Questions on health care and abortion
It’s becoming more and more likely that President Obama and the Democrats will pass a health care bill by the end of the year, probably with some form of public option, and subsidies to help low-income families purchase insurance. Overall, I think this is a good thing: as a Catholic, I agree with our Bishops that health care reform is a moral imperative, and that it should provide a preferential option for the poor. If my taxes end up having to be raised to pay for it, then so be it. I have no ideological aversion to “big government.”
However, as a Catholic, I also agree with our Bishops that we should not support a plan that funds the destruction of human life at its most innocent and vulnerable stage. That should be a deal-killer for all of us, simply because it is antithetical to the very purpose of medicine and the very ideals that cause us as Catholics to support health care reform. That said, the issue of abortion funding is a thorny and complicated one, and I’ve spent the last few days wondering what, exactly, “no federal funding of abortion” means. To put it another way, exactly which restrictions beyond those that are currently in place would allow sincerely pro-life Catholics to support a health care plan, and which allowances should cause us to reject it? I’ve listed some more specific questions below the fold, and I’d like to get a discussion going. These are not rhetorical questions; I am an 18 year-old pro-life Catholic with a limited knowledge of the intricacies of moral theology and public policy, and I would appreciate any insight as to what exactly I should and should not support or accept.
1. On the issue of federal subsidies for the poor: it goes without saying that the public plan cannot cover abortion, but should we insist that any private health insurance plans purchased using federal subsidies not cover abortion (as most private plans currently do)? If such a restriction is not included in the bill, must we reject it for this reason alone?
2. On the issue of birth control: should the fact that a public option, even if it specifically excludes abortion, will probably cover other forms of “family planning” cause us to reject it? There are two issues here: firstly, that we Catholics believe contraception to be an intrinsic evil; and secondly, that lots of institutions that provide contraceptives and family planning advice (i.e. Planned Parenthood) also provide abortions. Since money is fungible, this would essentially amount to indirect federal subsidization of abortion “services.” Should these factors cause us to reject any public plan that covers contraception?
3. Let’s say that a public insurance plan is subject to the same restrictions as Medicaid, which under the Hyde Amendment can only fund abortions in cases of rape or incest, or a threat to the life of the mother (I believe). Obviously, from our pro-life Catholic perspective, the moral evil of abortion admits of no exceptions: even those performed in such serious situations as these are unacceptable. May we be satisfied if the plan maintains this status quo? Is it acceptable to say that as long as the restrictions are not lessened (i.e. “as long as it doesn’t get any worse than it is now”), the moral good that would result from health care reform would outweigh the fact that the existing restrictions are less than ideal? This issue is complicated by the fact that, since the public option would cover more people than Medicaid, simple math suggests that the number of abortions paid for by the federal government will increase even if the current restrictions are carried forward.
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Mickey, those are important questions. Without a doubt, among other goals, we should work to make the national health care bill as anti-abortion as possible.
But I think we need to preface any discussion with an admission that these questions will require serious discernment and that faithful Catholics might well come to different conclusions. One example would be the question that is all money fungible? Clearly, there is no doctrine binding all Catholics on such a proposition.
Also, particularly when judging the actions of others, in any test we attach to the current legislation, we need to be honest as to if that same test has been applied to past initiatives and policies. Some have set standards for the health care bill (not that this makes them wrong) that, if applied to past actions, would make George W. Bush a radical liberalizer of abortion.
I’m increasingly disliking intrinsic evil being treated as a trump category. I think we need to go back to then-Cardinal Ratzinger’s letter on immunizations. It covers the principle of toleration quite well, and it also happens to address immunizations developed using aborted fetuses. Some bishops appear to be claiming that to support a bill that includes some abortion benefit, no matter how derived, would be formal cooperation in evil. I would disagree with this assessment. That said, those that make the claim of being pro-life need to work to bring forth a compromise that does not include an abortion benefit. I’m not optimistic on that front as many pro-lifers are opposed to social provision of medical benefits in principle.
Mickey,
I have a question to add, and I’ll use myself as an example. I work for a large corporation, and the insurance coverage it provides to all employees covers abortion. The company pays most of the cost of coverage, but employees pay part of the cost as well, and the employee part increases periodically. By accepting the insurance my company provides, and paying something toward the premiums, am I supporting abortion?
Must all Catholics who insist their tax dollars not be used to pay for abortion in any way, and who would be willing to see health-care reform abandoned rather than have it contribute in some direct or indirect way toward abortion, give up their own insurance if it covers abortion?
Is it acceptable to buy insurance from an insurance company the covers abortion in some of its plans even if you buy a plan that does not cover abortion?
Mickey,
First of all, congratulations. This is exactly the kind of conversation that needs to be happening in the Catholic blogosphere and in the American Church in general. As an outsider (a Canadian), I have been absolutely scandalized at the approach American Catholics have taken to the healthcare question. This is the approach that needs to be taken and it needs to be taken fast.
