Abortion as a trading card

December 06, 1993|By Anna Quindlen

WHEN President Clinton was working the Congress, marshaling the votes he needed for NAFTA, some saw him as a smart politician playing the horse-trading game and others as a cynical sharpie who would sell his soul to the Devil if the Devil would deliver an aye.

But some abortion rights advocates saw the shape of things to come. Someday soon, they fear, Mr. Clinton, pragmatist par excellence, will wheel and deal on a health-care reform package, and one of the cards he will trade away will be the inclusion of abortion coverage.

If those fears turn out to be true, it will truly be a shame. For in providing a standard benefit package that includes access for all to abortion, the Clinton administration has a unique opportunity to move beyond cheap rhetoric and into the reality of public funding.

One of the saddest sentences in the child-bearing lexicon surely must be, "Well, I can't afford an abortion so I guess I'll have the baby." It conjures up vague images of children unwanted and unloved.

But the specific tragedy of that sentence was made manifest recently in an analysis of the end to state Medicaid funding in Detroit, which has the highest percentage of children living in poverty of any major American city.

The Detroit News and Free Press found that the ban on state funding in Michigan in 1988 was followed by the sharpest increase in the Detroit birth rate since the peak years of the baby boom.

That is no tragedy. But this is: marked increases in low-birth-weight babies, in the number of newborns with critical medical problems, in births to mothers who had received little or no prenatal care.

This is what the Clinton administration now must weigh: the costs of providing abortion as part of a reproductive health package, and the costs of not providing it.

It is many times more expensive to provide prenatal care and delivery than an abortion, so arguments that the taxpayers save by excluding abortion coverage are simply wrong.

But this issue will be argued on the basis of deeply held feelings about what is just and moral, not on fiscal prudence.

The objection to public abortion funding heretofore has always been one of conscience, the old "I don't want my tax dollars to pay for" rationale. The Clinton plan offers some advocates the opportunity to state a new set of conscientious objections.

I don't want my tax dollars to pay for a plan that forces poor women to have babies they do not want and cannot afford to raise. I don't want my tax dollars to pay for a plan that will send a message to poor women, by offering to pay for prenatal care but not for abortion services, that it is always, under all circumstances, better to have a baby than an abortion. That's just not true.

At the same time that there are persistent calls for Draconian welfare reform and even the outright end of benefits to single mothers and their children, a health care plan that covers prenatal care, birth and baby care but denies abortion to those who want it constitutes a tacit agreement between government and citizen.

And that agreement is that government has a vested interest in, and an obligation to, the continuing well-being of that child. Would that there were any hope of living up to it. Besides, in the case of many poor women, this is not an agreement in which they participate; it's an arrangement to which they capitulate, having no other choice because they have no money.

The administration has made lukewarm arguments that, since abortion services are already provided by many private insurance plans, it would be unfair to take them away under a plan for universal coverage. That's not the point.

The point is to remove the biases from a system that now makes it impossible for many poor women to get abortions. Not only would middle-class women maintain their coverage; poor women would be able to make a true choice.

Health-care reform, after all, is not about people who already have health care; it's about the ones who don't. If, at the end of this process, women who once could not afford an abortion still cannot afford one, it will be because Mr. Clinton has used this critical issue as a trading card.

We all know now that he can deal. But can he stand strong?

Anna Quindlen is a columnist for the New York Times.

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