A plea to grant health care reform a papal dispensation.

A plea to grant health care reform a papal dispensation.

A plea to grant health care reform a papal dispensation.

How to fix health policy.
Feb. 5 2010 7:09 PM

Dear Pope Benedict

A plea to grant health care reform a papal dispensation.

Click here for a guide to following the health care reform story online.

Pope Benedict XVI blesses faithful at the end of the Vesper ceremony in the St. Peter's basilica at Vatican.
Pope Benedict XVI

Dear Pope Benedict XVI,

I am writing to request a papal dispensation. Not for myself—I'm not even Catholic. My plea is for the Patient Protection and Affordable Care Act, more commonly known as the health care reform bill.

I'm not sure you even know this, but (apart from the Republican Party) no institution poses a greater obstacle to the passage of health care reform than the Catholic Church. The U.S. Conference of Catholic Bishops refuses to support a compromise the Senate reached on the question of whether private health insurers operating within the new insurance exchanges established under the bill could provide unsubsidized coverage for abortions. This issue gave both the House and Senate considerable heartburn when they debated health reform (click here for a helpful analysis of their respective approaches), but they pushed through it. Now, however, some parliamentary peculiarities affecting the U.S. Congress make abortion the single biggest roadblock to final passage.

Ordinarily, I wouldn't waste my breath trying to change the Catholic Church's views on anything having to do with abortion. But I'm emboldened by a letter the U.S. Bishops sent on Jan. 26 to members of the House and Senate urging passage of health reform. "Now is not the time to abandon this task," wrote Bishops William F. Murphy (Rockville Center) and John Wester (Salt Lake City) and Cardinal Daniel DiNardo (Galveston-Houston),

but rather to set aside partisan divisions and special interest pressures to find ways to enact genuine reform. Although political contexts have changed, the moral and policy failure that leaves tens of millions of our sisters and brothers without access to health care remains. We encourage Congress to begin working in a bipartisan manner providing political courage, vision, and leadership.


These words gave me momentary hope that the U.S. Bishops, whose role in health reform previously had been confined largely to promoting the House-passed abortion amendment sponsored by Rep. Bart Stupak and opposing the Senate-passed compromise, had decided to set aside their concerns about precisely how the health insurance bill would restrict abortions (as both versions do) to serve the larger goal of extending health insurance to somewhere between 31 million and 36 million of the 45 million Americans who currently lack it. Healing the sick has always been among the Catholic Church's highest priorities. In his 1981 encyclical "On Human Work," your predecessor, John Paul II, wrote, "The expenses involved in health care, especially in the case of accidents at work, demand that medical assistance should be easily available for workers and that as far as possible it should be cheap or even free of charge." The U.S. Bishops put this quotation on their Web site. Health care, they wrote in the Jan. 26 letters, "is a basic human right." Surely the U.S Conference of Bishops has no greater desire than the U.S. Congress to contribute to a "moral and policy failure." Surely it, too, can work in a cooperative manner and demonstrate "courage, vision, and leadership."

Unfortunately, the Jan. 26 letters went on to reassert the bishops' unyielding opposition to the Senate abortion language. "Disappointingly," they wrote, "the Senate-passed bill … does not meet our moral criteria on life and conscience."

Specifically, it violates the long-standing federal policy against the use of federal funds for elective abortions and health plans that include such abortions—a policy upheld in all health programs covered by the Hyde Amendment as well as in the Children's Health Insurance Program, the Federal Employees Health Benefits Program, and now in the House-passed "Affordable Health Care for America Act." We believe legislation that fails to comply with this policy and precedent is not true health care reform and should be opposed until this fundamental problem is remedied.

The bishops giveth, and the bishops taketh away.


It isn't even true that the Senate bill allows federal funds to be used for abortions. I won't go into the details here (if you're curious, see my Nov. 4 column "Don't Be Stupak"), but when Senate Majority Leader Harry Reid inserted the final abortion compromise language into his manager's amendment, he was assured by the Congressional Budget Office (whose authority in Washington approaches that of the Holy See in Rome) that the abortion provision had no budgetary effect. How could it have no budgetary effect if it allowed federal funds to be used for abortions?

Ironically, the very fact that the Senate bill's abortion provision has no budgetary effect is precisely what is keeping the entire health reform bill bottled up.

You got a minute?

