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Healthcare, Abortion, and Republican Bad Faith

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This blog has observed more than once that the arbitrary obstacle course many states have constructed for women who want to obtain a safe abortion takes advantage of the moral discomfort many people who don’t want the procedure banned outright have with abortion. Even in principle, “women should only be able get abortions for reasons I find acceptable” is really bad — the state should not compel a woman to take on the serious health, emotional, time, and financial commitments of childbirth and childbearing against her will, and at least for pre-viabilty abortions “I don’t want to have a child now” is a plenty good enough reason. But even if you like the idea in principle, regulations on abortion don’t advance this goal in any way and most don’t even pretend to. Waiting periods or burdensome clinic regulations don’t prevent women from getting abortions for “bad” reasons; they just make it more difficult or impossible for some classes of women to obtain abortions for any reason. Discussions of “fuzzy” public opinion on abortion are deeply misleading, because vague moral qualms about abortion can’t actually be reflected by concrete statutory provisions. Either women get to make the decision, or they don’t. Permitting women to get abortions only for reasons that are “good enough” for you it not only morally odious in theory but impossible in practice.

As Chait says, the same is true for the appalling deserving/undeserving sick arguments now being made by Republicans to justify stripping health insurance from tens of millions of people. Even in theory, saying that (non-rich) people should be denied care because they made choices that may have contributed to their medical problems is grossly immoral. But, in addition, TrumpCare does not actually in any way provide or deny coverage based on whether individuals are “responsible” for their medical problems:

Let’s assume that we accept the premise that denial of medical care is a morally acceptable tool to attack this problem. (Which, to be clear, I very much reject.) Can the Republican health-care plan be justified as a response to this kind of moral hazard? No, it can’t.

The first problem is that the Republican health-care plan has no mechanism to sort the deserving sick from the undeserving. It simply uses the blunt tools of slashing hundreds of billions of dollars in subsidies to help people afford insurance, plus waivers for states to encourage insurers to medically underwrite their customers. Reducing subsidies, especially for older and low-income people, is not going to single out those who have made bad choices. It’s singling them out by age and income to make their insurance unaffordable.

Nor will the waivers to let insurers charge higher prices to people with different medical needs have such an effect. Insurers aren’t in the business of rewarding virtue. Yes, in an unregulated market, they would like to sign up healthy people with lower costs by offering them lower rates. But the insurers don’t care which expensive medical conditions are the result of sloth and which are the result of genetics. They want to avoid getting saddled with expensive customers of any kind.

It’s notable that, when Republicans need to come up with an example of a costly “essential benefit” mandated by Obamacare, their favorite one is maternity care. It is certainly true that eliminating coverage for childbirth would reduce costs for people who aren’t women of childbearing age, while raising costs for those who are. But having a baby is not a slothful lifestyle choice. It’s a medical cost that should either be borne by society as a whole (as Democrats prefer) or by the mothers alone (as Republicans do). Again, maternity benefits aren’t an example I am cherry-picking to make the GOP policy look bad. It is Republicans’ own favorite case of a way they plan to make insurance cheaper for non-mothers.

And, of course, to further to compound the bad faith the same faction making these morally and empirically bankrupt arguments have been calling Michelle Obama a fascist for wanting children to have healthier food options and encouraging them to exercise — thankfully that national nightmare is over! — and the president who would sign the AHCA openly boasts about not exercising and subsisting mostly on junk food. We really are dealing with incredibly horrible people here.

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