OP-ED

Abortion Coverage Is About Math As Well As Politics

Al LewisBy Al LEWIS

Let us start by acknowledging that those who think abortion is a sin must be respected, and not forced into a risk pool that covers abortion. Let us also acknowledge that those who are pro-choice need to acknowledge that abortion (except in the case of rape or incest or potential significant harm to the mother) is a personal choice (albeit usually as a result of an accident) rather than a health issue in the narrow sense of the word.

Therefore, leaving all the politics aside and just focusing on the question of what should be covered in a basic benefit, it is not unreasonable to require an actuarially appropriate rider to cover abortion.

What would that “actuarially appropriate rider” be? Probably only a dollar or two a month to begin with. Figure that there are 800,000 abortions per year. They cost maybe $1000 apiece. That’s $800,000,000. Divided by the 21-65 year-old health-insurance-buying population, we are talking about roughly $4/year. Next, figure some self-selection into the rider, so that people with the rider might, on average, think they have (for instance) three times the probability of an unwanted pregnancy than people without the rider, which is why they get the rider. Therefore their likelihood of abortion is three times higher than the average on which the above calculation was based. So that $4 becomes $12/year or $1/month, to begin with.

Note the phrase “to begin with.” Remember, we are talking about insurance here, and insurance is based on math and math is not a belief system. It is immutable. Is it not pretty to discuss abortion mathematically, but immutability trumps belief, whether one is pro-choice or pro-life. Therefore, an actuarially appropriate rider must reflect the total cost differential caused by abortion coverage between the risk pool with coverage and the risk pool without coverage.

Note the phrase, “the total cost differential.” In future years, the $1 rider would have to be adjusted not just by changes in the abortion rate and procedure cost, but also by the relative accidental birth rates (and pregnancy/delivery/neonatal costs) in both groups. Since there is no way of knowing the true accidental birth rate, perhaps the birth rate to minors could be used as a proxy, as most such pregnancies could be qualified as unplanned.

If in fact, the abortion rate and cost remain the same, and the accidental birth rate proves to be the same in both the pool with the coverage and the pool without, then the rider remains at $1 in future years. If that happens, it means that no minor in the pool with abortion coverage was more likely to get an abortion because it was covered, and – using minors as a proxy for accidents – covering abortion did not reduce the number of accidental births. Each abortion avoided an incremental pregnancy and therefore, there was no cost savings to the plan by covering abortion.

If in fact, the accidental birth rate turns out to be higher in the risk pool without abortion coverage, it implies that some people in the abortion pool were more likely to get an abortion than those in the other pool. In that case, the rider must be reset, lower. It may even be the case that the “rider” becomes negative, meaning that health insurance with abortion coverage costs less than health insurance without. That would happen if indeed the birth rate to minors – when projected to reflect all accidental births in the covered population – falls by enough to offset the costs of abortion coverage.

Therefore, the recommendation to those who support both health care and choice is to respect both your adversaries’ belief systems as well as the immutability of math, and not let a first-year rider of $1 for abortion coverage – with a possible reduction in future years even to $0 or below – influence your vote on health reform. Instead, simply insist that the Stupak Amendment rider be calculated in an actuarially sound manner – meaning that it captures any change in the birth rate caused by access to abortion — in all years.

It is not pretty to think about abortion mathematically, but ultimately health reform is about insurance, insurance is based on arithmetic, and this would be the way the arithmetic works out. Math is not, and — despite all the politics in Congress — will never be, a popularity contest.

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16 replies »

  1. This is just another Selective Morality Issue largely used for votes. Still,most Pro Lifers believe that life stops at birth.After a child is born.These selective pro lifers could care less. I’m more pro life than those lunatics that kill Doctors for their beliefs. Simply because a large part of the population and I believe that Pro Life doesn’t stop at Birth.
    At the same time I don’t see them adopting Foster Children and babies with drug related and HIV /aids related ailments.Men often argue these points when it is better left to women. Men Place women in these predicaments and they have a right to choose for them? How simplistically arrogant of them.

  2. A lot of the people on this particular comment section are guys. What would you know? How could you make a deduction as to how a woman feels to have a private desicion made for her? No matter how I feel spiritually about the matter, this is a women’s rights isswue. Men aren’t told internally to give up anything when an abortion takes place, so why would it matter if women don’t have that right, right? And what would a 9 year old do with a child, pel? How would you explain such a situation to a child of such a union? I guess it could be easy for you to say something like that, due to the fact that you don’t personally know this young girl nor care about if she dies in the childbirthing process. Who knows?

