Dear readers, it has been one of those weeks. And so today I just cannot muster a response to this op/ed by Bart Stupak, defending his amendment to the health care bill — an amendment that limits reproductive choice and goes far beyond the already egregious Hyde Amendment. However, nothing would make me happier than to see it torn to shreds. Also, there is far too much misinformation out there about Stupak and abortion coverage in the health care bill, and you are a generally well-informed, well-read, well-reasoned and often funny and entertaining bunch.
So, fair readers: Attack away.
I’m pro-choice, but if it comes down to it and the only way we can get expanded health care access for the poor (many of whom are women) is to accept Stupak, I hope the pro-choice members of Congress will do what is right for the greater good and save this particular battle as a fight for another day. 95% of a loaf is far better than none.
It’s a pretty conservative article (small “c”). He’s not saying why federal funds shouldn’t be used to pay for abortion, he’s just hiding behind a “this changes nothing” stance. You can do that when you limit yourself to inaction, but actually proposing and passing a bill means you’re not just supporting the status quo, but acting to sustain it in the face of change. His tone is an aw-shucks red herring that tries to have it both ways: “I’m just a guy, working in a system that’s already out there” “Vote for me, I’m an abortion opponent, fighting the good fight.”
There’s been boatloads of discussion about how his argument in here ignores the economics of insurance (though those are a little less compelling without a Public Option). The problem with Stupak is essentially the same the problem that doctors have with the health care reform effort in general: the government is so big, and the number of people this will touch is so extensive, that it cannot help but define the industry norms in a way that government involvement does not, currently.
Here are some reasons why its effect will not be limited:
a) When there is half-decent public coverage available to everyone, employers have less reason to provide health insurance, so more people are going to be going through the government system than are currently uninsured. This, in fact, is the basis of President Obama’s appeal to people for passing healthcare reform: you may think you have insurance now, but you won’t in a decade or two. With fewer employers providing healthcare plans, and with taxes being levied on private plans (That was a proposal at one time. Is it still out there?), private plans will have fewer people across whom to spread administrative costs and health risks. Private policies will become more expensive, so anything private insurance covers but public insurance won’t is effectively taken away from huge swaths of women who currently have those coverages.
b) There tends not to be a whole lot of sympathy for people who have government jobs that include insurance. People with federal health insurance mostly can manage to scrape together the money for an abortion or for supplemental coverage. But let’s talk about people on medicaid and their experience under government-provided healthcare. Right now, several states provide supplmental state money for their medicaid programs to cover abortion for low-income women. To what extent will state administration of medicaid cease under these programs, and will states then have to pay private insurers to cover abortion? Will states have to set up state-run abortion clinics for women on federal-assistance plans?
c) The idea behind insurance is that risks are spread out among the group of people paying into it. Right now, employers pick insurance plans that are big mixes of coverages, and then employees can usually only pick among one or two or three options within whatever the employer selects. The result is that the costs of abortions, which are disproportionately performed on young women, are spread out among all age groups. When abortion becomes a matter of individual choice, and the defining characteristic of some suplpemental policies is that they cover abortion, those policies are going to be more expensive because only young(er) women will opt into them, so the costs won’t be getting spread up to older, and usually higher-earning, people (or to unmarried men). Again, this makes them more expensive, and takes them out of reach for many people.
d) compensation for many, if not most, specialties in medicine is driven by structures created by medicare, because the number of people on medicare and the structures set up by medicare for billing are so pervasive that everyone else has to slip into those. Do you know what nobody ever ever ever submits a reimbursement to medicare for? Abortion. Do you know why? Because nobody over 65 has abortions. That’s not so bad, because OB/GYN offices have lots of procedures not covered by medicare for which they operate differently– nobody on medicare gives birth, either. But once the government is setting up structures for compensation for OB/GYN offices that don’t include abortion compensation mechanisms, to what extent are offices going to built around common, easy-to-get-compensated procedures? Or, on a similar note, to what extent is abortion going to become a revenue-generating procedure once it isn’t hampered by insurance processes, and therefore become more expensive *again*? Thigns not covered by insurance are frequently viewed as shoring up the hospital’s bottom line since government and insurance reimbursements are so difficult to get for anything complicated or unusual and since the rates are dictated by fiat and not by the doctor’s actual costs and needs.
Let’s look at some other things in the article:
1) “I’m hopeful that the spirit of our legislation will make it into the final bill.” WHY, BART? He never talks about why it’s worth preserving/advancing the Hyde amendment.
2) His discussion of the Capps proposal: this may be the most disingenuous thing in the piece. He doesn’t understand why a proposal that was built around *guaranteeing* abortion coverage is different from one that *forbids* insurance coverage?
3) Re: those who receive government funds for policies can still use their own money to buy private policies. Cue “welfare queen” claims in 5…4…3…2… I mean, who would have the cash for buying a supplemnetal private policy and still receive government money for their basic policy? They’re setting up their future targets. Also, from an economics standpoint, that *IS* the same as government money paying for abortion, because the person only has the money to pay for the private supplement because their insurance cost was covered by the government! it’s not like there’s special money from the government that’s qualitatively different from the money the person then spends on the private supplement. Money’s a commodity– a dollar bill the government spends on your coverage is a dollar bill that stays in your bank account when it would have been spent on insurance. So that dollar bill the government gave you for your basic policy is the same as the dollar bill you end up spending on your supplemental plan.
