Re: Health care and abortion
A reader writes in with another side of this debate:
In your recent post you mention that providing universal health care may make abortions go up or go down because "women have more access to birth control. Another answer is that there's no change because abortions are related to pregnancy rather than health-care coverage, and most women don't know that their insurance covers abortions anyway."
You forgot a 3rd reason: the cost of childbirth. When an uninsured woman finds out she's pregnant she also finds out she will need to spend about $25k to deliver the baby (assuming no complications), which she may not find fiscally palatable. In this case there's a strong financial incentive to go through with a substantially cheaper option: having an abortion.
This isn't just theory: a friend of our family faced this situation a couple years ago and she opted to have an abortion because she couldn't afford to have the baby. Having health insurance would have prevented this.
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March 19, 2010; 5:26 PM ET
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Posted by: nisleib | March 19, 2010 5:35 PM | Report abuse
It's not a theory, it's an anecdote!
Just having fun! I actually agree totally, but I felt the need to point out the reader's story was hardly dispositive.
Posted by: TMAC529 | March 19, 2010 5:38 PM | Report abuse
As the author of the NEJM article states, "the most significant factor: employment of the male sexual partner, which substantially decreases the likelihood that a woman will seek an abortion."
Again, the NEJM report concludes that "full insurance coverage of abortion services for all lower-income residents did not result in an increase in the number of abortions performed" in Massachusetts. The study specifically did not conclude that health care reform reduced abortion rates; rather it concluded that the previous reduction in the abortion rate reverse only slightly.
Posted by: rmgregory | March 19, 2010 5:43 PM | Report abuse
Not to mention that the child will need its own health care coverage. What's the pregnancy rate in Arizona?
Posted by: jwellington1 | March 19, 2010 6:12 PM | Report abuse
Earlier in the abortion contretemps in the House, I was curious to know just how much an abortion costs. If the National Abortion Federation is correct:
"I
n general, though, women getting an abortion between six and ten weeks' gestation can expect to pay about $350 at an abortion clinic and $500 at a physician's office. Providing abortions later in pregnancy is somewhat more complicated, and is usually more expensive. For example, at 16 weeks gestation, abortion clinics generally charge around $650 and physicians' offices generally charge around $700. After the 20th week, the cost rises to above $1,000. Other costs might result if care is not available locally. These might include travel costs, costs for overnight stays, or lost wages in states requiring waiting periods between pre-abortion counseling and the abortion itself." http://www.prochoice.org/about_abortion/facts/economics.html
When you think about the economics: delivery at $25K, abortion at $350-$700K, it's a mighty disincentive to deliver for an uninsured woman.
At least with a Health Care Reform bill in which more women can become insured, economic decisions won't have to play such a big role in what is already a difficult decision. I predict a slight trend downward in the number of abortions.
Posted by: JJenkins2 | March 19, 2010 6:22 PM | Report abuse
In just about every state, they will put you on Medicaid for an uninsured pregnancy. So while this woman may have thought abortion was her only option, it probably wasn't.
However, it's still her decision, whatever her reasons.
Posted by: uberblonde1 | March 19, 2010 9:13 PM | Report abuse
"This isn't just theory: a friend of our family faced this situation a couple years ago and she opted to have an abortion because she couldn't afford to have the baby. Having health insurance would have prevented this."
There are things other than having health insurance that would have prevented this.
Like birth control.
There are other options as well, but an ounce of prevention is always worth a pound of cure.
Posted by: bgmma50 | March 19, 2010 9:26 PM | Report abuse
Of course, if everybody else is subsidizing your pound of cure, why should you bother yourself with an ounce of prevention?
Posted by: bgmma50 | March 19, 2010 9:28 PM | Report abuse
Uh, $25,000 to deliver a baby?
That's the John Edwards premium isn't it? That guy singlehandedly drove medical malpractice insurance skyhigh.
We could probably reduce that cost by deporting John Edwards and those like him.
Posted by: muawiyah | March 19, 2010 9:34 PM | Report abuse
"We could probably reduce that cost by deporting John Edwards and those like him.
Posted by: muawiyah"
We'll have to give it a try, because Obamacare sure isn't going to reduce the cost of delivering a baby.
