During the past months as the financial crisis in the U.S has deepened, politicans, economists, and pundits have raised the specter of “another Great Depression.” Ben Bernanke's main credential for leading us out of this crisis has rested on his fame as a student of the Great Depression. Barack Obama's major test of leadership is already defined as whether or not he can lead us out of the worst economic downturn since the Great Depression.
But when interviewers actually talk to survivors of the Great Depression, the differences in daily experiences between then and now are sharply evident. Those who lived through the Great Depression speak of difficulties staying warm, or trying to pack nineteen people into a single house, or shipping children off to more affluent relatives because they could not afford to feed them.
Certainly the presence of a safety net in the form of unemployment insurance, food stamps, Medicaid and COBRA means that we are unlikely to see bread lines or tent cities unless things become much, much worse than we can imagine right now.
While many are quick to point out the stark differences in today's financial crisis and the crash of 1929 that turned into the Great Depression: 8-10% unemployment versus 25%, a loss of perhaps 7000 banks between 1930 and 1933 versus an estimated 1000 banks in danger of insolvency now, there is one striking parallel between that time of economic peril and our own.
The Great Depression saw a widespread reduction in the American standard of living that was not reversed until the postwar boom of the late 40s and 50s. Today there is also a widespread expectation among economists and the public at large that most Americans are likely to see their standard of living fall as taxpayers face a national debt that we and our children will be paying for the foreseeable future.
For generations, Americans have worked hard, not just in the hope, but rather in the expectation, that their children would have longer, healthier, and better lives than their own. Until this past year, many Americans in their 20s, 30s and 40s were enjoying a higher standard of living than their own parents, albeit at the cost of increasing debt loads and two-income households. That expectation is no longer a given for larger and larger sectors of the population.
But as I reflect on this prospect of a lowered standard of living, I find myself less afraid of than reflective about the future. In an odd sort of way, I feel a little bit relieved to be facing a reprieve from this endless cycle of expectation, of giving my children a higher standard of living than what they enjoy right now. “Do we have enough?” I ask myself as I also wonder, “Do we really need to strive for any more?”
Unlike most people my age, I am in fact the child of parents who came of age in the Great Depression rather than the great postwar Baby Boom. I was born at the very tail end of that boom, just as my siblings are part of its vanguard.
While I never experienced the hardships that my parents went through in the 1930s, their experiences shaped the way they brought me up and the expectations they set up for me.
I knew that my father, in particular, could not tolerate children who were fussy about what they were served at meals, a hang-over from days when it was the height of rudeness to refuse to eat whatever a family put on the table because it might be the only thing they had to offer a guest.
I felt a great deal of poignancy in finding a letter my mother wrote to her parents when she was a freshman at the University of Michigan in 1934, struggling to pay for books, and hoping that she could sell back her textbooks as quickly as possible to recoup what she had had to expend on them.
Sixteen years old and desperately homesick, she gave up the opportunity to get a college education away from home and returned to live with her parents and attend Wayne State University in her home town of Detroit. What part the family finances played in this decision remains a mystery to me, but the prospect of paying for tuition, room and board must have seemed an enormous expense to my grandparents who had never been to college themselves.
I do know that my father suddenly found himself the head of household at the age of eighteen in 1930 and that he worked very hard to make sure his five siblings went to college, or joined the military, or learned a trade. Even when they were all married and with children of their own, my father never stopped feeling a parental responsibility for his brothers and his youngest sister, Jean.
Since the weight of the Depression fell hardest on those with less education, it made my parents all the more determined to put their own children through college. In two generations my family experienced a huge boost in their standard of living that was almost exclusively due to education. My paternal grandfather arrived at Ellis Island in the 1890s with the expectation of learning a trade, and my mother's father had to leave school after the fourth grade to work to support his family. My parents were the first ones in their families to go to college, and for my siblings and our children, college has been a given.
Because of my parents' experiences during the Great Depression, I knew that our vacations would consist of trips to visit family or camping around the country and would rarely include a night in a hotel. Christmas gifts were plentiful but never included the latest “must have” toy; instead my father enjoyed the post-Christmas sales that helped him get bargain gifts for my January birthday, and once gleefully presented me with thirteen dolls because the sales had been too good to resist.
I remember when one family member came across a sign that said, “Eat it up, wear it out, make it do, or go without,” and told Dad that we had found his perfect motto. We joked about his penny-pinching ways, but his frugality allowed him to put four kids through college and help them get a good start in life.
So when I look at my own children and their friends and see the number of cell phones, iPods, video games etc. that they go through in a year, I find that a certain part of me is pretty much appalled at the materialistic excesses of the average American standard of living. I look around my own home with my kids' closets full of toys and the presence of five computers for three people, and that same accusing finger points right in my own face.
This is not to say that I want the doomsday scenario of another Great Depression to come true. Nor do I want people to lose their homes or their jobs or have to struggle to send their kids to college as a result of the current economic instability.
But it does seem to me that as the American consumers have put the brakes on their spending this year and started once again to increase the collective savings rate, there may be a silver lining in our financial woes.
If we start consuming less, perhaps we may find that we appreciate what have even more. And if our standard of living plateaus with this generation, we may find that we and our children can live quite well without always wanting more and more.
Just as the experience of the Great Depression profoundly affected the way my parents viewed money, today's economic crisis is likely to affect my own family and the ways that my children think about money and their own standard of living. They may find it harder to get a job that pays well or to afford a house, or they may make different choices about what they need to achieve a “good” standard of living.
What I believe won't change are the fundamental values that my grandparents passed on to their children, grandchildren, and great-grandchildren: the importance of education, supporting one's family, and the belief that you pay forward your own good fortune to the next generations. That's a legacy that can get you through the worst of times.
Saturday, March 7, 2009
Friday, March 6, 2009
The New "n-word": Nationalization
A number of readers who've commented to me about my recent blog on the financial crisis directed me to the March 3rd interview on NPR's Fresh Air with Simon Johnson, former research director at the IMF and now a professor of entrepreneurship at MIT's Sloan School of Management.
