Healthcare and Abortion

On the always interesting Public Discourse , James Capretta engages the question of how a pro-life person should think about the ongoing debates about healthcare. The question was raised by Richard Stith in a web article for First Things , who made the arresting observation that a nationalized healthcare policy, one with heavy federal subsidies, creates a political opportunity: the extension of the Hyde Amendment to Obamacare. It’s a move that would dramatically reduce amount of insurance money available for abortions.

Capretta makes some sensible and important observations:

The issue of how a healthcare system addresses abortion provision is of course of paramount concern. Indeed, it is a necessary condition of an acceptable program that it not force Americans to subsidize the elective abortions of others. That is a non-negotiable first principle that pro-lifers have rightly made their top priority.

But for many Americans, including many pro-lifers, that is a necessary but not sufficient criterion for determining the acceptability of a reform program. There¹s much, much more to consider. For many pro-lifers, even if the new healthcare law were amended to include the Hyde Amendment (against funding abortion) and Weldon Amendment (conscience protections), the amended law would still be so flawed, because of what it would do to the American economy as well as American health care, that the only remedy is its full repeal and replacement with economically sound reform that is also pro-life. Of course, pro-lifers are under no obligation to share this point of view. It is not a precondition for pro-life sentiments. But neither are pro-lifers under any obligation to accept at face value the supposed benefits of the new law when reason tells them otherwise.

Capretta is surely right. There are lots of reasons to think the health reform bill does a great deal more harm than good, not only to our economy and deficit, but also to the quality of care. Hence the legitimate desire to repeal and replace.

That said, I’m not sure Capretta has grappled with Stith’s main claim, which is that pro-life politics in America ought to consider that fact that a deeper federal involvement in health insurance creates an opportunity.

This is counter-intuitive for conservatives, because we have good reasons to want to limit the expansion of government. But it merits close attention.

For a long time I’ve believed that our job is to elect people who will appoint and confirm judges who will overturn Roe v. Wade , after which we’ll fight out the pro-life cause in state legislatures, with a great deal but certainly not complete success.

Stith’s insight sparked a new thought for me, not one that supersedes or cancels the main goal of overturning Roe v. Wade , but instead one that opens up a complementary line of political attack on the culture of death—the use of expanded federal financing of health care as a lever to drive abortion coverage out of most health insurance policies.

It’s a fresh thought, one that hadn’t occurred to me before. And the more I think about it, the more I’m inclined to appreciate the political promise of Stith’s insight. Imposing the Hyde Amendment the heath care bill—whether the current one or whatever we have after a push to repeal and replace—is, I think, politically doable. And because politically doeable, a pro-life person might want the “replace” part of “repeal and replace” to feature a fairly expansive use of federal funding. For expanding the scope of federal funding is a necessary condition for expanding the impact of the Hyde Amendment.

An interesting thought, very interesting. Maybe some pro-life policy wonks should think about how to maximize the scope of the smallest amount of tax money into a market-oriented financing system for healthcare.