much to do something positive gave a sunnier take to outlets such as Politico than was warranted, perhaps in an effort to build momentum toward a deal.

Late on Monday, Bloomberg’s James Rowley and Roxana Tiron reported (in an article not yet online) that Democrats on the budget committee were much less sanguine that an agreement is imminent. “It’s a jump ball right now,” Democratic Representative Chris Van Hollen of Maryland told reporters.

This suggests that the budget negotiations may instead follow a much more familiar pattern—rank-and-file members rebelling against leadership; mounting panic and economic uncertainty; and finally, as the shutdown threat looms, a last-minute deal that leaves everybody angry and unsatisfied.

Nevertheless, Chait thinks a deal is possible because “the Republican negotiating position is steadily eroding”:

The original design of sequestration was to impose automatic cuts that would give both parties an incentive to deal: half the cuts would go to domestic programs, which Democrats like, and half to defense, which Republicans like. Republicans persuaded their defense hawks to sit still and be quiet, in the belief that this would increase the GOP’s negotiating leverage. Last January, Boehner boasted, in an interview with The Wall Street Journal editorial page, that he had silenced pro-defense Republicans (“I got that in my back pocket”).

But pro-defense Republicans were only willing to sit quietly in Boehner’s pocket as long as they could rely on their party to ultimately cut a deal to prevent the $20 billion in defense cuts set to take place starting next month. As the deadline gets closer, dissent is popping up everywhere. Defense hawks are openly itching for a budget deal, as are the Republicans who have to actually draw up the cuts to domestic spending required by sequestration. (Those cuts include transportation, infrastructure, and other things Republicans hate much less than aid to poor people.) The Republican dissidents, combined with Democrats, form a potential majority in the House in favor of undoing sequestration.

Beutler considers Boehner’s options:

If Murray and Ryan manage to reach an agreement, conservatives groups — Heritage, Club for Growth and others — will very likely savage it, and if past is prologue, rank-and-file Republicans will follow, and GOP leaders will have to decide once again whether escalating a shutdown fight would be preferable to breaking the Hastert Rule.

If the deal falls through, Speaker John Boehner has posited that he’ll place legislation to renew funding for the government at sequestration levels on the House floor, and finish out the fiscal year without a budget. But it’s unclear if that bill could pass. House Republican military hawks are desperate to avoid this round of automatic cuts, because they primarily reduce defense spending. They’d have to be strong-armed into supporting a bill that allows those cuts to happen. Republicans might think battered Democrats would help them assemble a majority, but I believe they’re mistaken.

Does A Company Have Religious Rights? Ctd

A reader writes:

Please take a moment to merge your miscarriage series with the religious corporations thread, because science: Plan B does not cause abortion because it does not prevent implantation.  Plan B is progesterone.  It does absolutely nothing if you have already ovulated and had the misfortune of having conceived the night before.  In fact, as every woman who has had trouble staying pregnant knows, progesterone is what they prescribe, after a few miscarriages, to help a fertilized egg implant and “stick” in the uterus.  So it actually HELPS pregnancies become more viable.

But if you already conceived, you are screwed; Plan B actually ups the chances that you will end up with a baby. Plan B only works if you had sex and have not yet ovulated, in which case the hormone surge will push your ovulation a couple weeks into the future, preventing you from releasing that egg down into the fallopian pool of waiting sperm.  It in no way whatsoever interrupts an actual pregnancy after the moment of conception.  It does not harm a single hair on a blastocyst’s one-celled head.

Indeed, an overwhelming number of studies in the past decade back up the reader’s point that Plan B does not prevent implantation. Last year the NYT did an extensive investigation that showed how all the ambiguity around the issue is traced to the FDA’s dubious labeling of Plan B back in 1999:

Labels inside every box of morning-after pills, drugs widely used to prevent pregnancy after sex, say they may work by blocking fertilized eggs from implanting in a woman’s uterus. Respected medical authorities, including the National Institutes of Health and the Mayo Clinic, have said the same thing on their Web sites. …  But an examination by The New York Times has found that the federally approved labels and medical Web sites do not reflect what the science shows. Studies have not established that emergency contraceptive pills prevent fertilized eggs from implanting in the womb, leading scientists say. Rather, the pills delay ovulation, the release of eggs from ovaries that occurs before eggs are fertilized, and some pills also thicken cervical mucus so sperm have trouble swimming.