In that interview, Johnson argues forcefully that the United States government should follow the standard IMF formula for dealing with “bad” banks: nationalize them using FDIC intervention, reorganize them, clean them up, and immediately privatize them again.
Paraphrasing what Johnson has written in recent weeks, Terry Gross stated: “If you showed old hands at the International Monetary Fund... the U.S. ledger books, but you hid the name 'United States,' so that they didn't know what country you were talking about, they would all say, 'Nationalize the banking system. That's the solution.'”
Mr. Johnson agreed and in the rest of the interview made a very cogent argument for why such a policy makes the most economic sense as well as warning that the current policy of serial bailouts may only be prolonging the crisis and potentially making it worse.
But Terry Gross also pointed to a central flaw in this “obvious” solution when she drew a distinction between the hypothetical “if you hid the name of the country,” and the reality that this crisis is taking in the world's second largest economy and most powerful nation in the world.
Johnson himself acknowledged the political sensitivity surrounding the crisis when he said that since the United States is the IMF's largest shareholder, that organization doesn't even want to state publicly that U.S. should take the nationalization route.
The resulting paradox is that a temporary nationalization seems to be the sensible, time-tested solution to managing “bad” banks even for a superpower like the U.S. Yet no one dares say so.
Instead, as NPR “Planet Money” reporter Adam Davidson indicated on Morning Edition, “The official word is clear: The Obama administration and Federal Reserve officials say that nationalizing the banks is the wrong choice and that they have no intention of doing it,” (“Obama Administration Could Still Nationalize Banks,” March 6, 2009).
The reasons: 1) Republicans screaming about “socialism” in our banking system, even though the government already owns substantial portions of some of the largest banks like Citibank; 2) Fear that the very mention of the “n-word” will precipitate a run on banks or further devaluation of financial stocks in the stock market; and 3) the fact that many politicians are highly indebted to Wall Street for political contributions and don't want to be in the position of being responsible for their donors losing their jobs.
In fact, Simon Johnson's strongest criticism of the actions the Treasury Department has taken to date focuses on the fact that so many banking executives like Vikram Pandit of Citibank have been allowed to stay in their positions, when a central tenet of cleaning up banks is: First, fire all the top level executives.
However, while the government continues with its official denials of any intentions to “nationalize” failing banks, more and more of those in the financial world expect that behind the scenes, they are taking precisely the kinds of steps that would constitute nationalization in all but name through increasing levels of government ownership of struggling banks.
As one independent analyst, Sean West of Eurasia Group, told Adam Davidson, “The net effect, rather than actually talking in [the] language of nationalization, it's really [that] the government has opened the door to increasing ownership of these banks.” In other words, if the U.S. doesn't dare nationalize the banks openly, it may be setting up “stress tests” that force the banks to ask for such intervention, that is, to “nationalize themselves.”
So even if “nationalization” is the new “n-word” in the political lexicon, the extent of government intervention and government control of banks continues to increase. Taking the standard IMF approach to cleaning up the U.S. banking system may not be politically feasible or even logistically possible since the scale of clean-up required is unlike anything the IMF or FDIC or any regulatory agency have ever seen.
But it seems that whether or not we call it “nationalization,” we the people and our government are ending up owning a lot more of the banking system than we ever bargained for.
In that interview, Johnson argues forcefully that the United States government should follow the standard IMF formula for dealing with “bad” banks: nationalize them using FDIC intervention, reorganize them, clean them up, and immediately privatize them again.
Paraphrasing what Johnson has written in recent weeks, Terry Gross stated: “If you showed old hands at the International Monetary Fund... the U.S. ledger books, but you hid the name 'United States,' so that they didn't know what country you were talking about, they would all say, 'Nationalize the banking system. That's the solution.'”
Mr. Johnson agreed and in the rest of the interview made a very cogent argument for why such a policy makes the most economic sense as well as warning that the current policy of serial bailouts may only be prolonging the crisis and potentially making it worse.
But Terry Gross also pointed to a central flaw in this “obvious” solution when she drew a distinction between the hypothetical “if you hid the name of the country,” and the reality that this crisis is taking in the world's second largest economy and most powerful nation in the world.
Johnson himself acknowledged the political sensitivity surrounding the crisis when he said that since the United States is the IMF's largest shareholder, that organization doesn't even want to state publicly that U.S. should take the nationalization route.
The resulting paradox is that a temporary nationalization seems to be the sensible, time-tested solution to managing “bad” banks even for a superpower like the U.S. Yet no one dares say so.
Instead, as NPR “Planet Money” reporter Adam Davidson indicated on Morning Edition, “The official word is clear: The Obama administration and Federal Reserve officials say that nationalizing the banks is the wrong choice and that they have no intention of doing it,” (“Obama Administration Could Still Nationalize Banks,” March 6, 2009).
The reasons: 1) Republicans screaming about “socialism” in our banking system, even though the government already owns substantial portions of some of the largest banks like Citibank; 2) Fear that the very mention of the “n-word” will precipitate a run on banks or further devaluation of financial stocks in the stock market; and 3) the fact that many politicians are highly indebted to Wall Street for political contributions and don't want to be in the position of being responsible for their donors losing their jobs.
In fact, Simon Johnson's strongest criticism of the actions the Treasury Department has taken to date focuses on the fact that so many banking executives like Vikram Pandit of Citibank have been allowed to stay in their positions, when a central tenet of cleaning up banks is: First, fire all the top level executives.
However, while the government continues with its official denials of any intentions to “nationalize” failing banks, more and more of those in the financial world expect that behind the scenes, they are taking precisely the kinds of steps that would constitute nationalization in all but name through increasing levels of government ownership of struggling banks.
As one independent analyst, Sean West of Eurasia Group, told Adam Davidson, “The net effect, rather than actually talking in [the] language of nationalization, it's really [that] the government has opened the door to increasing ownership of these banks.” In other words, if the U.S. doesn't dare nationalize the banks openly, it may be setting up “stress tests” that force the banks to ask for such intervention, that is, to “nationalize themselves.”