The really disgusting thing to me is that the entire argument ignores later term, medically necessary abortions. The antis are so eager to obfuscate and slut shame that they don’t even acknowledge that the really expensive procedures won’t be covered until a problem has advanced so far as to be directly life-threatening. What kind of person poses a woman with a decision between a safe abortion now, along with bankruptcy when her insurance won’t pay for it because her life isn’t in danger yet, or a higher risk procedure in 3 weeks when her dead fetus has left her septic? Or forces a woman to choose not just between her eyesight or her pregnancy, but complicates the choice by making it eyesight + house and retirement savings vs. pregnancy. That’s just sick.
What I want to know is how he plans to cover all those babies that will be born because of his plan and the Hyde amendment. Oh, wait, he doesn’t..
Also, what I find appalling is the howling you’d hear if you took away the magic blue pill and urology coverage. Either everyone gets coverage below the belt or no one does. (And let’s not pretend erectile dysfunction is a medical condition, mmkay?)
What I want to know is how he plans to cover all those babies that will be born because of his plan and the Hyde amendment. Oh, wait, he doesn’t..
Also, what I find appalling is the howling you’d hear if you took away the magic blue pill and urology coverage. Either everyone gets coverage below the belt or no one does. (And let’s not pretend erectile dysfunction is a medical condition, mmkay?)
My (admittedly sketchy) analysis: Stupak’s arguments are basically all along the lines that, “Hey, insurance companies will still cover abortion, so poor people can choose to buy from them instead of the public option”: it’s a classic “let them eat cake” argument.
I may be wrong here, but I thought the whole point of health care reform was to provide coverage for those who can’t get it by paying for private insurance. So whatever Stupak might claim, his amendment clearly does intend to deny poorer Americans access to abortion.
At the time Stupak wrote his amendment, the public option and health insurance exchanges were still on the board. Health insurances companies would have less incentive to offer private insurance for abortions. The insurers want to get into the exchanges to get the poll of customers. Any public money that funded abortions would be against the law. It would be cheaper for insurance companies not to worry about the accounting hassle. Insurance companies are about profit. Not choice.
You know there’s a lot of things the government does that I don’t like, but they use my tax dollars for. I find it very silly that people think abortion should be exempt.
I also find it very silly that the government says its legal yet they feel the need to prevent people from getting one. I don’t see how the Hyde Amendment is constitutional.
“You know there’s a lot of things the government does that I don’t like, but they use my tax dollars for. I find it very silly that people think abortion should be exempt.”
I completely agree. And I have to love the completely obvious disparity between the attention focused on abortion shown by religious groups and the attention focused on other supposedly immoral government functions supported by taxes (like, I dunno, war and the DEATH penalty, as two really obvious basics).
We can talk about funding and policy and politics until we’re blue in the face, but the worst thing about the Stupak amendment is what it actually says about power. Stupak isn’t just about abortion, its about what power the government is going to claim in the private medical decisions of individuals who fall under their ever-expanding influence. Abortion is a convenient first target because of the politics around it, but its foolish to imagine that its anything other than the first attempt to use government payment as a cudgel.
What we’re talking about with Stupak is allowing the government to simply refuse access to certain legal medical procedures on the basis of politics and social engineering. Theres always going to be some asshole with a cause who is going to want to use the dollars flowing through a healthcare plan to control the behavior and choices of others. The HMOs did it to maximize profits, proto-humans like Stupak are using it to push the choices of Jesus freaks, and if you glance over at England you’ll see that every petty Nanny with a press release has an idea of how the government should use it’s involvement in health care to force someone else to toe a line. If we allow it to happen it will only get worse, especially with the precedent written in before the system is even established. The precedent Stupak sets is downright dangerous from every perspective outside of the worst kind of populism. Its a nightmare for progressives because it will reduce access to care, its nightmare for civil libertarians because it will endanger choice, its a nightmare for conservatives because it massively increases the government’s power to intrude.
Thats a scary sentiment. You hope that congress sacrifices the rights, and in all likelihood the lives, of some portion of the population in the name of the greater good? Stupak is going to reduce the liberty of everyone a little, of women a lot, and is going to directly cause the deaths of some. What you’re saying is that some women dying, and a whole lot more experiencing a real and material loss of liberty, is an acceptable trade in exchange for better health care overall. You’re saying that some kind of utilitarian calculus comparing the respective values of the lives, comforts, and rights of different people is not only possible but something other than morally repugnant. On another level what you’re saying is that women should shut up, take one for the team, and trust that the leaders who are throwing them under the bus today will help them tomorrow. You know, “if it comes down to it”, which is really code for “if it becomes politically expedient.”
This nation’s government doesn’t exist to promote someone’s idea of “the greater good,” it exists to protect the rights of it’s citizens. The very moment it stops doing that it becomes both illegitimate and dangerous. We aren’t supposed to compare the value of lives, we aren’t supposed to tell people to toughen up and bleed for the greater good, we aren’t supposed to restrict rights in order to advance someone’s cause. We’re supposed to resist because the bad guys never imagine themselves to be the bad guys. Jesse Helms honestly thought segregation was good for the South, Bush & Cheney honestly believed that they were saving this country and had God on their side, people who shoot doctors honestly believe they are saving lives. Once you open the door to that, you lose all control of what comes through.
Like I said, a well organized campaign against the blue pill ( and derivatives) needs to be organized.Those pills aren’t medically neccessary after all, and it’s the only way we can get Congress and the old fogeys to shut up about abortion.