Barack Obama, Nancy Pelosi, John Dingell -- all over Washington, Democrats who once supported single-payer health care are calling Congress' stalled health-reform efforts "uniquely American." This poll-tested rhetoric is intended to reassure us that a small public-insurance option won't kill capitalism. And yet, the longer the health-reform debate drags on, the longer we have to notice that what's "uniquely American" about our health-care system may be what is least worth preserving, from the outsize influence of private insurers to the role of skinflint employers as health-care middlemen.
But perhaps the most surreal -- and American -- element of the health-reform debate has been the extent to which abortion politics have slowed the proceedings. Just as the United States spends a greater percentage of its gross domestic product on health care than any other industrialized country, yet has worse health outcomes, the notion that tax dollars shouldn't pay for abortions is an international aberration, an example of American exceptionalism run amok. If the Democratic leadership allows this conviction to set the parameters of our new health-care system, American women -- particularly the poor -- will pay a steep price.
Neither the House nor Senate health-reform bills mention abortion coverage. Both maintain the existing restrictions on federally funded abortions for women on Medicaid, federal employees, women in the military, Peace Corps volunteers, and female prisoners. Yet since June, abortion opponents have been sounding an alarm, since both proposals leave open the possibility that the new public-insurance option could fund abortion services, as 89 percent of private insurance plans already do.
Last week, influenced by Republican talking points, Fox News featured daily segments on the threat of "subsidized abortion." Soon enough, five moderate Democrats, several of them facing tough re-election battles in swing districts, wrote a letter to Pelosi advocating a so-called "common ground" solution that would ban abortion coverage in the public plan, yet allow private insurance plans to continue to offer the procedure. That idea won a powerful backer when President Obama told Katie Couric he would consider deferring to the "tradition" of "not financing abortions as part of government-funded health care."
Is this a reasonable compromise? Should women who choose the new public-insurance plan -- either because it's cheaper, or because they want a plan that will travel with them from job to job -- be denied abortion coverage? The suggestion is preposterous. After all, Americans with moral qualms about abortion are already financing other people's abortions through private-insurance premiums and co-pays -- it's called socializing risk. The American insurance industry offers abortion coverage not because these corporations are ideologically pro-choice but because it is cost-effective to do so. Abortion is far cheaper and safer than pregnancy and childbirth and prevents society from shouldering the cost of children parents aren't prepared to care for. President Obama has said his health-reform goals are to offer Americans more health choices, bring down costs, and make our society, as a whole, a healthier one. In that context, abortion coverage is a no-brainer.
Right now in the United States, an individual's range of health-care options -- on reproductive care or anything else -- is determined by her ability to pay, or to transport herself to the location where a certain medical procedure is legal and available. It's not that abortion is uncontroversial in other Western nations -- far from it. It's just that in Europe, government-funded health care is supported across the political spectrum and is how almost every citizen accesses care. Even the most influential and affluent Europeans would be affected by government limits on abortion access. Unsurprisingly, then, few such limits exist.
The Netherlands, for example, has the lowest abortion rate in the world, yet access to the procedure is relatively open. A Dutch woman can choose abortion anytime between conception and fetal viability, and the government will pay, as long as the abortion is performed at a certified clinic or hospital. In Canada, abortion is legal, fully funded, and available in every province except Prince Edward Island. In Britain last year, Parliament voted, across party lines, to keep abortion legal through the eighth month of pregnancy. In heavily Catholic Portugal, abortion was legalized for the first time just two years ago. Though the change was controversial, the government health-care system now fully funds abortions within the first 10 weeks of pregnancy.
That's not to say these other nations are utopias for reproductive rights. Reflecting fears of crashing birth rates, many European countries infantilize women by forcing them to undergo counseling before abortions, wait several days, or get two doctors to sign off on the procedure. Yet even those laws are less stringent abroad than they are in some American states, where doctors are required to deliver a scripted speech to women seeking abortions, sometimes including medical misinformation about supposed risks to the pregnant woman's mental or physical health.
If every American were going to be covered by government-funded health insurance, we wouldn't be debating this topic. While constantly grandstanding on abortion, our political elites have been surprisingly adept at making sure women with the ability to pay -- in other words, the daughters, sisters, and girlfriends of politicians -- will always have access to abortion. But by maintaining a system full of inequities, in which women with fewer options and resources are more likely to rely on the new public plan, Democratic leaders have allowed abortion opponents, once again, to hijack a policy debate. And that, sadly, is uniquely American.