It turns out that the politically charged debate over morning-after pills and abortion, a divisive issue in this election year, is probably rooted in outdated or incorrect scientific guesses about how the pills work.

Because they block creation of fertilized eggs, they would not meet abortion opponents’ definition of abortion-inducing drugs. In contrast, RU-486, a medication prescribed for terminating pregnancies, destroys implanted embryos.

The notion that morning-after pills prevent eggs from implanting stems from the Food and Drug Administration’s decision during the drug-approval process to mention that possibility on the label — despite lack of scientific proof, scientists say, and objections by the manufacturer of Plan B, the pill on the market the longest. Leading scientists say studies since then provide strong evidence that Plan B does not prevent implantation, and no proof that a newer type of pill, Ella, does. Some abortion opponents said they remain unconvinced.

After The Times asked about this issue, A.D.A.M., the firm that writes medical entries for the National Institutes of Health Web sitedeleted passages suggesting emergency contraceptives could disrupt implantation. The Times, which uses A.D.A.M.’s content on its health Web page, updated its site. The medical editor in chief of the Web site for the Mayo Clinic, Dr. Roger W. Harms, said “we are champing at the bit” to revise the entry if the Food and Drug Administration changes labels or other agencies make official pronouncements. “These medications are there to prevent or delay ovulation,” said Dr. Petra M. Casey, an obstetrician-gynecologist at Mayo. “They don’t act after fertilization.”

The F.D.A. declined to discuss decisions about the effect on implantation or to say whether it would consider revising labels. But Erica Jefferson, an F.D.A. spokeswoman, acknowledged: “The emerging data on Plan B suggest that it does not inhibit implantation. Less is known about Ella. However, some data suggest it also does not inhibit implantation.”

Scientists say the pills work up to five days after sex, primarily stalling an egg’s release until sperm can no longer fertilize it. Although many people think sperm and egg unite immediately after sex, sperm need time to position themselves. … Some abortion opponents said that while emergency contraceptives’ primary function may be delaying ovulation, they doubted that scientists could exclude the possibility of implantation effects. “I would be relieved if it doesn’t have this effect,” said Richard Doerflinger, associate director of the Secretariat of Pro-Life Activities for the United States Conference of Catholic Bishops. “So far what I see is an unresolved debate and some studies on both sides,” he said, adding that because of difficulties in ethically testing the drugs on women, “it’s not only unresolved, but it may be unresolvable.”

Several scientists acknowledged that absolute proof may be elusive; in science, as James Trussell, a longtime emergency contraception researcher at Princeton, said, “You can never prove the negative.” But he and others said the evidence from multiple studies was persuasive.

How did the statement about implantation end up on F.D.A.-approved labels? Beginning with the 1999 approval process, the maker of Plan B — Barr Pharmaceuticals, later acquired by Teva Pharmaceuticals — asked the F.D.A. in writing not to list an implantation effect on the label, said people familiar with the requests who asked for anonymity because such discussions are considered confidential. Anti-abortion activists were not yet publicly focusing on the issue. “There were other drugs that I remember causing controversy,” said Dr. Jane E. Henney, the F.D.A. commissioner then. “This wasn’t one.”

Back then, scientific research concentrated on whether Plan B’s active ingredient, a synthetic progesterone, safely and effectively prevented pregnancy, not on how it worked, said Dr. Kristina Gemzell-Danielsson, an obstetrics and gynecology professor at the Karolinska Institute in Sweden, who participated in World Health Organization studies leading to F.D.A. approval. The F.D.A.’s own description was speculative, saying Plan B “could theoretically prevent pregnancy by interfering with a number of physiological processes” followed by a long list, including ovulation and implantation.

A New York Times review of hundreds of pages of approval process documents found no discussion of evidence supporting implantation effects.

The Wrong Way To Attack Obamacare

The above video of Georgia Insurance Commissioner Ralph Hudgens cracking a joke at the expense of sick people makes Kilgore, well, sick:

The robust laughs of Hudgen’s audience when he compared pre-existing condition coverage to an ex post facto request for auto insurance collision coverage after a motorist causes a wreck is about as disgusting as the stupid analogy itself.

