The Heat Is on, and It Looks like Waffles

ELLEN GOODMAN

October 01, 1993|By ELLEN GOODMAN

BOSTON. — Boston -- Maybe we should call it a pre-existing condition. Being female, that is.

After all, we've been promised that people with other pre-existing conditions, things like diabetes or asthma, won't be excluded from the new health plan. Maybe if femaleness, or at least fertility, were a pre-existing condition, we could be assured of coverage for the whole range of reproductive care, including abortion.

As things are, it's looking a bit dicey. Even before the president's speech, health guru Ira Magaziner said they were prepared to accept a plan without abortion coverage. It took a spine-stiffening visit from the Congressional Women's Caucus and a pre-emptive press conference by pro-choice leaders to get the administration back on track.

The party line now is that the plan will cover pregnancy-related care and that includes abortion. But when the heat is on, there is the distinct smell of waffles in the air.

There isn't a person in the Congress, or in the country, who doesn't know that this is going to be a major, knock-down, drag-out fight. But there is a belief that when pro-life push comes to pro-choice shove, the president's supporters are the ones who will compromise. Again.

We are already in a state of compromise. The end result of the abortion wars has been a two-tiered reproductive-health care system. One for the poor, one for the rest. One that is public and the other private.

Today, a woman can get a safe, legal abortion as long as she pays for it herself or with her insurance. She virtually can't get an abortion with federal money.

About 90 percent of private health-care plans cover abortion for any reason. But the federal government only pays for it in the case of rape, incest or the life of the mother. We have made a

compromise by compromising the poor.

We're still doing it. Last session, the Congress lifted one ban so that federal employees could pay for abortion coverage in their private plans. Then on Tuesday the Senate voted to retain another ban withholding money on all but a handful of Medicaid abortions.

The new health-care plan, however, is supposed to eliminate two-tier systems. It's supposed to do away with what Hillary Clinton called at the hearings this week, ''the inequities and the inconsistencies of a health-care system.'' We'll all get one basic, comprehensive package.

The question now is whether that package will look like Medicaid or like, say, Aetna. Whether poor women will gain abortion coverage or women with insurance will lose their coverage. The answer will be determined by some tough politics.

In the last election, pro-choice voters gave a lot and gained a lot. They gained a president, an attorney general and a Supreme Court justice who all believe that abortion should remain legal.

But there has not been a victory parade. Doctors have been shot and murdered, clinics burned, patients assaulted. There is no federal law yet to protect clinics. The attention has turned from keeping abortion legal to keeping it available.

If access is the issue at clinics, it's also the issue in the health-care debate. Operation Rescue is one barrier; money is another. One out of every five women has an abortion in her lifetime. Health-care policy should reduce abortion by promoting contraception, not by taking abortion out of the coverage.

The current debate is going to set policy about women's health for a long, long time. The president's pro-choice supporters don't want to be spoilers, but they also don't want to be losers.

As Pamela Maraldo, head of Planned Parenthood, says, ''We are acutely aware that the squeaky wheel gets oiled. For too long women's health has been sacrificed. We will not be sweet and nice and roll over.''

So this is where we are in the debate. We're on our way to discarding a two-tier health-care system. One for the poor, one for the rest. We're on our way to eliminating the two-tier reproductive health-care system. One public, one private. We have to do that by extending coverage to all women, not by eliminating it.

Remember all those pro-choice voters? Remember the ones with health insurance? They didn't send this administration to Washington to see their own choices diminished.

In this debate, political clout is also a pre-existing condition.

Ellen Goodman is a syndicated columnist.

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