Tangle - The Ohio trans healthcare legislation.

Starting point is 00:00:00 Based on Charles Yu's award-winning book, Interior Chinatown follows the story of Willis Wu, a background character trapped in a police procedural who dreams about a world beyond Chinatown. When he inadvertently becomes a witness to a crime, Willis begins to unravel a criminal web, his family's buried history, and what it feels like to be in the spotlight. Interior Chinatown is streaming November 19th, only on Disney+. The flu remains a serious disease. Last season, over 102,000 influenza cases have been reported across Canada, which is Chinatown is streaming November 19th, only on Disney+. yourself from the flu. It's the first cell-based flu vaccine authorized in Canada for ages six months and older, and it may be available for free in your province. Side effects and allergic reactions can occur, and 100% protection is not guaranteed. Learn more at flucellvax.ca.

Starting point is 00:01:00 From executive producer Isaac Saul, this is Tangle. Good morning, good afternoon, and good evening, and welcome to the Tangle podcast, a place we get views from across the political spectrum, some independent thinking, and a little bit of my take. I'm your host, Isaac Saul. Today is Tuesday, January 9th, and we're going to be covering Governor Mike DeWine from Ohio and some of the debate about some trans legislation, a bill that he vetoed, and then an executive order that he signed last week. We're going to break down exactly what happened, some arguments from both sides. And as always, I'll share a little bit of my thoughts on this one. It's actually a pretty interesting story. As always, though, before we jump in, we're going to kick things off with some quick hits.

Starting point is 00:02:12 First up, Secretary of State Antony Blinken is in Israel, insisting a path to a Palestinian state be left open. Separately, Israel has killed a senior Hezbollah leader in southern Lebanon, and over 300 people were arrested in New York after pro-Palestinian protesters blocked tunnels and bridges. Number two, Republican presidential primary candidate Vivek Ramaswamy has not qualified for CNN's final Republican debate before the Iowa caucuses. He will not be on the Illinois primary ballot, and several of his staffers are reportedly seeking jobs elsewhere. Number three, Florida Republicans ousted their state party chairman, who is facing allegations of rape. Number three, Florida Republicans ousted their state party chairman who is facing allegations of rape. Number four, Dr. Anthony Fauci is testifying behind closed doors today

Starting point is 00:02:52 before a House committee on the pandemic response. And number five, United Airlines found loose bolts on several 736 MAX 9 airplanes, the same Boeing model grounded after a fuselage blew off during an Alaska Airlines flight last week. Ohio lawmakers just passed a bill banning trans youth from accessing gender-affirming care. That means if the governor signs this, teens, their parents, their doctors are all prohibited from getting or prescribing hormone blockers or medical procedures. It also includes some mental health services. A little more than an hour ago, Governor Mike DeWine announcing he has vetoed House Bill 68, which in part would have banned some gender-affirming care for minors.

Starting point is 00:03:46 Governor DeWine says the bill would have had a grave impact on a very small population of Ohio children. I've stated my position, I think, very, very clearly that this is a question of the parents should be involved, not the state of Ohio, not the government. These are very difficult, very tough decisions that parents are involved in. They're the ones who live with the child. They're the ones who raise the child. They're the ones who love the child. They're the ones who should make the medical decisions and consultation with the best doctors that they can find. And that's the message that parents who I have talked to have given me. So that's why I vetoed the bill. Just one week after vetoing a ban on

Starting point is 00:04:28 gender reassignment surgery, puberty blockers, and hormone therapy for minors, Republican Ohio Governor Mike DeWine issued an executive order that prohibits gender transition surgeries for anyone under 18 at state hospitals or ambulatory clinics. Governor DeWine also directed Ohio health agencies to propose rules that require a multidisciplinary team of medical professionals to be involved in prescribing puberty blockers or hormone therapy for minors. Ohio's House of Representatives had previously passed HB 68, or the SAFE Act, a bill that would have barred transgender minors from puberty blockers, hormone therapy, or surgeries, and which DeWine vetoed. The bill also would have prohibited middle

Starting point is 00:05:10 and high school trans students from participating in sports that match their gender identity rather than their biological sex. DeWine's surprise veto of the bill was an unusual example of a Republican governor rejecting such prohibitions. Rather than ban the use of puberty blockers or hormone therapy outright, DeWine instead has signed an executive order that requires a team of medical providers like bioethicists, endocrinologists, and a mental health specialist to work together when prescribing care to transgender minors. The rules also mandate that patients give informed consent before treatment and after receiving information about risk, as well as undergo a period of psychological counseling