So even if “nationalization” is the new “n-word” in the political lexicon, the extent of government intervention and government control of banks continues to increase. Taking the standard IMF approach to cleaning up the U.S. banking system may not be politically feasible or even logistically possible since the scale of clean-up required is unlike anything the IMF or FDIC or any regulatory agency have ever seen.
But it seems that whether or not we call it “nationalization,” we the people and our government are ending up owning a lot more of the banking system than we ever bargained for.
Monday, March 2, 2009
Pay Now or Pay More Later: What Can We Really Do about Toxic Assets?
For those of you who still think a “tarp” is something to cover up ugly debris, the government's TARP (Troubled Asset Relief Program) program actually does reflect the literal sense of the word quite well. Although the TARP has been an ever evolving work-in-process since it was first conceived by Hank Paulson in the last days of the Bush Administration, one aspect of it has not changed. TARP still represents the government's best efforts to help the financial industry contain a mountain of largely uncollectible debt. Yet months after the first attempts to bail out the banks, we still don't know just how toxic their "troubled assets" really are.
If you are wondering why the Feds and the Treasury and SuperObama can't just clean up the mess, it's worth taking the better part of an hour to listen to this week's public radio program, This American Life. NPR's Adam Davidson and TAL's Alex Blumberg have produced some of the best reporting to date on the banking crisis (See “Giant Pool of Money” and “Another Frightening Show about the Economy”.)
The most recent segment, “Bad Bank,” explains why we American taxpayers may have no choice but to pay “as much as we can” to redeem debts that bankers made to people with lousy credit and no credible means to pay back their loans. As a researcher from Deutsche Bank, Joe Lavorgna, wrote bluntly in a recent report: “Ultimately, the taxpayer will be on the hook one way or another, either through greatly diminished job prospects and/or significantly higher taxes down the line.” Mr. Lavorgna goes on to suggest that the government should "estimate the highest price it can pay for the various toxic assets on financial institution balance sheets," and then then cough up the funds even at taxpayer expense.("Taxpayer Beware: Bank Bailout Will Hurt").
If this sounds like a holdup note, both the reporters on this story and the economists and bankers they interview agree, it is. The banking industry after all its greed and excesses is basically telling us, “Pay up now, or just pay more later.”
But as one expert in banking crises from the Columbia University School of Business points out, this aspect of the financial crisis is not really new. According to Professor David Beim, history shows that governments have always bailed out the banks because societies can't function without them. He cites the example of a banking crisis in 37 AD that had the Roman emperor galloping back to the capital posthaste with bags of money to give to the bankers who had created the problem by making bad loans. Sound familiar?
Professor Beim notes that this has happened over and over and over again, only not on such a global scale. We'd be in great shape, relatively speaking, if the U.S. were merely Indonesia or Argentina. The IMF could intervene, take over the bad banks, clean things up, and the global economy would keep chugging along nicely. But take a behemoth like the United States with its Bank of America and Citigroup, which together hold over a quarter of all the money in the U.S. banking system, and we face a dilemma of a different order of magnitude.
The problem is compounded by the continuing belief that such dire outcomes “can't happen here” and by the anger of the American public who are still telling politicians to let the bankers take it on the chin even though it could propel the United States into a economic crisis that would make make the Great Depression pale by comparison.
Yet by far the scariest part of this reporting on the state of “bad banks” does not come from tales of people losing jobs or homes or life savings, but rather from a simple graph. According to David Beim, this is the hard data that shows we are not simply facing a housing crisis or a credit crisis but something much deeper and more systemic.
The graph shows that for much of postwar history, the collective debt of the American consumer has always been a mere fraction of our gross domestic product (GDP), usually hovering around 30%, sometimes rising to 50%, but in the last ten years, rising faster and until it reaches a point where the indebtedness of the American people equals GDP. That means 100% of what we owe is equal to 100% of all the goods and services we produce.
That has only happened twice in the last hundred years: in 1929 and now. As a nation we are literally out of room to borrow because we don't have the assets to borrow against. From this perspective, the problem of banks' toxic assets, intractable as it seems to be, is just the tip of the iceberg. We have all been victims of our own collective greed and our collective indifference to consumer borrowing run amuck.
So what can we do? Well, according to the experts we don't have many choices. Thanks to the fiscal irresponsibility of the past decade, we have a war we've borrowed to pay for, and a financial system that deregulation has helped send into a tailspin. And we, as consumers, have gone along for the “free” ride that is proving to be a costly fantasy trip.
We can pay now, or pay more later. And no amount of outrage or denial will change that.
If you are wondering why the Feds and the Treasury and SuperObama can't just clean up the mess, it's worth taking the better part of an hour to listen to this week's public radio program, This American Life. NPR's Adam Davidson and TAL's Alex Blumberg have produced some of the best reporting to date on the banking crisis (See “Giant Pool of Money” and “Another Frightening Show about the Economy”.)
The most recent segment, “Bad Bank,” explains why we American taxpayers may have no choice but to pay “as much as we can” to redeem debts that bankers made to people with lousy credit and no credible means to pay back their loans. As a researcher from Deutsche Bank, Joe Lavorgna, wrote bluntly in a recent report: “Ultimately, the taxpayer will be on the hook one way or another, either through greatly diminished job prospects and/or significantly higher taxes down the line.” Mr. Lavorgna goes on to suggest that the government should "estimate the highest price it can pay for the various toxic assets on financial institution balance sheets," and then then cough up the funds even at taxpayer expense.("Taxpayer Beware: Bank Bailout Will Hurt").
If this sounds like a holdup note, both the reporters on this story and the economists and bankers they interview agree, it is. The banking industry after all its greed and excesses is basically telling us, “Pay up now, or just pay more later.”
