So long as Democrats and health care reform proponents allow themselves to be pushed into exhorting about the false choice between health care reform and access to this legal medical procedure aka abortion, real reform is in peril.

The single most important thing you need to know and repeat to everyone you know as the reform debate moves to the U.S. Senate after narrow passage of the Affordable Health Care for America Act (HR 3962) last Saturday, November 8, 2009 is that opportunism seen by abortion opponents has allowed this false choice to be framed and embraced and we must reject it.

This editorial in the New York Times, published last Monday, describes the beginning:

The bill [HR 3962] brought to the floor [prior to the Stupak Amendment] already included a careful compromise that should have satisfied reasonable legislators on both sides of the abortion issue. The vast majority of people expected to buy policies on the new exchanges would pay part of the premium and receive government tax credits to pay for the rest. The compromise would have prohibited the use of the tax subsidies to pay for almost all abortions, but it would have allowed the segregation and use of premium contributions and co-payments to pay for such coverage. A similar approach allows 17 state Medicaid programs to cover abortions using only state funds, not federal matching funds.

Yet neither the Roman Catholic bishops nor anti-abortion Democrats were willing to accept this compromise. They insisted on language that would ban the use of federal subsidies to pay for “any part” of a policy that includes abortion coverage.

The Stupak amendment enshrined that exclusionary language and garnered votes from 64 Democrats - yes, 64 (62 men and two women - Marcy Kaptur of my own Ohio and Kathy Dahlkemper of Pennsylvania).  Thus, they helped the Republican representatives pass it.

The editorial also explains succinctly how Stupak changes everything:

If insurers want to attract subsidized customers, who will be the great majority on the exchange, they will have to offer them plans that don’t cover abortions. It is theoretically possible that insurers could offer plans aimed only at nonsubsidized customers, but it is highly uncertain that they will find it worthwhile to do so.

In that case, some women who have coverage for abortion services through policies bought by small employers could actually lose that coverage if their employer decides to transfer its workers to the exchange. Ultimately, if larger employers are permitted to make use of the exchange, ever larger numbers of women might lose abortion coverage that they now have.

The restrictive language allows people to buy “riders” that would cover abortions. But nobody plans to have an unplanned pregnancy, so this concession is meaningless. It is not clear that insurers would even offer the riders since few people would buy them.

And that is how health care reform could fail millions of Americans and become, as some commentators have said, a "vagina-added tax" and a "penis subsidy."

Strident answers to the bottom-line question (and false choice) of what must be sacrificed in the name of achieving health care reform have been colliding ever since. Until the last few days, the answers were of two types:

One type is typified by a post at Betty Dodson with Carlin Ross. It notes that U.S. Senator from California, Barbara Boxer, believes that she has enough votes to block Stupak in the Senate:

"If someone wants to offer this very radical amendment, which would really tear apart [a decades-long] compromise, then I think at that point they would need to have 60 votes to do it," Boxer said. "And I believe in our Senate we can hold it."

"It is a much more pro-choice Senate than it has been in a long time," she added. "And it is much more pro-choice than the House."

And on the House side, U.S. Rep. Diane DeGette led a group of 41 female Members of Congress to sign a letter to Speaker Pelosi indicating their refusal to go along with a health care reform bill that includes Stupak restrictions. In her own words:

Our message is clear: we will not support any final bill that restricts women's access to reproductive health services beyond current law. Before any bill reaches the President's desk, language that takes us back to the last century by undermining women's rights must be eliminated.

Along the same vein, U.S. Senate Democratic primary candidate and current Massachusetts Attorney General, Martha Coakley, values the pre-Stupak standard of access to abortion over the health care reform:

Coakley, in her boldest gamble of the campaign, said that fighting for women’s access to abortions was more important than passing the overall bill, despite its aim of providing coverage for 36 million people, establishing a public insurance option, and prohibiting insurers from discriminating against patients with preexisting conditions.

“To pretend that now the House has passed this bill is real progress - it’s at the expense of women’s access to reproductive rights,’’ Coakley said in an interview, after making similar comments yesterday morning on Boston radio station WTKK-FM.

She said later at a campaign appearance in Worcester, “I refuse to acknowledge that this is the best we can do.’’

The other answer, which favors passing health care reform over objecting to Stupak's über-restriction of access to a legal medical procedure, is voiced in posts liked this one from Amy's Life in Brief, Paying for Abortions:

I am just frustrated that any progress we’ve made is going to grind to a halt because of this issue. I have friends on the pro-life side. I know that they feel by restricting access to abortions they are saving the lives of babies. But, if health care reform is halted because of this issue, people are going to die. People are dying now because they don’t have coverage. People are losing their homes and everything they’ve worked for because they don’t have coverage and they get sick. Something has to be done and we can’t let this one issue unravel everything.

