House of cards: Universal health reduces abortion argument

William Saunders Senior Vice President, Americans United for Life
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In response to a March 14, 2010, op-ed in the Washington Post by T.R. Reid, titled “Universal health care tends to cut the abortion rate,” Americans United for Life vice president for legal affairs William Saunders offers the following rebuttal.

T. R. Reid clearly wants the health care overhaul proposed by the government to pass.  He recognizes that the most immediate way to get that accomplished is to pass the abortion-funding Senate bill.  However, it is his logic, not that of pro-life opposition, that is flawed.

When Reid states, “It’s only in the United States that opponents of abortion are fighting against expanded health-care coverage,” he ignores the fact that Rep. Bart Stupak and his pro-life Democrat colleagues, members of the United States Conference of Catholic Bishops, and others, are in favor of universal health care.  They do not “oppose expanded coverage in the name of restricting abortion”; rather, they oppose paying for abortion in the name of expanding coverage.

What they do not accept is Reid’s implicit premise that universal health care cannot exclude abortion funding.  However, a government can choose to provide universal health care without accepting the false notion that abortion is health care—a point proved by the House’s final bill, passed in November, with Stupak’s funding restrictions and Stupak’s support.

Thus, it makes perfect sense that even if you accept Reid’s argument that universal health care lowers abortion rates, you do not have to accept universal health care that pays for abortion.

But Reid’s argument that a government takeover of health care is “one of the most powerful tools for reducing the numbers of abortions” is also suspect.  Looking at the data from http://data.un.org (particularly the data Reid omits), it is clear that abortion laws have a more obvious relationship to abortion rates in developed nations than whether or not the government runs the health care system.

First, however, as Dr. Michael New, a political science professor at the University of Alabama, has noted, the UN statistics misrepresent abortion rates in the United States. The most recent data available, from 2005, reported by the pro-abortion Guttmacher Institute and the Centers for Disease Control are 19.4 and 15, respectively. These figures put the United States on par with the abortion rates for Canada and Great Britain—universal health care nations listed by Reid—and are actually lower than other government-run health care countries, such as Australia and Sweden, which Reid forgets to mention.

Dr. New has also cited experience from within the United States that disproves Reid’s theory.  For example, Hawaii’s abortion rate consistently exceeds the national average, even though since 1974 the state has required all employers to provide relatively generous health care benefits to any employee who works 20 hours a week or more, and has consistently had one of the lowest rates of uninsured adults in the country.  Moreover, while the Guttmacher Institute reports the national abortion rate fell by 13.8 percent between 1995 and 2005, in Tennessee the abortion rate fell by only 3.3 percent, even though the state program TennCare, created in 1994, has expanded Medicaid to cover those who cannot afford insurance or who had been denied coverage by an insurance company.

While Reid’s argument that health care benefits reduce abortion rates is unsupported, and even disproved, studies do confirm that abortion law has a direct impact on the incidence of abortion. A 2004 study that appeared in The Journal of Law and Economics analyzed the relationship between changes in abortion policies and abortion rates in post-communist Eastern Europe (where under communist rule health care was “universal” and abortion rates were tremendously high). Modest restrictions on abortion were found to reduce abortion rates by around 25 percent.

Poland, as one of the few countries to have significantly tightened restrictions on abortion, is an excellent case-study. In 1993 abortion was restricted to cases where the life or health of the mother was threatened, where the child was disabled, or in cases of rape—and they have strictly enforced these grounds.  The number of abortions in Poland has drastically decreased since.

We know from our own history that the laws governing abortion directly affect the number of abortions.  Between 1973, when the Supreme Court overturned state laws restricting abortion in Roe v. Wade, and 1980 the number of abortions more than doubled.  But since Planned Parenthood v. Casey in 1992 permitted some abortion restrictions, the number of abortions in the United States has been steadily and significantly declining.

Another piece of history Reid neglects is our experience with funding abortions.  Medicaid, the federal government-run health care program, funded elective abortions, around 300,000 per year, until the Hyde Amendment was first enacted in 1976.  Since then, states have taken various approaches on abortion funding.  A Guttmacher Institute literature review released in 2009 shows strong consensus that abortion rates are reduced when public funding is restricted.  The review cites 20 academic studies documenting this relationship and only four that found the results of public-funding inconclusive.

Furthermore, while abortion rates are declining in the United States, they are rising in parts of Europe – including Great Britain.  While these nations have not altered their laws on health care coverage, many have liberalized their abortion laws suggesting, again, that the latter is what drives abortion rates.

Underlying Reid’s argument is the faulty idea that you cannot both have universal health care and not fund abortions.  Reid supports his argument with selected data from one chart, a statement from a girl he knows that lives in Great Britain, the personal beliefs of unidentified people he talked to when researching for a book, and a statement drawn from the musings of Britain’s Cardinal Basil Hume.  To come to his conclusion he also ignores a much larger and more authoritative body of evidence.  As desperately as Reid wants universal health care in the United States, he is simply wrong to claim it would reduce the rate of abortion—especially when, as is the case with the Senate-passed bill, it funds abortion. 

William Saunders is vice president for legal affairs at Americans United for Life.