Well, the knives are out. Senator Bob Casey has come forward with a compromise proposal regarding federal funding of abortion in the health care reform bill and some pro-life advocates are already piling on. Mind you, no one really knows precisely what is in the proposal at this point, but why let a little thing like facts get in the way.
Douglas Johnson is so unrelentingly hostile and strident I think his group should change its name to the Nasty Right to Life Committee. He denounced Sen. Casey’s efforts in stark terms: "This proposal would break from the long-established principles of the Hyde Amendment by providing federal subsidies for health plans that cover abortion on demand. This is entirely unacceptable…This is an exercise is cosmetics -- like putting lipstick on a legislative warthog." I confess the reference to a warthog is a nice touch.
On the merits of the issue, incidentally, I happen to agree with Johnson. I think the idea of segregating funds in a non-starter. I also think he should have the decency to acknowledge, however, that thirty states use the segregated funds approach to provide abortion coverage for Medicaid recipients using state money and in many if not all of those states, there is really no effort to segregate the funds. The reason there is no effort is, I suspect, because money really is fungible as the USCCB has recognized. So, one of the effects of the health care debate is that we are realizing that the Hyde Amendment may not do what it purports to do, and that is worth looking at.
Theoretically, there is a way to segregate funds so that no federal dollars go to support abortion coverage, but the segregation of funds doesn’t really matter. If subsidized plans can cover abortion, there will be an increase in the number of people who have abortion coverage. But, it is not clear what effect that will have on the abortion rate: Only about 12% of abortions in America are currently paid for by insurance plans as most women prefer to pay out of pocket and maintain their privacy. Yes, some studies indicate that women who have abortion coverage are more likely to get an abortion but those studies do not apply to the current health care reform debate because only with the reform will all women have health insurance for childbirth! Johnson and his apologists at right-wing groups like CatholicVote.org and the American Life League are just as capable of distorting facts and arguments as is Sen. Barabara Boxer.
It also can’t be repeated too often that groups like NRLC and the American Principles Project and other right-wing outfits have contributed to the likelihood that the Senate will pass something that extends abortion coverage. Go to Mr. Johnson’s website and the heading says, "Stop Abortion and Rationing in Health Care!" Rationing? Of course, health care is rationed today. The concern about rationing is a GOP talking point and it gives away NRLC’s true objective which is to defeat the bill no matter what. Just so, as I have never tired of repeating, they give the Congress and the White House no reason to listen to them. They are going to oppose the bill no matter what. The USCCB, by contrast, has made clear that they want health care reform but that they can’t support a bill that extends coverage. The bishops bring something to the table which is why they get listened to.
The reason to oppose the extension of abortion coverage is not primarily a practical objection because no one knows how this health care reform will play out exactly. The reason to support the firmer language of the Stupak Amendment is that we think it is important that the government register the fact that, while abortion might be considered a constitutional right under Roe, it is not a procedure that we want to encourage in any way, shape or form. Even those who are committed to keeping abortion legal may have a deep and profound ambivalence about abortion, and the Hyde Amendment registered that ambivalence.
There is one other point here that needs to be made. Sen. Bob Casey is trying his best to find a way to advance the health care debate and to accommodate the concerns of pro-life advocates, indeed, to honor his own pro-life commitments. These issues are never as cut-and-dried as the zealots of left and right would have you think. I wish Casey would dig in a little more forcefully, the way others dug in opposing the public option, but I applaud his effort to keep negotiating. I am sure that any legislative language built around segregating funds will not pass muster with the USCCB and probably not with me either for that matter. But, the demonization of Sen. Casey is a Republican, not a Catholic and not a pro-life objective. Remember that next time you get an email alert from Mr. Johnson.
The whole "rationing" canard gives a clue to their partisanship. They are unaware that rationing by cost is endemic in the US health care system, moreso than any comparator country. If they want a country that provides universal affordable high-quality healthcare without rationing, they should look to France. But they don't do that, do they?
And it is sad that you have joined the club of denial over the massive abortion-expanding effect of a health reform bill that gives every woman free abortions (as ALL Democrat versions and "compromises" do): "Approximately one-fourth of women who would have Medicaid-funded abortions instead give birth when this funding is unavailable." http://www.guttmacher.org/pubs/MedicaidLitReview.pdf
Any bill that allows government funding of insurance plans covering abortion is a massive expansion of abortion. I am glad that "On the merits of the issue, incidentally, I happen to agree with Johnson." I hope you will stick to your promise to stand with the USCCB against abortion in health reform and against politicians who cause it to happen. Any Catholic liberal who won't stand by Stupak never really wanted pro-life Democrats in the first place, they just sold that bill of goods to get Catholics to vote for Obama.
