Our entire health-care system is filled with complex moral choices. We shouldn’t make our health-care debate about just one.Nov 18, 2009
We suffer, this week, from a moral myopia. Thanks to the passage in Congress of a health-reform bill, abortion is in the news again, but with the same old warriors brandishing their same old spears. Kate Michelman and Frances Kissling talk about how the current version of the health-care bill “risks the well-being of millions of women for generations to come.” The United States Conference of Catholic Bishops thanks the members of the House, “who took this courageous and principled step to oppose measures that would force Americans to pay for the destruction of unborn children.”Abortion, the pundits like to say, is a “complex moral issue.” According to recent research by the Pew Forum, about half of Americans believe abortion is “morally wrong,” yet half wish it to remain legal most of the time. Surely we and our representatives in Congress, who are able to hold such paradoxical views in mind, are not so deafened, cowed, or paralyzed by the screaming on both sides that we can’t absorb a truer reality. Culture warriors are not the only arbiters of the great moral questions of the day, and abortion is hardly the only ethical component of the health-care debate. Our entire health-care system (and the proposed reform) is rife with “complex moral issues.” To activate our consciences only in the realm of abortion relieves those consciences of too much responsibility.
Take a “complex moral issue” completely unrelated to fetuses. One in 10 Americans suffers from hearing loss—including more than a million children. Few private insurers cover hearing aids, which cost, on average, more than $2,000 each. Medicaid covers hearing aids for kids, but after 21, they’re on their own. What this means, in effect, is that people who can afford hearing aids can hear. People who can’t—well, they can’t. Nothing about this is equitable. Nothing about this shows—as the bishops articulated in their victorious letter to constituents after health care passed the House— a concern for “the poor and vulnerable.” Yet we have so far lived equably with this injustice. We rarely consider the plight of the hearing impaired. We have had no public conversation about whether taxpayer money should cover hearing aids. No religious group has taken up the case of affordable hearing aids for the middle class. That the American Academy of Audiology and others successfully lobbied Congress to include a provision in the health-care plan that guarantees patients the flexibility to select an insurance provider based on individual hearing needs has made no headlines.
In the arena of what the right likes to call unborn children, our health-care system is dramatically inconsistent, a morass of moral contradictions. Americans of every political and religious denomination agree that there should be fewer abortions. But only one state—Kansas—requires an adoptive mother’s private insurance to cover the birth mother’s prenatal care, according to Mark McDermott, legislative chairman of the American Academy of Adoption Attorneys. Thus adoptive parents often pay thousands of dollars out of pocket in health-care costs for the birth mother. What is our moral position here? That we oppose what one right-to-lifer whom I spoke to the other day called “the chopping up of little babies,” but when an uninsured woman wants to give her baby up for adoption—or carry it to term and keep it herself—we can’t figure out how to pay for her prenatal care?
Perhaps a reformed health-care system will fix this problem. But not if it’s scuttled in a fight over abortion.
Our health-care system—and our culture—has an inconsistent view on the value of the human fetus. Most employer-based plans currently pay for an abortion, which costs, on average, about $400. (The Hyde amendment forbids the use of federal money for abortions to Medicaid recipients, but 17 states will provide them to Medicaid recipients through the use of state funds.) Some private insurers, depending on the state, will also pay for assisted reproductive technology, including in vitro fertilization. But very few will pay for the long-term storage of embryos—that is to say, freezing—created through IVF. What are the moral lessons, here? That we care enough about families to create embryos, but not enough to maintain them? To be sure, private insurers should not be in the business of establishing ethically consistent health-care policy. And perhaps, with such questions, consistency is unattainable and even undesirable. But our public conversation about fetuses needs to include these technological developments; 1 percent of all babies born in America are conceived through assisted reproductive technology.
It is disingenuous to argue against abortion in the health-care bill on the grounds that taxpayers should not have to pay for something that goes against their conscience. Taxpayers pay for things they find morally objectionable all the time—war, death-row executions, and the bailout of irresponsible investment banks, for starters. It is similarly disingenuous to describe the Stupak amendment, whose fine points are too wooly to describe here, as a “ban” on abortion. It does raise obstacles, which I believe would unfairly penalize poor and middle-class women. But should the Stupak amendment (or something like it) pass the Senate, abortion would remain legal. In the first trimester, it would continue to be quick, safe, and relatively inexpensive—a lot less than a hearing aid. Most women, according to the Guttmacher Institute, pay for their abortions out of their own pockets; they could continue to do so.
Our so-called moral outrage, then, is preventing us from taking a clear-eyed look at the moral dimension not just of abortion but of health care as a whole. Ironically, perhaps, the Roman Catholic Church offers one of the most coherent theologies of “life” out there, a commitment to see as sacred all human life, from the embryo to the death-row inmate to the innocent casualties of war. “We’re picking and choosing issues,” complains Father John Dear, a Jesuit priest and peace activist. “The church has been politicized and the bishops are hammering away at abortion, but that just doesn’t make sense.” This week’s abortion conversation is about politics. Let’s not pretend it’s about anything else.
With Jessica Ramirez
Let’s compare moral atrocities: I bet Lisa Miller can find more holes in YOUR moral argument than MINE!