It will be major irony if the Senate health care reform bill, an irresponsible, cynical, dishonest piece of legislation (any legislation that is 2000 pages, unreadable, and largely unread by those voting for it is, by definition, irresponsible, cynical and dishonest), fails because of its position on abortion. The bill is an abomination and deserves to fail, but not because of that.
I believe Roe v. Wade is a legal and ethical embarrassment, and that the day will come when civilized people look at the right to abortion on demand as we look today at slavery before the Civil War: an embarrassing and incomprehensible ethical lapse that somehow gained a cultural foothold and took decades to reform. Nonetheless, it is currently the law of the land. As such, it makes no sense to create a health care bill that exempts abortion, a medical procedure, from coverage. And yes, the Hyde Amendment, which bans using federal money to fund abortions, is also ethically senseless.
The arguments in both cases are the same: citizens with strong moral and ethical objections to abortion should not have their tax money pay for abortions. Really? Why? We don’t allow that with any other national policy. Tax money pays for wars, and many Americans have moral and ethical objections to wars. Tax money pays for capital punishment, subsidies for meat producers, support for polluting industries, bail-outs for financial institutions that many believe are intrinsically evil. Tax money supports experiments on lab animals, and pays the salaries of communist and anti-American college professors. It supports the administration of cruel prisons, pays for criminally inept school administrators, supports artists that many find obscene or blasphemous. Why should abortion, and only abortion, be the one legal activity that citizens can opt out of supporting with tax dollars? It fails the basic test of universality, which is applicable here. Is it desirable to make this principle universal? If the U.S. permitted every citizen to withhold taxes from national policies he or she found repugnant, there could be no government, and we would live in anarchy. Because that would be bad (it would, you know), the principle behind the anti-abortion movement against the health care bill is unethical.
This is a government by law and majority, even when the law and majority are dead wrong, as I believe they are on abortion. It is unethical to play these funding games with abortion, for three reasons.
- First, it is unfair for a vocal minority to diminish a right that the Supreme Court, erroneously or not, has said is guaranteed by the Constitution.
- Second, it is a cop-out, creating the illusion for those who oppose Roe that they can sit innocently on the sidelines, ducking accountability for abortions because their tax dollars supposedly aren’t sullied by them. Every U.S. citizen is accountable for the laws of the land, and it is usually when accountability for those laws become personally intolerable that effective movements build to change them.
- Third, the theory that citizens have the right to designate their tax money for only the policies they approve of is anti-democratic, undermining the integrity of our system of government by creating a legal way to violate the spirit of the law.
If the Senate health care is going to be defeated, it ought to be defeated on its merits, or lack of them, and not its failure to treat a legal medical procedure as if it wasn’t.
Ethics Alarms 
I’m afraid I have to disagree on your suggestion that abortions should be covered, and propose the following reconsideration:
Medically necessary abortions should be covered, just as medically necessary plastic surgery should be covered. But abortion is most often a purely elective procedure, just as a tummy tuck or a nose job is. We aren’t going to have insurance cover elective plastic surgery, so we shouldn’t have it cover elective abortions.
The rational approach would be to allow payments only for medically necessary abortions. As to what comprises medical necessity, I would contend that is a matter for doctors to determine. It is true that some doctors will be unethical and decide that an abortion is necessary when, in fact, it is not, but unfortunately, that is just the way of things.
If we are going to be about trusting doctors to make decisions, then we should do that. Hopefully, most doctors will adhere to the reasonable requirement that medical necessity be defensible, but if they don’t there’s not really much we could do about it.
I strongly oppose abortion, but as you say, Roe vs. Wade is the law of the land, stare decisis is a doctrine that would seem to apply, and no, people have no right to control where their tax money goes. They ostensibly do that by proxy at the ballot box, and if that doesn’t work out for them, they can vote for somebody else.