Nelson told KLIN radio in Lincoln, Nebraska, Thursday that an attempt at compromise doesn't get to the fundamental issue of barring federal funding for abortions.
Nelson says without further changes the compromise isn't sufficient.
Catholic and anti-abortion groups have also weighed in against the new language, which attempts to separate public from private funding of abortion.
Democrats are wooing Nelson in order to get the 60 votes needed to pass a sweeping health care bill by Christmas.
But Nelson said abortion wasn't his only concern and he didn't see how the Christmas deadline could be met.
Since Senator Casey is trying to get people to endorse his proposal based on summary representations, we will respond on the basis of the information provided. If he thinks we have it wrong, then let everybody see the bill language.
Mr. Winters says that I lack ''the decency to acknowledge, however, that thirty states use the segregated funds approach to provide abortion coverage for Medicaid recipients using state money and in many if not all of those states, there is really no effort to segregate the funds.'' I must indecently point out that this is pure fiction. The Hyde Amendment explicitly prohibits any Medicaid fund from paying for abortions (except in cases of rape or incest, or to save the mother's life), and this prohibition explicitly applies to state Medicaid matching funds. A state can set up a program to pay for abortions with state funds, whether for Medicaid-eligible people or anybody else, and 17 (not 30) have done so, but when they pay for those abortions, it is not Medicaid per se but a state program (as Dennis Smith, the official who ran the program under President Bush, recently pointed out in a monograph on the subject). Fund segregation does not enter into it because the state program is entirely under state control. In contrast, the Reid bill establishes a new program in which FEDERAL funds would be used to purchase private health plans that cover abortion on demand. This would be a sharp break from the principles of the Hyde Amendment (see above), which have also long governed the Federal Employees Health Benefits programs - none of which are allowed to cover elective abortions, although they are private plans, because they are federally subsidized.
By the way, the Senate actually has already made the original Reid bill WORSE on abortion by adopting, on December 3, the Mikulski Amendment, under which the federal Department of Health and Human Services would have authority to order every PRIVATE health plan in the country to cover any service listed as a ''preventive'' service. Can you think of a likely procedure to be put on such a list? One Senate Democrat pointed out the danger that this amendment could provide the legal basis for a sweeping abortion mandate, and voted against it: Senator Ben Nelson (D-Ne.).
Douglas Johnson
Legislative Director
National Right to Life Committee
Washington, D.C.
http://www.nrlc.org
legfederal // at // aol-dot-come
The bottom line: the fact that Sen. Bob Casey, Jr. would recommend language making federal funding of abortion the default position of health care reform proves once and for all he is not “pro-life.”
Casey’s “compromise” language is a compromise all right — it compromises the Catholic Church’s teaching on the protection of innocent life.
Some excerpts from the USCCB’s 12/14/09 letter:
“The central argument against the Nelson amendment, voiced during floor debate by many Senators, was that this amendment goes too far by barring federal subsidies to entire
health plans that include abortion coverage. The three-decades-long precedent of the Hyde amendment and similar provisions governing all other federal health programs, it
was claimed, is this: Federal funds may not be used “directly” for an elective abortion,but non-Federal funds such as private premium dollars may be used in the same health plan for such abortions. The underlying health care reform bill was said to respect this tradition by “segregating” funds with plans to allow “private” funding of abortion. It was chiefly on the basis of this argument that the Nelson amendment was tabled....
However, yesterday’s overwhelming vote to approve the Consolidated Appropriations Act creates a new situation. In that vote, almost all Democrats, including almost
every Senator who claimed the Nelson amendment’s policy goes too far, voted in favor of that exact policy. For these Senators voted to retain the actual current language of the Hyde amendment, and of the parallel provision governing abortion in the Federal Employees Health Benefits Program – and that language clearly requires a policy in all other federal health programs that is identical to that of the Nelson amendment.”
The letter then sets forth the language of the Nelson and Hyde Amendments, and the language approved in the CAA as to the Federal Employees Health Benefits Program (FEHBP), before continuing as follows:
“Literally the only substantive difference between these noncontroversial and widely supported provisions [i.e., the Hyde Amendment and the FEHBP] and the Nelson amendment is that the latter explains at length that (a) it does not prevent purchasers who do not receive federal subsidies from buying a health plan including elective abortions, even on the Exchange created by the health carereform bill, and (b) it does not prevent purchasers receiving federal subsidies from buying separate supplemental abortion coverage with their own funds.
