By Drs. David Himmelstein and Steffie Woolhandler
The following letter was submitted to the Washington Post on Nov. 18.
To the Editor,
As Ms. Maggie Mahar admits in āIf conservatives ran health careā (Nov. 15, 2009), government employeesā policies do, in fact, cover birth control, and did so while many private insurers were still refusing to. Similarly, she seems oblivious to the fact that Medicare is the major payer for hospice and other palliative care.
If anything, her argument points up the fact that tax-funded programs like these that enroll middle-class people are far better protected than ghettoized programs like Medicaid or the puny public option in the bills before Congress. The reason some private policies cover abortion is that women have demanded it. The voices of middle-class women have been important in this regard.
The constituency for maintaining reproductive choice will be broad if middle-class women rely on the same system as the poor and near-poor. Because the new Medicaid and subsidized coverage will go to lower-income people, the middle class has little reason to be threatened by restrictions on abortions in that coverage. The lifeboat is kept in better repair if everyone — rich and poor alike — must rely upon it.
The public option will enroll very few people, so again, the political constituency for reproductive choice in that option will be small. In contrast, both Medicare and the federal employees program have been harder to attack because assaults on these programs affect large and powerful elements of the population.
Ms. Mahar does point up an important lesson of this yearās health policy debate. We must all stay involved in discourse on health policy (with or without passage of a single-payer bill) lest the process, and our health system, be hijacked by ideologues of the far right.
David Himmelstein, M.D.
Steffie Woolhandler, M.D.
Cambridge, Mass.
The authors are co-founders of Physicians for a National Health Program (www.pnhp.org).