Theoretically and practically I agree with your approach, Glenn; realistically and legally, however, we can’t get there from here. The Roe v. Wade logic is predicated on the idea (disingenuous as I think it may be) that no human life is lost in the process, so distinguishing between “necessary” and “elective” is irrelevant; not only that, it’s impossible under the language of Roe. I see no constitutional way a judge could tell a woman that her “private decision” was “unnecessary.” It’s really either all or nothing. All is repugnant, but nothing makes no sense.
Wait a minute, now. The Supreme Court, if I understand it well, has said that women may have an abortion anytime they want it. Even if no human life is lost in the process, how does that make “elective” irrelevant?
Abortion is a medical procedure, is it not?
What I am talking about is a judgment by Congress to fund an abortion, not whether or not the woman has a right to have one. She can always have one under Roe, as long as she pays for it or has an insurance company willing to do so, or a physician willing to do it for free.
But how can you say that Congress must pay for a medically unnecessary procedure? They won’t fund other medically necessary procedures, like elective plastic surgery. Technically, there is no difference. A person has a right under the Constitution to have both procedures done.
Roe cannot reasonably be read to require an insurance plan passed by Congress to pay for an abortion just because it is a woman’s right to have one. At least, that’s how I see it.
I am very sure that under the current law’s logic, allowing a woman not to havea baby she doesn’t want (“choose”) to have is a necessary procedure, regardless of the reason. The reason may be cosmetic, but it’s not like cosmetic surgery. When the gestation is past the Roe limits and a balancing must occur, THEN the assessment of need (life or health of the mother) becomes critical. Not before. I can’t see that changing before Roe goes down, if that ever happens.
Okay, I got that, but we are still talking about Congress authorizing a payment here. We are not talking about Congress refusing to allow the procedure.
I can’t see why Congress could not draw the distinction, for reasons of payment, that Roe refuses to do.
If it is a medical procedure, and is not medically necessary, then Congress (or the random health insurance company of your choice) should be able to say “No coverage. Sorry.”
There is no rational ethical obligation, that I can see, that would require them to cover a medically unnecessary procedure. Or a legal one. Roe certainly doesn’t, at least as I understand it.
I’m dubious that any Congress could ever craft a distinction that would allow a male doctor to tell a pregnant woman that her abortion wasn’t “necessary.” What standards would you have? Is a single mother’s abortion “necessary”? A poor woman’s abortion? A rich, fat, single woman? A career woman? A teenager whose father will throw her out?
I understand, but the Congress doesn’t have to. It can simply use the words “medically necessary.”
Look, Jack, I totally get that my perception of necessary and unnecessary is subjective. But what is at stake here are not the things you mention.
I am sympathetic to all the cases you mention above, but you are the one who claimed that the Supreme Court’s reasoning was flawed, hence the result was flawed. But in the end, that is not relevant.
Roe established abortion as a right, but it is no more a right than any other elective surgery. And that is what it is in most circumstances, particularly the most objectionable.
It is just as easy for me to say that the women in question could not fail to be aware of the consequences of unprotected sex, given the current state of education, which nearly requires the handing out of contraceptive devices and all sorts of other sex education that you and I likely never had the advantage of.
In the end, we are talking about making a decision to cover an elective procedure. Nothing more, nothing less. If it is medically necessary, there should be no debate, and whether the doctor is male or female is of no particular moment — are we going to make the assertion that only female doctors are competent to make decisions about the necessity of an abortion? That seems to be where you are going with your argument. But even if so, the woman could certainly avail herself of that.
An elective procedure is an elective procedure. A woman may feel that she doesn’t want to have a baby. A man may feel like he wants his hair back. They may not seem equivalent, but they are. More than that, the man, at least, had no say in the loss of his hair.
We cannot conclude that the right to an abortion is the right to compel the state to pay for it if they decide to get in the health care business, or that it is less than ethical to constrain that payment to necessity. That is simply not logical, nor is it ethical, in my mind.
Glenn: I guess my sticking point is that abortion is different from other procedures, at least in the view of its advocates, which is the prevailing one. It may be life-necessary, personal liberty-necessary, even when it isn’t medically necessary. Realistically, I don’t see any way to bifurcate the necessity. I certainly agree that there should be a clear difference, but its not a politically tenable one.