But as one expert in banking crises from the Columbia University School of Business points out, this aspect of the financial crisis is not really new. According to Professor David Beim, history shows that governments have always bailed out the banks because societies can't function without them. He cites the example of a banking crisis in 37 AD that had the Roman emperor galloping back to the capital posthaste with bags of money to give to the bankers who had created the problem by making bad loans. Sound familiar?
Professor Beim notes that this has happened over and over and over again, only not on such a global scale. We'd be in great shape, relatively speaking, if the U.S. were merely Indonesia or Argentina. The IMF could intervene, take over the bad banks, clean things up, and the global economy would keep chugging along nicely. But take a behemoth like the United States with its Bank of America and Citigroup, which together hold over a quarter of all the money in the U.S. banking system, and we face a dilemma of a different order of magnitude.
The problem is compounded by the continuing belief that such dire outcomes “can't happen here” and by the anger of the American public who are still telling politicians to let the bankers take it on the chin even though it could propel the United States into a economic crisis that would make make the Great Depression pale by comparison.
Yet by far the scariest part of this reporting on the state of “bad banks” does not come from tales of people losing jobs or homes or life savings, but rather from a simple graph. According to David Beim, this is the hard data that shows we are not simply facing a housing crisis or a credit crisis but something much deeper and more systemic.
The graph shows that for much of postwar history, the collective debt of the American consumer has always been a mere fraction of our gross domestic product (GDP), usually hovering around 30%, sometimes rising to 50%, but in the last ten years, rising faster and until it reaches a point where the indebtedness of the American people equals GDP. That means 100% of what we owe is equal to 100% of all the goods and services we produce.
That has only happened twice in the last hundred years: in 1929 and now. As a nation we are literally out of room to borrow because we don't have the assets to borrow against. From this perspective, the problem of banks' toxic assets, intractable as it seems to be, is just the tip of the iceberg. We have all been victims of our own collective greed and our collective indifference to consumer borrowing run amuck.
So what can we do? Well, according to the experts we don't have many choices. Thanks to the fiscal irresponsibility of the past decade, we have a war we've borrowed to pay for, and a financial system that deregulation has helped send into a tailspin. And we, as consumers, have gone along for the “free” ride that is proving to be a costly fantasy trip.
We can pay now, or pay more later. And no amount of outrage or denial will change that.
Thursday, February 26, 2009
In Vitro Fertilization: Too Much of a Good Thing?
Talking whether or not to have children in contemporary American society seems as fraught with danger as talking about religion, politics, or sex itself. First of all, the act of reproduction is now largely perceived as a matter of choice rather than an accident, a chance occurrence, or a reflection of the will of God.
For this reason we tend to view reproduction almost exclusively as an activity within the individual's control, You want to have a child; check when the female partner is ovulating and have fun. You don't want to have children: have fun but don't forget the birth control. This reductive either/or thinking makes it all to easy to forget how vulnerable we humans still are to flawed genes, the curve ball of disease, and the threat of infertility that increases as we defer parenting to our late thirties or forties.
New reproductive technologies have offered one form of reassurance to those who have trouble conceiving, especially those who have deferred the choice to have children until infertility presents a serious impediment. They also make it possible for lesbian couples to conceive and for gay male couples to have children as well if they can find a female surrogate.
But while new technologies like in-vitro fertilization offer solve a number of problems for these couples, they also raise serious ethical questions that medical practitioners and those seeking such treatment are often ill-equipped to answer.
For example, the ability for infertile couples to use in-vitro techniques as an alternative to adoption has fostered a situation in the United States in which large numbers of children remain locked into the foster care system, often seen as “unadoptable” by the very families who might once have taken a closer look at them. Moreover, infertile couples are not simply choosing to conceive one or two embryos that might be born as their biological children but are choosing a technology so costly that many choose to risk multiple births rather than lose the opportunity of becoming pregnant at all.
The case of Nadya Suleman, the single mother who chose to have so many embryos implanted in her womb that she gave birth to octuplets, merely writes large the ethical dilemmas that such unregulated reproductive technologies have generated.
The cost of in-vitro fertilization is high, and since few have health insurance to cover the cost, the incentive is even greater to try to get the most “bang for your buck” by having as many embryos implanted in the womb as possible.
The problem is that the human womb is not designed for more than one or two occupants at best, and the situation of multiple births automatically presents high risks and higher medical costs for both mother and babies, some of which may persist for the life of the children who survive. In fact, the ugly underside of potential multiple births is the real possibility of multiple deaths as the survival rate lessens dramatically for twins, triplets, quadruplets, and higher multiples. (For an excellent overview of these issues,read Liza Mundy, Everything Conceivable: How Assisted Reproduction Is Changing Our World).
The other side of this reproductive superabundance is also reflected in the dilemma of what to do with the embryos that are not implanted. In almost every in-vitro situation, there are “left over” embryos that a couple may want to use for future births. By one estimate, there may be half a million of these potential babies.
Unfortunately, once a couple has the number of children they desire, many cannot face the ethical dilemma of what to do with the embryos they no longer need. Do they donate them to other infertile couples? Do they allow them to “expire”? Do they offer them for scientific research? A growing number of people, unable to decide, simply stop paying the fees to keep their embryos frozen, but doctors are often too afraid of legal problems not to continue keeping them in this reproductive limbo.
Which brings me back to Nadya Suleman. The public is quick to condemn her for choosing to give birth to children she cannot afford to raise and has not the means to care for, but the same public says little about the many couples who abandon their unused embryos, leaving them in a legal and physical limbo, a financial charge to the labs that helped create them.
Indeed, the amount of vitriol directed at this woman rivals that provoked by Ronald Reagan's mythical Welfare Queen, and reflects the resentment of an American public that can barely afford to feed, house, educated and provide health care for its own children, much less subsidize a woman who appears to have her children at “taxpayer expense.”
But we don't see nearly the same amount of outrage directed at the doctors and hospital that agreed to provide this infertility treatment to Ms. Suleman, even knowing full well that she already had six children from previous treatments. The real scandal that Ms. Suleman's multiple births has revealed is that of a medical profession operating under “wild west” conditions guidelines but no clear rules that might have immediately rendered Ms. Suleman an inadmissible candidate for further in-vitro fertilization treatments.
