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The Devil in the Details

In the important and seemingly endless health care debate, a crucial item that has rightly received much attention here is whether the Senate bill provides sufficient safeguards in the matter of not funding abortion on the part of the federal government.Despite the strong counter-position taken by the Bishops Conference, I am sufficiently impressed by the careful analyses of people like Peter Nixon and Matthew Boudway to think that in this prudential judgment of how pro-life principles may be preserved and hopefully strengthened, I can, in conscience, support the Senate bill in this respect.But I think it important to underline that this is a prudential judgment, based in part upon a personal, non-expert, reading of the material, but also on personal trust placed in those who seem to be both extremely knowledgeable and deeply committed to moral principles in keeping with the Catholic tradition. I certainly do not escape responsibility for that prudential judgment. May I also, respectfully, suggest that those who advocate for such a decision, in favor of the Senate bill, also bear an added responsibility for their advocacy.It might be of help, then, if all sides were to acknowledge the fallibility of their prudential judgment, and that it is entered upon with a certain salutary "fear and trembling," since so much is at stake.That said, there are other aspects to the bill that also merit attention, as this story from today's Washington Post indicates:

virtually everything House Democrats want to achieve in their package costs money. For example, Obama and House leaders have promised to increase government subsidies to help lower-income people purchase insurance, to fully close the coverage gap known as the doughnut hole in the Medicare prescription drug program, and to extend to all states the deal cut with Nebraska Sen. Ben Nelson (D), under which the federal government would pay for a proposed expansion of Medicaid.Meanwhile, House leaders want to dramatically scale back one of the most powerful deficit-reduction tools in the Senate bill: a 40 percent excise tax on high-cost insurance policies. Obama has proposed to delay implementation of the tax until 2018 and to limit the number of policies that would be subject to the tax.Obama and House Democrats have proposed to pay for their changes by raising Medicare taxes on the wealthy. They were hoping to reduce deficits further by incorporating Obama's plan to overhaul the federal student loan program to cut out private lenders.Those changes are unlikely to match the long-term savings proposed in the Senate bill, aides and lawmakers said, leaving House leaders scrambling to come up with additional sources of cash. Failure to comply with the reconciliation rules would imperil the package in the Senate and could cause big problems in the House, where the votes of many fiscally conservative Democrats hinge on the ability of health-care legislation to rein in soaring budget deficits.


Commenting Guidelines

Nancy said:"I am wondering if those of you who profess to be Catholic can explain why you would support a National Health Care Plan that would include insurance for elective abortions --"Let me ask you: are you covered by any private health insurance? If so, I'm willing to bet that it covers abortions, vasectomies and birth control meds and devices. Have you checked into that? If that is true, have you resigned from that plan? If not, then you are guilty of accommodating sin for your own benefit.If Catholics can impose their morality on a proposed healtcare program, why can't the Christian Scientists do the same? That would mean, of course, that there would be NO healthcare coverage for anyone. Goose, gander.Full disclosure: I am not now, nor have I ever been, a pope, cardinal, bishop, priest, nun nor transvestite.

"Jim, so you have compromised your integrity and your faith, according to the criteria you impose on Grant and Commonweal."David G - if you really want to prolong this, you'll need to connect the dots for me.I don't know of any particular reason you should believe anything I say, whether I am a deacon or not. Ultimately my opinions rise and fall on their merits.

"Ultimately my opinions rise and fall on their merits."I think that is a good rule to follow for you, and to apply to others here.

David - agreed

"Ann, the intention of this Health Care Bill is to provide quality, affordable Health Care, AND to make elective abortions more affordable, despite the fact that we all know elective abortion is not Health Care."Nancy --We all know no such thing.

Nancy --Clarification -- I meant that we do not all know that the intention of this Bill is to make elective abortins more affordable. You are begging the question.