  3. Interesting discussion happening here. Pel, “Wouldn’t the insurance plan cover the pregnancy? If so, wouldn’t it cover all of the costs associated with carrying the child to term and delivering him or her?”
    Touche, this is a really good point.
    Are we, collectively as a society, fiscally responsible to each other for any medical procedure we may want or need, or are we collectively responsible to each other for the public good? I’m on the public good side of the fence and don’t see where abortions or IVF belong on this side of the fence. Who is going to determine medical “wants” vs “needs.”? I don’t think anybody ever could, we’d never agree. I don’t want to be mandated to purchase insurance, I know a lot of other people don’t, either. I have no problem with mandates that serve the public good.

  4. > I would point out that very often women and teenagers find themselves facing a problem pregnancy that may involve contraceptive failure (IUD, oral contraception, or diaphragm), date rape, or a medically compelling situation (such as a molar pregnancy, when the fetus itself becomes cancerous).
    Medically compelling situations (such as molar pregnancy) whose resolution is abortion. Do those occur “very often” ? And, under a new regime of outlawed abortions, would a doctor & mother likely be prosecuted (court of justice, or court of opinion) for terminating a pregnancy in the face of an imminent threat to loss of life for the mother?
    > I once knew of a 9 year old girl, who’d been menstruating for two years, who found herself pregnant following a gang rape by a number of members of a local football team. Think about this. It’s unthinkably dreadful, but should this third grader and her mother have anticipated such a thing, and planned their insurance choice accordingly? This is not theoretical, but it happened, and there are any number of unthinkable situations that occur every day.
    Wouldn’t the insurance plan cover the pregnancy? If so, wouldn’t it cover all of the costs associated with carrying the child to term and delivering him or her?

  5. I applaud Al for offering an interesting point of view that’s stimulated thoughtful responses. It’s refreshing to encounter reasoned discourse on this blog rather than verbal, ad hominem harrassment in whatever direction.
    However, the theorizing doesn’t match up with the realities of problem pregnancy experience. In fact, it is still true despite the onslaught of anti-abortion activities, Roman Catholic women, for example, seek pregnancy termination as often as women of any faith or no faith tradition. I just confirmed that this is an accurate statistic from Guttmacher Institute. It is fair to assume that perhaps the majority of these women did not think beforehand that they would choose to terminate a pregnancy.
    In fact, only 22% of Roman Catholics in the US agree with the bishops that abortion should be entirely banned (see rcrc.org Catholic perspectives link).
    I would point out that very often women and teenagers find themselves facing a problem pregnancy that may involve contraceptive failure (IUD, oral contraception, or diaphragm), date rape, or a medically compelling situation (such as a molar pregnancy, when the fetus itself becomes cancerous). There are any number of situations in which those who were staunchly opposed to abortion in theory, when faced with their daughter’s’ or their own real life situations, find themselves choosing to terminate a pregnancy, even one which may have been longed for mightily.
    Many of us come from faith traditions, including my own Episcopalian faith, which accords women and their daughters the legitimacy of their own highly personal decisions in these utterly private matters. It is precisely because these decisions are made situationally that the preexisting philosophical stances don’t predict what a woman and her family would decide when a pregnancy occurs in unforeseeable
    real world circumstances.
    I once knew of a 9 year old girl, who’d been menstruating for two years, who found herself pregnant following a gang rape by a number of members of a local football team. Think about this. It’s unthinkably dreadful, but should this third grader and her mother have anticipated such a thing, and planned their insurance choice accordingly? This is not theoretical, but it happened, and there are any number of unthinkable situations that occur every day.

  6. Again, let me see if I understand this correctly:
    Jehovah’s Witnesses are some people who strongly believe that receiving whole blood transfusions is sinful. Of course I acknowledge and respect their right to believe this, without holding that particular belief myself, and also acknowledge their right to refuse transfusions for themselves. But, here you are saying that as a result of the existence of this belief (or perhaps its strength; I’m unclear as to how the degree of fervor factors into the calculations), JWs should not be in a risk pool that pays for transfusions.
    So, then you’d propose to exclude coverage of blood transfusions as a basic benefit but then make some actuarially sound calculations to determine the cost of the additional rider that non-Jehovah’s Witnesses would need to cover transfusions?