The medical profession that practices these techniques needs to take a hard look at itself and ask some pressing questions such as: What role does the profit motive play in decisions to offer in-vitro fertilization services? Under what conditions, if any, should a doctor refuse to provide in-vitro fertilization? Rich or poor, there may well be an ethical limit to the number of children that any medical professional should help a couple conceive by these means.
Certainly, as a society, there is a public interest in determining to what degree tax payers should subsidize the infertile when we already underfund housing, education, and services for children who do not have families to care for them.
And we should also be asking those who provide the technology for the infertile to conceive to make sure that these same couples fully comprehend the implications they face in making the decision to create multiple embryos or undertake multiple births. We cannot allow those who make the choice to create multiple embryos simply to walk away from those choices when they become inconvenient or superfluous.
Nor should we sweep under the table the negative effects of reproductive technologies' effects on women's health, on the ability of families to cope with the economic, emotional, and physical stresses of raising multiple babies at once, and the many costs to society of providing care to these children, who are often more vulnerable to disease and disability than their singleton counterparts.
In-vitro fertilization has offered many couples the opportunity to turn the dream of having a child into a reality, and I fully support the efforts of any couple, straight or gay, to have a child who shares at least some of their own unique genetic makeup.
But as Nadya Suleman's tragic situation demonstrates, an unregulated and unquestioning field of reproductive technology also poses the nightmare scenario of a society subsidizing one woman's unrealistic obsession that has turned into the grim reality of fourteen very young and very vulnerable children, who are dependent on one mother and an increasingly fragile safety net for their very survival.
That fact alone should have the medical community and the public large asking the question: Can in-vitro fertilization be too much of a good thing?
For this reason we tend to view reproduction almost exclusively as an activity within the individual's control, You want to have a child; check when the female partner is ovulating and have fun. You don't want to have children: have fun but don't forget the birth control. This reductive either/or thinking makes it all to easy to forget how vulnerable we humans still are to flawed genes, the curve ball of disease, and the threat of infertility that increases as we defer parenting to our late thirties or forties.
New reproductive technologies have offered one form of reassurance to those who have trouble conceiving, especially those who have deferred the choice to have children until infertility presents a serious impediment. They also make it possible for lesbian couples to conceive and for gay male couples to have children as well if they can find a female surrogate.
But while new technologies like in-vitro fertilization offer solve a number of problems for these couples, they also raise serious ethical questions that medical practitioners and those seeking such treatment are often ill-equipped to answer.
For example, the ability for infertile couples to use in-vitro techniques as an alternative to adoption has fostered a situation in the United States in which large numbers of children remain locked into the foster care system, often seen as “unadoptable” by the very families who might once have taken a closer look at them. Moreover, infertile couples are not simply choosing to conceive one or two embryos that might be born as their biological children but are choosing a technology so costly that many choose to risk multiple births rather than lose the opportunity of becoming pregnant at all.
The case of Nadya Suleman, the single mother who chose to have so many embryos implanted in her womb that she gave birth to octuplets, merely writes large the ethical dilemmas that such unregulated reproductive technologies have generated.
The cost of in-vitro fertilization is high, and since few have health insurance to cover the cost, the incentive is even greater to try to get the most “bang for your buck” by having as many embryos implanted in the womb as possible.
The problem is that the human womb is not designed for more than one or two occupants at best, and the situation of multiple births automatically presents high risks and higher medical costs for both mother and babies, some of which may persist for the life of the children who survive. In fact, the ugly underside of potential multiple births is the real possibility of multiple deaths as the survival rate lessens dramatically for twins, triplets, quadruplets, and higher multiples. (For an excellent overview of these issues,read Liza Mundy, Everything Conceivable: How Assisted Reproduction Is Changing Our World).
The other side of this reproductive superabundance is also reflected in the dilemma of what to do with the embryos that are not implanted. In almost every in-vitro situation, there are “left over” embryos that a couple may want to use for future births. By one estimate, there may be half a million of these potential babies.
Unfortunately, once a couple has the number of children they desire, many cannot face the ethical dilemma of what to do with the embryos they no longer need. Do they donate them to other infertile couples? Do they allow them to “expire”? Do they offer them for scientific research? A growing number of people, unable to decide, simply stop paying the fees to keep their embryos frozen, but doctors are often too afraid of legal problems not to continue keeping them in this reproductive limbo.
Which brings me back to Nadya Suleman. The public is quick to condemn her for choosing to give birth to children she cannot afford to raise and has not the means to care for, but the same public says little about the many couples who abandon their unused embryos, leaving them in a legal and physical limbo, a financial charge to the labs that helped create them.
Indeed, the amount of vitriol directed at this woman rivals that provoked by Ronald Reagan's mythical Welfare Queen, and reflects the resentment of an American public that can barely afford to feed, house, educated and provide health care for its own children, much less subsidize a woman who appears to have her children at “taxpayer expense.”
But we don't see nearly the same amount of outrage directed at the doctors and hospital that agreed to provide this infertility treatment to Ms. Suleman, even knowing full well that she already had six children from previous treatments. The real scandal that Ms. Suleman's multiple births has revealed is that of a medical profession operating under “wild west” conditions guidelines but no clear rules that might have immediately rendered Ms. Suleman an inadmissible candidate for further in-vitro fertilization treatments.
The medical profession that practices these techniques needs to take a hard look at itself and ask some pressing questions such as: What role does the profit motive play in decisions to offer in-vitro fertilization services? Under what conditions, if any, should a doctor refuse to provide in-vitro fertilization? Rich or poor, there may well be an ethical limit to the number of children that any medical professional should help a couple conceive by these means.
Certainly, as a society, there is a public interest in determining to what degree tax payers should subsidize the infertile when we already underfund housing, education, and services for children who do not have families to care for them.