Beutler comments on the video:

This might sound unusually callous, even for a Georgia Republican — or like typical reactionary anti-Obamacare horseshit taken just a bit too far. But it’s actually worse. It’s a symptom of how deep the rot of 47 percenter thinking has crept in the conservative movement.

It’s no longer just people who have negative income tax liability whom conservatives write off as hopeless dependents, but anyone who benefits in any way from any government program or consumer protection (except, of course, for Hudgens’ mortgage interest deduction, or the irrelevance of his preexisting conditions as a member of a group plan, or his untaxed premium contributions, or his parents’ Medicare).

Hudgens has already apologized for his remarks, and his experience will serve as a warning to Republicans running for office on anti-Obamacare platforms not to take their attacks too far. But this wasn’t a symptom of an ideologue’s tendency to exaggerate — it’s part of the foundation of the conservative belief system. The fact that it’s an Obamacare benefit just makes it more likely that one or more Republicans will screw up or fall into a similar trap.

Drum joins the discussion:

It’s one thing to oppose Obamacare. But Republicans have no realistic alternative. They can blather away about tort reform and HSAs forever, but even low-information voters dimly understand that it’s just blather. Either you’re going to cover sick people or you aren’t. And if you do, you’re going to end up with something that has most of the same features of Obamacare. Smarter Republicans understand this perfectly well, which is why they dance around the issue so manically. They know that their plans don’t actually provide health coverage for much of anyone at all. Dimmer Republicans like Hudgens don’t have a clue, so they just tell dumb stories to well-heeled crowds. I’m not really sure which is worse.

Fighting HIV Without Condoms?

Condom

About fifteen years after most gay men figured it out, Mark Joseph Stern stumbles onto the truth that, with HIV no longer a death sentence in developed countries, the era of simply scaring gay men away from unprotected sex is over. And, unlike so many well-meant public health campaigns, he is prepared to tell the obvious truth:

Bareback sex feels better for both partners. At some point, almost every gay man will learn this fact—so why lie about it?

Indeed. That one fact combined with one other – that middle-class gay men can suppress the virus indefinitely with the cocktail – has to be integrated into a sane, safer sex message. I’ve been banging on about this for years, of course, and there have been initiatives, in San Francisco particularly, where these insights have indeed been integrated into public health campaigns. And they’ve been among the most successful in restraining infection. But Stern goes one step further:

If we don’t give gay men the promise of the reward, a foreseeable end to the hassles of condoms, they’re bound to get frustrated and either slip up or give up. Giving men the goal of a committed relationship—and with it, the perk of unprotected sex—might convert barebacking from a forbidden fruit to a reward worth working toward.

Yes, and no. First off, can we retire the term “barebacking” and simply refer to it as sex without condoms, i.e. the activity formerly known as sex? Stigmatizing latex-free sex as “barebacking” may have had some logic in the plague years, but it can be psychologically toxic today. It renders the most intimate of sexual interactions a pathology, and that can’t be right.

Second, the prize of non-rubbered sex in a monogamous relationship is a little more fraught than Stern makes it out to be. It makes huge sense if both men are HIV-positive. In that case, there is no danger that sex outside the marriage – sometimes lied about, or hidden, or unspoken – can lead to indirect infection, because both men are infected already. But if both men are negative, it puts much more pressure on monogamy and on a marriage than might be wise. One slip and you’re not only betraying your partner, you could also be deeply damaging his health. Although it’s noble as an ideal, the standard here may be simply practically too high, certainly over a lifetime, for most men to achieve. And the consequences of failure can be terrible for a relationship.

I think we should leave it to married couples or committed lovers to figure their way through this – and avoid harshness and easy judgment. We’re all human and in sexual desire, more human and flawed than in most other areas. But, as a practical matter, you don’t have to restrict non-rubbered sex solely to monogamous married couples to have an impact on infection rates.

The more important goal is for HIV-positive men to have sex mainly with other HIV-positive men, restricting the virus to a pool of the already infected. This is called “sero-sorting” and it has happened for years (it was my strategy back in the day for making sure I never put anyone at risk). It has cut infection rates markedly where it has prevailed. But for the HIV-negative, sero-sorting is a lot trickier. You simply cannot know if your sex partner is positive or not. He may not even know. Leaving rubbers behind is a big risk always in this context, even though it is far, far smaller than it once was. A more practical option for HIV-negative men is to go on Prep – take preventive HIV drugs to make infection far less likely even without condoms, and to use condoms outside a truly monogamous relationship or marriage.

