08/30/2009 05:12 am ET | Updated May 25, 2011

A Taxing Problem

Last week, five pro-life Democrats, headed by Rep. Tim Ryan (D-OH), sent Speaker Pelosi a letter suggesting a "common ground" solution to the abortion "roadblock" in health care reform. They proposed that insurance companies neither be required to nor prohibited from paying for abortion and that no federal subsidies be used to pay for the procedure.

Ryan and his co-signers should be applauded for placing primary importance on the need to provide health care coverage to the more than 50 million Americans who currently go without insurance and for being unwilling to sacrifice health care reform on the altar of abortion politics. This is in welcome contrast to the stonewalling and ultimatums coming from Rep. Bart Stupak (D-MI) and his allies. But Ryan's proposal is based on a misguided and attenuated definition of government spending, and it conflicts with what Americans want and expect from health care reform.

Health care reform legislation does not contemplate taxpayer-subsidized abortion. The bills under discussion essentially propose a sliding scale premium to individuals and families based on their income. Rather than offering a tax credit, voucher, or other form of direct cash payment to help families purchase health care, the government would offset lower premiums by paying the remainder directly to the insurance company. By analogy, we're talking farm subsidies, not food stamps.

What's more, when people purchase insurance, they buy a comprehensive package of services they hope they will never have to use. The whole purpose of insurance pooling is to offset risk, knowing that not everyone will utilize every service covered.

The suggestion that a health plan might offer abortion coverage and it might be used by someone who might have paid a lower premium than someone else because the government might have helped pay their premium is a horrible reason for Congress to carve out an explicit exception to a bill that is otherwise entirely silent on coverage options.

Understood in this light, the arguments about taxpayer-funded abortions are simply too tangential to withstand scrutiny.

Even if you share Ryan's overly expansive definition of government spending, whether we like it or not, taxpayers do not have the right to specify how their tax money should be spent. I understand why people would want to withhold their taxes from purposes they oppose, but our system does not -- nor should it -- work that way.

The Constitution authorizes Congress to collect taxes to provide for the common defense and general welfare. There is no footnote that says, "unless some of us disagree." All Americans can surely think of at least one use of their taxes to which they object -- for some liberals, it might be the death penalty; for some conservatives, the teaching of evolution in public school. There are proper channels for disputing such policies, but attacking government funding is not one of them.

The "common ground" solution here is to let the experts -- not politicians -- decide what services should be covered. A recent poll shows that Americans are extremely wary of having Congress or the president pick and choose which medical services will be covered or excluded in a new health care system. Seventy-five percent of voters would rather have an independent commission of medical experts and citizens decide these critical issues--Republicans are the strongest supporters of this approach, with 78 percent in favor.

And contrary to the prevailing conventional wisdom, strong majorities of voters recognize the full range of reproductive health services--including prenatal and maternity care, contraception, screening for cancer and sexually transmitted infections, and, yes, abortion -- as basic health care. They want those services to be covered and would oppose any health care reform plan that does not include comprehensive reproductive health services.

Americans do not want politics to drive coverage decisions. In other words, they object precisely to the type of food fight brewing on Capitol Hill right now. A recent report finds that the Millennial generation finds culture war issues such as abortion much less salient to their lives than previous generations. It is high time that Congress moves on from the culture wars too.

Jessica Arons is the Director of the Women's Health & Rights Program at the Center for American Progress.