  7. With all due respect, you are not being attacked “from the left wing.” Your very specious assumptions outlined in your initial introductory paragraph are being reasonably critiqued.
    As a start, we do not theoretically in this country base our laws on what any given group may regard as “sin.” That would be more akin to sharia. Not meaning to argue, of course, that we haven’t done this in our history (Prohibition, anti-sodomy laws, etc.), but that in principle, this country is not a theocracy.
    There just is not any basis for exempting folks from risk pools based on their particular beliefs concerning sin.
    Seconding Jaye’s comment as well–as a female, why should I be forced into a risk pool that covers viagra or prostate cancer treatment and screening? One could divide risk pools ad infinitum in such a way as to negate the very purpose of pooling risk.
    But really, your last sentence deserves scurtiny as well. I’m not quite sure just what you mean with “a personal choice rather than a health issue in the narrow sense of the word.” That’s because in most, if not all, instances, availing oneself of medical treatment is a choice in itself. Having my bunion fixed or my benign mole removed or my knee replaced is a personal choice at some level. Taking insulin treatment if I am diabetic is a choice. Having my appendix removed for appendicitis is a choice. Having breast augmentation surgery is a choice. Now just exactly how are you going to manage to define which of these many treatments and procedures are health issues in the narrow sense of the word versus personal choices?

  8. Shelia, a person attacks a pregnant women, cuts out the 8 3/4 month old egg which dies in the process. The women lives so by your logic since no one died this assailant should be charged with assault?
    I’m not aware of any state that doesn’t treat an unborn fetus as a person when a crime is commited against it, only when liberals want to willy nilly kill them because they are inconvientant do they have no rights.
    “I’d bet that most women who get abortions probably never thought they’d be in that position.”
    Are you talking their first one or do you bet when they make the appointment for their 10th they never thought they would have that many?

  9. “but I think it is far better to educate and discourage it rather than punish people who need it”.
    -I agree with the first half of your sentence.
    re:the second part about “punishing”
    -How in the h*ll is an anti abortionist “punishing” a woman that made the choice to have sex resulting in her pregnancy?
    Because I don’t want to pay for her “mistake”/ “accident” I’m “punishing” her? How about personal responsibility? Any rational adult will run through a quick risk analysis prior to engaging in risky activities, ie; I choose not to go snowboarding/skateboarding due to the high risk of severly injuring myself.
    Sorry hun, I am not responsible for anybody’s mistake.

  10. Margalit,
    No one lacks access to health care. They just want it to be free. With insurance it LOOKS free. It is not.
    Anyone can afford basic healthcare if they choose to prioritize for it. But they all want it to be free.
    No way.

  11. I think all health issues are personal. Does the government pay for putting people to death by a court order? Yes! I think that is killing a “person” and my belief choice is that it wrong; so my tax dollars should not be used for this.
    Furthermore, I do not believe that an embryo is a “person”, and a fetus without a functioning brain for that matter, is not a “person”. And furthermore is a corporation a “person”? I definitly think not!
    I like to use the chicken and the egg anology. When I consume an egg (fertilized or not)I know it is not yet a living, breathing, vital “chicken”. It is an egg; just the same as an embryo is. During fertilization of an egg, women discard numerous eggs; even fertilized ones. Do you think by doing so that we are killing life? And is “life” the same as a “person”. Why is the definition of life different if it is in the womb or not? It is so bizarre to think that a fertilized egg is a “person”. Yes, it is alive, but so are all those eggs we discard monthly as well as those that are fertilized and destroyed because they fail to pervail.
    In the State of Texas, doctors determine whether a life in the form of an actual person is in their opinion viable. They can by law withdraw medical care and let the person die simply because they think the life will not be worthwhile; such as in the case of severe disability. This is allowed even when they know the person’s brain is functional. Isn’t that murder by the same definition anti-abortionist use when talking about abortion?
    I believe that there should be an abortion option in the public option and that funds from the government should be allowed for use when necessary. There should be two public options available so that anti-abortion supporters could choose one with or without abortion coverage. From the statistics I have seen, the evangelicals have a higher percentage of teen births. Maybe we should not provide insurance for pregnancies in the public opton unless people are married, over 18, or for that that matter, use viagra, or birth control, or any medical procedure that prevents birth or encourages the creation of unwanted pregnacies. Maybe we should force women to give birth every nine months so we don’t kill so many eggs; firtilized or not. Have these anti-abortionist thought of funding research to harvest all eggs from women to prevent the eggs from dying in the woman’s body? What extremes will these anti-abortionist go to in order to control our bodies and our minds. It is scary.
    Personally, I am sick and tired of the people who want to legislate my childbearing and birthing decisions. I don’t want to promote abortion, but I think it is far better to educate and discourage it rather than punish people who need it.

