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Medicaid Expansion Is a Stealth Success, and That’s Just Fine

Mother Jones

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Obamacare ended the year with about 2 million people who signed up through the insurance marketplaces and maybe three times that many who signed up for Medicaid. That makes the Medicaid expansion a big success, but neither party really wants to admit it:

To Drew Altman, president of the Kaiser Family Foundation, this exposes a core reality of U.S. health-care politics. “Republicans don’t like entitlement programs, and Democrats want to portray the ACA as mostly a marketplace solution based on private insurance and not another expansion of a government program,” he said, “so neither side wants to emphasize the ACA’s success enrolling people in Medicaid even though it may be the law’s biggest achievement so far in terms of expanding coverage.”

This has left both the Obama administration and Republicans in a tight spot. The White House can’t really tout the Medicaid expansion because it’ll revive fears on the right that Obamacare is really a stealthy effort to create a single-payer health-care system, and it’ll arouse criticism on the left that the administration should have expanded Medicaid to all.

As for Republicans, they can’t admit the Medicaid expansion is going well because doing so is dangerously close to advocating a single-payer health-care system. The exchanges, marred by their troubled introduction, are also a problem as they are a Republican idea, enshrined in Rep. Paul Ryan’s health-care bill.

I think I’d analyze this a bit differently. I don’t really have a sense that much of anyone associates Medicaid expansion with a push for single-payer. Rather, Democrats don’t want to talk about it because Medicaid is a program for the poor, and they don’t want middle-class voters thinking that Obamacare is just another way to funnel their tax dollars into welfare programs for other people. Likewise, Republicans oppose Medicaid expansion simply because they don’t like entitlement programs; they don’t like higher taxes; and they’ve always wanted to block-grant Medicaid and starve it to death. I don’t think it’s really any more complicated than that.

In any case, I’m fine with this. I think Medicaid expansion is great, but unlike a lot of lefties, I also think it’s a dead end. It’s not going to lead to single-payer, and it’s never going to be a template for future health care reforms. The marketplaces, despite all their problems, have far more potential to eventually lead to health care coverage for all. I think they also have more potential to produce delivery reforms down the road and to rein in cost growth. For that reason, I’m OK with the Medicaid expansion staying under the radar. That’s a fine place for it.

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Medicaid Expansion Is a Stealth Success, and That’s Just Fine

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Planet Likely to Warm by 4C by 2100

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This story originally appeared in the Guardian and is reproduced here as part of the Climate Desk initiative.

Temperature rises resulting from unchecked climate change will be at the severe end of those projected, according to a new scientific study.

The scientist leading the research said that unless emissions of greenhouse gases were cut, the planet would heat up by a minimum of 4°C by 2100, twice the level the world’s governments deem dangerous.

The research indicates that fewer clouds form as the planet warms, meaning less sunlight is reflected back into space, driving temperatures up further still. The way clouds affect global warming has been the biggest mystery surrounding future climate change.

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Planet Likely to Warm by 4C by 2100

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Year-End Whining Gets Results!

Mother Jones

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Normally, my blog whining produces no results worth mentioning. But last month was different: two, count ’em, two of my whines got results. This is easily a new personal best.

First up: I complained bitterly that Charlie Stross’s newly revised Merchant Princes series was available in Britain but not in the US. I understand why the publishing schedule for the physical books might be off in the future, but why not release the e-versions? Well, the estimable Patrick Nielsen Hayden of Tor Books heard my lament and sprung into action. As a result, digital versions of these books will be available in the United States next Tuesday, January 7. Details and links here.

Second: I expressed surprise that no one was talking yet about Thomas Piketty’s new book, Capital in the 21st Century. Sure, it’s only available in French at the moment, but there must be at least a few economists who read French and have something to say about it. Right? Well, Brad DeLong, who (a) reads French, (b) also happens to have on hand a manuscript of the English translation, and (c) has read the PowerPoint notes for a lecture Piketty gave based on his book, provides us with a synopsis of Piketty’s findings:

  1. As growth rates decline in the Old World (Europe and Japan), we will once again see the dominance of capital: a greater proportion of the wealth of society will be held in the form of physical and other non-human-skill assets, and inheritance and position will matter more and individual effort and luck less.
  2. In fact, given relatively high average rates of return on capital and thus a large gap vis-a-vis the growth rate, wealth concentration is likely to reach and then surpass peak levels seen in previous history as the superrich become those who started wealthy and benefitted from compound interest and luck.
  3. America remains an exceptional puzzle: it looks, however, like it is headed for an even more extreme distribution of wealth than is the Old World.
  4. Remember, however: the evolution of income and wealth distributions is always political, chaotic, unpredictable–and nation-specific: not global market conditions but national identities rule wealth distributions.
  5. High wealth inequality is not due to any “market failure”: this is a market success: the more frictionless and distortion-free are capital markets, the higher will wealth inequality become.
  6. The ideal solution? Progressive global-scale wealth taxes.