And, for those of us a generation or two or three removed from college freshmen, consider what Trisha Jain writes at The Michigan Daily:

I am pro-choice, but not pro-abortion. I wholeheartedly support your right to choose abortion, but I would strongly encourage you not to. It would have been none of my business — your private insurance is exactly that, yours and private — but when we as a nation pleaded for health care reform at any cost, we pleaded to make it my business. We removed the line between public and private and made it our collective business. Now, my tax dollars will subsidize your insurance policy to make it affordable, and yours mine. And unlike the choice to remove your tonsils, your choice to undergo abortion is heavy. It’s loaded with religious and moral significance — make it, by all means, but please don’t ask me to pay for any part of it.

...

...by garnering the votes of pro-life Democrats for the health care bill, the Stupak Amendment has essentially given 47 million Americans access to insurance. As for the whittled-down range, I have no doubt that a private organization with thick-walleted, pro-choice donors will emerge shortly to fund abortions for those who cannot afford them out of pocket. It is not and was never the government’s place to do so. It is the government’s place to ensure that the low-income woman with a high fever can see a doctor, and that medical care for the rest of her body is not held hostage for the sake of her ovaries. In that regard, Stupak is anything but stupid.

Hmm.

Not to be ignored, there's the role of the Catholic Church to be considered further, as mentioned here by L.A. Newman at The Other Spoon:

The failure to protect women's reproductive rights in health care reform doesn't fall to a predictable, traditional, partriarchal church body, but to those in our government who failed to acknowledge that, while the church (and I'll include the evangelical church along with the Catholic here) may work to protect the "least of these," giving them deference in issues of policy-making will always mean sanctioning women's rights.

More has been written about the bishops by Nancy Keenan, president of NARAL Pro-Choice America and Jon O’Brien is president of Catholics for Choice:

The bishops know that a vast majority of Americans, including Catholics, disagree with their hard-line dictates regarding reproductive-health care, including the bishops’ opposition to contraception.

However, when it comes to health care reform — from which many millions of people will benefit — the bishops injected divisive politics into the process and overran a compromise that would have guaranteed that no federal dollars would cover abortion care.

As this debate moves forward, U.S. senators and the public should challenge the bishops’ hypocrisy. If separation of federal funds and private dollars works for the church hierarchy, then it should also work for women’s reproductive-health care.

A look at the other side of the religion coin: Stupak is unconstitutional because it restricts religious freedom.

Then, there's the role our anatomy plays in how Stupak, as applied, would discriminate and unfairly burden more than half this country's population:

The Vagina-added Tax:

Hey ladies! Congressman Pete Sessions of Texas thinks you should pay more for your insurance because you chose to have all that crazy plumbing with its nook and crannies down there instead of a good old fashioned American penis.

This was an unhealthy choice on your part… like taking up smoking.

No. Really.

and The Penis Subsidy:

It is grossly unfair to require both men and women to purchase a product, then sabotage said product so that it is harmful only to women. Since we have, as a nation, apparently decided that it is somehow immoral to provide proper and affordable women’s healthcare in either the public option or the Exchange, it is only just that we exempt women from the mandate.

Otherwise this bill amounts to nothing less than a tax on being female, and a subsidy for having a penis.

Gloria Feldt, former head of Planned Parenthood and writing on BlogHer, highlights more culprits who've aided the ascendency of this culture war.  She describes the dilemma as being a result of the Democratic Party's own (male) leaders:

Howard Dean, who had entered the 2004 presidential race proclaiming himself the candidate from the “Democratic wing of the Democratic Party,” became, ironically, one of the main architects of a desperation plan to recruit any anti-choice pol who had a chance to defeat a Republican. 

Some strategists, like Daily Beast columnist Peter Beinert, assert this was the smart way for the Democrats to gain a governing majority. But if party powers had recruited, supported, and funded progressive women candidates at the level they wooed Blue Dogs, they could have saved both their integrity and their majority, and they’d be much stronger today.

Kate Michelman and Frances Kissling believe likewise:

...When it comes to abortion, [Democratic party leaders] seem to think all positions are of equal value so long as the party maintains a majority. But the party will eventually reap what it has sown. If Democrats do not commit themselves to defeating the amendment, then they will face an uncompromising effort by Democratic women to defeat them, regardless of the cost to the party’s precious majority.

In the meantime, the victims of their folly will be the millions of women who once could count on the Democratic Party to protect them from those who would sacrifice their rights for political gains.

And, our BlogHers have been anything but silent on Stupak.

The Momocrats wrote a letter to the House members who voted for Stupak:

Thank you for taking the time to read this letter and accept the enclosed package. In it you will find my uterus. I believe you’ll see that the tag on the bottom says, “Please return to original owner, the United States House of Representatives, when not in use.”  Per those instructions, here it is.

I already have one son and one daughter and though in the past I have entertained the idea of a third, I recently decided against it. Mainly due to the passing of the Stupak-Pitts amendment last weekend. I figure if my uterus is not really mine you should go ahead and have it back. Frankly, I’d rather not deal with it anymore.