So add it up: tout the intimacy of rubber-free monogamy for some; encourage HIV-positive men to have sex with other HIV-positive men; get as many HIV-negative men onto preventive drugs that can drastically lower the risk of infection; and, above all, encourage disclosure and testing so that gay men, rather than being treated like children, can assess all the information and make informed choices. This wouldn’t be a panacea, but it would be a constructive way forward.

(Photo: By BSIP/UIG Via Getty Images.)

Now France Is Rolling Back Prostitution?

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It’s moving in that direction:

On December 4th, the lower house of parliament voted [268 to 138] to make prostitution a crime for those who pay for sex, subject to a fine of €1,500 ($2,030) for a first offense and €3,750 thereafter. “I don’t want a society in which women have a price,” said Najat Vallaud-Belkacem, the women’s minister. She wants nothing less than to “abolish” prostitution in France.  With Germany having second thoughts about its decision over a decade ago to liberalize the world’s oldest profession, the French have decided to follow Sweden, Finland and Norway in restricting prostitution. Paying for sex is not now illegal, although brothels, soliciting and pimping are.

The bill must still pass the Senate and be signed by the president before it becomes law, a process that could take several months. Christopher Dickey calls the debate “ferociously ideological in ways that are very French indeed”:

While just about everyone denounces the trafficking of women and men treated as virtual slaves, much of the most passionate debate has focused on the cases of independent sex workers, a relatively small minority, and whether they have the right to use their bodies – and sell their services – as they see fit. The free-wheeling publication Causeur provoked sensational headlines when it issued a manifesto signed by hundreds of self-proclaimed “bastards” – all men – warning the government, “hands off my whore.” “We love liberty, literature and intimacy,” it claimed, “and when the state concerns itself with our asses, all three are in danger. … Against the ‘sexually correct,’ we intend to live like adults.”

But the most intense debate is not so much with or against macho posturing, it is among France’s feminists. The daily Le Monde discerned four or five distinct currents:

the prohibitionists, who want to forbid prostitution and consider everyone involved to be criminal; the abolitionists, like Vallaud-Belkacem, who want to do away with prostitution but don’t want to treat the prostitutes themselves as criminals; the libertarians, who argue that the state has no business interfering with whatever a woman wants to do with her own body; and the rule-makers, who take a similar position but think some regulation is necessary.

As Le Monde points out, these positions start to get confused when the same feminists are asked to address other issues. Thus Elisabeth Badinter, one of France’s wealthiest citizens and one of its most influential intellectuals, defends the right of women to sell their sexual services but opposes the right of Muslim women to wear the veil if they choose. (Merteuil of STRASS, by contrast, proclaims that her organization is “pro-sex, pro-porn, pro-whores, and for the freedom to wear the veil.”)

Feargus Sullivan looks at the trend across Europe:

France’s neighbor Germany, meanwhile, will be watching its plans closely. … The incoming coalition government plans to revise prostitution laws, and have just agreed to ban flat-rate brothels, where customers can purchase unlimited sex during a single visit for a fixed fee. They are also making it a crime to buy sex from someone who has been trafficked.

Meanwhile in Ireland, a consortium called Turn off the Red Light is campaigning for law changes similar to France’s. Irish public opinion is being swayed by a series of high profile exposés of the sex trade’s international reach, pushing the issue up the public agenda. Even in the famously permissive Netherlands, Amsterdam is reining in its red light district.

The issue seems to be human trafficking:

According to a EU-funded report, over 23,000 people were trafficked in Europe between the years 2008 to 2010, and 62 percent of them for were destined for sexual exploitation. While pro-prostitution debate often focuses on a hypothetical free woman making an entirely unforced choice, the reality is that many European prostitutes have no such freedom. According to anti-trafficking campaigners, legal prostitution is making this situation worse, giving pimps and traffickers ways to operate further and hide their victims in plain sight.