"Let me ask you: are you covered by any private health insurance? If so, Im willing to bet that it covers abortions, vasectomies and birth control meds and devices. Have you checked into that?"Current commercial health insurance plans sometimes charge women of childbearing age more in premiums and/or balk at covering pregnancy but happily cover sterilization and abortion. Several stories appeared in national media about this last fall. Here's a representative story from the Denver Post: a working woman's employer offers such a policy, can she switch to a different plan? Possibly. If an employer allows her to waive the company plan, she may get a small kickback that she could use to look for insurance elsewhere. But she will be outside of a group, and individual rates will likely cost far more than the coverage on the company plan. The picture doesn't get much better when a woman moves beyond child-bearing age. Women still cost more b/c of post-menopausal diagnostics that men don't get.

I will leave it to the liberals on the blog to identify the conservative minds fatal conceitI cant think of one!There it is!!That absence of self-criticism, and the subsequent desire to blame everything on somebody else, almost completely alienates and isolates conservatives. It creates a closed enclave of people who can identify with the speaker, while excluding everyone else.So don't sell yourself short Mark. You not only CAN identify the conservative's fatal conceit, you have identified it.

I have stated from the beginning that elective abortion is not Health Care because one can not be preserving Human Life while destroying Human Life simultaneously. No insurance policy should cover elective abortion because elective abortion is not Health Care. Since it is true that the Right to Life of every Human Individual is unalienable because this fundamental Right to Life comes from God, how can anyone support this National Health Care Bill, which will include an obtion to include abortion coverage, without denying The Lord and Giver of Life as well as the self-evident truths upon which this Nation was founded?

Nancy, who here is arguing that abortion is health care or that it's constitutional? As I understand it, here's the way the bill would work at the individual level:1. You will be required to buy insurance on your own if your employer doesn't offer it. If your income is low enough, you could receive help to a) purchase a policy or b) go on Medicaid. (Will more employers drop coverage in the wake of the bill? This is one of my concerns.)2. If a), then you will need to find a policy you can afford given whatever the government will offer you as assistance. If you have never had the dubious pleasure of dealing with insurance companies and agents looking for coverage, be prepared to take time off to deal with it. It can turn into a full-time job.3. If the bill requires that you purchase a policy that does NOT cover abortion, it will likely cost a good deal more because abortions are a lot cheaper for insurance companies to pay for than pregnancies. (So will your insurance be more affordable under the bill? Probably not if you are required to purchase a no-abortion policy.)4. If you CAN purchase a policy that covers abortions, of course there's nothing that says you must use that coverage. Moreover, there would have to be a mechanism in your government assistance that would take away whatever the abortion cost, because you can't use federal dollars for abortions.5. If you qualify for Medicaid, I think the rules are more straightforward; federal dollars cannot be spent on abortions. However, some Medicaid patients in some states have access to abortions through state funds.David Gibson (or anyone) please step in to keep me honest if I'm missing something in the above analysis.But, Nancy, I cannot see that what I have described would lead to MORE abortions than we have now--or any fewer abortions. The cheap and handy "abortion in a pill" methods now available make abortion within reach of just about anybody, whether they can afford health care or not. Sad, but nothing to do with the current bill.Where I do see negative effects (aside from those in this screed so far) is that there is no mechanism I'm aware of that would prevent your premiums from rising beyond your means if you get really sick. You could move to Medicaid if you lost your job due to illness, but it already takes months to years to get on that, and you could be dead and your family saddled with ruinous debt before that happened.The one benefit of the bill is that when everyone has health care, there will be fewer defaults on big hospital bills. And if that happens, the cost for medical care could go down, or at least stabilize.I think it's all a great big crap shoot. I dislike the bill. But as someone without insurance, I will take what I can get and hope for the best. Even though none of this will kick in in full for about five years.

" You will be required to buy insurance on your own if your employer doesnt offer it. "My understanding is that people such as myself who do not have health insurance but who do not want to purchase any can pay a tax instead. Is that not correct?

Jim--You got me--never saw that coming. ;-)

MAT, correct.You can opt out of the health insurance rules by paying a fee equal to 2 percent of your income.

The problem with an opt out is it defeats the purpose of insurance, which is shared risk. Moreover, for many people, paying 2 percent of their income is going to be significantly less than an insurance premium, and therefore an incentive to decline insurance. Rendering the bill even less effective.Rumblings in Michigan are that a GOP contingent in the Legislature is looking for a way to opt out of the bill's provisions as a state, en masse. If states are allowed to opt out, this will erode any benefits of the bill (which I think are already very weak and dicey) even further.On the other hand, as many have noted here, you leave an old lady like me off health care long enough, and I'm gonna get really sick with something that's going to get passed on to the rest of you one way or another. And the number of us old ladies is growing as age catches up with the Boomers.

