Abortion rights have triumphed. Against all odds (and, I'm afraid, against all logic), the basic holding of Roe v. Wade is secure in the Supreme Court. It's easy to forget how unlikely this seemed just a few years ago--before a series of new Republican-appointed justices betrayed those who had appointed them, and then a Democrat unexpectedly captured the White House.
A clear majority of Americans favors a woman's right to choose. Opportunistic politicians who used to pander to the right-to-life movement now swear their fealty to choice. Republican leaders are desperate to reposition their party as moderate or agnostic on the issue. Congress has passed, and the president has signed, a bill cracking down on disruptions at abortion clinics. The ban on medical research involving fetal tissues has been lifted. So has the effective blockade against ru-486, the French abortion pill.
But the crowning triumph--- a national freedom of choice law--- has been sidelined. Why? Because the abortion rights movement has decided to concentrate on making sure that abortion is among the guaranteed benefits in health care reform. This is a pity, for two reasons. First, a freedom of choice law would guarantee abortion rights the correct way, democratically, rather than by constitutional origami. Second, guaranteed financing of abortion as part of health care reform is a much more dubious proposition.
Right-to-lifers ask a good question: Why should they be forced to help pay, through their taxes, for a procedure they find morally repellent? Government- financed abortions for poor women probably would save taxpayers' money overall, by reducing the long-term welfare burden. But that doesn't answer those whose concern is the principle, not the cash.
In fact, mandating abortion coverage would forcibly implicate abortion opponents in two ways: through whatever government subsidies end up being part of the system, and through their private insurance premiums, which--by law-- would have to pay for abortions. To be sure, two-thirds of all private health insurance now covers abortion. Millions of abortion opponents are already subsidizing the procedure either without realizing it or without any special trauma. This is another example (like rationing) of how health care reform will force people to confront moral dilemmas that the old system left comfortingly muddled. Under current rules, at least, anyone who really thinks that abortion is murder can opt out if she wants to. If abortion becomes a universal, guaranteed benefit, that will be impossible.
In a democracy, the majority rules. Everyone doesn't like something-or-other the government does, but the government obviously couldn't function if all taxpayers could pick and choose what government functions they cared to pay for. There are those who object to military spending and argue with the same passion as the right-to-lifers that forcing them to pay for bombers leaves blood on their hands. Should they be allowed to opt out, too?
The trouble with this tempting argument is that the national defense is what economists call a "public good": it is a benefit that cannot be supplied to one without being supplied to all. How much of it we buy has got to be a collective decision, made by majority. That's not true of abortions.
Furthermore, abortion is a uniquely divisive and emotional issue in American democracy. A substantial minority believes deeply that it is morally wrong. By comparison, the number of those who have deep moral objections to bombers per se (as opposed to those who merely believe that the current level of military spending is unnecessary) is quite small. Simple political comity suggests that this passionate minority should not have its nose rubbed in the dirt. Respect for the sensitivities of a minority, even this minority, ought to come easily to liberals and civil libertarians.
There are less highfalutin considerations as well. Health care reform is the fight of the Clinton presidency. Why force him to use up chips, alienate millions of potential supporters and end with weak reform or no reform at all, over a side issue? Women in general, and poor women in particular, will gain greatly from health care reform. Women are disproportionately among the currently uninsured. Clinton's package contains a fairly generous array of benefits. But everything is up for grabs in the coming negotiations. How much is worth giving up to save payments for abortion?
It's true, of course, that your right to abortion isn't worth much if you can't afford to exercise it. A less-than- satisfactory answer is that this is true of all our basic rights. Freedom of speech doesn't get you a megaphone, let alone a t.v. station. Freedom of religion doesn't buy you transportation to church. These are rights against government interference, not rights to a government-financed supply of the good in question.
In real life, how many women don't have abortions because they can't afford one? Some, to be sure. But a straightforward, first-trimester abortion in a clinic costs about $250. Thanks to the semi-repeal of the Hyde Amendment, Medicaid now pays for abortions in cases of rape or incest or when the woman's life is at risk. In other cases, even a poor woman will find a way to scrape together $250--especially when the alternative is the cost of bearing and raising an unwanted child. The bigger problem isn't money. It's that in many parts of the country abortion is unavailable at any cost. But forcing opponents to pay for abortions against their will won't solve that problem. (ru-486 might, and might make abortion cheaper still.)
The argument is made that leaving abortion out of the guaranteed benefits package under health care reform could deny abortion coverage to the millions who have it now, since that package will become the de facto standard for all private insurance as well. I can't prove that this won't happen. But if polls promoted by abortion rights groups are even close to accurate in showing that large majorities of Americans want abortion covered by insurance, it seems an unlikely development.
For believers in abortion rights, just like abortion opponents, the issue of abortion's role in health reform is more about the principle than about the money. It would be nice if abortion could just blend into the landscape--could become so uncontroversial that no special arrangements needed to be made for it. But we're still a long way from the point where abortion can be regarded as just one more "pregnancy-related service." I hope we get there. Meanwhile, even right-to-lifers deserve the right to choose.