Abolishing legal prostitution does seem to reduce trafficking. In Sweden, prostitution has plummeted since a 1999 ban on buying sex. In 2007, Der Spiegel reported a maximum of 130 prostitutes working in Stockholm, compared to 5,000 in its smaller Norwegian neighbor Oslo (which in 2009, followed Sweden’s ban with its own). And while an estimated 600 women are believed to be trafficked into Sweden every year, this number pails in comparison to the 15,000 trafficked annually to Finland, a country with a population half the size.

But of course, no one can verify how much prostitution and trafficking continues undetected. The amount may have drastically fallen, but occasional cases such as that of a judge fined for visiting a brothel suggest that a prostitution underworld does persist in Sweden.

Recent Dish on prostitution in Europe here.

(Photo: A prostitute dances during a demonstration of sex workers in Paris on December 4 after French lawmakers approved a controversial bill that will make the clients of prostitutes liable for fines starting at 1,500 euros ($2,000). By Joel Saget/AFP/Getty Images)

The ACA’s Missing Pieces

The part of Healthcare.gov that pays insurers won’t be built by January:

The administration is planning a “workaround” for payments, said Daniel Durham, vice president for policy and regulatory affairs at America’s Health Insurance Plans. Health plans will estimate how much they are owed, and submit that estimate to the government. Once the system is built, the government and insurers can reconcile the payments made with the plan data to “true up” payments, he said “The intent is to make sure plans get paid on time, which is a good thing,” Durham told Reuters.

The fix puts an additional “burden” on insurance companies, already taxed by having to double-check faulty enrollment data from the HealthCare.gov system. Now, companies need to quickly put together financial management systems to make the payment estimates, so they can be paid beginning in January, he said. “They have to recognize that plans are already quite stressed and introducing this at the last minute just adds substantial burden for plans to deal with,” Durham said.

Suderman takes the administration to task:

The core service that health insurers provide is paying for eligible claims by beneficiaries. But if insurers don’t get paid themselves, they can’t cut checks for those claims.

Some of the larger insurers could finance delays, at least for a little while, but as former Medicare official Kevin Lucia tells Reuters, smaller insurance plans, which are heavily represented in the health law’s exchanges, aren’t well equipped to do so. Plan providers need that money, and they need it soon if they’re going to be able to actually provide insurance to their plan members.

The fact that these critical systems haven’t been built—months after the launch of the exchanges and with just weeks to go until insurers need to start being paid—makes it clear that the implementation effort still lags far behind. And if the rollout of portions that remain incomplete resembles the rollout so far, that means there are lots of new problems still to come. But it’s not just that there’s a lot of work still to do. The insurer payment workaround also highlights how much of Obamacare’s buggy implementation is still being managed on a temporary, ad hoc basis. The administration is flying a broken vessel without a flight plan.

Meanwhile, Beutler parses recent enrollment numbers:

[T]he latest numbers — which administration officials are all of a sudden so eager to leak for some reason — really demonstrate three things. One is that it’s easy to torture scarce and selectively leaked data to fit just about any preconceived narrative. Another is that Healthcare.gov’s terrible rollout didn’t completely discourage people from giving the site a second look, let alone destroy the demand for health insurance across the country. Third is that, simply by leaking, administration officials demonstrated some degree of confidence that the worst of their implementation woes are behind them.

That’s all basically good news. But it’s really all we can say for now. And it doesn’t prove that the Affordable Care Act is completely out of the woods yet.

Mandela’s Legacy

A group of American and South African students, aged from 11 to 19, met with Nelson Mandela at the Nelson Mandela Foundation in Johannesburg, on 2 June 2009. This is part of a series of activities ahead of Mandela Day on 18 July.

Massie pays tribute:

We lapse into cynicism all too easily and sometimes cynicism is an appropriate response to the daily degradations of ordinary politics. But there are other times – and this is one – in which cynicism is best put aside. If we can – and we do – recognise greatness in other fields of human endeavour we should be prepared to countenance the idea it can exist in politics too. Few may be admitted to the pantheon but the pantheon exists.

Nelson Mandela was a great man. The greatest man of my lifetime. No-one else these past forty years has had such an impact. There were many heroes who helped tear down the Berlin Wall but none of them as individuals played as decisive or transformational role as Mandela did in South Africa.

