Plus, a reader question about falling birth rates.
I’m Isaac Saul, and this is Tangle: an independent, nonpartisan, subscriber-supported politics newsletter that summarizes the best arguments from across the political spectrum on the news of the day — then “my take.”
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Today's read: 11 minutes.
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Quick hits.
- Secretary of State Antony Blinken is in Israel insisting a path to a Palestinian state be left open (The message). Separately, 300 people were arrested in New York after pro-Palestinian protesters blocked tunnels and bridges. (The arrests)
- Republican presidential primary candidate Vivek Ramaswamy has not qualified for CNN's Republican debate on January 10, won't be on the Illinois primary ballot, and has reportedly had several of his staffers seek jobs elsewhere. (The reports)
- Florida Republicans ousted state party chairman Christian Ziegler, who is facing allegations of rape. (The charges)
- Dr. Anthony Fauci is testifying behind closed doors today before a House committee on the pandemic response. (The testimony)
- United Airlines found loose bolts on several 737 MAX 9 airplanes, the same Boeing model grounded after a piece of fuselage blew off during an Alaska Airlines flight last week. (The discovery)
Shoutout to you and us.
In our 2023 Tangle survey, for the second year in a row the results showed what I imagine is the most diverse audience in political news. Roughly 41% self-identified as liberal or left of center, 31% self-identified conservative or right of center, and 28% self-identified as center or independent. I think it is a testament your open-mindedness that such a diverse group of politically minded people are all under one roof. Thank you for all your support.
Today's topic.
Gov. Mike DeWine and trans legislation. Just one week after vetoing a ban on gender-reassignment surgery, puberty blockers and hormone therapy for minors, Republican Ohio Gov. Mike DeWine issued an executive order that prohibits gender-transition surgeries for anyone under 18 at state hospitals or ambulatory clinics. Gov. 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 HB68 (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 and high school trans students from participating in sports that matched 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.
In the executive order, rather than ban the use of puberty blockers or hormone therapy outright, DeWine calls for a team of medical providers like bioethicists, endocrinologists, and mental health specialists 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 risks, as well as undergo a period of psychological counseling before receiving hormone therapy. The 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 DeWine to negotiate with fellow Republicans and work out compromise 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 at what age and how regularly gender transition treatments should be provided.
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 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.
Today, we’re going to break down the legislation, executive order, and the arguments about DeWine’s actions from the left and right. Then, my take.
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 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, Madeleine Kearns wrote “do better, DeWine.”
“Before DeWine’s order, Ohio Republicans were expected to vote to override his veto. Presumably, it’s 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,” Kearns said. “DeWine’s executive order is not a step in the right direction but a doubling down on his initial error.”
“In 2021, South Dakota governor Kristi 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.”
In The Hill, Harmeet K. Dhillon said “Gov. 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 Gov. 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,” Dhillon 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… But what he seems to be ignoring is who is pushing these parents into 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,” Dhillon added. “Ohio legislators must override Gov. DeWine’s veto of the SAFE Act and get serious about protecting Ohio’s children.”
In Hot Air, Jazz Shaw explored DeWine’s “U-turn on child trans surgeries.”
“I’m not generally a fan of executive orders and see them as an 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 just such a piece of legislation sitting on his desk since December 15th. And that bill went much further, stopping the prescription of puberty 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, 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.”
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’s staked out an incoherent position.
- Others attribute DeWine’s sudden pivot to increased pressure from the far right.
In Cleveland.com, Thomas Suddes 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 deindustrialization of Northeast Ohio; and the fact that many young Ohioans don’t see a future for themselves in their home state,” Suddes 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 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,’” Suddes 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 Houghtaling 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,” Houghtaling wrote. “Under the new set of 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 lifesaving care for transgender individuals,” Houghtaling said. What’s more troubling, though, is the lack of clarity on “why DeWine suddenly had a change of heart and decided to expand restrictions on gender-affirming care to Ohioans of all ages.”
In The Buckeye Flame, Maria Bruno said Ohio “need[s] a miracle” to prevent HB 68 from becoming law.
“Legislators are coming back early from their holiday vacations solely to take healthcare 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 the 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 during his press conference announcing the decision,” Bruno added. “That’s why we know this has nothing to do with wanting to protect kids — it’s pure partisan politics. Because if it were about protecting kids and following the facts, they’d 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.”
My take.
- Any time issues like this are divided so strongly on partisan lines, we should take a step back and think.
- I thought DeWine’s reasoning for his veto was strong, and overall I think the executive order he issued was a pretty good olive branch.
- There’s good reason to be concerned about this issue for minors, but I don’t think we need more government intervention here.
Before spilling any ink here I think it is important to call something out: The fight over this bill in Ohio is happening almost entirely along partisan lines.
An issue dividing Republicans and Democrats so neatly is a sign of just how tribal our politics are and how wired politicians (and we, the voters) have become to falling in line. On partisan issues like this one, there is a very good chance your own tribal politics are driving your opinion about who is right and who is wrong, so it's even 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 would say 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 and again in their practices.
