The pro-choice argument against health care reform.

Science, technology, and life.
Sept. 30 2009 8:05 AM

Keep Your Subsidies off My Ovaries

The pro-choice argument against health care reform.

Still from CPR ad.
An ad by Conservatives for Patients' Rights

This week, the Senate finance committee is considering amendments that would bar coverage of abortions under federally subsidized health insurance. Pro-choice groups are up in arms. After all, says NARAL Pro-Choice America, "In the current insurance marketplace, private plans can choose whether to cover abortion care—and most do." If Congress enacts subsidies that exclude abortion, "women could lose coverage for abortion care, even if their private health-insurance plan already covers it!" The organization urges lawmakers to "vote against any plan that takes coverage for abortion away from women who already have it in their private insurance plans."

William Saletan William Saletan

Will Saletan writes about politics, science, technology, and other stuff for Slate. He’s the author of Bearing Right.

At the Planned Parenthood Action Fund, the message is the same: Pro-life meddlers "will not stop until access to abortion is completely eliminated—even in private insurance plans, the vast majority of which currently cover abortion." The fund concludes, "If we don't act now, women may find themselves worse off after health care reform passes than they are now." Ditto from the Center for Reproductive Rights: "Today, most private insurers offer abortion coverage, and it is critical that no healthcare bill backslide from the current state of affairs." If plans that cover abortion can't be subsidized, the center warns, "millions of women would … lose the benefits they already have."

The argument these groups make is perfectly logical: If you standardize health insurance through federal subsidies and coverage requirements, people might lose benefits they used to enjoy in the private sector. But that's more than an argument against excluding abortion. It's an argument against health care reform altogether.

The nuances of the abortion-coverage fight can be tricky, but the core of the problem is simple. Each side is willing to accept a compromise in which no federal tax dollars fund abortion. Pro-choicers have one definition of what this means: Federal money can subsidize any insurance plan, as long as the insurer doesn't use these subsidies to directly cover abortions. Pro-lifers have a more strenuous definition: Federal money can't subsidize any plan that covers abortions, since the insurer would simply take the money with one hand while writing abortion checks with the other. In a private insurance market, each side could stick to its own principles and interpretations. But a socialized market throws them together. To get what they consider neutrality, pro-choicers have to make pro-lifers pay indirectly for abortions. And to keep what they consider clean hands, pro-lifers have to make abortion coverage federally unsupportable and therefore, in a subsidy-dependent system, commercially nonviable.

So the left's argument against abortion exclusion is the right's argument against socialization. And this is no fluke. For 25 years, the central message of the abortion rights movement has been libertarian. In Arkansas, where the message was originally refined for conservative voters, it was explicitly linked to guns and desegregation: "The government is threatening to take away our right to own a gun and telling us where to send our children to school, and now they want to say that women can't have abortions—even if they're raped."

Does this left-right linkage matter today? To put it concretely: Will the uprising against government meddling in abortion coverage strengthen the uprising against government meddling in health insurance? We already know the answer, because we've seen this movie before. In 1993, President Clinton tried to subsidize and standardize health insurance. The proposal was different, but the same fight erupted over abortion coverage, and pro-choice groups made the same libertarian argument. "Politicians and strangers do not have the right to choose any woman's coverage for her," said a NARAL official. Planned Parenthood's president said Congress shouldn't be allowed to "pick and choose the services that are best for American women." But Clinton's plan was predicated on lawmakers and regulators choosing medical services for which everyone would be insured. The only way to avert this was to kill the whole plan.

And that's what happened. The famous Harry and Louise ads, sponsored by the Health Insurance Association of America, were carbon copies of the pro-choice message on abortion. "The government may force us to pick from a few health care plans designed by government bureaucrats," said one ad. "If we let the government choose, we lose."

What happened to Clinton is now happening to President Obama. "We don't want to turn health care over to a bunch of bureaucrats in Washington, who then will determine what kind of health care we have," says Sen. Orrin Hatch, R-Utah. An ad from the Americans for Prosperity Foundation declares, "Government should never come between your family and your doctor." Another ad, aired by the Campaign for Responsible Health Care Reform, concludes, "Expanded government control over your health. Tell Congress: Let's slow down." A third ad, sponsored by Conservatives for Patients' Rights, shows a bow-tied bureaucrat armed with a folder labeled "Federal Health Police." As he steps between a woman and her physician, wagging a scolding finger, the female narrator says:

Today, you make the medical decisions that are best for you, without government interference. But if Congress passes a government-run health plan, you could end up with government bureaucrats taking away your choices, getting in between you and your doctor and your personal medical decisions. It's not too late to put patients first. Say no to government-run health care.

When Clinton launched his health care initiative in September 1993, 38 percent of respondents in an ABC/Washington Post poll said the plan would create too much government involvement in the health care system. That was twice the number who said it wouldn't do enough. By March 1994, the percentage who said the plan entailed too much government involvement was up to 47 percent, triple the number who said it wouldn't do enough. Today, the percentage who say Obama's plan would usher in too much government involvement stands at 45. Just 12 percent say it wouldn't do enough.

The good news, if you're a pro-choice progressive, is that freedom-loving Americans will protect your private abortion coverage. The bad news is that they'll do it by killing health care reform.

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