Mark Gevisser reflects on yesterday’s news:

The words “Nelson Mandela is dead” feel strange in the mouth today, almost impossible to say, given the unique way he was both martyred and canonised during his lifetime. He embodies a paradox: on the one hand we love him for his humanity; on the other, he already passed long ago from the world of the flesh. He is a peak of moral authority, rising above the soulless wasteland of the 20th century; he is a universal symbol for goodness and wisdom, for the ability to change, and the power of reconciliation.

Gevisser considers how his halo affected South Africa:

Mandela’s perceived sanctity has had a powerful effect, not always positive, on the growth of the democracy he played so great a role in nurturing. Certainly, it has conferred on South Africa a moral heft that has enabled the country to punch significantly above its weight in the global arena, and it has accorded us South Africans an internal moral voice, even if we have not always heeded it: “What would Madiba do?”

But the Mandela legacy has also given South Africa a distorted sense of exceptionalism. We were, the world had us believe, the “world’s greatest fairy tale.” We were, our own beloved Archbishop Desmond Tutu told us, “the rainbow children of God.” How could we ever live up to such hype? How could we be as good—as forgiving or as a noble—as Mandela? And how could we ever deliver to the expectations of a global community that used Mandela as its measure? With every massacre, every national strike, every corruption scandal, we were found wanting, not least by ourselves.

Richard Stengel compares the man Mandela was before prison to the one he was after:

In many ways, the image of Nelson Mandela has become a kind of fairy tale: he is the last noble man, a figure of heroic achievement. Indeed, his life has -followed the narrative of the archetypal hero, of great suffering followed by redemption. But as he said to me and to many others over the years, “I am not a saint.” And he wasn’t. As a young revolutionary, he was fiery and rowdy. He originally wanted to exclude Indians and communists from the freedom struggle. He was the founder of Umkhonto we Sizwe (Spear of the Nation), the military wing of the African National Congress, and was considered South Africa’s No 1. terrorist in the 1950s. He admired Gandhi, who started his own freedom struggle in South Africa in the 1890s, but as he explained to me, he regarded nonviolence as a tactic, not a principle. If it was the most successful means to the freedom of his people, he would embrace it. If it was not, he would abandon it. And he did. But like Gandhi, like Lincoln, like Churchill, he was doggedly, obstinately right about one -overarching thing, and he never lost sight of that.

Prison was the crucible that formed the Mandela we know. The man who went into prison in 1962 was hotheaded and easily stung. The man who walked out into the sunshine of the mall in Cape Town 27 years later was measured, even serene. It was a hard-won moderation. In prison, he learned to control his anger. He had no choice. And he came to understand that if he was ever to achieve that free and nonracial South Africa of his dreams, he would have to come to terms with his oppressors. He would have to forgive them. After I asked him many times during our weeks and months of conversation what was different about the man who came out of prison compared with the man who went in, he finally sighed and then said simply, “I came out mature.”

Max Boot has high praise for Mandela:

[T]he largest part of the explanation for why South Africa is light years ahead of most African nations–why, for all its struggles with high unemployment, crime, corruption, and other woes, it is freer and more prosperous than most of its neighbors–is the character of Nelson Mandela. Had he turned out to be another Mugabe, there is every likelihood that South Africa would now be on the same road to ruin as Zimbabwe. But that did not happen because Mandela turned out to be, quite simply, a great man–someone who could spend 27 years in jail and emerge with no evident bitterness to make a deal with his jailers that allowed them to give up power peacefully and to avoid persecution.

Mandela knew that South Africa could not afford to nationalize the economy or to chase out the white and mixed-raced middle class. He knew that the price of revenge for the undoubted evils that apartheid had inflicted upon the majority of South Africans would be too high to pay–that the ultimate cost would be borne by ordinary black Africans. Therefore he governed inclusively and, most important of all, he voluntarily gave up power after one term when he could easily have proclaimed himself president for life.

Beinart recalls that many Americans didn’t always view Mandela so favorably:

They called him a “terrorist” because he had waged armed resistance to apartheid. They called him a “communist” because the Soviet Union was the ANC’s chief external benefactor and the South African Communist Party was among its closest domestic allies. More fundamentally, what Mandela’s American detractors understood is that he considered himself an opponent, not an ally, of American power. And that’s exactly what Mandela’s American admirers must remember now.