Starting point is 00:05:50 before receiving hormone therapy. DeWine's executive order also requires parental consent for all treatments. An adult who goes in for this care will get this lead-up psychiatric care and the counseling that is absolutely the key, whether you're dealing with an adult or whether you're dealing with a child, DeWine said. The bill that I vetoed that the legislature put forward did not deal with that at all. DeWine stood by his decision to veto the bill that would have banned broader therapies along with gender transition surgery. I believe the parents, not the government, should be making these crucial decisions for their children, he said about hormone therapies. Many interpreted the veto and subsequent executive order as an attempt by Duan

Starting point is 00:06:30 to negotiate with fellow Republicans and work out compromised legislation. Gender transition surgeries in minors remain extremely rare, though breast removal surgeries have become more common in recent years. The American Academy of Pediatrics and Medical Professionals across the world have been debating how regularly and at what age gender transition treatment should be provided. However, DeWine's proposed rules also apply to adult transgender patients, which the vetoed bill would not have. The rules require comprehensive and lengthy mental health counseling for gender transition care. 22 states have passed bans on various gender transition treatments for minors in the last year, ranging from

Starting point is 00:07:09 surgeries to puberty blockers. However, several judges and courts have struck down such bans, deeming them unconstitutional. Ohio House Republicans are expected to attempt to override the veto with a three-fifths majority vote on Wednesday, and the state Senate will vote on the bill later this month. Today, we're going to break down the legislation, executive order, and the arguments about DeWine's actions from the left and the right, then my take. We'll be right back after this quick commercial break. All right, first up, we'll start with what the right is saying. The right is highly critical of DeWine's veto and partial backtracking. Some call on the state legislature to override the

Starting point is 00:07:59 governor's veto of HB 68, calling it a superior option to the executive order. Others say the similarities between the executive order and HB 68 make the choice to go at the issue without the legislature puzzling. In National Review, Madeline Kearns wrote, Do Better, DeWine. Before DeWine's order, Ohio Republicans were expected to vote to override his veto. Presumably, it is with this humiliation in mind that DeWine is attempting to extend an olive branch, effectively telling his fellow Republicans that it's not too late to find a consensus on the issue. But whatever his reasoning, it's not good enough, Kern said. DeWine's executive order is not a step in the right direction, but a doubling down on his

Starting point is 00:08:39 initial error. In 2021, South Dakota Governor Chrissy Noem faced fierce backlash after vetoing a bill protecting women's sports. Noem's version of damage control included claiming it was the method, not the message, she opposed. But she changed direction too, hastily assembling a website dedicated to the protection of Title IX, issuing executive orders, and ultimately lobbying for and signing a very similar bill. DeWine is attempting similar optics as Noem did, but without learning the lesson about substance. When it comes to protecting minors from gender experiments, no half measures will do.

Starting point is 00:09:14 In The Hill, Harmeet Dhillon said Governor DeWine failed Ohio's kids. The legislature must make it right. Ohio legislators have one last chance to protect children from gender-affirming care. They must not be fooled by Governor Mike DeWine's diluted executive order that bans gender transition surgeries but does nothing to stop the chemical castration of vulnerable children or protect equal opportunities for girls in athletics, Dillon wrote. The governor declared that his veto was an effort to save lives and keep the state out of decisions that parents should be making for their children. What he seems to be ignoring is who is pushing these parents into

Starting point is 00:09:49 believing the falsehood that permanently deforming their children is the only solution to their gender dysphoria. DeWine's executive order doesn't go nearly far enough to protect vulnerable children, overwhelmingly young girls, from the gender-affirming care industry. Puberty blockers and cross-sex hormone treatments permanently injure minors, impacting bone density and reproductive health, among other basic bodily functions. They are every bit as dangerous to children as surgeries, Dillon added. Ohio legislators must override Governor DeWine's veto of the SAFE Act and get serious about protecting Ohio's children. In hot air, Jazz Shawl explored DeWine's U-turn on child trans surgeries. I'm not generally a fan of executive orders and see them as an