Secondly, these are excellent questions to which I don’t have great answers. Fungible money has always seemed a conundrum for me. It almost makes it seem like I shouldn’t ever spend money on anything.
Thirdly, I would just like to add that another consideration in this discussion might be, “How do we make a healthcare system that encourages women to choose to keep their babies?” I don’t know your system well, but it seems to me that having a baby involves medical expenses and that such medical expenses can be overwhelming. Can a well-done overhaul of the health care system actually lower abortion rates? If so, how?
I think the principle of double effect is at play when wondering if either your tax money or insurance money is cooperation in sin. It is Christ who when shown a Roman coin and tested on the matter of paying taxes to Caesar said: “Then render to Caesar what belongs to Caesar and to God what belongs to God.”
Such tax went simultaneously to good things that Rome did and evil things that it did but perhaps in that time in history prior to Caligula etc, Rome was a great source of order in general which is a good for families especially. And a Roman centurion is noted by Christ as having more faith than He had found in all Israel and when Paul later was near be killed by those of the synogogue, he declared before the Romans that he was a Roman citizen and was appealing to the emperor whereupon the Roman leader on the spot assigned a centurion to Paul to take him all the way to Rome and he was given a house guard for months while his appeal waited in Rome. That same Rome also killed criminals in a torturous manner etc. and the state was involved in the gladiator system wherein mostly criminals or those conquered in war fought to the death or to great harm.. so that one’s taxes were going to largely the good of society and some evil.
With that in mind, look at the principle of double effect from as to number 4 since the others are not at question: 4.The bad effect cannot outweigh the good effect; there is a proportionate reason to tolerate the bad effect.
If you see little good in the general order of society which being young you take for granted, you will have to disagree with Christ that it was right to pay tax to Caesar since in many young peoples’ mind….a torturous death for criminals in crucifixion outweighs the good of the order that Rome produced for safe families. The older one gets or the more one travels to dangerous parts of the world the more one agrees with Christ that the order produced by Rome outweighed the evil of crucifixion and gladiator events at His time etc. Later when persecution of Christians was absolutely brutal with the use of wild animals etc, then the same moral question might have a different answer but one would have to move from Rome to avoid taxes and then the question would be whether any other place was better.
Each can use Christ’s answer about Rome to analyze these modern situations.
Kurt: agreed.
M.Z.: I agree that the members of the “mainstream” pro-life movement have completely blown away any opportunity to have their voices heard on the health care issue, for reasons we’ve discussed in previous posts. But I think the pro-life Democrats in the House, and even more so Senators Casey and Nelson in the Senate, still have a shot at ensuring at least that there is no direct abortion funding in a public plan. I communicated with Kirsten Day of Democrats for Life via Facebook several days ago, and she was actually very confident that the final bill would contain an explicit abortion exclusion.
Brett: thank you for pointing to an issue that has often been neglected in the health care/abortion debate. The argument that economic factors like the availability of affordable health care to pregnant women can decrease the abortion rate is often viewed disdainfully as a “cop-out” by most pro-life leaders in the US. To be fair, part of that is Obama’s fault, since it’s become clear that most of his talk about finding “common ground” around this idea was really just a smokescreen for pro-abortion policies. But both theory and empirical evidence do suggest that there’s a lot of largely unexplored possibility in that area, and that those who reject it out of hand really do quite a large disservice to the unborn children who might actually be saved from abortion if pro-lifers took the time to lobby for such initiatives (again, to be fair, some organizations like Feminists for Life and Democrats for Life have done great work in that area).
Bill: thank you for your response. I found it to be very helpful and revealing as I struggle personally with these questions. At the very least, it confirms what Kurt pointed out, namely that there truly is a lot of room for prudential judgment here.
I suppose that at this point, Christian humility demands that we not presume to have these answers right away, but rather that we spend some time in prayer imploring God to bless us with wisdom and to forgive us if we, in our fallible, fallen humanity, get it wrong.
What is “our issue,” us Catholics? Gosh, we have so many, but they are prioritized. In this discussion, it seems to me that we must stand back and assess what we morally hold uncompromising within Christ’s teachings. That would be, I propose, avoiding the killing of others, which, in the uterine environment, we call abortion or abortifacient. Our imperative is “don’t kill nascent human life” ~ no matter how nascent – how embryonic.
What I don’t get is why is this so hard to follow? It seems plain, reasonable and divine … don’t do it, don’t agree to do it, don’t support legislation or rules or policies that promote it. Why is this so hard for you guys?
BTW #1, here, there are exceptions. We need doctors and “abortion” services for those rare situations where husband and wife choose to save the mother’s life over the live(s) of a fetus. Catholic theology does not require a woman to die to birth – though pursuit of birth is the stuff of saints.