We must remember it because in Washington today, politicians and pundits breezily describe the Cold War as a struggle between the forces of freedom, backed by the U.S., and the forces of tyranny, backed by the USSR. In some places—Germany, Eastern Europe, eventually Korea—that was largely true. But in South Africa, the Cold War was something utterly different. In South Africa, for decades, American presidents backed apartheid in the name of anti-communism. Indeed, the language of the Cold War proved so morally corrupting that in 1981, Reagan, without irony, called South Africa’s monstrous regime “essential to the free world.”.

Moynihan wants a clear-eyed understanding of the civil rights leader’s flaws:

[H]ere is where one must bring the knives out for Mandela. For a man imprisoned for his political beliefs, he had a weakness for those who did the very same thing to their ideological opponents, but were allowed a pass because they supported, for realpolitik reasons, the struggle against Apartheid. So Mandela was painfully slow in denouncing the squalid dictatorship of Robert Mugabe. He was rather fond of Cuban dictator Fidel Castro (it won’t take you long to find photos of the two bear-hugging each other in Havana) and regularly referred to Libyan tyrant Muammar Qaddafi as “Brother Leader of the Revolution of the Libyan Jamahariya.” It was on a return visit to Robbin Island, when Mandela, as president, announced with appalling tone deafness that he would invite both Castro and Qaddafi to South Africa.

Eve Fairbanks highlights the continued economic inequalities between blacks and whites in South Africa and wonders, “How much truth is there to the perception that the terms worked out by Mandela and his fellow negotiators during South Africa’s democratic transition enriched a few blacks at the expense of the masses?”

I asked Pierre de Vos, a University of Cape Town–based constitutional scholar. “If you look at the final constitution, the African National Congress”—the ANC, Mandela’s party—“got about eighty percent of what they wanted,” de Vos told me over the phone. “I think the ANC out-negotiated the [Afrikaner] National Party completely.” However, there was also “a deal that was made outside” the constitutional negotiations, de Vos added, a “gentleman’s agreement” between Mandela and “the commanding heights of the economy.”

Adam Roberts also wants people to acknowledge Mandela’s flaws:

His achievements are the greater because he himself admitted to errors, at times bungling policy. Those failings matter. He was more likely to learn from mistakes than the haughty sort of leader who refuses to accept he made any. Others should pay as much attention to his slip-ups as to his achievements.

Take the great post-apartheid misery that South Africa suffered in the first two decades of democracy: the AIDS epidemic. Mandela failed as president to tackle the spread of HIV, even as terrifyingly large numbers of South Africans became infected. As early as 1991 he had grasped (judging from one of his private notebooks from that year) that the disease threatened a “crisis for the country.” Yet in office he did almost nothing to stop its spread. …

To his immense credit, however, Mandela conceded his early error. After leaving the presidency, he became a significant part of a campaign for a new AIDS policy. In retirement, he would speak up for effective education and treatment, especially when his own son succumbed to the disease in 2005.

Burroway recognizes Mandela’s strong support for gay equality:

He was also a strong supporter for human rights generally, including those of LGBT people. Mandela was President of the African National Congress when it added an LGBT-rights plank to its platform in 1993. That same year, the interim constitution included a provision banning discrimination on the basis of sexual orientation, making South Africa the first nation in the world with such a constitutional provision. The discrimination ban remained in place when South Africa formally adopted its permanent constitution in 1996. Soon after Mandela became President in 1994, he appointed Edwin Cameron, an openly gay, HIV-positive judge, to South Africa’s High Court of Appeal. That set the stage for South Africa to become the first (and, so far, only) nation on the African continent to provide marriage equality for its LGBT citizens.

All of this reflected Mandela’s view in which all human rights were linked together: “I am not truly free if I am taking away someone else’s freedom, just as surely as I am not free when my freedom is taken from me. The oppressed and the oppressor alike are robbed of their humanity.”

How Charlayne Hunter-Gault ends her post on Mandela:

I am reminded of something else I learned during my years in the country—which is probably why South Africans, though sad now that the Father of the Nation has closed his eyes forever, will not be desolate. It is the tradition that takes South Africans to the gravesite of a departed one to speak about whatever problems they may be having, in the belief that wisdom will come from one who is now an ancestor, and who lives forever.

(Photo: Media24/Gallo Images/Getty Images)