Starting point is 00:10:31 occasionally necessary evil at the best of times. It's always better to build consensus and pass legislation where possible, allowing the people's directly elected representatives to have a hand in the process. Mike DeWine had such a piece of legislation sitting on his desk since December 15th, and that bill went much further, stopping the prescription of purity blockers and wrong sex hormones to children, as well as keeping men out of women's sports. But DeWine elected to veto the measure and do this instead, Shaw said. The real question here is why he finally pulled out the veto pen. DeWine continues to insist that it was the right decision because he believes that parents, not the government, should be making these crucial decisions for their children. In general, that's a fair,

Starting point is 00:11:13 small-government, conservative position to hold. But a lot of parents are making very bad decisions based on dangerously misguided medical advice, Shaw wrote. By enacting bans via executive order, though, DeWine is now even more personally accountable for whatever backlash may come by doing it single-handedly rather than working with a majority in the legislature. All right, that is it for the rightist saying, which brings us to what the left is saying. The left is equally critical of DeWine, albeit for opposite reasons. Some who supported the rationale behind his initial veto now say he staked out an incoherent position. Others attribute DeWine's sudden pivot to increased pressure from the far right.

Starting point is 00:12:01 In Cleveland.com, Thomas Sudds bashed the legislators poised to undercut DeWine. That's how it goes in a general assembly that for 20-plus years has taken off after sexual minorities to distract Ohioans from the real problems afflicting the state, lagging per capita income, the de-industrialization of Northeast Ohio, and the fact that many young Ohioans don't see a future for themselves in their home states, Huds wrote. Moreover, the vetoed bill makes a mockery of the doctor-patient relationship that so many Republicans cited for so long to fight government-sponsored health care programs such as Medicare, Medicaid, and the Affordable Care Act. HB 68 is anything but harmless. It will

Starting point is 00:12:41 do real damage to young Ohioans at a time in their lives when figuring out one's place in a community is a central concern, especially so in a state whose legislature says, in so many words, we don't want you, Sud said. So much for the party of personal liberty, which seems much more concerned about regulating Ohioans' private lives and reproductive health than, say, policing Ohio's biggest special interests, banks, insurance companies, and electric utilities. In the New Republic, Ellie Quinlan Hotelling questioned the logic behind DeWine's executive order. After the rest of his party threatened to override his veto, DeWine did something unexpected. He went above and beyond the original bill, restricting some access to gender-affirming care for adults as well, Hotelling wrote. Under the new set of

Starting point is 00:13:25 administrative rules, both minors and adults seeking any gender-affirming care will require sign-offs by multidisciplinary teams. That team could include, but is not limited to, an endocrinologist, a bioethicist, and a psychiatrist. Trans adults will also have to undergo a lengthy period of mental health counseling before seeking care. The new steep barrier of entry, which is not required in most states across the nation, will likely tack on incredible medical expenses, only further limiting access to what is often viewed as life-saving care for transgender individuals, Hotelling said. What's more troubling, though, is the lack of clarity on why DeWinely had a change of heart and decided to expand restrictions

Starting point is 00:14:05 on gender-affirming care to Ohioans of all ages. In the Buckeye Flame, Maria Bruno said Ohio needs a miracle to prevent HB 68 from becoming law. Legislators are coming back early from their holiday vacations solely to take health care from kids. On the heels of the Ohio is Home Coalition's Herculean accomplishment of convincing Governor DeWine to veto HB 68, proponents of the bill have responded about as graciously as we would expect, Bruno wrote. They've recruited the national Republican heavy hitters, including Trump, to weigh in against DeWine's decision, and the leadership of Ohio House appears to have immediately buckled to the pressure by obediently expediting their plan to override the veto. Governor DeWine debunked every major anti-gender-affirming care talking point

Starting point is 00:14:51 during his press conference announcing the decision, Bruno said. That's why we know this has nothing to do with wanting to protect kids. It's pure partisan politics. Because if we're about protecting kids and following the facts, they listen to doctors, to patients, to parents, to members of the trans community, to social workers, to subject matter experts, and they'd reach the same conclusion DeWine did. Gender-affirming care saves lives. All right, that is it for the left and the rightist thing, which brings us to my take. Based on Charles Yu's award-winning book, Interior Chinatown follows the story of Willis Wu,