There’s much more at the link, including the complete set of slides from Piketty’s talk. Or you can wait until March when the English translation comes out and everyone dives in.

I am excited that my end-of-year whining has produced such stunning results. All that’s left is to figure out if this is just a coincidence, or if my whining has somehow become more effective lately. Perhaps I should whine more to find out?

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Year-End Whining Gets Results!

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Does More Marijuana Smoking Mean Lower Attendance at the Opera?

Mother Jones

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David Brooks smoked marijuana in his youth, but then got bored with it and stopped. He says it never seemed like a very uplifting pastime, and this makes him nervous about about legalization:

I don’t have any problem with somebody who gets high from time to time, but I guess, on the whole, I think being stoned is not a particularly uplifting form of pleasure and should be discouraged more than encouraged.

We now have a couple states — Colorado and Washington — that have gone into the business of effectively encouraging drug use. By making weed legal, they are creating a situation in which the price will drop substantially. One RAND study suggests that prices could plummet by up to 90 percent, before taxes and such. As prices drop and legal fears go away, usage is bound to increase. This is simple economics, and it is confirmed by much research. Colorado and Washington, in other words, are producing more users.

….I’d say that in healthy societies government wants to subtly tip the scale to favor temperate, prudent, self-governing citizenship. In those societies, government subtly encourages the highest pleasures, like enjoying the arts or being in nature, and discourages lesser pleasures, like being stoned.

Brooks’ column is getting a lot of mockery in my Twitter feed, but for once I guess I can’t really join in. It’s not that I agree with Brooks—and I’ll concede that his comparison of pot smoking with “higher pleasures” is kind of silly. But for the most part, all his column does is express a fairly modest sense of unease about the fact that legalization will almost certainly increase pot smoking a fair amount. There’s really nothing wrong with being a little nervous about that. These new laws will increase marijuana use.

But the big thing Brooks misses is the question of whether this will increase overall intoxication. It might. Alternatively, marijuana might largely displace alcohol use, producing little or no net increase in intoxication but producing a safer society overall since pot tends to be less damaging than alcohol. In the lingo, this is a question of whether marijuana and alcohol are economic substitutes or economic complements, and the research on this point is inconclusive. One of the great benefits of legalization in Washington and Colorado is that it will finally start to give us some decent data on this. For various reasons, it won’t settle the question definitively, but two or three years from now we’ll certainly have a much better idea than we do today about the net effect of marijuana legalization.

And if it turns out that legalizing pot reduces alcohol use? Then Brooks should be happy. There will still be plenty of idiots getting drunk and stoned, but there won’t be any more than there are now. We’ll have an increase in personal freedom; a reduction in drug war costs; and no significant change in the number of people pursuing higher pleasures. It’s well worth finding out if this will be the case.

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Does More Marijuana Smoking Mean Lower Attendance at the Opera?

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We’re Still at War: Photo of the Day for January 3, 2014

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An MV-22 Osprey flies over Helmand province, Afghanistan, Dec. 25, 2013. Commandant of the Marine Corps Gen. James F. Amos, his wife Bonnie, Sgt. Maj. of the Marine Corps Micheal P. Barrett and Sgt. Dakota Meyer traveled around Regional Command (Southwest) to visit troops for the holiday season. (U.S. Marine Corps Photo by Sgt. Tammy K. Hineline/Released)

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We’re Still at War: Photo of the Day for January 3, 2014

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Here’s the Worst Part of the Target Data Breach

Mother Jones

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You know what the most infuriating part of the massive data breach at Target is? This:

Over the last decade, most countries have moved toward using credit cards that carry information on embeddable microchips rather than magnetic strips. The additional encryption on so-called smart cards has made the kind of brazen data thefts suffered by Target almost impossible to pull off in most other countries.

Because the U.S. is one of the few places yet to widely deploy such technology, the nation has increasingly become the focus of hackers seeking to steal such information. The stolen data can easily be turned into phony credit cards that are sold on black markets around the world.

There’s really no excuse for this. The technology to avoid this kind of hacking is available, and it’s been in real-world use for many years. Every bank and every merchant in American knows how to implement it. But it would cost a bit of money, so they don’t. And who pays the price? Not the banks:

J.P. Morgan Chase & Co. Saturday told debit-card holders who shopped at Target during a 20-day data breach that the bank would be limiting cash withdrawals to $100 and putting on a $300 daily-purchasing cap, a move that shows how banks will try to limit exposure to potential fraud.