And we should also be asking those who provide the technology for the infertile to conceive to make sure that these same couples fully comprehend the implications they face in making the decision to create multiple embryos or undertake multiple births. We cannot allow those who make the choice to create multiple embryos simply to walk away from those choices when they become inconvenient or superfluous.
Nor should we sweep under the table the negative effects of reproductive technologies' effects on women's health, on the ability of families to cope with the economic, emotional, and physical stresses of raising multiple babies at once, and the many costs to society of providing care to these children, who are often more vulnerable to disease and disability than their singleton counterparts.
In-vitro fertilization has offered many couples the opportunity to turn the dream of having a child into a reality, and I fully support the efforts of any couple, straight or gay, to have a child who shares at least some of their own unique genetic makeup.
But as Nadya Suleman's tragic situation demonstrates, an unregulated and unquestioning field of reproductive technology also poses the nightmare scenario of a society subsidizing one woman's unrealistic obsession that has turned into the grim reality of fourteen very young and very vulnerable children, who are dependent on one mother and an increasingly fragile safety net for their very survival.
That fact alone should have the medical community and the public large asking the question: Can in-vitro fertilization be too much of a good thing?
Friday, February 20, 2009
A Melancholy Month
T.S. Eliot wrote that April was the cruelest month, but for me it's always been February that is the most difficult time of year to get through.
When I was growing up in Detroit, it seemed that February was the time when winter settled in with grey clouds, biting cold, and not even a glimpse of blue sky for weeks on end. It was when the snow either settled into a permanent crust with snow tires creating deep grooves that remained permanently frozen, or fell from the sky in a perpetual icy drizzle that was not quite rain, or else simply melted into black slush, an ugly combination of salt, snow, and mud.
They hadn't invented the term “SAD" (seasonal affect disorder), but I knew that if I ever had the choice, I would definitely spend those twenty-some days in a place far warmer and sunnier than Michigan.
Now that I live in northern California, I no longer feel saddened by the winter weather. Instead, I feel anxious if we have too many stretches of sunshine between the rainstorms that roll in from the Pacific, and I enjoy afternoons where the temperature reaches 70 degrees in January with more than a tinge of guilt, knowing that the warmth doesn't bode well for the Sierra snow pack.
My February blues these days don't come with the weather but with my own inevitable sense of disappointment and failure to live up to my own expectations. I always look to January, the month when I was born, as a turning point in the year; a time to take stock and start over. As anyone in my family will tell you, I am not a laissez-faire sort of personality. I want to take life by the shoulders and shake some sense into it. Like my hero, Captain Jean-Luc Picard, I want my “Earl Grey hot” as soon as I finish saying the words, and my dream is to arrange real life so that “Make it so” could be more than a line in a sci-fi script.
Unfortunately, none of my other family members ever conform to this fantasy, and February has had more than its share of small domestic dramas that have kept me awake at the wee hours of the morning worrying about how my teen is ever going to make it to college and how my little one can find a school that values rather than tries to suppress his energy and enthusiasm.
I worry about how we're going to find the funding to sustain the great ideas my husband has for his new company and whether or not I'm ever going to find a job I love again. I worry and worry some more, joining the company of thousands of Americans who lie awake at 3:00 a.m. wondering if they can keep a roof over their heads or pay their medical bills or avoid the pink slips that seem to be sprouting like the buds in my garden.
Each day seems to set a new low for the stock market, and a new dip in consumer confidence. I know I am not alone in my February melancholy and my heart goes out to those who have far more reason for a heavy heart than I do.
But knowing that your misery is shared does not necessarily make the sufferer any happier. So a couple of days ago, after getting the kids off to school, I went back to bed with an escapist novel and spent as much of the day as I could in my pajamas before heading off to the airport to pick up my husband.
If I were the bubble bath sort, it would definitely have been a “Calgon, take me away!” sort of moment, but for me, just a couple of hours in self-indulgent sloth is enough for me to gird my loins and return to the grey skies of February and a reality that we could all stand to be a little less grim.
When I was growing up in Detroit, it seemed that February was the time when winter settled in with grey clouds, biting cold, and not even a glimpse of blue sky for weeks on end. It was when the snow either settled into a permanent crust with snow tires creating deep grooves that remained permanently frozen, or fell from the sky in a perpetual icy drizzle that was not quite rain, or else simply melted into black slush, an ugly combination of salt, snow, and mud.
They hadn't invented the term “SAD" (seasonal affect disorder), but I knew that if I ever had the choice, I would definitely spend those twenty-some days in a place far warmer and sunnier than Michigan.
Now that I live in northern California, I no longer feel saddened by the winter weather. Instead, I feel anxious if we have too many stretches of sunshine between the rainstorms that roll in from the Pacific, and I enjoy afternoons where the temperature reaches 70 degrees in January with more than a tinge of guilt, knowing that the warmth doesn't bode well for the Sierra snow pack.
My February blues these days don't come with the weather but with my own inevitable sense of disappointment and failure to live up to my own expectations. I always look to January, the month when I was born, as a turning point in the year; a time to take stock and start over. As anyone in my family will tell you, I am not a laissez-faire sort of personality. I want to take life by the shoulders and shake some sense into it. Like my hero, Captain Jean-Luc Picard, I want my “Earl Grey hot” as soon as I finish saying the words, and my dream is to arrange real life so that “Make it so” could be more than a line in a sci-fi script.
Unfortunately, none of my other family members ever conform to this fantasy, and February has had more than its share of small domestic dramas that have kept me awake at the wee hours of the morning worrying about how my teen is ever going to make it to college and how my little one can find a school that values rather than tries to suppress his energy and enthusiasm.
I worry about how we're going to find the funding to sustain the great ideas my husband has for his new company and whether or not I'm ever going to find a job I love again. I worry and worry some more, joining the company of thousands of Americans who lie awake at 3:00 a.m. wondering if they can keep a roof over their heads or pay their medical bills or avoid the pink slips that seem to be sprouting like the buds in my garden.
