A Taxing Problem: Abortion and Health Reform


This article was originally posted on Huffington Post.

Last week, five pro-life Democrats, headed by Rep. Tim Ryan (D-OH), sent Speaker Pelosi a letter suggesting a "common ground"
solution to the abortion "roadblock" in health care reform. They
proposed that insurance companies neither be required to nor prohibited
from paying for abortion and that no federal subsidies be used to pay
for the procedure.

Ryan and his co-signers should be applauded for placing primary importance on the need to provide health care coverage to the more than 50 million
Americans who currently go without insurance and for being unwilling to
sacrifice health care reform on the altar of abortion politics. This is
in welcome contrast to the stonewalling and ultimatums coming
from Rep. Bart Stupak (D-MI) and his allies. But Ryan’s proposal is
based on a misguided and attenuated definition of government spending,
and it conflicts with what Americans want and expect from health care
reform.

Health care reform legislation does not contemplate
taxpayer-subsidized abortion. The bills under discussion essentially
propose a sliding scale premium to individuals and families based on
their income. Rather than offering a tax credit, voucher, or other form
of direct cash payment to help families purchase health care, the
government would offset lower premiums by paying the remainder directly
to the insurance company. By analogy, we’re talking farm subsidies, not
food stamps.

What’s more, when people purchase insurance, they buy a
comprehensive package of services they hope they will never have to
use. The whole purpose of insurance pooling is to offset risk, knowing
that not everyone will utilize every service covered.

The suggestion that a health plan might offer abortion coverage and it might be used by someone who might have paid a lower premium than someone else because the government might have
helped pay their premium is a horrible reason for Congress to carve out
an explicit exception to a bill that is otherwise entirely silent on
coverage options.

Understood in this light, the arguments about taxpayer-funded abortions are simply too tangential to withstand scrutiny.

Even if you share Ryan’s overly expansive definition of government
spending, whether we like it or not, taxpayers do not have the right to
specify how their tax money should be spent. I understand why people
would want to withhold their taxes from purposes they oppose, but our
system does not — nor should it — work that way.

The Constitution authorizes Congress to collect taxes to provide for the common defense and general welfare.
There is no footnote that says, "unless some of us disagree." All
Americans can surely think of at least one use of their taxes to which
they object — for some liberals, it might be the death penalty; for
some conservatives, the teaching of evolution in public school. There
are proper channels for disputing such policies, but attacking
government funding is not one of them.

The "common ground" solution here is to let the experts — not
politicians — decide what services should be covered. A recent poll
shows that Americans are extremely wary of having Congress or the
president pick and choose which medical services will be covered or
excluded in a new health care system. Seventy-five percent of
voters would rather have an independent commission of medical experts
and citizens decide these critical issues–Republicans are the
strongest supporters of this approach, with 78 percent in favor.

And contrary to the prevailing conventional wisdom, strong
majorities of voters recognize the full range of reproductive health
services–including prenatal and maternity care, contraception,
screening for cancer and sexually transmitted infections, and, yes,
abortion — as basic health care. They want those services to be
covered and would oppose any health care reform plan that does not include comprehensive reproductive health services.

Americans do not want politics to drive coverage decisions. In other
words, they object precisely to the type of food fight brewing on
Capitol Hill right now. A recent report finds
that the Millennial generation finds culture war issues such as
abortion much less salient to their lives than previous generations. It
is high time that Congress moves on from the culture wars too.

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  • alison-cole

    This is such an important discussion. I personally am an absolute pacifist, and it eats me up knowing that my tax dollars fund the Pentagon. I will march for peace, and I will continue to pay my taxes.

    Regarding health care reform, I absolutely agree that a panel of experts — including women who are not medical professionals, but consumers of health care — needs to decide what is covered and what isn’t. I hope they look at good science, showing that midwifery care is safe and cost-effective, and that abortion and contraception are necessary components of women’s health care.

  • invalid-0

    Here’s a “common-ground” solution: the free market. (No, not the HMO-laden, required-group-plan, monopoly system we have now that bears little resemblance to a free market.) How about a real free market, in which the consumer dictates his or her own care, and physicians and hospitals either provide the kind of care their customers want, or they go out of business.

    In a free market, there is no question of national dictates about “coverage.” There is no question of fundamentalist Christians having their earnings taxed to pay for an abortion, or Catholics having their earnings taxed to pay for the Pill, or environmentalists having their earnings taxed to pay for the birth of another Dugger.

    If health care is important to you–if you value being able to choose a midwife, a different vaccination schedule, long-term breastfeeding, homeopathic or herbal remedies, or a whole other host of options that are not mainstream–please think about who is going to be in charge of nationalized healthcare. Those “expert panels” are not going to include low-cost, high-touch care providers like midwives and naturopaths; they’re going to be made up of all the AMA, FDA, ACOG, etc., folks who are already destroying what used to be the best health care market in the world.