In a letter to debit card holders posted on its website, the bank said such limitations on spending would be temporary while it plans to reissue cards. The spending restrictions don’t affect credit card users, the bank said.

That’s right: it’s you who pays the price. Oh, these breaches are a pain in the ass for card-issuing banks and for Target itself, and it will end up costing them some money. But mainly it’s a pain in the ass for consumers. And if this breach causes you to be a victim of identity theft, you can be sure that neither Target nor your bank nor your credit rating agency will give you so much as the time of day. It’ll be up to you to reclaim your life even though it wasn’t your fault in any way. It’s a disgrace.

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Here’s the Worst Part of the Target Data Breach

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California Is Giving Tesla Another Huge Tax Break. Good Move.

Mother Jones

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This story originally appear on Slate and is reproduced here as part of the ClimateDesk collaboration.

This is going to drive the Tesla-haters crazy. The luxury electric-car maker is getting a huge new tax break from California, SFGate reports. The state will let it off the hook for sales and use taxes on some $415 million in new equipment it’s purchasing in order to expand production of the Model S at its Bay Area factory. That amounts to a $34.7 million tax break to produce more of a vehicle whose sticker price starts above $70,000.

Tax breaks for the rich! Corporate giveaways! The working people forced to pay for tech titans’ fancy rides!

Well, sort of. But as SFGate‘s David R. Baker explains:

California is one of the few states to tax the purchase of manufacturing equipment, a policy that California business associations have spent years trying to change. But the state does grant exemptions for clean-tech companies as a way to encourage the industry’s growth. The exemptions are issued by the California Alternative Energy and Advanced Transportation Financing Authority, chaired by State Treasurer Bill Lockyer.

So, in fact, it isn’t Tesla per se that’s getting special treatment from the state. It’s the clean-tech industry in general, which California is very keen to promote for two reasons. One, it wants to establish itself as a leader in a sector that it believes will be a big driver of its economy in the decades to come. And two, it’s one of the few states in the country that’s actually, genuinely serious about reducing its greenhouse-gas emissions. Promoting clean energy is a crucial part of its strategy.

More broadly, whatever sense a tax on the purchase of manufacturing equipment might once have made for California, it’s patently counterproductive in the context of clean-tech startups in the 21st century. Add to that some of the highest income and sales taxes in the nation, and it’s no wonder California is worried about companies like Tesla picking up stakes and heading elsewhere. Businessweek notes that new manufacturing jobs in the state have risen less than 1 percent since 2010, compared with nearly 5 percent nationally. Gov. Jerry Brown has been chipping away at the tax already, and Tesla is just the latest example.

Nor is the deal likely to burden the state’s taxpayers. Tesla’s Model S is in huge demand, and the company has been scrambling since its launch to ramp up production. SFGate reports the new equipment will help Tesla boost production by some 35,000 vehicles a year from its current annual rate of 21,000. State analysts predict the added jobs and vehicle sales are expected to bring in more money to the state than the tax break will take away.

For all that, I think some criticism might still be justified if Tesla in the end simply remains a producer of luxury cars for the wealthiest consumers. But the company has insisted from the outset that its ultimate goal is to produce an all-electric car that middle-class buyers can afford. A Tesla spokeswoman told me last week the company is still on track to release its third-generation vehicle by 2016 or 2017. The price is widely expected to be about half that of the Model S—not cheap, but certainly headed in the right direction.

Meanwhile, the success of the Model S has kickstarted the industry as a whole and made California the epicenter of the electric-car world. That’s thanks in part to a similar tax break the state gave the company several years ago to manufacture its cars there in the first place. I’d say there are worse ways for a state to spend a few tens of millions. But if you’re still convinced that tax breaks to big manufacturers are unfair and wrong, you might want to train your ire on a state a little further north, which just offered an all-time record $8.7 billion in tax breaks to a company that manufactures perhaps the least-green transportation technology of all. The worst part: Boeing might just move out anyway.

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California Is Giving Tesla Another Huge Tax Break. Good Move.

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Friday Cat Blogging – 20 December 2013

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This is the second of Marian’s watercolor heart quilts. (You saw the other one in August, and yet another heart-themed quilt on Valentine’s Day.) It’s machine pieced and machine quilted. It’s also nearly our last quilt of the year. There’s one more to go next Friday, which will make for a grand total of 23 quilts if I’ve counted correctly, and then in 2014 we’ll return to garden-variety catblogging. In the meantime, enjoy your weekend and watch out for the shopping mobs.