....
From the outset of the health care reform debate, we have not sought to use this legislation as a vehicle for advancing the pro-life cause – and we have urged others not to use it to advance the pro-abortion cause. The current Senate bill fails to achieve this balance. While its abortion language has been called a “compromise,” it is only a compromise between current law and a broader policy on abortion funding, as it explicitly authorizes the use of federal funds to subsidize health plans covering elective abortions for the first time in history. Health care reform is too urgently needed to be placed at risk by one lobbying group’s insistence on changing the law. Before the Senate considers final votes on its health care reform legislation, please incorporate into this bill the longstanding and widely supported policies of current law, acknowledged and reaffirmed by the Senate itself only yesterday. Please give the American people health care reform that respects the life, health and consciences of all.”
The 2/14 letter is available in its entirety here:
http://www.usccb.org/healthcare/DiNardo_1214_letter.pdf
According to the Milwaukee Journal Sentinel, under questioning by a three-judge panel Bopp ''said judges have a right to mislead voters in their campaign ads. 'I don't think misleading is something good, (but) it can't be sanctioned,'' he said."
As MSW said, why let facts get in the way? Anything for a victory.
And Mr. Johnson failed to retract his shameful misinformation and obfuscation regarding rationing.
I've been a great fan of many features of America, but it's about time the Jesuits reign in these articles that undermine those of us working in the trenches of the pro-life movement.
Anyone who is interested in really understanding the grounds for NRLC's concerns regarding provisions of the bill that could lead to government-imposed rationing of lifesaving care for the medically dependent and disabled (as opposed to merely repeating sound bites picked up off MSNBC) can find abundent material here: http://www.nrlc.org/HealthCareRationing/Index.html
Douglas Johnson
Legislative Director
National Right to Life Committee
legfederal // at // aol-dot-com
The second point is that the cost of American healthcare is the highest in the world, with nothing to show for it. Americans pay more than twice as much per capita per healthcare, and outcomes are actually worse (think of life expectancy, infant mortality, etc). And who is paying the price? Ordinary people, through lower wages - this is the great hidden cost of healthcare. It is one of the primary reasons why median real income has been stagnant since the early 1970s. Any Catholic would recognize that the living wage is becoming harder to attain.
While imperfect in so many ways, the latest Senate bill is quite revolutionary on cost control. Right now, reimbursement is based on quantity of treatment, thus creating the incentive to overtreat. The bill has a number of small elements that in combintion could significantly "bend the curve" and prevent the unsustainable rise in healthcare costs, which already swallow 16 percent of GDP. Has Mr. Johnson given any thought to what will happen in the future if the status quo continues? It's not pretty, and the most vulnerable will suffer most. The key elements of cost containment include the Medicare Commission, bundled payments, prudent purchasing (control over entry to exchanges), the excise tax on high-value health insurance, comparative effectiveness review, better health information technology, and the individual mandate. This is all geared toward controlling costs, while protecting benefits and moving toward universal coverage.
I would love for once the NRLC to come out and declare that universal healthcare is a basic human right. It is a pillar of Catholic social teaching. Instead, they complain about stripping away subsidies to private insurance to cover Medicare patients, not recognizing that the reason for doing this is because traditional Medicare can deliver the same care for less money (yes, there are some things the government does better). They complain about sliding toward euthanasia, while "death panels" already exist - they are called private insurance companies and hospital boards. In Texas, for example, hispital ethics committees can withdraw life suataining treatment based on cost even over the objections of the family. Oh yes, and this was signed into law by a man called George Bush. Where was the NRLC then?
While the NRLC rails against cuts to Medicare, I would like to know where it was when the GOP pushed for cuts of 14 percent in 1995 and 13 prercent in 1997 - far far more than anthing envisaged today. When the NRLC rails against end-of-life counselling, I would like to know where it was when the exact same provision was included in the GOP 203 bill. In short, maybe it could be a little less partisan and a little more pro-life?
I once attend a NRLC event, at the Waldorf in NYC in the mid-1990s. The food was excellent. I was more naive in those days, though. But when I saw some of the people in attendance, and being honored, I recoiled in horror. For there was Phyllis Schlalfy, a woman who is on record defending the American use of nuclear weapons. Now, Moral Theology 101 tells us that she is defending an intrinsically evil anti-life act on consequentialist grounds - exactly like the defenders of abortion. And she is held in high regard by a movement dubbed "pro life"? I left that dinner in disgust, and have not dealt with the NRLC since.