The health reform bill is now in House-Senate conference. Prior to the Jan. 19 Massachusetts special election to replace Sen. Ted Kennedy, D.-Mass., it was assumed the bill would be sent with minor changes to the House and Senate for final passage. Somewhat unexpectedly, however, a Republican opposed to health reform won the seat, denying Senate Democrats a filibuster-proof 60-vote majority. OK then, House Speaker Nancy Pelosi reasoned, let's just grab the Senate bill and pass it; a few necessary changes can be made in a separate bill to be considered in the Senate under budget reconciliation rules, which do not allow for filibusters; 51 yeas would be sufficient. The Senate bill ought to be an easier sell to conservative Democrats in the House because the Senate bill is on the whole more conservative.


The problem is that the Senate bill's abortion provision is a smidgen more liberal than the House's. And precisely because it would have no budgetary effect, it is not permitted under Senate rules to be part of a cleanup reconciliation bill. So instead of a two-step procedure, Pelosi and Reid would need to arrange a three-step procedure: House adoption of Senate bill; reconciliation bill on most outstanding differences between the House and Senate; stand-alone bill substituting the Senate's abortion language with the House's abortion language. But could you really get majorities in either the House or the Senate for a bill that would consist entirely of the House abortion restriction, which most Democrats find abhorrent? It was one thing for them to hold their noses and support it as part of a larger health reform bill. It would be quite another for them to vote for a bill whose sole purpose was to limit the availability of abortions in the private sector.

Nate Silver, the brainy numbers-cruncher at FiveThirtyEight.com, did a little whip count on Jan. 27. He counted six likely House defections over abortion, and another six that were "possible." The first six are enough to block passage of health care reform; House Democrats can afford to lose only one vote. (The House bill passed with two votes to spare, 220-215, and one of the ayes, Rep. Robert Wexler, has since retired; a special election to replace him won't take place until April.) Balanced against these six to 12, Silver argued, are somewhere between three and 17 possible additions. The likeliest of these are two House Democrats who voted against the bill because it wasn't liberal enough (Dennis Kucinich of Ohio and Eric Massa of New York). After that, Silver's reasoning starts to sound like wishful thinking. Three House Democrats—Bart Gordon and John Tanner of Tennessee and Brian Baird of Washington—have decided not to run again, and therefore might (in theory) figure they have nothing to lose by switching their votes to an "aye." But there's no particular reason to believe these representatives' consciences are pro-reform. Separately, Silver judges three conservative Democrats to occupy a "top tier" of gettability: Rep. John Barrow of Georgia, Rep. Mike Ross of Arkansas, and Rep. Jason Altmire of Pennsylvania. Of these three, Altmire is probably the best bet. But even if Pelosi were to secure all three, plus the two liberals, that still wouldn't likely be enough to outweigh a mere seven defections over abortion. To overcome the abortion obstacle, Pelosi needs to pick up many more House conservatives who earlier voted no, and in the current climate of post-Massachusetts panic I don't see that happening.

But what if the six to 12 pro-life Democrats could be persuaded to support the Senate bill? That's where you come in, Your Holiness.

I'm going over the U.S. Bishops' heads because I don't see much likelihood of changing their minds. They're too invested in opposing the Senate bill. But you, Holy Father, aren't invested in any position at all, as far as I can tell. I know you're very conservative, but I wonder whether you really want your bishops mucking around in U.S. politics to quite this extent. Are you prepared to see the Catholic Church blamed for denying health insurance to 31 million to 36 million Americans? Primum non nocere.


The Catholic Church, I'm told, is a very hierarchical organization. A simple, private word from you to the U.S. Conference of Bishops would secure from that group a grudging public statement to the effect that the Senate abortion compromise, while hardly ideal, is tolerable under the circumstances. That, in turn, would give Stupak (a Catholic) and his followers sufficient cover to support the Senate bill. Nobody wants to be more Catholic than you.

If you like, you can let word leak out in a year or two or five that you played a key role in creating universal health care in the United States. Your predecessor gained considerable luster from his role in ending communism. This secular achievement would be somewhat less spectacular, but on the other hand your centrality to the outcome would be much greater. Alternatively, if you didn't want anyone to know about your role, you could tell the U.S. Bishops to keep their yaps shut. Catholic clerics have always been extremely good—sometimes a little too good—at keeping secrets.

Think it over.

All best,
Timothy Noah

E-mail Timothy Noah at chatterbox@slate.com.