Does Better Health Care Coverage Reduce Abortion?

In his most recent column, T.R. Reid posits a connection between the absence of national health coverage in the United States and the unusually high number of abortions. Comparing the U.S. to other industrialized nations, Reid points out that the U.S. has a substantially higher rate of abortion than countries that have adopted national health care systems. The author uses this as evidence to suggest that opponents of abortion should be more willing to accept national health care as a way to advance their cause.

However, Reid’s argument ignores at least two other important points.

First, Reid fails to acknowledge the wide range of abortion rates among countries that have adopted national health care systems. The variation among states with universal health care is far greater than the variation between the United States and the United Kingdom. In Germany, for example, the number of abortions for women ages 15 to 44 is 7.8 per 1000 women, compared to 17 per 1000 women in the United Kingdom. (The rate in the United States is 20.8 per 1000 women.) This suggests that, when it comes to abortion rates, the health care system may not be as important as more subtle forces like culture.

Second, Reid does not take into account national teen pregnancy rates, which are far higher in the United States than in other industrialized countries. Because higher rates of teen pregnancy are likely connected to higher abortion rates, it seems plausible that there is a third variable – perhaps some measure of social responsibility – contributing to both the absence of a national health care system in the United States and the higher rates of teen pregnancy and abortion. Isn't it possible that American couples are less responsible about pregnancy because they have less of a sense of responsibility to society? Wouldn't this lack of social responsibility also make Americans less concerned about the uninsured?

Unfortunately, Reid chooses not to even consider this possibility. He simply asserts that there are “various reasons” why universal health care reduces the rate of abortion, acting as though correlation automatically implies causation.

As a supporter of national health care and abortion rights, I wish Reid’s contention were true. But wishing does not make it so. In his eagerness to connect national health care with lower rates of abortion, Reid overlooks essential details and relies far too extensively on testimonial evidence.

Time To Move On . . .

I went to Wordle today to get an idea of what I've been talking about for the past week:


[Click to enlarge]

I think I need to move on to a new topic . . .

Stupak and the NYT

In criticizing the Stupak Amendment this past Monday, the NYT Editorial Board wrote:

The bill brought to the floor already included a careful compromise that should have satisfied reasonable legislators on both sides of the abortion issue. The vast majority of people expected to buy policies on the new exchanges would pay part of the premium and receive government tax credits to pay for the rest. The compromise would have prohibited the use of the tax subsidies to pay for almost all abortions, but it would have allowed the segregation and use of premium contributions and co-payments to pay for such coverage.

I'm opposed to the Stupak Amendment and broadly in favor of abortion rights, but I don’t see how this original compromise could be considered “reasonable.” Money is fungible. There is no way to 'segregate' the tax subsidies from the abortion coverage. Either the federal government funds abortion or it doesn't.

This seems a rather obvious point. In fact, read what the NYT Editorial Board wrote just over a year ago in its commentary ('Money Really is Fungible') on executive pay caps:

Just weeks after the Treasury Department gave nine of the nation’s top banks $125 billion in taxpayer dollars to save them from unprecedented calamity, bank executives are salting money away in billionaire bonus pools to reward themselves for their performance.

Outraged? The bankers (who didn’t anticipate the subprime crisis) were ready for that. So they are assuring everyone that this self-directed largess won’t be paid with the same dollars they got from taxpayers. They’ll use other ones.

What we want to know is will they be marking the bills so they can be sure which is which?

Is there any real difference between these two situations, other than the fact that the former involves abortion and the latter involves greedy bank executives? How can you recognize the absurdity of one scenario, and consider the other “reasonable”?

If the NYT Editorial Board was honest, it would make the case that abortions should be publically funded. Instead, it has decided to chastise abortion opponents who refused to accept an illogical compromise.

Update: Conor Friedersdorf responds to Ann Friedman's post on the Stupak Amendment:

There are many women in the United States who oppose abortion, and if asked would agree that federal money shouldn’t fund it, so the assertion that the amendment throws 50 percent of the population under the bus isn’t accurate, unless one takes the position that these anti-abortion women are suffering from false consciousness.

Friedman's reply:

Actually, no matter what their beliefs about abortion, every woman in this country is indeed screwed over by this amendment. Many, many women who are opposed abortion rights have exercised those rights themselves -- whether for health reasons or because, when it came right down to it, they simply found themselves making a different choice than they thought they would in that situation.

Megan McArdle is concerned with Friedman's argument:

[A]s a response, this seems to trivialize the preferences of pro-life women in a way that I find pretty disturbing from feminists. In what other area of life is it okay to pat the little lady on the head and tell her that she doesn't really want what she says she wants, because she might regret it later?

. . .

Obviously, since I'm pro-choice, I think you can argue against abortion control in many effective ways. But this is not one of them--at least not if you hew to the feminist notion that women are entitled to their own choices and preferences as individuals, not lumped in with some vast undifferentiated mass of women who all want the same thing.

Abortion Amendment

A few thoughts on the recently-passed Stupak Amendment, which limits federally-subsidized abortion coverage . . . .

First, President Obama feverishly (and, at the time, disingenuously) denied allegations that the health care reform bills before Congress would allow for any federal funding of abortions. This was essentially the status quo under the Hyde Amendment and subsequent legislation. No one should be surprised that this amendment passed, since the president had promised as much.

Second, the amendment does not prohibit federal funding for all abortions. There are exceptions for rape, incest and the health of the mother. These exceptions fit with the mainstream view on abortion rights.

Third, a strong plurality of Americans believe that abortion should be "legal only in a few circumstances." This is reflected in the composition of the House of Representatives, where a majority of legislators supported the amendment. Those who are broadly in favor of abortion rights (myself included) must acknowledge that we live in a democracy where relatively few Americans support a universal right to abortion. Most people have complex views on the subject.

Fourth, a person's stance on abortion is not strongly associated with gender. In fact, most studies I've seen show no statistically significant difference between men and women on this issue. Today, women are more likely to call themselves "pro-life" than "pro-choice."

Update: Ezra Klein makes an interesting point:

[T]he biggest federal subsidy for private insurance coverage is untouched by Stupak's amendment. It's the $250 billion the government spends each year making employer-sponsored health-care insurance tax-free.

That money, however, subsidizes the insurance of 157 million Americans, many of them quite affluent. Imagine if Stupak had attempted to expand his amendment to their coverage. It would, after all, have been the same principle: Federal policy should not subsidize insurance that offers abortion coverage.

This is certainly how economists and policy analysts would view the situation. Although, I suspect most ordinary Americans would recognize a slight difference between providing a direct federal subsidy for health insurance and merely lifting the tax on employer-provided insurance.

I wonder if Ezra shares Greg Mankiw's fears about marginal tax rates . . . .