ObamaCare Is Not Pro‐​Choice — for Anyone

November 13, 2009 • Commentary
This article appeared on Town​Hall​.com on November 13, 2009.

“This is a health care bill, not an abortion bill,” says President Obama. Au contraire, mon frère.

Whatever your views on abortion, the fight over abortion in the Obama health plan illustrates perfectly why government should stay out of health care.

When the government subsidizes health care, anything you do with that money becomes the voters’ business. And rather than allow for choice between different ways of doing things, the government typically imposes the preferences of the majority — or sometimes, a vocal minority — on everybody.

On Saturday, the House of Representatives passed their version of President Obama’s health care overhaul. Among other things, the legislation would subsidize private health insurance for millions of Americans.

To appease pro‐​life Democrats, Speaker Nancy Pelosi (D‐​Calif.) allowed them to insert an amendment to prohibit taxpayer dollars from touching any health insurance plan that covers abortion. House Majority Whip Jim Clyburn (D-S.C.) says the bill would have come up 10 votes short without it.

The amendment incensed pro‐​choice Democrats. The bill’s subsidies would be so pervasive that prohibiting the use of taxpayer dollars for abortion coverage would restrict access to such coverage even for women who don’t use the subsidies. Rep. Diana DeGette (Colo.) says she and 40 other pro‐​choice Democrats “are not going to let this into law.”

Democratic leaders are searching for a compromise, but there is no way to split the baby here. Either the government will force taxpayers to fund abortions, or the restrictions necessary to prevent taxpayer funding will reduce access to abortion coverage. There is no middle ground. Somebody has to lose. Welcome to government‐​run health care.

The same thing happens, in all areas of health care, whenever government foots the bill. Do you think chiropractic is nonsense? Too bad, the government forces you to pay for it through Medicare.

Faith healing seem like quackery too you? Sorry, Charlie. Medicare and Medicaid force you to pay for faith healers at prices “comparable with those of real health care providers,” according to law professors David Hyman and Charles Silver.

The problem extends far beyond those trivial examples. The government uses price and exchange controls to pay health care providers. We call those controls Medicare’s “fee‐​for‐​service payment system” in polite company. Yet the effects are anything but genteel.

Researchers believe Medicare’s exchange controls encourage unnecessary services, which account for at least one third of its $430 billion budget, according to the Dartmouth Atlas. Those controls actually penalize doctors and hospitals that coordinate care, use electronic medical records, or try to reduce the estimated 100,000 annual deaths due to medical errors. Congress has “reformed” Medicare’s exchange controls approximately once in the program’s 43‐​year history, with a “payment system” that encourages an estimated $12 billion of avoidable hospitalizations per year.

President Obama’s economic advisor Larry Summers sums it up: “Price and exchange controls inevitably create harmful economic distortions. Both the distortions and the economic damage get worse with time.”

Should grandma want to escape Medicare’s price and exchange controls — if she would rather see a doctor that operates under less‐​perverse financial incentives — too bad. If she would prefer a smaller network of doctors that provides safer, more convenient, coordinated care, she’s out of luck. The choice of what kind of medicine she receives belongs to the majority, or a vocal minority.

To be fair, the Medicare Advantage program allows some seniors to escape the traditional Medicare program’s price and exchange controls. But Medicare Advantage has its own perversities, thanks to a separate price‐​and‐​exchange‐​control scheme the government uses to pay participating insurers. And in keeping with the overall hypothesis, Democrats are trying to eliminate Medicare Advantage, anyway.

Pro‐​choice Democrats want to preserve access to private abortion coverage. Pro‐​life Democrats want to preserve the right to choose whether to fund abortions. Fair enough. But any vote for government subsidies is a vote against choice.

Get government out of health care, and you’ll be able to make choices for yourself. Not before.

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