John Schwenkler is right about this post by Ross Douthat. It is,as Schwenkler says, honest and charitable.(Douthat's writing almost always is.) But on his way to making a good point about the relationship of the prolife movement to America's two major political parties, Douthat rather too casually dismisses Commonweal's position. According to Douthat, Bart Stupak deserves some prolife sympathy because he fought the good fight until the very last moment, when he finally capitulated by adopting the position of liberal Catholics like us and E. J. Dionne:
Here was a politician who embodies what a half-century ago would have been considered the sensible center in American politics economically liberal, socially conservative and whose politics represent a good faith effort to live out the social teaching of Americas largest religious body, the Roman Catholic Church. Yet who, in the political arena, really seemed to be on his side? Not the pro-choice left, obviously, which was willing to sacrifice the entire health care bill to the principle that nobody should have to pay for an abortion out of pocket. Not Stupaks fellow liberal Catholics (E.J. Dionne, the editors of Commonweal, etc.) whose attitude seemed to be, cmon, Stupak, just get with the program, and sign up for the compromise that a pro-choice White House wants you to live with.
In other words, Stupak only became an appeaser at the end, whereas we had been appeasers all along, so intent on promoting the Democrats' health-care reform that we were willing to settle for whatever compromise the Most Prochoice President in History was willing to toss us.In the context of the larger discussion now going on among prolifers, this is actuallya fairly moderate position -- and it is even moderately fair, at least to Stupak. But it getsthis magazine'sposition wrong by assuming that we understood the Patient Protection and Affordable Care Act the way Douthat seems to:
Yes, the executive order that Stupak accepted as cover for his pivotal health care vote is probably meaningless. And yes, the health care bill, as passed, effectively tilts public policy in a more pro-choice direction: The fact that women are required to write a separate check for abortion coverage means that public money isnt literally paying for abortion, but it doesnt change the fact that federal dollars are being spent in ways that make it much easier to obtain abortion-covering insurance.
Adverbs are doing a lot of work here. The executive order is "probably" meaningless; the bill "effectively" tilts public policy in a more prochoice direction; and though the federal funds won't "literally" pay for abortion, they may as well, since it will now be easier to obtain abortion coverage.
I understand Douthat's reluctance to offer apodictic judgments about what the new law will do. It's a very complicated piece of legislation. Much will depend on how it's implemented, and on how insurance companies andtheir customers respond to its provisions. Still, beneath Douthat's careful hedgework, one can just make out an important misunderstanding. He believes the Democrats' health-care reform tilts public policy in a prochoice direction because it makes getting abortion coverage easier. This interpretation has a certain plausibility: obviously prolifers don't want more people buying health insurance that covers abortion, not only because it could increase the number of abortions, but also because such coverage tends to normalize abortion, making it just another medical procedure. But in a country where elective abortion and insurance that covers it are both legal, any law that makes health insurance more affordable for those who now lack it will also make it easier to get abortion coverage -- or, because money is fungible, anything else that costs money. The Stupak amendment that Douthat presumably favors would also have made it easier, in this sense, for people to get insurance that covered elective abortion. They might have had to get it as a separate rider to their health insurance policy, but that would have been no more difficult than sending a separate check, which is what they'll have to do now.
For us, the real questionswere: Will the reform bill force more prolifers to pay for other people's abortions? And, above all,is the reform bill likely to lead to more or fewer abortions.
The answer to the first question is clearly No. The bill will make it less likely that people pay for abortion coverage without knowing it, as many insured prolifers now do. Anyone who gets his or her insurance through the new state exchanges will have to pay separately for abortion coverage. It will behard to do that without noticing. So, yes, it will be easier for many people to afford plans that cover abortion (or plans that don't), but it will also be easier for people to avoid such plans. And surely many people will avoid them, whatever they think of abortion. People too old or too male to get pregnant won't want them. Neither will women -- prolife or prochoice -- who are confident they'd never want an abortion. Nor those whowouldn't want an abortion to appear on their insurance record.
And does Douthat really think that a lawthat expands Medicaid, subsidizes private insurance for lower-income workers, and increases funding for community health centers won't lead to fewer abortions? Again and again I hear conservative prolifers say that there is no hard evidence that universal health care, or any other entitlement program, brings down the abortion rate. There may not be evidence hard enough to satisfy them, but it would be very surprising to most people if meeting some of the material needs of poor expectant mothers did not make it less likely that they would choose to have an abortion. Indeed, this is the premise of any prolife effort to provide medical care and material support to pregnant women in distress. If providing such support does nothing to reduce the number of abortions, then crisis pregnancy centers are wasting their time.
To believe that the federal government should not participate in such efforts is to believe it should not do all it could do to lower the abortion rate. Whatever reason someone might have for such a belief, it would not be a prolife reason. One might believe that government efforts to help the poor are always inefficient or ineffectual -- that whatever the state can do private charity can do better if only the state will get out of the way. No doubt many prolife Americans do in fact believe this, not because they are prolife but because they are small-government conservatives. But no one who knows anything about poverty and abortion would deny that the two are related, and no one who has studied the health care bill would deny that, whatever else it does or fails to do, it greatly increases the medical resources available to women who may worry they can't afford to have a child.
If Stupak switched sides, then, it wasn't from prolife principle to appeasement; it was from one way of reading the Senate bill to another, the way we had been reading it from the start. For us, it was never a question of compromising on abortion to push a reform bill we supported for other reasons. We think the bill Congress passed is a modest prolife victory -- even if most prolifers won't claim it -- and we're not surprised that many prochoice activists agree. No federal money will be spent on elective abortions, "literally" or otherwise, and billions of dollars will go to clinics that provide prenatal care to uninsured women (many of them illegal immigrants) who can't afford to pay for it. What's not to like?
About the Author
Matthew Boudway is an associate editor of Commonweal.