Starting point is 00:15:37 a background character trapped in a police procedural who dreams about a world beyond Chinatown. When he inadvertently becomes a witness to a crime, Willis begins to unravel a criminal web, his family's buried history, and what it feels like to be in the spotlight. Interior Chinatown is streaming November 19th, only on Disney+. The flu remains a serious disease. Last season, over 102,000 influenza cases

Starting point is 00:16:00 have been reported across Canada, which is nearly double the historic average of 52,000 cases. What can you do this flu season? Talk to your pharmacist or doctor about getting a flu shot. Consider FluCellVax Quad and help protect yourself from the flu. It's the first cell-based flu vaccine authorized in Canada for ages six months and older, and it may be available for free in your province.

Starting point is 00:16:20 Side effects and allergic reactions can occur, and 100% protection is not guaranteed. Learn more at FluCcellvax.ca. So before spilling any ink here, I think it is important to call something out. The fighting over this bill in Ohio is happening almost entirely along partisan lines. The idea that an issue like this divides Republicans and Democrats so neatly is a sign of just how tribal our politics are and how wired politicians and us, the voters, have become to falling in line with their teams. On partisan issues like this one, there is a very good chance

Starting point is 00:16:57 your own tribal politics are driving your opinion about who's right and who is wrong, so it's more important than usual to try to let go of any preconceived notions and think about this debate with an open mind. For me, the most fascinating aspect of this entire ordeal is that the Mike DeWine who vetoed this bill basically undermined everything the Mike DeWine who signed this executive order said just a week later. In his press conference announcing his veto, DeWine explained that he had faced parents who told him that their children were only alive because of gender affirming care, teenagers who told him that they were thriving because of treatments like puberty blockers, adults who said they would have taken their own lives if not for such treatments, and medical professionals who insisted they had seen positive results from these treatments again

Starting point is 00:17:42 and again. His full comments on vetoing the bill neatly explained how his decision was based not just on his best estimation of the medical reality, but also based on his conservative principles. He said, and I quote, these are gut-wrenching decisions that should be made by parents and should be made by teams of doctors that are advising them. Were I to sign House Bill 68 or were House Bill 68 to become law, Ohio would be saying that the state, that the government, knows better what is medically best for a child than the two people who love that child the most, the parents. Now, while there are rare times in the law and other circumstances where the state overrules the medical decisions

Starting point is 00:18:21 made by the parents, I can think of no example where this is done where it is not only against the decision of the parents, but also against the medical judgment of the treating physician and against the judgment of the treating team of medical experts. Therefore, I cannot sign this bill as it is currently written. DeWine went on to explain that he believed Ohio's legislators genuinely aimed to create a bill that protected children and that decent and smart people interested in doing the right thing have strong disagreements about this issue. But his position is that the bill went too far in taking that control away from parents. To me, that position, articulated from a clear and straightforward conservative lens from a bona fide conservative governor governor is the right one. The executive order

Starting point is 00:19:05 is a bit different, and I'll get to that shortly. I want to be clear that taking that position does not simply absolve all care from transgender minors as being the right or safe thing to do. On the contrary, I actually think a healthy dose of skepticism about the state of care for transgender minors is appropriate right now. There are far too many experts in the space concerned about it for any rational person to feel otherwise. In 2022, an international group of experts released new guidelines saying that adolescents must undergo mental health assessments and must have questioned their gender identity for several years before receiving drugs or surgeries. That position was far from unifying. In fact, it was very divisive. But the reality that hormone therapy or surgeries can have lasting or permanent effects

Starting point is 00:19:50 like fertility loss, and the fact that in rare cases trans adolescents detransition as adults, should be enough for these medical experts to call for caution. That reality is also enough to insist on holistic incremental care, and for us non-experts, it is enough to approach this complicated issue with some humility. Those risks also provide a good reason to keep the state from making black and white wholesale prohibitions on this kind of treatment, which is why DeWine ultimately made the right call in vetoing this bill and trying to do something that more narrowly restricted that kind of care. Of course, it isn't that simple for a lot of people. As Harmeet K. Dhillon argued, the fact that there are laws banning minors from drinking,