Each day seems to set a new low for the stock market, and a new dip in consumer confidence. I know I am not alone in my February melancholy and my heart goes out to those who have far more reason for a heavy heart than I do.
But knowing that your misery is shared does not necessarily make the sufferer any happier. So a couple of days ago, after getting the kids off to school, I went back to bed with an escapist novel and spent as much of the day as I could in my pajamas before heading off to the airport to pick up my husband.
If I were the bubble bath sort, it would definitely have been a “Calgon, take me away!” sort of moment, but for me, just a couple of hours in self-indulgent sloth is enough for me to gird my loins and return to the grey skies of February and a reality that we could all stand to be a little less grim.
Tuesday, February 3, 2009
In Politics, the Poor are Expendable
It's a truism that politicians talk a lot about their concern for children and the poor, especially when they are in front of cameras. But when it comes to voting, too many politicians pay the most attention to their donors and to the constituents they believe are most likely to participate in the next election.
Unfortunately, the most recent compromise on the President's economic subsidy proposals proves this truism correct once again. With Republicans going on and on in front of TV news cameras about the inclusion of “millions of dollars for contraceptives,” President Obama caved in and jettisoned an important subsidy for poor women to gain access to contraception. Thus conservative hypocrisy won over common sense, and good public policy lost out to political expediency.
Hypocrisy is a strong term for describing conservative objections to this subsidy, but I cannot think of anything less accurate. With their emphasis on self-sufficiency, Republicans surely can not be said to be in favor of the poor having more children they cannot afford, and they are even more adamantly opposed to terminating an unintended pregnancy. Can you imagine the outrage they could have generated by showing up on Fox News and shouting, “This stimulus plan includes millions for publicly funded abortions”??
Yet what logical reason can they put forward for objecting to helping poor women control their family size and prevent the spread of sexually transmitted diseases? Is money spent helping pharmaceuticals offer contraceptives any better or worse than subsidizing an expensive drug plan for the elderly? According to most economists, it doesn't matter where you spend the money, as long as the government is pumping cash into the economy. So why are contraceptives any worse a product to subsidize than corn or wheat or any other commodity?
Do conservatives want poor women to stop having sex? Perhaps so. But given that poor women are disproportionately young and less educated, many of them may not have the power, real or perceived, of just saying “no” to a sexual partner. Moreover, since many conservatives are also libertarian in their thinking, they surely cannot favor the government either explicitly or implicitly getting into the business of dictating such choices.
And since Republicans always want the government to spend less, why wouldn't they want to spend a little on contraception in order to avoid spending a lot more subsidizing health care, education, and Aid to Dependent Children as well as the public spending on AIDS and sexually transmitted diseases that could be avoided by more women using contraceptives?
So why do poor women have to lose again? By courting conservative votes (which he didn't get), and avoiding any kind of controversy (especially around sex), President Obama chose to cede this issue to the conservative right. But that doesn't mean that voters have to go along with such political expediency. If those of us who take our ability to access contraceptives for granted don't speak up on behalf of poor women who don't enjoy that privilege, no one will.
Unfortunately, the most recent compromise on the President's economic subsidy proposals proves this truism correct once again. With Republicans going on and on in front of TV news cameras about the inclusion of “millions of dollars for contraceptives,” President Obama caved in and jettisoned an important subsidy for poor women to gain access to contraception. Thus conservative hypocrisy won over common sense, and good public policy lost out to political expediency.
Hypocrisy is a strong term for describing conservative objections to this subsidy, but I cannot think of anything less accurate. With their emphasis on self-sufficiency, Republicans surely can not be said to be in favor of the poor having more children they cannot afford, and they are even more adamantly opposed to terminating an unintended pregnancy. Can you imagine the outrage they could have generated by showing up on Fox News and shouting, “This stimulus plan includes millions for publicly funded abortions”??
Yet what logical reason can they put forward for objecting to helping poor women control their family size and prevent the spread of sexually transmitted diseases? Is money spent helping pharmaceuticals offer contraceptives any better or worse than subsidizing an expensive drug plan for the elderly? According to most economists, it doesn't matter where you spend the money, as long as the government is pumping cash into the economy. So why are contraceptives any worse a product to subsidize than corn or wheat or any other commodity?
Do conservatives want poor women to stop having sex? Perhaps so. But given that poor women are disproportionately young and less educated, many of them may not have the power, real or perceived, of just saying “no” to a sexual partner. Moreover, since many conservatives are also libertarian in their thinking, they surely cannot favor the government either explicitly or implicitly getting into the business of dictating such choices.
And since Republicans always want the government to spend less, why wouldn't they want to spend a little on contraception in order to avoid spending a lot more subsidizing health care, education, and Aid to Dependent Children as well as the public spending on AIDS and sexually transmitted diseases that could be avoided by more women using contraceptives?
So why do poor women have to lose again? By courting conservative votes (which he didn't get), and avoiding any kind of controversy (especially around sex), President Obama chose to cede this issue to the conservative right. But that doesn't mean that voters have to go along with such political expediency. If those of us who take our ability to access contraceptives for granted don't speak up on behalf of poor women who don't enjoy that privilege, no one will.
Back to the Gym
Okay, I confess. I have made that most banal of all New Year's resolutions, namely to get myself in shape.
But this year I have an extra incentive. The thrifty part of me that hearkens back to my dad's love of a bargain and the motto – “Eat it up, wear it out, make it do, or go without” – has made me answer the call of the January coupons for “free trial memberships” that every local gym seems to be offering.
Thus far, I've had a week at the Y and I've just finished two weeks at a new gym, which I could probably follow by one more trial if I pushed it. Don't get me wrong. I really am looking for a gym, and I do intend to pay for it, but not until I've explored every cross-trainer, every weight machine, and every free 30-minute personal training session to get the best bang for my buck.
Trying out the Y was actually a return to familiar ground since I used to be a member there for years before I moved to Albuquerque. I took prenatal dance before my first son was born by C-section, and afterward returned to post-natal classes. By the time I was pregnant with my third son, I was no longer paying much attention to all the hype about not getting your heart rate up too high or worrying about lifting weights.
