Why the restriction on abortion in the health care bill is unfair.Rep. Bart Stupak
(D-MI) tussled with his party's leadership in the House of Representatives for months before finally making an actionable threat: give me a floor vote on an abortion-restricting amendment, or I'll kill your health care bill. Under the terms of that health care bill, uninsured Americans will be required to purchase health insurance, and the government will partially subsidize those who can't cover the hefty price. The so-called Stupak amendment, which passed with the support of dozens of Democrats, forbids people who receive that government assistance from buying insurance policies that cover abortion.The pro-life argument for the dread Stupak amendment is pretty straightforward: If the government helps a woman buy health insurance, and she uses that insurance to finance an abortion, then the government is indirectly spending taxpayer money on abortions. And we can't have that because...a majority in Congress say we can't.So now, if Stupak and his sympathizers get their way, most, if not all women paying for health insurance will be forbidden from buying plans that cover abortions. What this will mean for the vast majority of women, who will continue to receive health insurance from their employers, isn't known. If over time most people enter the market to buy their own insurance, the impact could be farther-reaching than even Stupak himself foresees. But at least the government won't be "funding" abortions, right?The problem is that the argument for the Stupak amendment oversimplifies the connection between government money and abortions. Even before Stupak muscled his way into the health care fight, the government was never really going to be funding abortions. The government was going to be funding insurance-private insurance, for the most part-which is really just an intermediary tool for pooling risk and money to finance privately-provided health care services, including, in some cases, abortion.If you're opposed to abortion, and think the government should stay out of it, this may sound like a direct enough connection to justify the Stupak amendment. But there's a logical flaw at the heart of that position that hasn't been fully explored, and that can only be resolved if the government were to either criminalize abortion or end all welfare services completely.The problem with the Stupak amendment is that it assumes there's something unique about each individual dollar-that serial numbers are like DNA and government dollars are distinct from private dollars in a meaningful sense. But they're not. The insurance subsidies can't be used directly to finance other spending-a woman couldn't take her insurance tax credit directly to a grocery store to buy canned goods-but, like all welfare, the point of the spending is to ease up the burden for working Americans so that they're free to pay for other goods and services without going broke. This concept-fungibility-leads us uncomfortable places.Imagine for a moment that Members of Congress had decided that obesity, not abortion, was the nation's most pressing crisis. Americans are too fat, they'd say. Heart disease is a shameful epidemic. They could do a lot of things, in theory, to change peoples' behavior. But, of course, this is America, so taxes and blanket prohibitions are out of the question. Enter hypothetical Rep. Art Stupak, who has a different approach. Instead of battling to ban transfats, Art Stupak demands instead that poor people be forbidden from redeeming food stamps at stores that sell junk food. Government money, he says, shouldn't be used to finance heart disease and its causes.Let's say he wins. Soon, thousands of poor people will cash in their food stamps for Shredded Wheat, resulting in profits for the same company that makes Oreos. Isn't this also the same as government funding junk food? To really cut the tie, you'd have to ban junk food, or end the food stamp program. Anything in between would be an unfair half-measure targeted at the poor.Back in the real world, conservatives may not be a huge fans of food stamps in principle, but they would mock Democrats if they described the food stamp program as "government financing of Nabisco." And yet, this is exactly the gambit Bart Stupak and his allies are pulling in their quest to reduce abortions in this country.That their pet policy will disproportionately effect low- and middle-income women is, for them, an unavoidable side-effect, and an afterthought (if by some curse or miracle, 65 year old, voting women started becoming pregnant, would Stupak be so cavalier about forbidding Medicare from financing abortions?)Now take the logic one step further. Somewhere in America a poor woman on Medicaid is feeding her family with foodstamps, while saving up for an abortion. Obviously she can't redeem her foodstamps at Planned Parenthood, but the dollars are basically still interchangible, and if it weren't for those welfare programs she'd never put together enough money to pay a doctor to end her pregnancy. So is the government funding her abortion? If Bart Stupak had the courage of his convictions, he'd say yes. Welfare, he'd say, is incompatible with the idea that the government shouldn't finance abortions. But nobody says this, either because they don't believe it, or they realize that resolving the conflict would result in an unthinkable injustisce. So instead the fallback position becomes, "make it as hard as possible for the neediest among us to do things we don't like."The political opportunism at the heart of the Stupak amendment is precisely what makes it so incoherent. Private doctors and private hospitals provide abortions, and private insurers feel it's within their interests to finance them. Today
, anybody who has the money can buy such a policy, or they can buy abortions out of pocket. That includes rich men, and poor women on food stamps and people whose paychecks come from the government. Using Stupak's logic, and the logic of fungibility, the latter two groups of people are guilty of using government money to help fund abortions.In three years, millions of people will likely be required to buy health insurance. Subsidies are the price
the government has to pay to foist that requirement upon them. But the Stupak amendment treats the subsidies as a gift they give to women, conditional on their adherence to pro-life protocols. They've got it backward.