Posted by: bgmma50 | March 19, 2010 9:52 PM | Report abuse
*****That's the John Edwards premium isn't it? That guy singlehandedly drove medical malpractice insurance sky-high*****
I once sat on a jury (October 2007) that awarded a working class Latino family here in Massachusetts $27 million for a botched delivery that resulted in a severe case of CP (a lifetime with the cognitive function of a six month old baby). There was nothing at all flashy or slick about the plaintiff's lawyers, or the case they made, which was that the OB/GYN team failed to act reasonably in not at least discussing the possibility of a C-Section when all the dangers signs were flashing code red.
When you add up the lost wages, and the crushing cost of a lifetime of 24/7 care, and you try to calculate a net present value, that's what we came up with.
The poor fellow deserved every penny (not that I imagine the medical team was carrying that much insurance, but that's another issue).
Posted by: Jasper999 | March 20, 2010 1:12 AM | Report abuse
Not that this is an example conservatives would love to point to, but this does illustrate one of the reasons some people are concerned about cost control.
Each person who switches from having an abortion to having a baby is sending costs up ~$24,500. A religious conservative probably would think this is worth the money, if he or she believed abortion to be murder. That all being said, if this proposal reduces abortions by 1 million over the next decade (decline of ~8% or so), then with inflation total health care expenditures are increased by something like $30 billion due to more deliveries alone. I'm sure this isn't the only place where reform has the potential to significantly lift total spending.
Skepticism is also triggered by comments in the link below. Seeing total health care costs fall below projected trends even as health care utilization rises means far lower prices for providers - provider interest groups are going to work night and day to minimize the impact of cuts to their income.
http://www.cap.org/apps/cap.portal?_nfpb=true&cntvwrPtlt_actionOverride=/portlets/contentViewer/show&_windowLabel=cntvwrPtlt&cntvwrPtlt{actionForm.contentReference}=statline/special_report_healthcare_reform_2010.html&_state=maximized&_pageLabel=cntvwr
At the end of the day, all of the proposed reforms might reduce aggregate healthcare expenditures, and that would be a tremendous achievement. But there will be a lot of pressure pushing in the other direction.
Posted by: justin84 | March 20, 2010 9:44 AM | Report abuse
THIS IS AN ABSOLUTE MUST READ....
If this Bill passes today, it will mark the END of the DEMOCRATIC PARTY in this Country. The "blow back" from the American people on having this incredibly expensive bill rammed down their throats during the worst economic down turns in the history of this Country will certainly produce an ANGER VOTE that will be unpresidented, and unlike any the US has ever seen. Nancy Pelosi is sadly bringing forth not only the end of our very proud Democratic Party, but also ending the Obama Administrations opportunity to true make long term serious changes. A win on this vote will almost certainly end the careers of any and all Career Democratic legislators beginning in November, and as all the analysts are clearly stating, most likely lead to impeachment procedures for President Obama. Was the Health Care Bill actually doomed from the start? No, with the proper timing and building of support it probably would have been very successful. However in the midst of this current economic situation, and the fact that it is having to be forced down the throats of all American without their support, and against their wishes, at a time when they simply can not afford it, will certainly produce a backlash of anger voting that will destroy any and all chances of bringing true long term changes to our Country. Goodbye Democratic Party...bad timing, poor judgment and a forced vote have determined your fate. Goodbye Career Democrats, Nancy Pelosi rushed in too fast, with the wrong timing and fumbled the ball at a time when the economic climate has forced the American voter to "find someone to blame".
If this passes, it will be the straw that beaks the back of our once proud, and extremely powerful party.
Goodnight all.
A trillion Dollar Bill --- Taxes will go through the roof.
All Health Care Procedure costs will rise, while options drop.
Fewer treatments, fewer choices and sub standard treatment.
Our premiums will go through the roof.
The Provider to Patient ratio will increase 1000%
How do we know these facts?
Simple. The State of Massachusetts passed the the State Health Care Reform Bill a few years ago as a test for the National bill.
The Result: A max Exodus of people from the State moved to other States.
Don't believe it -- Do the research yourself.
IN THE MEANTIME WRITE DOWN AND REMEMBER YOUR DEMOCRATIC REPRESENTATIVES NAMES WHO VOTED TODAY, SO YOU WILL HAVE SOMEONE TO CALL INTO ACCOUNTABILITY AND ASK THEM WHY....
Posted by: dnrainmaker | March 21, 2010 7:30 PM | Report abuse
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This was my point from an earlier thread.
That said, there are organizations that will, if you agree to give up the child to adoption once born, pay for your medical expenses while pregnant. That may seem a little weird, but, in my book, it is better than abortion.