Single-payer, abortion, and civil unrest
Among the many intractable issues involved in any switch to a “single payer” (or comparable) health care plan is that of abortion.
Under such a plan, would the taxpayers have to pay for elective abortions? No doubt some people think the answer is easy: “Just do it my way, and pay for them!” (or “don’t pay for them”).
Cooler heads know it’s not that easy.
If elective abortions were left out of a single-payer system – which by definition is a system in which only the government legally may pay for health care – the result would be the effective banning of abortion nationwide. The likely result would be widespread civil unrest. Very likely, also, the U.S. Supreme Court (which has ruled that the government may refuse to pay for abortion when there are other means of procuring them) would, in the context of single-payer, declare a funding ban unconstitutional.
But if abortion were left out of single-payer so that private funding was permitted, it would create a loophole in a system that, to work at all, must admit of no loopholes. The maneuvering would begin (“How can we argue that this is not an elective abortion so we can get the government to pay?” or “How can we get out from under the government rules by classifying this an abortion-related service?” And so forth.)
The most likely option, given the present political configuration in Washington, would be for the federal government to pay for all abortions. This would be a particularly dangerous course, and I don’t mean just for the unborn children. It could well be the last straw for many in the frustrated pro-life movement. It could trigger widespread civil disobedience, violence, even rebellion.
Fantasy? Not at all. One of the things that drove the abolitionists to fury before the Civil War was the belief that, not only was slavery being tolerated, but that they were forced to pay for it with their tax dollars. This helped create tragedies like John Brown’s raids and “bleeding Kansas.” Much more recently – in the Vietnam Era – there was widespread civil unrest because of violent disagreement with how the government was spending defense money.
But in the eyes of abortion opponents, slavery was “only” servitude – abortion is homicide. And defense can be paid for only collectively. There is no such excuse for government funding for abortion.
Wise statesmen avoid pushing things too far. Perhaps that’s one reason Senator Baucus says that a single-payer plan is “off the table.” For once, I agree with him.
Baucus is merely afraid of taking the enemy on head on – the insurance industry. If he’s a “statesman”, I’m a llama.
Seems to me that the Supreme Court’s ruling on the federal government paying for abortion was just and is the law of the land. Those who craft much-needed reform of our health care system have to follow that law – unlike Bush, I doubt the current administration will be nose-thumbers. And given teh corporate funding of both parties, what “reform” we see will include subsidies for the insurance industry, just like Baucus proposes.
Someday the right wing is going to have to come to grips with the fact that other countries manage to take care of all their citizens for half of what we spend. Their systems vary from single-payer to government provided care and mixtures of private insurance thrown in. But private insurance is always threatened by adverse selection, and insurers can only prosper when they are able to deny clients and care. That’s why our system is fundamentally broken.
Your stance on abortion is widely known. You are at odds with many world religions and most American citizens, who are capable of a more nuanced approach. Abortion has been with us since the dawn of time and will not go away, no matter heavy-handed movements to ban it. It is. It just is.
When doctors here form unions, like in enlightened European countries in response to nationalized healthcare, we will see the true benfits of healthcare reform… much the same way that the NEA and the NFT have brought quality education to every American child.
Uhhhh … ever heard of the AMA?
Mark T, so you are equating the AMA with the UAW and such. When has the AMA ordered a strike over or even bargained for wages, benefits, work rules and the like?
Mark, you keep talking about “half the cost”. Your objection is, in part, that the claims processing overhead of private insurance is 30% in the U.S. It’s roughly 10% in Canada (as I recall, correct me if I’m wrong.) So that’s 20% of the 50% differential. Where do we get the other 30%?
That’s not even a sensible question – you’re equating the systems. Think of it this way – 50% per capita of what we spend treats 100% of the population. We’re not talaking about a 20% difference – we’re talking much more than that.
I know where you’re going – you still want to cap lawsuit settlements.
That’s not a sensible question? Per capita is per capita by any measure. Where do we save the other 30%? Don’t hide behind your assumptions of me.
No – you’re wrong. Per capita costs in the US are the costs of caring for those who get care – not those who don’t, which are in the high millions. In other words, if you subtract the 47 million uninsured from the bottom part of your fraction, the number goes even higher.
Bullshit, Mark, the costs are Total costs per capita including those that are treated without insurance. The National Coalition On Health Care says that the government pays $100 billion/year to provide health care to the uninsured. They also say that an addition $70 billion +/- is paid by uninsured individuals and other private sources. That’s about 8% of total health care spending.
But let’s use the conservative principle. Assume that 16% are uninsured. What do we do for the other 14%?
Another thought. If I subtract the 47 million out of the equation then the per capita costs are more than 50% higher – which gives us more than a 30% cost differential – which means that there is even greater need to look at costs.
Still, no ideas on how to address that from you.
Whatever the approach, it is critical to me that it is self-funding. The French healthcare system is $14B in the red and sinking. Let’s not emulate and praise a sinking ship.
Baucus’s plan is already in effect in Mass. where everyone is required to get health insurance or pay a fine. That isn’t working out too well for them either, since people are still not participating. Other statewide systems like Tennessee and Hawaii went broke soon after implementing them, and California, well, we all know what is happening there.
Good intentions do not necessarily make a good plan. Absent drafting all the medical workers into the system and paying them a GS rate of some sort, Max’s plan is going to fail just as miserably. Amazing how we elect people who totally disregard reality.
Mark T said- “But private insurance is always threatened by adverse selection, and insurers can only prosper when they are able to deny clients and care.”
Funny how he thinks it’s bad when an insurance company limits care but has no problem when a government does it (ala Canada) by limiting budgets for CT and MRI facilities along with other forms of rationing. Americans think more of their care than Canadians do but we are to believe that their system is better based on cost alone.
http://www.gallup.com/poll/14638/Britons-Americans-Canadians-Diagnose-Healthcare.aspx