Stupak-Pitts and the “Special Interest” Treatment of Women’s Health

November 13, 2009 Written by Current Events , Families and Caregiving , Politics and Public Policy , Women

The now-infamous Stupak-Pitts Amendment, attached late Saturday night to the House health care reform bill, might stand out for its unprecedented assault on a woman’s right to choose (not to mention the right of individuals and insurance companies to operate independently of Catholic bishops). But it is also the latest in a long line of moves during the debate painting women’s reproductive health as a "special" category whose political value is only in pleasing an "interest group." Indeed, one of the more offensive undertones of the debate on the amendment was that abortion was approached as an entirely separate issue from providing women with reproductive health care. Throughout their lives, 51% of the population require health care based on their reproductive organs, be it pre-natal care, birth control or menopause treatment. Given that more than half of the individuals in this country have a uterus, isn’t covering the whole spectrum of things that go on in it a very basic concern when crafting comprehensive health care legislation?

One of the chief problems with the broader conversation about gender in the United States is that women are still treated as a deviation from the norm. Men — specifically, wealthy, white and straight men — are presumed to be the standard by which we all must measure ourselves when it comes to defining "basic" or "normal" or "average," particularly when the conversation turns to health care. That approach might not have a noticeable effect on legislation if we’re talking strictly about things like accident coverage or diseases known to impact both men and women, but when we’re talking about what happens at your annual doctor’s visit – preventative care, childbearing or protecting against unplanned pregnancy, and the aging process, all significant steps in life — it absolutely matters that women and their health needs be seen as an integral part of the conversation rather than an "interest group" requiring "special" legislation. Sen. Debbie Stabenow’s snarky comeback to Sen. John Kyl’s suggestion that maternity benefits fell into the "interest group" rather than "standard" category drove home just how easy it can be to slip into such narrow thinking. Women need access to the full range of reproductive health care options, not simply what certain Congressional representatives determine should be standard and what is "special."

Thankfully, the health care bill produced by the House is not all bad news. As Ann Friedman at Feministing pointed out, it ends discrimination based on pre-existing conditions, prevents insurance companies from charging higher premiums based on gender or medical history (including whether or not a woman has had a Caesarean section), expands Medicaid coverage, contains provisions to improve the health of LGBT Americans, and offers funding for comprehensive sex education. But the Stupak-Pitts Amendment — to say nothing of the lengthy battle it took to get women to this stage of integration in the health care conversation — is a reminder of the work that still needs to be done to expand the concept of "standard" health care to include all of women’s health needs.

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  • Joe

    Serious question: Why should coverage of abortion be part of a woman’s standard health care package? It is entirely an elective procedure and, with the exception of the oft-noted “rape, incest or life and health of the woman” circumstance, not at all necessary for maintaining a woman’s general health. An abortion costs anywhere from about $250-$450 which puts it at the affordable end of surgical procedures, to be sure. That’s probably below the deductible on most insurance policies today. So, if we mandate that all insurance policies must cover it, aren’t we really costing ourselves more money. Why not, in that case, require mandatory insurance coverage for boob jobs, penile implants, vasectomies, laser eye surgery, liposuction, rhinoplasty, tummy tucks and other elective surgeries? Recognize that abortion coverage is mostly an issue in this debate because pro-choice advocates are always on the lookout for any legislation that would have the effect of de-legitimizing abortion or limiting its availability, while pro-lifers are looking to minimize the chance that it gets public funding of any kind. That’s fair enough, but if you turn the tables around and question the same assumptions for something like laser eye surgery, this starts to look more political than medical.

    Second point I can’t resist making: conservatives have been saying all along that if you set up a health care system run by the government, you will have bureaucrats making medical decisions for people whose best interests they do not have at heart. Here, ironically, is a CLASSIC example of just that fact. So, can you now understand a little better why conservatives have been able to score points against government-run health care by pointing out that it means that medical decisions will be made by “faceless bureaucrats?” That is precisely what you’re trying to prevent here.

  • Gloria Pan

    Joe, what if a fetus dies in the womb? What if a woman is pregnant with twins, and only one would have even a chance of survival if she makes the difficult decision of removing one of the fetuses or both would die? These are both expensive – and in my opinion NOT elective – abortion procedures. In your world, the default for women in these situations would be to carry dead fetuses until their bodies naturally expel them, an agonizing prospect that increases the chances of serious complications.

    As for your second point, that “conservatives have been saying all along that if you set up a health care system run by the government, you will have bureaucrats making medical decisions for people whose best interests they do not have at heart.” Actually, I believe the conservatives’ point is that people are better at having their own best interests at heart and that bureaucrats should stay out of the way. But they say that against the obvious success of programs like Medicare, without which millions of seniors would not have healthcare at all. Joe, unless you are prepared to forgo your right to Medicare when the time comes, a government program designed and administered by government bureaucrats, your broad dismissal of their intentions and abilities flies in the face of logic.

    By dismissing bureaucrats, you imply that for-profit companies or the free market are better guardians of people’s best interests? Please. We’ve seen time and again that entities and mechanisms that exist for the sole purpose of financial gain are machines to generate money, that do not have hearts at all let alone any awareness of any living thing’s best interests.

  • Joe

    Gloria,

    I do differentiate when abortion is a medical necessity, such as your examples. That’s precisely the point I wanted to make — that abortion in most cases has nothing to do with a woman’s “reproductive health” any more than liposuction has to do with someone’s mental health. Insisting it be included in required health care packages, as Meg does, seems to me to be wasteful. But I realize that the reason has to do with the politics of the abortion debate, NOT the economics of health insurance. Pro-choice advocates fight and (he cynically observed) fundraise based on advocating for abortion’s coverage under Medicaid, international family planning monies, etc. It’s political, not economic.

    I agree with you, that conservatives believe people should be free to choose the coverage they want, at the price they want. Government intrusion into the normal economic activity surrounding this is doomed to fail because the government is slow, biased, bureaucratic, and obsessed with equity. The “free market” simply means letting competition among providers flow into more and more areas of this economic sector. Think of how the cost for laser eye surgery, which is almost never covered by employers’ eye care insurance, has fallen in the last several years. That’s a great thing to aspire to.

    You’re right to think that for-profit companies have the patient’s interest less in mind than their own profitability. Except that the difference is that they have competitors who would steal business from them in a competitive market for providing lousy coverage or bad customer service. This, after all, is what we mean when we talk about “the free market.” The government almost never responds to people’s needs in the same way. That’s why the horror stories about socialized medicine from Canada and UK matter, because they all tell the story of a slow-footed, inflexible bureaucracy.