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The Irony of the Stupak Amendment

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Hello all. A recent move and career change means I’ve not been the most prolific of bloggers lately, but hopefully I’ll have more time, now that I’m settled, to pop in now and again. For those that don’t remember me, I run a right-of-centre trans-Atlantic group blog called The Crossed Pond. I’m a RiNO, for the sake of succinctness.

In any event, one of the most talked about aspects of the House’s passage of the health care bill on Saturday was the last minute addition of a rather significant concession. Namely, a number of pro-life Democrats and a few moderate Republicans have been worried about Tea Party rhetoric about “ObamaCare Funding Abortion!” and the like, and so they demanded the inclusion of an amendment offered by Rep. Bart Stupak (D-Mich) that reads simply:

(a) IN GENERAL.–No funds authorized or appropriated by this Act (or any amendment made by this Act) may be used to pay for any abortion or to cover any part of the costs of any health plan that includes coverage of abortion, except in the case where a woman suffers from a physical disorder, physical injury, or physical illness that would, as certified by a physician, place the woman in danger of death unless an abortion is performed, including a life-endangering physical condition caused by or arising from the pregnancy itself, or unless the pregnancy is the result of an act of pregnancy or incest.

Because the Democrats did not have enough votes to pass the bill without this small cadre of pro-lifers, the amendment was begrudgingly accepted, and we got our health care bill. Only now, of course, the people who fall into the public option safety net (i.e. the poor) will not be covered for elective abortions, as they would otherwise be in about 2/3s or private insurance plans and in some state Medicaid programs (though Medicaid federally is governed by a similar amendment, some states have bypassed that). Meaning, those most unable to care for an unwanted child and most likely to fall into that position will have to go out of pocket if they desire the procedure. And many fear that private insurers, now competing with the public option, will also have incentive to drop coverage of abortion.

Now presumably the people insured through the public option are currently uninsured, so one could argue that, as far as abortion is concerned, this is just the status quo. It is unclear how all of this would iron out in practice, as it is unclear whether the amendment even survives the Senate. Pro-choice progressives are livid, and with good reason. It’s bad law, if you ask me. Abortion is a legal medical procedure, and whether or not it is covered should be decided on a contextual, ideally case-by-case basis, a question to be settled between individual doctors, patients, and insurance boards (or whoever ultimately administers the public option), rather than a dozen or so Blue Dog Democrats in 2009. It should, in short, be decided on medical rather than political grounds. Liberals are right to cry foul in that regard.

But here’s the irony: the central argument against the public option in the first place is precisely what is being illustrated by the Stupak amendment. Namely, people will lose coverage (as will happen if private insurers drop abortion coverage, and in the case of those who go from private insurance or Medicaid in certain cases to the public option) and freedom of choice. You put medical decisions in the hands of bureaucrats and politicians rather than doctors and patients.

As William Salaten explains:

Welcome to socialism.

I don’t mean to exaggerate the House and Senate bills. They don’t nationalize medicine or set up a single-payer system. As socialism goes, they’re modest. But they do mandate, standardize, and subsidize health insurance. They mix public with private. And when you do that, you invite public-sector problems into matters that used to be nobody’s business.

One of these problems is that people don’t like their tax money being used for procedures that offend them. You may think that’s stupid. You may point out that your tax money is used for wars you don’t like. But you don’t have two or three dozen swing votes in the House. Pro-life Democrats do. They don’t have the clout to ban abortion, but they have the clout to keep tax money from paying for it.

Until health care reform came along, this wasn’t your problem. It was a problem for women who depended on public programs like Medicaid. But you wanted a better world. You wanted health insurance for everyone, and you wanted the government to help pay for it. Congratulations. You’ve brought the tax moralists into your life.

That goes both ways of course. It’s amazing to me that the same people who have been mewling about the loss of freedom that will occur under this health care plan are suddenly a-okay with taking away that freedom in the case of medical procedures that happens to offend them. And it’s not just abortion—those same social conservatives have pushed for the inclusion of language that may cover Christian Science prayer treatments. So, as has often been the case with Republican defenders-of-the-markets, freedom of choice is fine and dandy as long as it is, according to their morals, the right choice.

But liberals too need to understand that, when you put decisions like what kind of medical care is insured under the purview of a central, political authority, you will get central, political decisions. I have a number of hardcore progressives who comment at my blog, and one of the things that always leaves me befuddled is what often seems to be the central underpinning of their political worldview: namely, to centralize authority and instill regulations because people cannot be trusted. The inherent contradiction, of course, is the people who will be creating, manning, and administering said central authority are, of course, people too, prone to the same mistakes, errors in judgments, and corruptions as anyone else (only with more incentive to do so, because they have more power to parlay with). Or, to put that another way, the sort of Democrats who believe everything would be working just fine if the government were only staffed by 100% progressive liberals with everybody’s best interests at heart (good luck with that guys). The “representative democracy is great when everybody agrees with me” approach to governance. In this case, Democrats love the idea of a government-run health care program, because it never seems to occur to them that this same government-run health care program will also be run by conservatives—who make, on average, about half of government, and probably always will. So literally the first decision made by the new liberal health care paradigm is a social conservative one. News flash: that’s not a problem with social conservatism, it’s a problem with the mechanism that allows social conservatives to push their agenda on private citizens in an area they were previously kept out of because it was a market issue.

Salaten is right. The most fundamental criticism of government-run health care is perfectly illustrated in this case. Liberals have (or soon will) the central government-run health care system they wanted, and suddenly cry foul when that system takes a freedom away from individuals who had it in the market. And conservatives want to keep government out of health care—but by the way, now that we’re in it, can we outlaw abortion?

I’m against the amendment, and more-or-less for this health care reform, but in my view, both sides are getting what they deserve on this one.

Too bad it’s the public option patients who will suffer for it.