  12. The math is irrelevant. The actuarial value is irrelevant. The abortion discussion is not about money. It’s about principles.
    Personally, I find it refreshing that people are debating principles when legislation is made. Everything else in this health care reform debate is all about dollars.
    Wouldn’t it be nice to discuss the lack of access to health care from the same perspective we discuss abortion?
    Surely, sanctity of life applies to humans after being born as well as prior to that event.

  13. I second Jaye’s comment!
    Wouldn’t Viagra use ALSO fall into the category of “personal choice rather than a health issue in the narrow sense of the word?”
    The point of being pro-choice, is that women should not be penalized for their decision whether it to have an abortion or to keep the child, with the associated costs and risks of pregnancy.
    The point of insurance is to guard against unforseen events. I’d bet that most women who get abortions probably never thought they’d be in that position.

  14. I expected to be attacked by the right wing, not the left. To those who are pro-choice (including me) and pro-health reform, I say, suck it up, the Shupak Amendment is here to stay, and rather than oppose health reform because you got outmaneuvered, just tweak the Shupak Amendment language math so that it may become the case that the coverage with abortion becomes less expensive than the coverage without.
    Also, please recognize that your belief system is not universally shared and that some people feel very strongly that abortion is a sin, and as a result, should not be in a risk pool that pays for them if another option is available.
    However, the latter group needs to be willing to pay more for its insurance than the former group, if indeed its insurance costs more due to a higher accidental birth rate.
    As for the exceptions to the abortion rule you mentioned, that’s not me — that’s Medicaid rules in most states, and that’s likely the Shupak Amendment that you are arguing with.
    The point is, assuming there is going to be a Shupak Amendment, the rider should be priced in an actuarially correct manner.

  15. Let us also acknowledge that those who are pro-choice need to acknowledge that abortion (except in the case of rape or incest or potential significant harm to the mother) is a personal choice
    I’m sorry, but this is an indefensible position.
    If abortion is a sin, than it is ALWAYS a sin. If a fetus is the same as a child, then it’s the same as a child. If you killed a 6 month old infant that was the product of incest or a rape, it would be murder. How in the world would it be OK to kill someone because his or her father was a rapist?
    Likewise, if I will die without a bone marrow transplant from my sister and she doesn’t want to give it to me, I can’t make her give it to me. I certainly can’t kill her and take the bone marrow. Her life is equal to mine, and even if I will die without harming her, I cannot harm her without her consent–even if the harm is incredibly minimal, the way a bone marrow transplant is.
    Why, then, would it be OK for me to kill a fetus (which, again, you argue is morally identical to a full-grown person) simply because I might die or be harmed by bringing it to term?
    You have made a personal choice that a fetus is not a person when you say it’s not a person. In your case, that’s when its father is a rapist, or when pregnancy would harm the mother. You have a PERSONAL definition of when abortion is OK. A lot of people tend to agree with you, but a sizeable number of people disagree (not to mention, your position is logically indefensible). But the reality is that this is your PERSONAL opinion.
    I don’t see why YOUR definition of when abortion is OK should supercede the opinion of the PERSON WHO IS ACTUALLY PREGNANT.
    It is ALWAYS a personal choice to have an abortion. You’re just deciding that your personal choice is the one that counts.
    Sorry, but I think the personal choice of the person who is pregnant is the ONLY one that matters. All people will simply NEVER agree on when an abortion is OK, and it’s ridiculous that we should write laws expecting that they all will. If you ever get pregnant, I will support YOUR choice. I won’t pretend my opinion is more important than yours with regard to your pregnancy–no matter how much I disagree with your logic or with your decision.
    And part of living in a society is accepting that your taxes will occasionally support things you disagree with. I certainly have seen a lot more of my tax money go to Iraq than to abortions. If you don’t like it, then go live on an ungoverned island somewhere. This is the price of civilization.

  16. OK, so why am I “forced into a risk pool” where I am paying for coverage for prostate cancer treatment? for Viagra? One of those things can be needed for something that can be, but isn’t always, life threatening, one is for something difficult and definitely life impacting. Guess what — pregnancy can also be any of those things.
    I’m of a religion that’s opposed to funding armaments of war. Does that mean I can just refuse to pay taxes because I don’t want to fund the pentagon?

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