BTW #2, do I pay dollars in my ordinary life regime that incidentally fund death enterprises? You betcha. But I make an issue of it where I can be heard. The rest of my energy, I devote to my family, my church and my community where my voice actually impacts.
MZ,
If the Stupak and Hatch amendments in the House and Senate (which would accomplish Mickey’s point 1 above) come to a vote, would you say that voting against them would be a formal cooperation with evil?
I can’t speak to them specifically, but I would be inclined to say yes.
Marjorie: you ask, “Why is this so hard for you guys?” It’s not; you will see in my post that I use the term “deal-breaker” in reference to the killing of our brothers and sisters in the womb. I assure you that I do get it, and I apologize if I have ever come off as anything less than 100% committed to the Church’s teaching on the necessity to defend innocent human life. But unfortunately, though this teaching is not complicated at all, the intricacies of public policy and federal appropriations ARE, in fact, very complicated. That’s why I’m asking questions. Now, do I want to support health care reform? You bet. 18,000 Americans die every year because they lack health insurance, and in the richest country in the world I find that obscene. But I agree with you that we must “make an issue of [abortion] where we can be heard,” because the killing of the unborn is also obscene. All I’m asking is what, exactly, that should mean for us Catholics in a practical sense as we seek to pass a reform that avoids the killing of others under the guise of “health care.”
Mickey,
I don’t think Marjorie was trying to insinuate anything here, and certainly, I don’t think she intended anything to be an insult. I know that was not the intention.
BTW #1, here, there are exceptions. We need doctors and “abortion” services for those rare situations where husband and wife choose to save the mother’s life over the live(s) of a fetus. Catholic theology does not require a woman to die to birth – though pursuit of birth is the stuff of saints.
Marjorie,
I am not exactly sure what you are saying, but direct abortion is not permitted by Catholic theology, even to save the life of the mother.
I don’t understand why abortion is an issue when government gets involved in health insurance, but it is apparently not an issue when individuals or employers deal with health insurance.
Should someone who is pro-life work for an insurance company that provides abortion coverage? Should someone who is pro-life work for a company that provides health insurance to employees that covers abortion? Should someone buy their own health insurance from an insurance company that covers abortion, even if the policy they buy does not include abortion?
It seems to me that in regard to health-care reform, the pro-life movement is not so much interested in abortion per se but rather in politics. I don’t recall anyone ever raising the kinds of questions I have raised above regarding one’s personal responsibility regarding abortion and health insurance. It would seem to me to be a prerequisite that pro-lifers deal with issue of insurance and abortion in their own personal lives before attempting to dictate public policy.
This seems to me to be a case of taking the beam out of your own eye before attempting to take the splinter out of your neighbor’s eye.
Henry,
Thanks for clarifying. In my haste, I must not have read her comment correctly. I have edited my own response to it.
If the Stupak and Hatch amendments in the House and Senate (which would accomplish Mickey’s point 1 above) come to a vote, would you say that voting against them would be a formal cooperation with evil?
If the Stupak or Hatch Amendments are adopted (as it looks like they may), thereby giving us a national health care bill in which we would improve on the status quo from an anti-abortion perspective, would you say that voting against the health care reform bill would be a formal cooperation with evil?
Kurt: some would probably say that it would be OK to oppose the bill as long as you were doing so for other reasons. Of course, by that logic, it should also be acceptable to vote for a pro-choice candidate if you do so for reasons other than abortion.
Kurt,
I would echo Mickey – once could still oppose the bill for proportionate reasons, just as one could vote for a pro-choice candidate for reasons other than abortion. In both cases, I would tend to argue that though one’s vote is permissible, it is a prudential mistake, although I could very well be wrong. My concerns with healthcare reform extend beyond the issue of abortion to worries about whether it would actually work, and whether it would contain costs.
Ooops. Seems my intention got called into question? I apologize if I worded poorly. I was trying to dialogue. I do understand that some people like to parse the “what ifs” … but, at some point, we all have to make the fundamental decision whether we commit to the church’s teaching, and whether we can support the Church and each other in living that commitment (which will, in the particulars, take different shape for different people and entities). That was my point.
Re David’s question, I’ll just quote Helen Alvare.
“4. Medical necessity. What about the argument that the Church must make exceptions to its teaching when abortion is medically necessary for the mother’s health . . . ?
First, while the Church opposes all direct abortions, it does not condemn procedures which result, indirectly, in the loss of the unborn child as a “secondary effect.” For example, if a mother is suffering an ectopic pregnancy (a baby is developing in her fallopian tube, not the womb), a doctor may remove the fallopian tube as therapeutic treatment to prevent the mother’s death. The infant will not survive long after this, but the intention of the procedure and its action is to preserve the mother’s life. It is not a direct abortion.
There also occur, very rarely, situations in which, in order to save the mother’s life, the child needs to be delivered early. But this can be done safely with a normal, induced delivery, or a caesarean section.”
http://www.americancatholic.org/Newsletters/CU/ac0898.asp