Health Care Reform -- or Abortion

Killing is bad.
Abortion is killing.
So abortion is bad.

So if a health-care reform bill would in any way pay for -- or even condone -- abortion, it should not be passed.

But wait a minute: is abortion worse than other forms of killing? If your family is penniless and your child dies of malnutrition, is that not a form of killing? If you have a treatable disease but die because you couldn’t afford treatment, haven’t you been killed just as surely as if someone shot you?

How many women have abortions in a year? How many people die because of inadequate health care?

Some experts are saying that some 15,000 people die yearly because they lack access to health care. Either they don’t seek treatment because they can’t afford it, or they are turned away from hospitals or doctor’s offices for lack of insurance.

The counterargument has been that uninsured people can always go to an emergency room and receive treatment. Now there are studies that show that such people have a higher death rate than insured people with the same ailments. Why? Because the uninsured have not received the early interventions -- in the beginning stages of the disease -- and go to the emergency room only when the disease is far advanced. And they do not receive any follow-up after they leave the emergency room. So let’s add these numbers to those who die for lack of access.

And here’s something that perhaps should not be brought up here, since it would be hard to attach numbers to related early deaths, but here it is anyhow: It is well documented that about half of all bankruptcies -- and that’s several hundred thousand a year -- are medical related. Typical scenario: You have a job, and you have health insurance. You come down with a catastrophic illness -- perhaps a cancer that requires long and expensive treatment. You are out of work so long that you lose your job. Soon the health insurance expires or reaches a maximum pay-out level, and the insurance company tells you your treatments will no longer be covered. You borrow, you re-mortgage your house, eventually you declare bankruptcy, and you and your family are penniless. We have read -- anecdotally -- or people who have committed suicide in despair when they find themselves in such a situation. Obviously, there is a heavy economic and emotional cost to this scenario, and undoubtedly a cost in lives as well, even if we’d have trouble attaching numbers to it.

About abortions: I agree with the way Hilary Clinton phrased it: “Abortions should safe, available -- and rare.” Instead of banning abortions, it makes more sense to me to try to remove the conditions that cause unwanted pregnancies. Let’s teach young people -- male and female -- about human dignity, about respect for themselves and their partners, about sex as an expression of love and respect and dignity. And while we teach young people these things, let’s also teach them that if they insist on having sex without the intention of creating babies, they need to take precautions so as not to create babies. If we as a society could succeed in doing these things, there would be very few abortions in any case.

I would urge the anti-abortion opponents of health-care reform to save lives by working on eliminating the need for abortion, and to save more lives by supporting health-care reform.

Choices need comparisons

We are confronted constantly with the prospect of change. Change itself is a different matter: once it happens, all we can do is figure out how to deal with it. But the prospect -- that involves decision-making, whether we are trying to decide whom to vote for or whether to buy a new car, or how we feel about proposed health-care reform.
Too often, the choice is presented as being between the status quo and the new arrangement -- usually a bogus choice, since if we reject the change, the status quo will change in some other direction, and that's what we must calculate and compare with.
An example: Forty years ago when I was living in Charlotte, before the advent of its expressway system, I attended a neighborhood meeting hosted by city officials to present plans for the first segment of downtown expressway. Wonderful. With these wide straight expressways, everyone will be able to zip around town without worrying about traffic. What could be better? Then I raised my hand, knowing what I had seen during a year in Germany: "What provision is being made in all these expressway plans for mass transit?" Silence. Then the response: "None." The shocked look on my face must have convinced the speaker that more explanation was in order: "People in Charlotte prefer to ride in their own cars."
So here's what I'm talking about: The speaker was, without really thinking about it, implying a choice: We can either drive our own cars, or we could ride in Charlotte's existing buses -- dirty, noisy, unreliable, and slow. And it's perfectly clear what any sensible person would choose. The other possibility -- fast, clean, quiet, dependable, modern trains, buses, and streetcars -- was not part of the calculation, and no one considered offering that alternative to the citizens.
In our personal choices -- say, whether to buy a new car or heating system -- it's also a choice between at least two options: What will my total costs be over five years with a new car, vs. keeping the old one? The old one is paid for, so no car payments that way. But what about repair costs? What about costs if the old one dies on the road, miles from home? This is the difficulty with using the status quo as one of the options -- the status quo will change, but how?
Without going into all the arguments in the health-care-reform debate (let's save that for another day), let me just point out that this involves the same kinds of choices. First, we can look at one of the proposed new plans. How will that work for me? for the typical person? for a person with a "pre-existing condition"? What will the actual costs (premiums, co-pays, out-of-pocket payments) be, under this or that set of conditions?
But then, what are we comparing that with? If the comparison is with the present system, we have to run through all the same possibilities, as with the new plan being considered. And -- the hard part -- we have to factor in the likely changes in the existing system, starting with the fact that the existing system is not static but is getting 8% more expensive every year.
In other words, it's not sufficient to dismiss the proposed new program with, "It's too expensive." The question is, "How expensive will the new plan be (for you and me, for the government, for people without insurance now, etc.) compared to how expensive it will be -- with future cost increases -- for all these various groups if we don't implement one or another of the proposed plans?"