Health Care Reform and the Culture of Personal Responsibility

I live in the great Commonwealth of Massachusetts, where we have had laws mandating that all residents must have health insurance on the books since 2006. Indeed, the Massachusetts healthcare reform law was supported and largely guided by then-governor and once and future Republican presidential hopeful Mitt Romney, who may be a secret baby-eating liberal at the state level, but is most assuredly not one at the federal level. Opponents (and people who like to coin dumb new words) called it “Romneycare”, so when you hear “Obamacare” today, you’ll have a sense of the background of the term. As a result, the healthcare reform bill that this weekend squeezed quietly though Congress, like an elephant trying to silently cross a floor made of eggshells during a funeral, won’t change my life as much as it will some folks’; I am used to my semi-outrageous state income taxes paying for social programs, and frankly I am happy to contribute. Unlike my federal taxes, for example, I needn’t worry that my state taxes are funding wars I do not support, as to the best of my knowledge Massachusetts has yet to declare war on anyone (aside from the Yankees… rimshot!).

So I’ve watched the reform debate with great interest, albeit without a clear idea of how it will or won’t affect me in my own damn life. And one aspect of the debate in particular has drawn my attention, for a variety of reasons which I will cheerily elucidate below: the abortion issue.

For those just tuning in, and for my readers who live in countries with established and civilized healthcare regulations, anti-abortion Democrats have been creating a huge drag on the passage of this bill. In the interest of getting shit done, back in November Democratic representative Bart Stupak proposed an amendment to the bill specifying that federal funds would not be used “to pay for any abortion or to cover any part of the costs of any health plan that includes coverage of abortion”. Ostensibly, this would prevent taxpayer money from going to pay for abortions, a distinction about which anti-abortion advocates are really quite stodgy. (No word on how the same folks feel about taxpayer money going to pay for, say, the execution of state and federal prisoners, or the deaths of tens of thousands of civilians in Iraq as a result of the US-led war there. Not all life is precious, kids!) On the surface, this might even seem like a reasonable concession, if you’re not deeply committed to women’s privacy and right to make decisions about her own body. But there are a few aspects of this amendment that betray a larger cultural movement with which I have major problems as it relates to bodies in general — not just female ones, and not just ones that are knocked up.

First, in the interest of full disclosure, I should note that I do not get the whole fetus obsession many anti-abortion folks have. I work extremely hard to keep an open mind on these issues, and to find common ground even with people with whom I have major philosophical differences. If I cannot agree with them, I try to at least gain some level of understanding of the alternative positions. And I’ve spent literal years reading debates and looking for an answer to the question of why an anti-abortion advocate would be in favor of forcing a woman to carry and deliver a child she does not want. Don’t we have plenty of evidence as to what happens to kids with mothers who ignore or resent them? Or who cannot afford them? On that note, I had an essentialist feminist professor many years ago who, stunningly, was fond of arguing that “pro-choice” as a term was misleading, because, according to her beliefs, many women have abortions simply because they cannot afford to have the child. The implication being that OF COURSE all women want to carry and deliver babies, if only we lived in a communist system that would support them; she would even, on occasion, go so far as to argue that under such a system, abortion would magically disappear. I found this horrifying, partly because of the suggestion that women intrinsically want to be mothers (and those who say they don’t are fooling themselves), and partly because it was an insane derailment of the actual point, that being that the choices women make about their bodies should be free of government intervention. Thus I continue to be baffled by those who would support government initiatives to restrict abortion, particularly since many of these same people are uniformly opposed to the impositions of a large and powerful federal government in all circumstances that do NOT involve fetuses.

Ultimately, the Stupak amendment was scuttled in favor of an executive order issued by the President specifying that no federal money would pay for abortions, a compromise which enabled the remaining anti-abortion Democratic stragglers to vote in favor and pass the damn thing. But the problem, amendment or executive order, remains the same: this restriction may not simply limit government funding for abortion, but may in fact lead private healthcare providers to drop abortion coverage altogether. The alternative would be to offer it as a separate rider on a policy, but this is hardly worthwhile as very few women go about life ever expecting to need to abortion such that they would pay for additional coverage. Ultimately, what we have here is a situation in which the personal beliefs of a few is dictating the medical realities of the multitudes, even extending to impose said beliefs on those who may not share them.

So, what’s my damage? Certainly abortion is a long-standing cultural hotpoint, so the fact that it’s appeared as a sticking point here is not surprising. But this isn’t simply about abortion. Indeed, this points to a more troubling overall trend of the past decade, in which people’s choices about their health are open to public debate and judgment. This idea is rooted in the American tradition of personal responsibility; note that all but the most radical abortion opponents allow for exceptions in cases of the Holy Abortion Trinity of rape, incest, or in which the life of the mother is endangered by the pregnancy. The distinction being that, from this perspective, abortion should only be an option when the pregnancy results from assault and is not a result of a “mistake” on the part of the knocked-up. This approach might work for a lot of abortion opponents in theory, but when you extend this thinking, which will inevitably happen as those who take such positions gain footing as they have above, it becomes startlingly limiting. This is where my criticism comes in. Let’s indulge in a little thought experiment in which we evolve this perspective into a broader ideology that seeks to limit funding to pay for the health care of those who make other “bad choices” in their lives. If you are injured in a car accident in which you were driving under the influence, maybe your insurance would refuse to cover your medical bills. Smokers diagnosed with lung cancer may be likewise denied (with an exception, perhaps, for those who have quit, along the lines of rape/incest/mother’s life above). Did you fail to get a mammogram promptly in your 40s that would have caught breast cancer at stage early enough that your treatment would have been less expensive? Wow, you fucked up. No coverage for you. Or hey, what about fat people who develop diabetes, or arthritis, or heart disease? Given the conventional wisdom (true or not) that these conditions are inextricably correlated with fatness, we might be looking at a moral opposition to paying for their treatment. Personal responsibility! Health insurance only for the healthy!

The truth is, simply living is dangerous to one’s health, and not every decision we make in our daily lives is reached after a thorough consultation with the possible health consequences. And yet, we’re turning into a nation of judgers, happy to hold others to a ridiculously high standard that we ourselves cannot hope to reach. Buying health insurance is not a promise that we won’t do anything to endanger our health; it’s a protection that when we DO get sick or injured, as is inevitable, we’ll be able to get the care we need. Health insurance coverage does not drop out in case of negligence, and arguably that’s a good thing, because we’re only human, and we make mistakes, and whether those mistakes result in an unwanted pregnancy or a broken ankle, we shouldn’t also have to prove ourselves faultless in order to justify our care.

The examples above are far from reality, and we can be thankful for that, but as long as our culture (not to mention our government) is moving in a direction that positions our bodies and our health as public property, open to conjecture and debate, the movement to demand private information and hold people individually responsible is a danger to everyone. Lest you think me overly alarmist, remember that we’ve already seen the argument against fatness framed as an issue in which the non-fat rail against having their insurance premiums paying for the treatment of those disgusting and soulless fat people, so it’s hardly a stretch to imagine that the growing public discourse against “obesity” might eventually evolve into a movement that seeks to actively (as well as passively) punish the fat for… being so fat. But when this sort of thinking prevails, nobody wins, as none of us are entirely pure.

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