I was working out on my due date when one of the trainers came up to me and asked when the baby was expected to arrive (I looked like an advertisement for Omar the Tent-Maker at this point). “Oh the baby is due today, actually,” I replied nonchalantly. With a look of horror, the trainer took one more look at my belly and said, “What the hell are you doing here then?” as if he expected a Hollywood scene to ensue with water bursting, me screaming and panting, and the arrival of a baby on an exercise mat right there in front of him.
So I was rather sad when I returned during my trial period and didn't see him there. I wanted to tell him that my son had arrived a bare fifteen minutes after I arrived at Stanford Hospital, just to get a rise out of him.
It was a little eerie seeing the same cast of characters I'd grown so used to, still working out, no one either visibly thinner or fatter, but all with the little quirks I'd grown so fond of. There was the elderly man and his wife who always worked out together; he often wore a Tam o'shanter on his head and sported a tie-dye t-shirt. Or the guy who always biked to the gym but never took off his windbreaker while he worked out; I never understood how he didn't die of heat exhaustion keeping it on after a hard ride. Or the friendly woman who always used to come up to me and say, “Now I know I've seen you before, but I can't remember your name” as she proceeded to introduce herself for at least the fifth time. To be fair, I never remembered her name either, but I always felt like I was in some kind of Star Trek time distortion whenever we went through this ritual
You may wonder why I took such an interest in my fellows as I did my own exercise routine, but I learned long ago as a graduate student when I started a weight training class at a university gym: “The guys are going to look at you; lifting weights is really boring, so don't take it personally.” That was the advice of our female trainer who was there to make us feel comfortable in this relatively alien territory, and it certainly freed me from any inhibitions about letting my curiosity have free reign while I was resting between sets.
But what I loved most about the Y was the fact that I never saw a woman arriving to work out in full make-up or with perfectly matched leotard or workout gear. The Y crowd was an unpretentious group, who came there to get a workout and not to make a fashion statement.
So it was with regret that I came back to find that although all my favorite cast of characters were still there, the gym had also been caught in a bit of a time warp so that the machines were rather out-of-date and that the place had grown even more crowded in the intervening years. It was difficult to get on the machine you liked or find a space to stretch afterward.
I will be moving on to one of the newer facilities in the area with their state-of-the-art exercise machines, and pristine facilities, but I hope that in trading the new for the familiar, I'll still find the people-watching part of my exercise routine as entertaining as ever and the folks I exercise with similarly unpretentious in their pursuit of good health. After all, it's much more fun to watch people when you work out than CNN.
But this year I have an extra incentive. The thrifty part of me that hearkens back to my dad's love of a bargain and the motto – “Eat it up, wear it out, make it do, or go without” – has made me answer the call of the January coupons for “free trial memberships” that every local gym seems to be offering.
Thus far, I've had a week at the Y and I've just finished two weeks at a new gym, which I could probably follow by one more trial if I pushed it. Don't get me wrong. I really am looking for a gym, and I do intend to pay for it, but not until I've explored every cross-trainer, every weight machine, and every free 30-minute personal training session to get the best bang for my buck.
Trying out the Y was actually a return to familiar ground since I used to be a member there for years before I moved to Albuquerque. I took prenatal dance before my first son was born by C-section, and afterward returned to post-natal classes. By the time I was pregnant with my third son, I was no longer paying much attention to all the hype about not getting your heart rate up too high or worrying about lifting weights.
I was working out on my due date when one of the trainers came up to me and asked when the baby was expected to arrive (I looked like an advertisement for Omar the Tent-Maker at this point). “Oh the baby is due today, actually,” I replied nonchalantly. With a look of horror, the trainer took one more look at my belly and said, “What the hell are you doing here then?” as if he expected a Hollywood scene to ensue with water bursting, me screaming and panting, and the arrival of a baby on an exercise mat right there in front of him.
So I was rather sad when I returned during my trial period and didn't see him there. I wanted to tell him that my son had arrived a bare fifteen minutes after I arrived at Stanford Hospital, just to get a rise out of him.
It was a little eerie seeing the same cast of characters I'd grown so used to, still working out, no one either visibly thinner or fatter, but all with the little quirks I'd grown so fond of. There was the elderly man and his wife who always worked out together; he often wore a Tam o'shanter on his head and sported a tie-dye t-shirt. Or the guy who always biked to the gym but never took off his windbreaker while he worked out; I never understood how he didn't die of heat exhaustion keeping it on after a hard ride. Or the friendly woman who always used to come up to me and say, “Now I know I've seen you before, but I can't remember your name” as she proceeded to introduce herself for at least the fifth time. To be fair, I never remembered her name either, but I always felt like I was in some kind of Star Trek time distortion whenever we went through this ritual
You may wonder why I took such an interest in my fellows as I did my own exercise routine, but I learned long ago as a graduate student when I started a weight training class at a university gym: “The guys are going to look at you; lifting weights is really boring, so don't take it personally.” That was the advice of our female trainer who was there to make us feel comfortable in this relatively alien territory, and it certainly freed me from any inhibitions about letting my curiosity have free reign while I was resting between sets.
But what I loved most about the Y was the fact that I never saw a woman arriving to work out in full make-up or with perfectly matched leotard or workout gear. The Y crowd was an unpretentious group, who came there to get a workout and not to make a fashion statement.
So it was with regret that I came back to find that although all my favorite cast of characters were still there, the gym had also been caught in a bit of a time warp so that the machines were rather out-of-date and that the place had grown even more crowded in the intervening years. It was difficult to get on the machine you liked or find a space to stretch afterward.
I will be moving on to one of the newer facilities in the area with their state-of-the-art exercise machines, and pristine facilities, but I hope that in trading the new for the familiar, I'll still find the people-watching part of my exercise routine as entertaining as ever and the folks I exercise with similarly unpretentious in their pursuit of good health. After all, it's much more fun to watch people when you work out than CNN.
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