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Friday Cat Blogging – 20 December 2013

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Red States Remain Adamantly Opposed to Medicaid Expansion

Mother Jones

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A lot of people, myself included, have hoped that pressure from health care groups will eventually persuade even deep red states to enact the Medicaid expansion that’s part of Obamacare. After all, the expansion is almost entirely paid for by the federal government, and the loss of Medicaid money hurts doctors and hospitals in the affected states.

Today, Dylan Scott reports that the key word here is “eventually.” For now, anyway, red-state politicians are adamant about never, ever expanding Medicaid by even a dime:

Top officials for powerful trade organizations in three of the largest states not expanding Medicaid under Obamacare told TPM that they have effectively given up that fight until political conditions change, setting their sights on 2015 at the earliest.

“What I’m really struggling with is — I don’t even know how to talk about expanding Medicaid without just pissing Republicans the hell off and making them think I’m part of the problem,” said a top official for one of the industry groups, who spoke on the condition of anonymity to talk frankly about the political reality in their state and avoid upsetting the chances of expansion in the long term.

….These organizations approached Medicaid expansion as a typical legislative issue last year — the kind where the promise of billions in federal dollars and opportunity to insure thousands of your constituents would trump ideological purity….”We found that this issue is much bigger than that. The influences are much stronger than a state-derived influence in terms of keeping states in the ‘No’ column,” a trade group official in a third state said. “We can’t even call it Medicaid expansion here. That’s a politically incorrect way of saying it.”

Ideological purity continues to trump the prospect of helping the poor, even when that help is all but free. Ladies and gentlemen, this is your modern Republican Party.

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Red States Remain Adamantly Opposed to Medicaid Expansion

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The 9 Worst Things Said About Women, Abortion, and Rape in 2013

Mother Jones

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Opponents of reproductive rights had a busy 2013. By the end of June, state lawmakers had passed 43 abortion restrictions into law—as many restrictions as were enacted in all of 2012, according to an analysis by the Guttmacher Institute, an abortion rights think tank. By August, when many state legislatures had wrapped up their 2013 session, lawmakers had introduced more than 300 abortion restrictions, according to the American Civil Liberties Union.

Defending these restrictions inspired a string of public figures to make foot-in-mouth statements about women, their choices, and their bodies. Below, we’ve assembled the worst of these comments.

Pregnancy from rape is too rare too justify rape exceptions to abortion bans.
Rep. Trent Franks (R-Ariz.) sponsored the year’s most high-profile abortion restriction—a House bill to ban all abortions in the United States at 20 weeks after conception. So it’s only appropriate that he uttered the most notorious abortion-related gaffe of the year: “The incidence of pregnancy resulting from rape are very low.”

Franks made that statement in June, by way of explaining to the House Judiciary Committee why it wasn’t necessary to amend the bill to include an exception for women who became pregnant by rape or incest. (In fact, women who are victims of rape frequently become pregnant.) But his comment generated so much backlash that, a few days later, Republicans quietly amended the bill to add an exception for rape and incest victims. Franks’ bill passed the House but was never taken up by the Democratic-controlled Senate. A spokesman for Franks told Talking Points Memo later that the congressman meant to say that abortions of pregnancies that resulted from rape were rare.

Rape is like a car accident: It calls for “extra insurance.”
Legislation that banned Obamacare health insurance plans from covering abortion was all the rage this year. Nearly half of all statehouses passed some form of a measure forcing women who wanted abortion coverage to purchase it as a separate abortion-only policy, called a rider.

Some of these state laws, including one the Michigan Legislature passed this month, did not include exceptions allowing insurance to cover abortions in cases of rape or incest. This May, when asked why should women be forced to pay extra to cover their abortions in these cases, Barbara Listing, the president of Michigan Right to Life, explained, “It’s simply, like, nobody plans to have an accident in a car accident, nobody plans to have their homes flooded. You have to buy extra insurance for those.”

Listing’s statement generated a lot of outrage—but it didn’t matter to Michigan legislators, who passed the ban anyway.

Male fetuses masturbate at 15 weeks—proving the need for an abortion ban.
Rep. Michael Burgess (R-Texas) said as much while defending that same 20-week abortion ban that inspired Franks to doubt that rape causes pregnancy. Burgess, who is a pro-life OB-GYN, told a House committee that he was positive fetuses could feel pain at 20 weeks after conception, despite a medical consensus to the contrary: “Watch a sonogram of a 15-week baby, and they have movements that are purposeful,” he said. “They stroke their face. If they’re a male baby, they may have their hand between their legs. They feel pleasure. Why is it so hard to think that they could feel pain?”