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:
"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, in other circumstances, where the state overrules the medical decisions 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 while decent and smart people interested in doing the right thing have strong disagreements about this issue, his position is that the bill went too far in taking that control away from parents.
To me, the decision to veto HB68 — articulated from a clear and straightforward conservative lens, from a bonafide conservative governor — is the right one.
I want to be clear that taking that position does not simply absolve all care for 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 to not share or at least heed some of their worries.
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 permanent effects like fertility loss, and the fact that in rare cases trans adolescents "detransition" as adults, should be enough for these medical experts to advise caution. That reality is also enough to insist on holistic, incremental care.
For us non-experts, that should be enough to approach this very complicated issue with humility. And for the state, those risks should also provide a good reason not to make black-and-white, wholesale prohibitions on this kind of treatment.
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, 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 argument is less a "slam dunk" than it is just lazy and unconvincing. For starters, those laws exist because we have vastly 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 sensible prohibition on what kids can buy over the counter in a CVS.
For instance, it is also illegal for a minor to buy Adderall over the counter. Yet if a child is diagnosed with ADHD and their parents want that kid to take Adderall, we let them. That’s a better analogy — and a better one still is that teenagers can get breast implants, breast reductions, or facial cosmetic surgeries with parental consent.
As for the executive order DeWine signed, I actually don’t think it is that bad. 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 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 it’s flawed, too. DeWine’s executive order adds more restrictions to decisions transgender adults can make, which runs counter to the reasoning DeWine gave for vetoing the original bill. There is also a good chance it makes healthcare for trans people more expensive, a legitimate cost but probably a worthwhile trade-off in the grand scheme of improving care and safety for kids. That’s the kind of messy conclusion you’d expect when a governor bucks his own party, but I give credit to DeWine for thinking independently, vetoing the original bill, and trying to find some compromise.
Your questions, answered.
Q: What do you think of birth rates plummeting? If you think this is a negative to society what would you like to see policy (or culture) wise to change it?
— Shruthi from Charlottesville, Virginia
Tangle: On a personal level, let me just say I'm a little biased by the fact I'm 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’m 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 put the 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.
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. A shrinking population 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 birth rates are declining: New motherhood dread, parenthood dread, and an ideological gender divide.
In our second-ever Sunday edition, we shared a longform piece on how millennial women are dreading motherhood. That 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 feel 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. 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. 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 to this issue.
As for solutions, I don’t support government solutions for problems that don’t necessarily require them. And many of these problems contributing to the falling fertility rate are social issues, so I don’t think the government has to solve them. But the government can help. Extending the child tax credit or helping to make child care more affordable through policies like paid maternity leave would make the decision to have kids more appealing.
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 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. And in that context, some policy to make child care a little easier and more affordable might actually be enough to fully address it.
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Under the radar.
U.S. allies are seeking to increase their support for Ukraine amid signs another package from Washington may not come anytime soon, Semafor 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 than the U.S. Germany is even taking shots at France for not doing enough. Semafor has the story.
Numbers.
- 3,700. The approximate number of gender-affirming surgeries performed in the U.S. on patients ages 12-18 between 2016-2019, according to a study from JAMA Network Open.
- 26,000. The approximate number of gender-transition surgeries performed in the U.S. on patients ages 19-30 between 2016-2019.
- 510. The number of “anti-LGBTQ bills” identified by the ACLU across all U.S. states in the 2023 legislative session.
- 68%. The percentage of Americans who said they oppose puberty-blocking medication for trans children ages 10-14, according to a 2022 Washington Post-KFF poll.
- 62%. The percentage of Americans who said they support gender-affirming counseling or therapy for trans children ages 10-14.
- 58%. The percentage of Americans who said they oppose hormonal treatments for trans teens ages 15-17.
- 66%. The percentage of Americans who said they support gender-affirming counseling or therapy for trans teens ages 15-17.
The extras.
- One year ago today we wrote about Republicans nominating Kevin McCarthy for speaker.
- The most clicked link in yesterday's newsletter was Pew's 10 facts about alcohol consumption.
- Smart politics: 656 Tangle readers responded to our poll asking about Joe Biden's campaign speech with 57% saying he is right that Trump is a threat to democracy and smart to campaign on it. 5% said he's right but not smart to campaign on it, 25% said he's wrong but smart to campaign on it, and 11% said he's wrong and not smart to campaign on it. "The problem for Biden is that any mention of Trump guarantees the former president's name will appear in the media, which helps Trump's candidacy," one respondent said.
- Nothing to do with politics: In Florida, an aggregation of hundreds of manatees.
- Take the poll. What do you think of Gov. DeWine's veto and executive order? Let us know!
Have a nice day.
Over the course 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 (MAAP), 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 Brazil, but the decrease was shared across all nine Amazon countries. The slowing of 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 Amazon research collective. "These data show there still is hope for the Amazon," said MAAP director Matt Finer. Reuters has the story.
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