“Fungibility” and Abortion in Health Reform: Irrational… But Effective and Dangerous

In their zeal to block virtually all coverage of safe, legal abortion services in health care plans, the U.S. Catholic bishops – and their organization, the U.S. Conference of Catholic Bishops – apparently will stop at nothing. They are now using the bizarrely flawed argument of “fungibility” to make their case. In brief, they claim that unless abortion is specifically, broadly and totally excluded from health care reform, taxpayers really will be paying for abortion services. This argument is so weak that it’s hard to believe a rational person would accept it, but it has worked in the past and may well work again.

According to dictionary definitions, “fungibility” is a property of a good or a commodity whose individual units can be mutually substituted. For example, crude oil, wheat, orange juice, precious metals, and currencies are highly fungible commodities.

How does that apply to women’s reproductive health services? In a recent letter to U.S. senators, Cardinal Justin Rigali, head of USCCB’s pro-life committee, stated that “federal taxpayer funds will subsidize the operating budget and provider networks that expand access to abortion" unless abortion is specifically banned.

In other words, funding any health care service – anything at all – could free up dollars for abortion services, unless abortion is specifically and across-the-board excluded from health care reform.

According to the Women’s Health Policy report of October 19, Amy Sullivan, writing in the October 18 issue of Time, explained:

In July, Cardinal Justin Rigali, then the head of USCCB’s pro-life committee, said the bishops wanted health reform that lacked "direct federal funding for abortion." Sullivan wrote that this "language was important because it seemed to match an amendment" by Rep. Lois Capps (D-Calif.) under which no federal dollars could directly fund abortion procedures. "An individual could obtain an abortion if her insurance plan covered it," Sullivan explained, "but the procedure would be paid with segregated dollars from a pool funded by privately paid premiums." Democrats felt confident that the Capps amendment would clear the way for the bishops’ support of health reform, but a few weeks later, Rigali sent a second letter claiming that funding to insurers is "fungible, and federal taxpayer funds will subsidize the operating budget and provider networks that expand access to abortion."

The fungibility doctrine has been used successfully before, to restrict U.S. taxpayer dollars from going to clinics in the poorest developing countries that provided family planning services. The argument was that by funding birth control, the U.S. would be freeing up money for abortion. The reality is that 70,000 women a year die in developing countries from unsafe abortion and there are five million cases of severe complications each year. By funding birth control, we would limit unintended and unsafe pregnancies and save lives. “Pro-life” legislators and groups such as the Catholic bishops’ conference that put forth the fungibility doctrine were – whether they meant to or not – contributing to the death of women from preventable, pregnancy-related causes.

In the U.S. health care reform debate over covering abortion services, “fungibility” is a doctrine being used by those who have no medical, health or moral grounds to stand on. It is a doctrine born of fear. It is difficult to imagine any religious or ethical sentiment that could justify it.

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  • crowepps

    Using this logic – “frees up money for abortion” – ANY federal support in ANY program shouldn’t be provided to ANY women because, for instance, student grants helping to pay for college tuition may “free up money for abortion” or emergency food and shelter money may “free up money for abortion”.

  • colleen

    It should be clear by now that The Bishops aren’t interested in effective reform and are collectively and in many cases individually interested in derailing the process.
    The Church has a big stake in the present day health care system. They own something like 15% of all US hospitals and I certainly don’t see them (or any other ‘pro-life’ institution) sponsoring free clinics like the recent ones in Tennessee and Houston nor do I see them offering a sliding scale fee structure like Planned Parenthood clinics offer. Indeed the recently built Catholic owned for profit hospital and trauma center just up the way turns away the poor and uninsured and sends them to a secular hospital 20 miles away.
    It would be interesting to see an analysis of the financial stake the Catholic church has in maintaining the present day dysfunctional system. Does anyone know of such a study?

    The only difference between the American anti-abortion movement and the Taliban is about 8,000 miles.

    Dr Warren Hern, MD

  • anne

    don’t see PP or the free clinics offering other types of outreach that the Church does either–including various help to the hungry and poor.  I know you are focusing on women’s reproductive rights here, so if that’s the focus one could say that perhaps PP should be helping to fund crisis pregnancy centers, like the Church does.  The Catholic Church does a really good job in helping many people all over the world who need help-and in many cases who would be left to die otherwise among many groups of people, many of them women and children.  This 15% and profits aside–tell me what the other organizations you mention are doing to come close to the outreach the Church does?  Also, does anyone have info on how the profits of PP compare to those of Catholic hospitals?  The Church is able to do many great things to help people without having to add or advocate something that goes entirely against their teaching: abortion.  And in fact, the Bishops are doing their job every time they speak against the public direct funding of it.

  • crowepps

    First, Planned Parenthood is not a church. They are not a ‘belief system’ run by a hierarchy but instead offer scientifically based medical services which women can choose or refuse. It’s my understanding that PP does refer women who decide that they don’t want an abortion to other agencies for help, but it isn’t their role to ‘provide other services’ than medical care in an effort to influence their patients’ decisions.

    The Catholic Church may do a really good job in some places helping the poor but how does the one thing influence the other? Because they do good work helping the poor in Indian it’s okay if they refuse to allow tubal ligations in Georgia at the only hospital within 100 miles? That’s the absolute opposite reasoning from the movement to defund PP from funds used for providing breast exams and PAP smears because a small portion of their services is abortions. Or, for that matter, from the Bishops failing to help the poor by holding the poors’ health care hostage until they’ve extorted a promise that women with problem pregnancies will be allowed to die as sacrifices to their doomed fetuses.

  • drdredd

    <blockquote>Catholic owned for profit hospital and trauma center just up the way turns away the poor and uninsured and sends them to a secular hospital 20 miles away.</blockquote>


    If that’s really the case, then the hospital is in violation of EMTALA and/or other anti-dumping statutes.  Go after them that way.