Transvaginal ultrasounds are not intrusive because women get “vaginally pregnant.”
In February, abortion rights foes in the Indiana Legislature pushed a bill that would force women who wanted to use an abortion pill to end their pregnancies to undergo not one, but two medically unnecessary ultrasounds—one before taking the pill, and one after.

Many Indiana residents found the idea of forcing doctors to probe women for no good reason to be repugnant. But Indiana Right to Life legislative director Sue Swayze didn’t see the problem. “I got pregnant vaginally,” she said. “Something else could come in my vagina for a medical test that wouldn’t be that intrusive to me. So I find that argument a little ridiculous.”

The Indiana Legislature removed the second ultrasound—but not the first—from the bill before it eventually became law in May.

Moving across state lines while pregnant is “reprehensible.”
Earlier this year, Olympic skier Bode Miller and his short-term girlfriend Sara McKenna became embroiled in a nasty custody battle over their newborn son. Miller—despite skipping McKenna’s prenatal appointments because, as he texted her, “U made this choice against my wish”—fought for custody of the child after a pregnant McKenna moved from California to New York to attend Columbia University.

Miller briefly prevailed in May when a New York family court judge found McKenna’s “appropriation of the child while in utero”—i.e., her decision to move while pregnant—to be “irresponsible, reprehensible,” and just shy of abduction. The decision incensed women’s rights advocates. A five-judge appeals panel reversed that decision in November, explaining, “putative fathers have neither the right nor the ability to restrict a pregnant woman from her constitutionally protected liberty.”

Rape is okay when the victim seems “older than her chronological age.”
Montana Judge G. Todd Baugh caused a scandal this year when he sentenced teacher Stacey Rambold, 54, to just 30 days in prison after Rambold was convicted of raping a 14-year-old student. But Baugh was resolute in the face of a national outcry. He told the Billings Gazette that the student, Cherise Moralez, was “as much in control of the situation” as Rambold, and was “older than her chronological age.” Moralez committed suicide while Rambold’s criminal trial was ongoing.

Baugh later apologized for his remarks, although he did not apologize for his sentencing decision. And in his apology, he took pains to explain that he didn’t think Rambold’s crime was that bad: “I think that people have in mind that this was some violent, forcible, horrible rape…It was horrible enough as it is, just given her age, but it wasn’t this forcible beat-up rape.” Montana prosecutors are still fighting for a harsher sentence for Rambold—who finished serving his 30 days this September.

Pregnant women are just “little girls” who don’t understand their own bodies.
Supporters of mandatory ultrasounds or waiting periods for women who want abortions often say they want women to fully contemplate the consequences of an abortion before having one. It’s a patronizing sentiment—especially when articulated by Greg Brannon, a pro-life North Carolina OB-GYN and a GOP candidate for the US Senate. Brannon, a Rand Paul endorsee, has described pregnant women as “little girls who don’t understand what’s going on to their bodies”—adding that if they show up to his office with their boyfriends, he will “whoop on them with love” to get married.

Rape exceptions to abortion bans are “little gotcha amendments.”
There are those who think that placing rape and incest exceptions in bills restricting abortion access is a common-sense nod to overwhelming public opinion in favor of these exceptions. Others think proponents of abortion rights only harp on rape and incest exceptions to embarrass abortion foes.

GOP Kansas Senate Majority Leader Terry Bruce is among the latter group. This spring, his party advanced an omnibus abortion bill that would have defined life as beginning at conception. As Democrats proposed amendments, including exceptions for cases of rape and incest, to make the bill less draconian, Bruce said, “These amendments are little gotcha amendments. I’m getting a little irritated at it.”

Getting an abortion after being raped is criminal evidence tampering.
In January, Republican state Rep. Cathrynn Brown of New Mexico caused an uproar with a bill to make obtaining an abortion in cases of rape or incest felony evidence tampering punishable by up to three years in prison.

Brown quickly clarified that the bill was only meant to give prosecutors a means to go after rapists. But you’d be forgiven for fearing that the legislation could be used to target abortion providers or rape victims themselves. The bill defined tampering with evidence to include “procuring or facilitating an abortion, or compelling or coercing another to obtain an abortion, of a fetus that is the result of criminal sexual penetration or incest with the intent to destroy evidence of the crime.”

The bill, introduced to a Legislature controlled by Democrats, was doomed from the start, moving Huffington Post‘s Kate Sheppard to call it “some world-class trolling.”

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The 9 Worst Things Said About Women, Abortion, and Rape in 2013

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