Starting point is 00:20:30 getting tattoos, smoking, driving, marrying, and having sex is proof that we restrict these kinds of things for minors all the time. But that very common and slam-dunk sounding argument is also very lazy. For starters, those laws exist because we have a lot more information about the safety risks of kids smoking or drinking than we do about them taking puberty blockers. On top of that, we are talking about a medical intervention for gender dysphoria, not a broad prohibition on what kids can buy over the counter in a CVS. For instance, it is also illegal for a minor to walk into a CVS and buy Adderall. Yet, if a child is diagnosed with ADHD and their parents want that kid to take Adderall, we let them. That's a better comparison,

Starting point is 00:21:11 and a better one still is the fact that 17-year-olds can get breast implants or breast reductions or facial cosmetic surgery with parental consent. As for the executive order DeWine signed, I actually don't think it is that bad, at least directionally. It's far more likely to stand up to legal scrutiny than the bill he vetoed, given that others like it have been struck down by the courts in other states. DeWine's executive order calls for new rules in Ohio that require holistic medical teams to be involved in a child's gender therapy, which, based on everything I just said above, seems perfectly wise. And it bans gender transition surgeries for minors, which is the kind of olive branch to the Republican legislature that may actually keep them at bay. But the executive order is flawed too. The worst part about the bill is

Starting point is 00:21:56 that it adds more restrictions to decisions transgender adults can make, which is counterintuitive for all the reasons DeWine gave for vetoing the bill. There's also a good chance it makes health care for trans people more expensive, which is a downside to this kind of legislation, but also something that is probably a worthwhile trade-off in the grand scheme of improving care and safety for kids. We'll be right back after this quick break. All right, that is it for my take, which brings us to your questions answered. This one's from Sruthi in Charlottesville, Virginia, who said, what do you think of birth rates plummeting? If you think this is a negative to society,

Starting point is 00:22:44 what would you like to see policy or culture-wise to change it? Okay, so first of all, just on a personal level, let me just say that I'm a little biased by the fact that I am very pro-kids. I love big families, I love my nieces and nephews, I love my siblings, and while I'm not yet a father, I am very excited to be one. That said, I think there are a lot of angles to look at the falling birth rate from, and I think they're all pretty concerning. First, I want to actually put this issue in perspective. 50 years ago, the average woman had five children. Today, that number is 2.3. In the United States, the fertility rate peaked at 3.61 in 1971 and is now at 1.66.

Starting point is 00:23:27 Simply put, that's not great. The replacement rate to prevent our population from shrinking is 2.1, and we don't want to be too far under that number. Population degrowth can be very detrimental for any country, so I think it's safe to say this is a negative for society. And I think there are three broad reasons why we're seeing birth rates decline. New motherhood dread, parenthood dread, and an ideological gender divide. In our second ever Sunday edition, we shared a long-form piece on how millennial women

Starting point is 00:23:55 are dreading motherhood. That whole piece is worth the read, but the upshot is that a side effect of normalizing discussions about the downsides of being a new mother has made the prospect of being a new mother extra daunting for this generation of women. Additionally, regardless of how you personally feel about abortion, the issue is affecting the birth rate, both because women can get abortions that weren't easily accessible 75 years ago, and because women are more nervous about not being able to get an abortion should they have a pregnancy complication. We've also covered another issue facing prospective millennial parents, environmental pessimism.

Starting point is 00:24:35 The basics are that a lot of people are pessimistic about the world and humanity's place in it and are asking themselves if having kids is the right thing to do ethically, not just for themselves, but for the planet. I don't personally find that point of view convincing, but that doesn't really matter. It's still a part of the problem. Lastly, there's a growing political divide between men and women in their 20s. Young women are getting politically more liberal at a time when young men are getting more conservative, and while more and more people don't want to date people who have different political views. I highly doubt that this will be a permanent state of affairs, but I have a hard time believing it's not a contributing factor on this particular issue. As for solutions, I don't support government

Starting point is 00:25:10 solutions for problems that don't require them. And all of these problems contributing to the falling fertility rate are social issues, so I don't think the government should try to solve them. But the government can help. Extending the child tax credit or helping make child care more affordable would make the decision to have kids more appealing, and both proposals have broad bipartisan support. I'll also add one more complicating factor. Childhood mortality is down to 4.3% from 27% in 1950, so way more children are surviving to adulthood today than they did 75 years ago. So, while our declining birth rate is still a problem, it's not as existential an issue as a first glance might make it seem.