It is alleged that we have done nothing to advance access to health insurance for all. Look, please, at our website under www.nrlc.org/MedEthics/SaveNotRation.html where you will find comprehensive information about the detailed proposal we put forth at our 2007 convention (a proposal whose basic principles we had been advocating for over a decade) , demonstrating how health insurance for all could be funded without rationing. NRLC’s Powell Center personnel have worked tirelessly, if so far unsuccessfully, to promote that approach in a number of state legislatures as well as in Congress.
We do indeed assert – and here we differ with as many conservatives and Republicans as liberals and Democrats – that America CAN afford to continue to increase the proportion of our GDP devoted to saving lives through health care, and that efforts to limit continuing increases in health care expenditures or ''bend the cost curve'' are fundamentally unnecessary and undesirable. See http://www.nrlc.org/MedEthics/AmericaCanAfford.html and especially take the time to view the webinar http://nrlcomm.wordpress.com/2009/06/13/hcrwebinar/ .
More to come . . .
Burke J. Balch, J.D., Director, Robert Powell Center for Medical Ethics, National Right to Life Committee
The often-heard claim that the higher rate of per capita health care expenditure in the U.S. results in outcomes that are ''actually worse (think of life expectancy, infant mortality, etc.)'' than in other countries, as one blogger put it, is refuted at http://www.nrlc.org/news/2009/NRL05/InaccurateGrounds.html .
More to come . . .
Burke J. Balch, J.D., Director, Robert Powell Center for Medical Ethics, National Right to Life Committee
?
While NRLC has in general criticized cutting back on Medicare as a means to subsidize extension of health care insurance (''robbing Peter to pay Paul'') in contrast to more appropriate and sustainable means of funding such an extension, we have taken no position – either this year or in the past – on the specific issue of how much government funding should be provided to Medicare Advantage plans (''subsidies to private insurance to cover Medicare patients''). We have instead focused on preserving the ability of senior citizens, if they choose, to add their own funds on top of the government subsidy in order to achieve care less like to be rationed. We have maintained that, because of private-sector cost-shifting, this is more likely to lead to better care for those who cannot afford to add their own money; see http://www.nrlc.org/MedEthics/JusticeArgument.html .
More to come . . . (I'll need a fourth and final part.)
Burke J. Balch, J.D., Director, Robert Powell Center for Medical Ethics, National Right to Life Committee
The accusation that NRLC is ''right wing'' or ''partisan'' is false. How do people suppose that we were able to get so many Democratic Representatives to support the Stupak Amendment? Our state affiliates and national organization have long worked with and supported pro-life Democrats. I am sorry that one blogger was offended upon attending an NRLC-sponsored event to find that it was also attended by prominent conservatives. The fact is that we are a single-issue organization, and we are effective precisely because we are a coalition of liberals and conservatives, Republicans, Democrats, Libertarians, and Socialists, people of every religious affiliation and of none. I can assure you that in informal discussions at social occasions, staff members at our national office argue vigorously with each other about just about every contentious issue other than abortion and euthanasia. The pro-life movement has been called – accurately, I believe – one of the greatest social reform movements in contemporary America. Our fight on behalf of the lives of the most vulnerable in our society – unborn children, older people, and people with disabilities – will not be deterred by mischaracterizations.
Burke J. Balch, J.D., Director, Robert Powell Center for Medical Ethics, National Right to Life Committee
Making abortion financially costless through federal subsidies (as Reid-Nelson will do, except in those states that refuse the federal funds) may appear to make women more free, but in fact it empowers those men who control their sexual partners (especially among the poor). Ordinary abortion is not expensive, but the decision to spend any money at all is a real-world point of deliberation and negotiation. As the cost of an abortion is reduced almost to zero, some women will lose a last locus of possible resistance to their exploiters: "Just you get on down to that clinic, sweetheart. It's free."
The Left should be concerned about one more real-world result (and, for some, purpose) of federal abortion funding: its disproportionate effect on minority races.
For example, if a private plan charges a higher premium to include cardiac care for those over 65, those having to pay the higher premium will be unhappy but will probably understand that this is just a business judgment that young people have fewer heart problems and does not reflect any notion that older folks are less worthy to live.
By contrast, if the political community (in a public insurance plan) charges the old more than the young for the same benefit, this may well seem unfair and in fact may become a precedent for further unequal treatments of different ages.
There is no space here to elaborate upon the rationality or irrationality of the different standards to which we hold private companies vs. public authrities, but we certainly do so (and not only re health insurance; see e.g. private vs. state action that discriminates on the basis of religion).