Unintended Consequences of a Single Payer System

Unintended Consequences of a Single Payer System


Maggie Mahar has an interesting observation in Sunday’s Washington Post:

If you’re a progressive like me, and you’re upset by the Stupak amendment, which bars federally subsidized insurance from covering abortions, consider this: What if we had a single-payer health-care system and someone like Jeb Bush or Sarah Palin were running the country?

The Stupak amendment is often described as an extension of the long-standing Hyde Amendment barring the use of federal funds to directly fund abortion. Since 1976, the Hyde Amendment has enjoyed broad support among the public, including among many pro-choice people. The sentiment seems to be summed up in the statement that “you can have an abortion as long as you don’t ask me to pay for it.”

But the Stupak amendment, part of the recently passed House health bill, the “Affordable Health Care for America” act, HR 3962 (PDF file), actually goes much farther than just banning direct funding of abortion.

HR 3962 sets up an “insurance exchange”, where private insurers would bid on individual coverage. The intent is to give individuals the same buying leverage as a large company. Sounds like a good idea, and pretty close to the “free market” solution many of us would like to see. The insurers would be standard health insurance companies like Kaiser, Aetna and Health South. Because some of the people looking for insurance would get a federal subsidy based on income levels, none of the policies issued, by private companies and paid for by individual citizen’s funds, could cover abortion services.

So if you earn $200,000 a year, and pay for every cent of your insurance policy, the federal government is stepping between you and the insurance company to prohibit coverage of abortion. Yet, many of those policies do currently cover abortion (it is, after all, cheaper than a live birth, and these are insurance companies we’re talking about).

As a pro-life Republican, I’m delighted by this amendment. But I also see the same danger as Mahar, perhaps for a different reason. I see the reach of the federal government into health care decisions as necessarily chipping away at personal freedom. Freedom to do legal things, to have an abortion, smoke a cigar, or be fat.

Mahar provides an example:

With such an administration in power, social conservatives might move to exert pressure on health-care decisions beyond abortion. For example, could women be told that their government insurance won’t cover birth control? In 2001, President George W. Bush proposed eliminating the requirement that all Federal Employees Health Benefits plans include coverage for contraception. At the time, Susan Orr, who would later become Bush’s deputy assistant secretary of health and human services for population affairs, applauded the president’s suggestion, saying: “We’re quite pleased because fertility is not a disease. It’s not a medical necessity that you have [contraception.]”

I’m glad someone on the left has seen that centralizing power necessarily means that freedom is lost, bit by little bit. Trading freedom for security is often a poor bargain, even when the security is “health care for all”.

Cross-posted to FrankHagan.com

  • http://sovereignmind.wordpress.com Mike

    “But the Stupak amendment… actually goes much farther than just banning direct funding of abortion.”

    The amendment allows for private plans to be offered in the exchange that cover abortions but people who qualify for subsidies can’t buy them. The amendment also allows rider insurance to be purchased that that covers abortion. Considering insurance companies have a financial incentive to offer this coverage, I see nothing in this amendment that would prevent someone from getting coverage for abortion if they want it.

    But regarding the main point of your post: I agree. The Republicans have been saying all of this time that this bill means that the government will have its nose in your private health care decisions. I think they’ve exaggerated that claim, but it is ironic that now we are seeing what pro-choicers would describe as the government sticking its nose into private health care decisions, and before the bill has even been made law.

  • Brain

    This post needs a correction. The phrase “pro-life Republican” should be changed to “anti-choice Republican”. Thanks!

  • Jim F

    As everyone knows,the common laborer is still starting out under $10 an hour. With inflation as high as it kept gooing in the past 25 years,how do they expect anyone to pay for any insurence? They already know people are loosing their homes with state taxes and other things to keep living. These people better go back to school.

  • Jim F

    You always make it hard to comment on purpose. This is where i quite as you keep taking it off. This is the third time. And i put down what the passward said too. What party are you from?

  • Chris

    I think if the government made it illegal for republicans to be fat, then maybe no abortions would be a good trade off.

  • http://frankhagan.com Frank Hagan

    Mike, thanks for the clarification. I had thought that none of the “standard plans” offered in the insurance exchange could cover abortion based on the early stories I read. The reasoning was that the ability to be able to offer your product in the exchange was a form of government subsidy. A kind of “marketing subsidy” to the companies if you will. But many of the editorials I have since read do clarify that its the individual buying insurance within the exchange with “federal affordability credits” that would be directly affected.

    Of course, the “chilling effect” is still present, and I doubt that the plans offered through the exchange will offer the coverage at all. With all the new mandates placed on the insurers, I doubt there will be any “freebies” included. That probably means that those with private insurance through their employers will drop the coverage as well if the exchange products must be “equivalent to” the private product.

  • http://frankhagan.com Frank Hagan

    Brian, I generally use the accepted terms for various political positions, even if I disagree with them. I don’t call abortion “murder”, even though I believe it is the taking of an innocent human life, because the generally accepted term is “abortion”. The use of non-accepted terms is unnecessarily confrontative, and wouldn’t be appropriate for use in a forum such as Donklephant.

  • http://godlessliberalhomo.blogspot.com/ libhomo

    The Hyde Amendment is misogynistic, fundamentalist, and racist. It should have been overturned years ago.

    If the Democrats push through an anti choice “healthcare reform” bill, I will vote party line Green in November 2010. I am so sick of militant, anti American fundamentalists abusing the political process to push through their Taliban style political agenda.

  • http://sovereignmind.wordpress.com Mike

    Frank: “I doubt that the plans offered through the exchange will offer the coverage at all. With all the new mandates placed on the insurers, I doubt there will be any “freebies” included.”

    Sure there won’t be “freebies”. But if it was profitable for the insurance company to offer abortion coverage as part of their plan before, I don’t see why it wouldn’t be profitable for them to do so (a) within the exchange in addition to their non-abortion covering plan (for a slightly higher premium of course, since it is covering an additional procedure), and (b) as supplemental rider coverage for those who do qualify for subsidies.

    I could go into more details but it’s off topic, and i don’t want to detract further from your main point of the post which I agree with.

  • http://centristcoalition.com/blog/ kranky kritter

    If the Democrats push through an anti choice “healthcare reform” bill, I will vote party line Green in November 2010.

    Since only democrats and republicans are viable, you subtract a vote from the liberal agenda of the democrats, which helps the conservative agenda. You’re stuck with the system, just like the rest of us.

    Go ahead, pretend the greens are viable and can impact the issues you’re complaining about. We save the best lies for ourselves, right?

  • http://sovereignmind.wordpress.com Mike

    kranky kritter,

    Third party candidates don’t have to win to impact the issues: http://sovereignmind.wordpress.com/2008/10/10/the-case-for-three/