Starting point is 00:25:51 And in that context, some policy to make child care a little easier might actually be enough to fully address it. All right, that is it for our reader question today, which brings us to our under-the-radar section. U.S. allies are seeking to up their support for Ukraine amid signs another package from Washington may not come anytime soon, Semaphore reports. Germany is calling for higher contributions from Europe. Japan's foreign minister is promising anti-drone funds. And countries like Lithuania, Latvia, Poland, Spain, Italy, France, and the United Kingdom are already giving higher percentages of their GDP to Ukraine

Starting point is 00:26:30 than the U.S. Germany is even taking shots at France. Semaphore has the story, and there's a link to it in today's episode description. All right, next up is our numbers section. The approximate number of gender-affirming surgeries performed in the U.S. on patients aged 12 to 18 between 2016 and 2019 was 3,700, according to a study from the JAMA Network Open. The approximate number of gender-transition surgeries performed in the U.S. on patients aged 19 to 30 between 2016 and 2019 was 26,000. The number of quote-unquote anti-LGBTQ bills identified by the ACLU across all U.S. states in the 2023 legislative session was 510. The percentage of Americans who say they oppose puberty-blocking medication for children age 10 to 14 is 68%, according to a 2022 Washington Post KFF poll. The percentage of Americans who say they support gender-affirming counseling or therapy for children ages 10 to 14 is 62%.

Starting point is 00:27:37 The percentage of Americans who say they oppose hormonal treatment for trans teens 15 to 17 is 58%, and the percentage of Americans who say they support gender-affirming counseling or therapy for teens age 15 to 17 is 66%. All right, and last but not least, our Have a Nice Day section. Over the course of 2023, deforestation across the Amazon rainforest fell by 56%, of 2023, deforestation across the Amazon rainforest fell by 56%, making it the year with the lowest deforestation since 2019. The data was provided by the monitoring of the Andean Amazon Project, which tracks forest cover and loss across all the nations of the Amazon using the European Space Agency's Sentinel-2 satellite. The data showed a 59% drop in primary forest loss in

Starting point is 00:28:24 Brazil, but the decrease was shared across all nine Amazon countries. The data showed a 59% drop in primary forest loss in Brazil, but the decrease was shared across all nine Amazon countries. The slowing of the Amazon rainforest deforestation is wonderful news, said Carlos Nobre, an Earth Systems Scientist at University of Sao Paulo and a co-founder of the Science Panel for the American Research Collective. These data show there's still hope for the Amazon, said MAP Director Matt Feiner. Reuters has the story and there's a link to it in today's episode description. All right, everybody, that is it for today's podcast. As always, if you want to support our work, you can go to reetangled.com and consider becoming a member.

Starting point is 00:28:57 Don't forget, our membership fees are going up this year very soon. This week, I guess, actually, that's happening. So keep an ear out for that. And of course, as always, we are working on the podcast. We're going to get you some exclusive Friday edition here going forward in 2024. We've got some fun announcements coming up. So I hope you guys stay tuned. We'll be right back here same time tomorrow. Have a good one. Peace. Have a good one.

Starting point is 00:29:24 Peace. Our podcast is written by me, Isaac Saul, and edited and engineered by John Wall. The script is edited by our managing editor, Ari Weitzman, Will Kabak, Bailey Saul, and Sean Brady. The logo for our podcast was designed by Magdalena Bokova, who is also our social media manager. Music for the podcast was produced by Diet75. And if you're looking for more from Tangle,

Starting point is 00:29:48 please go to readtangle.com and check out our website. Based on Charles Yu's award-winning book, We'll be right back. Willis begins to unravel a criminal web, his family's buried history, and what it feels like to be in the spotlight. Interior Chinatown is streaming November 19th, only on Disney+. The flu remains a serious disease. Last season, over 102,000 influenza cases have been reported across Canada, which is nearly double the historic average of 52,000 cases. What can you do this flu season? Talk to your pharmacist or doctor about getting a flu shot. Consider FluCellVax Quad and help protect yourself from the flu. It's the first cell-based flu vaccine authorized in Canada for ages 6 months and older,

Starting point is 00:30:52 and it may be available for free in your province. Side effects and allergic reactions can occur, and 100% protection is not guaranteed. Learn more at FluCellVax.ca.

Tangle - The Ohio trans healthcare legislation.

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