The Abortion Wars Heat Up

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As the Senate moves to debate the Senate health care bill, we're seeing another stream of opinion pieces that fall into the broad category of "Oh my God!  Who would have thought that a government run health care plan would make coverage decisions based on political considerations?" 

Most of them seem to come from feminists who blithely assume away concerns about the personhood of the fetus, and the staunch political opposition to subsidized abortion from those who lean towards the "person" side.  This allows them to spend 1,000 words or so having a completely irrelevant discussion of the disparate effects of the Stupak amendment on poor women, arguing that women's reproductive health care is too real health care, and similarly unrelated side points. 

Memo to authors: you could prove beyond a shadow of a doubt that women's health care is important, that this has a hugely disparate impact on women, that it will result in more women carrying unplanned pregnancies to term, etc . . . and that still wouldn't make a majority of the country want to pay for other peoples' abortions out of their tax dollars.  

Moreover, there is near-perfect overlap between the group of people who most fervently desires a national health care system, and the group of people who are "strong" supporters of abortion rights (don't want them to be illegal at any time for any reason).  This group thus has zero bargaining power, because at the end of the day, they are not going to walk away from this bill.  The pro-lifers can and will.  

(And no, you cannot get around this by arguing that the Catholic Church/evangelical liberals should care as much about the people who die from lack of health care as the fetuses killed by abortions.  Last time I looked, there were over 1 million abortions a year in the United States.  The most methodologically shoddy, activist-induced statistics on the number who die from lack of health insurance is 44,000, and the real number is much lower.  The abortion statistics, on the other hand, are carefully collected numbers from a pro-choice group.  Even if you only value a fetus as 1/20th of a person, the fetuses win.)

Moreover, abortion rights aren't really a good reason to walk away from this bill.  The women who genuinely can't afford $500 bucks for an abortion are the women closest to the poverty line.  Those women will be covered by Medicare, and they won't get abortion coverage anyway in most states.  The women who will be buying insurance on the exchanges presumably mostly do not have health insurance now, and thus are losing nothing if their new insurance doesn't cover abortions.  

The Joint Committee on Taxation does estimate that approximately 3 million people will exit employer-based health insurance for the exchanges, but almost certainly the majority of them will be people who are unlikely to be in need of abortion services, which are overwhelmingly consumed by a minority of women in a pretty narrow age band.  Right now only 13% of abortions are currently paid for by private insurance.

If insurers do take abortion services out of their coverage, then according to the model used by the CBO and the JCT, that will reduce the price of insurance, and that money will flow back into paychecks.   

Obviously, I am not saying that feminists shouldn't worry whether women will be denied access to abortion if this passes.  But the number of people who are going to lose access that they currently have, and therefore be forced to carry a pregnancy to term, is not likely to be all that large.  We're mostly talking about a modest number of women who will have to hand over several hundred dollars that they would really rather spend elsewhere.  The very small number of women who currently have access to abortion services, and will lose them, and cannot get together a few hundred dollars for an abortion in time--those women can easily be taken care of if everyone who is outraged by this makes a small donation to Planned Parenthood.

So I don't get the outsized reaction to all this--I mean, outside the professional interest groups, who of course are contractually obligated to get outraged about everything.  Fears that women will lose their current access to abortion often seem to be muddled together with frustration at not being able to expand access to abortion.  But anyone who was not seriously entangled in an opaque ideological cocoon could see that using government funds to help expand access to abortion was never. going. to. happen.  More people are against it than for it, and they're in a stronger bargaining position. 

I wouldn't mind the complaining so much except for one thing; it's actually absorbing the energy, and media attention, that should be used to debate a real setback for women's reproductive health: the current Senate bill apparently does not include routine gynecological care in its basic package of required services.   

Regular pap smears are the reason that cervical cancer is no longer a leading killer of women, and the exams can also help detect other problems that menace women's health and fertility.  Most of the women who leave their employer plans for the exchanges won't be getting abortions--but most of them should be getting annual exams.  Why not focus the movement's energy on something with a prayer of actually changing these bills for the better?

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Megan McArdle is a columnist at Bloomberg View and a former senior editor at The Atlantic. Her new book is The Up Side of Down.

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