"Current commercial health insurance plans sometimes charge women of childbearing age more in premiums and/or balk at covering pregnancy --"Back in the almost dark ages when I was a benefits manager, I head of a (thankfully short-lived) propsal by some health insurance companies to deny pregnancy claims because they were "self-inflicted injuries."I always suspected that was an urban benefits manager legend, but after spending as much time in benefits as I did, my suspicion wasn't too strong!If an insurance company can deny treatment for a baby born with a cleft palate because said injury is a pre-existing condition, all things are possible.

" --- elective abortion is not Health Care."Is a vasectomy, IVF, birth control or viagra health care? They are all covered by health insurance plans.

Jean, as I understand it, those who support a Health Care Bill that will include optional insurance for abortion don't care that elective abortion is unconstitutional and is in direct conflict with protecting the Right to Life of every Human Individual.So why don't you explain to us why it is necessary to include optional insurance for abortion in the Health Care Bill?

Nancy, I've outlined how I think the bill will work, where it's fuzzy on abortion, and why, though I am uninsured, I don't find it a particularly good piece of legislation. I've never said that it is necessary to include optional insurance for abortion. I do think that the bill will have a zero effect on abortion rates, and I've explained why.If you're seeking to engage with someone who wholeheartedly supports this bill and just doesn't care about whether it will increase abortions, I'm not your person.In the spirit of charity, let me say that if you have read the health care legislation as haphazardly as you seem to have read my last post, I think you hurt your arguments, and the cause of the unborn you laudably seek to protect. Arguing against the bills (and there's plenty to argue against) from an informed position will strengthen your assertions.Apologies in advance if I offend.

There are many people in this country who support a womans legal right to choose and have an abortion. They also believe this right should be covered under a healthcare plan, be it public, private or some combination thereof.You may not want your taxes to provide this coverage, but your taxes are used to fund many things with which you may not agree: undeclared wars, public schools, roadways, welfare, government monitoring to banks, mutual funds, food safety, etc. Everyone has her/his reasons for supporting some things and disliking others. Look at any community with a preponderance of retired seniors and youll discover a difficult row to hoe when it comes to getting school bonds passed. People complain about alleged excessive funding of roadways vs. public transportation.Bottom line: we hold our noses and go along with those things support by the many for what is viewed as the common good. Pro-abortion believers think that discontinuing unwanted pregnancies that have resulted from a variety of reasons is part of the common good.Like it or not, the vote tomorrow is not about a Roman Catholic Healthcare Program. It is about an American Healthcare Program that many people need and want and if it includes implicit or explicit funding for abortions, that is what will happen.

This vote is about honesty!! Now that it is over, I go back to my earlier comment on this blog: these politicians are not trustworthy. Even Stupak! And certainly Joe Biden who was looking for last-hour Catholic support? Here's a guy from Delaware who told everyone he was a Scrantonite to get the area's Catholic vote in the election! I spent twenty three years with these characters. Other than a few, they are dishonest to the core.

Jim, Biden lived in Scranton as a kid. He belonged to my parish. Won't vouch for his honesty beyond that, but he came by his Scranton roots the old-fashioned way. (It's "Scrantonian," by the way.)

I'm trying to remember when Biden ever lied to Scranton-area voters about how long he'd lived there or where he'd spent his adult years. By all means, don't trust him. But if politicking in his swing-state hometown during a campaign is the most crooked thing Joe Biden has ever done, he may be the most honest man in Washington.

Mollie - I knew he was raised here for a short time as I work in Scranton - but he's been in Delaware for over 50 years - Obama and he needed to hold onto PA, thus, Biden pushed his roots - however, he was pushing his Catholic roots though he supported partial-birth abortion - he is a "Scrantonian" when he needs their vote and he is the "everyman" who takes the Amtrak - I worked in Washington DC and spent some time on the Hill and do not trust any of these people - limited government equals limited corruption