Monday, November 9, 2009

'What have here is a failure to communicate..." (Or: Why Moderates Are Stupid About Abortion)

When I wrote my first piece on abortion, I had intended for that to be the end of it... at least for the year. A great many people of all political stripes throw wood into that particular oven every day all over the internet and it's not my intention to simply talk about what everyone else is talking about. I try to stay on track with economic, social, and political philosophy and commentary and a heavy dose of social and political criticism. The abortion debate in America, as driven by the right wing (aided and abetted by the unthinking center), has very little to do with the facts or realities of abortion. I had meant to say so, communicate the facts, and be done for at least the foreseeable future. While I had mentioned abortion in a recent criticism of moderates and 'fiscal conservatives', it was in tandem with other personal rights issues.

Unfortunately, Michigan Congressman Bart Stupak (D) and Pennsylvania Congressman Joe Pitts (R) made it an issue again with an amendment that would bar even indirect federal funding of abortion by denying private insurers in the national insurance exchange the commercial freedom to offer abortion to their customers if those customers are receiving federal subsidies to help them purchase health insurance. It's worth nothing that this is an issue of commercial freedom as much it is an issue of abortion rights. Barring private health insurers from offering a legal medical service to paying customers is restraint of trade. This is also a medical issue, as it is precisely the sort of intervention by government in the patient-physician decision making process that Republicans claim to oppose. Dr. Ron Chusid makes precisely this point on the excellent Liberal Values. Southern Beale mentions this as well, and also offers the more traditional feminist criticism of the bill. I agree with both of them.

Now some of you who read me closely may accuse me of being inconsistent and waffling on this issue, because when I proposed my own health care plan I included elective abortion on a list of procedures not to be covered by a national health care plan. First, that was just that: a national health care plan, not a program of health insurance reform such as Congress is currently considering. Second, I specifically noted that only truly elective abortions should not be funded and that medically necessary abortions were not elective at all and should be covered. Period. If one is going to undertake a massive program to fund necessary healthcare costs (as I believe we inevitably must) then one is going to need to exclude a range of genuinely elective medicine in order to reasonably control costs. Several of the items I included on that list are male-specific medical services or procedures that currently are covered by most insurance. As a note, I think birth control medication should be covered by such a plan.

Private insurance is not a national health care plan, however. While I am no supporter of the lawless state of volia advocated by today's conservatives, I believe in the free market. If we are to keep health care, for the time being, primarily in the preserve of the market than we have no business restricting the supplier's right to sell the consumer what they want or the consumer's right to buy it. Even if the consumer is buying, partially, on the government's dime it is still the consumer and the supplier who must make the decision in question. The government's role is to ensure that supplier offers a quality product. Not to restrict the supplier from offering legal products to paying customers. As the public option is intended to compete in the free market with private health insurance, it must be empowered to offer its paying customers a full choice of legal products as well. Offering abortion coverage with the public option is not 'federal funding of abortion.' It is offering a paying customer a legal product.

I want to be clear that anyone saying otherwise is grossly in error or guilty of deliberate intellectual dishonesty.

I worry that it breaks the thread of my narrative and somewhat undermines my point, but most private insurance already does not cover abortion. Southern Beale has rather firmly and thoroughly described the real inequities in health insurance costs for men and women. One of the goals of health insurance reform, if we cannot yet get real health care reform, should be to establish a regulatory framework to eliminate such inequities rather than to legally reenforce them.

I am on record supporting insurance reform efforts in the short term because it would improve the current system and establish a precedent for future reform. In the most basic examination, any improvement over our broken system is radical improvement. However, it must be real improvement and the Stupak-Pitts amendment is reenforcement of much that is wrong with the current private health insurance picture. It is also a reenforcement of much of what is wrong with the current political debate on the issues of both abortion and health care.

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