From Sirens, a blurb about the HR 3962 that reflects the two ends of the yeah! nooo! spectrum:

Hooray: We’re one step closer to healthcare reform! The House of Representatives pushed forth the Obama Administration’s healthcare reform bill, which–if approved by the Senate—will extend coverage to nearly every American. Oh, wait, there’s a catch (of course). In order to get the bill out of committee, a drastic compromise was made: Said healthcare insurance cannot and will not cover abortions. The Stupak Amendment will virtually eliminate insurance coverage for abortion. Again, this issue is at the center of the Republican/Democratic divide. We’re wondering when reproductive rights for women will actually be just that: our rights.

And, another example of just how we see both sides and try to come down on both but ultimately the options remain diabolically difficult comes from Charlotte at Theatrical Milestones in a post aptly title, Boobs 2.0:

First of all: I agree with Jill [at Feministe, not me]: Any Democratic Representative who voted for the amendment and therefore against choice should be removed in the next primaries and substituted by a politician who takes his commitment to women's health more seriously.

Secondly, though, I'm of two minds. While the abortion issue matters on a very political level and rightly evokes feminist anger and activism, we're looking at Health Care Reform here. This means extending benefits to everyone in the nation. My question is: What medical procedures do people go broke over? Abortions? Cancer treatments? Heart transplants? Heart disease is the number one killer of women. Cancer is up there, too. Those bills run into the millions of dollars over the years of treatments that it takes to survive. An abortion, depending on where it is performed, is largely a one-time procedure of between $500 and $2,000. So, if it ever came down to choosing between covering cancer treatments and abortions, which one is more urgent to you?

Wow - such great debate, right?

Wrong.

Why "wrong"?

Because it's a debate that centers around the false choice and notion that we cannot have health care reform and retain the current practices around how federal money is prevented from being used for abortion.  And this fact is finally getting through at both the online and print levels of the media.

From BlogHer's Morra Aarons-Mele:

If we don't push back against the meme that this is an "either-or" situation we force pro-choice legislators to make a Hobson's choice. The problem is, the pro-choice movement's political capital is an unknown quantity. We know that the Catholic Bishops can go to the brink, threaten, and get their way. But I don't know that in a country where the very word abortion is almost impossible to say, it's possible to ask pro-choice leaders to do the same and expect them to win. That's why we must stress that choosing between health care reform and the right to choose is, in the words of Massachusetts Senate Candidate Martha Coakley, a "false choice."

And Ellen Goodman, in an ominous column written two days before Morra's:

Where exactly do you draw a line when the opposition keeps moving it? How do you compromise with those who are uncompromising? These questions are too common in our polarized climate, but the stakes are even higher in this debate.

...

As Coakley says, “I can’t believe that we are now reduced to saying the only way we can get good health care is by taking steps backward on women’s rights. It’s a false choice.’’

She's right. Now we'll see if this false choice becomes the final choice.

Nothing could be more clear: we can have both health care reform and the legal access to abortion that we've had since Roe.  And we should have both.

And the absurdity that any American would settle for anything less than both is what the debate should be about.

It's true - the divide between Democrats (and particularly men and women Democrats in Congress) over the Stupak amendment is enormous (here's a petition to send a coathanger to the 20 male Democrats who voted for Stupak).  And it's less problematic than the gorge between Democrats and Republicans since no one is anticipating any GOP members to vote for the reform bill in the House or the Senate other than those who already have signaled support (New Orleans' U.S. Representative., Joseph Cao and Maine's U.S. Senator, Olympia Snowe).

The Democratic Senators to watch, according to Talking Points Memo:

(each name is linked to an article that describes just how tough this could be in the Senate because of the respective Senator):

Ben Nelson (NE)

Blanche Lincoln (AR)

Evan Bayh (IN)

Joe Lieberman (CT)

Kent Conrad (ND)

Mary Landrieu (LA)

The female Democrats in the House stuck together against Stupak except for the aforementioned two (Kaptur and Dahlkemper). The women in the Senate, in addition to Lincoln and Landrieu, include 11 other Democrats (Barbara Boxer (CA), Maria Cantwell (WA), Diane Fienstein (CA), Amy Klobuchar (MN), Claire McCaskill (MI), Jeanne Shaheen (NH), Kay Hagan (NC), Debbie Stabenow (MI), Barbara Mikulski (DE), Kirsten Gillibrand (NY), Patty Murray (WA)) and four Republicans (Collins and Snowe of Maine, Murkowski of Alaska and Hutchison of Texas).

For a summary of where the battle lines are drawn among the Democrats, here's Katha Pollit in her column, "Whose Team Is It Anyway," in The Nation:

You know what I don't want to hear right now about the Stupak-Pitts amendment banning abortion coverage from federally subsidized health insurance policies? That it's the price of reform, and prochoice women should shut up and take one for the team. "If you want to rebuild the American welfare state," Peter Beinart writes in the Daily Beast, "there is no alternative" than for Democrats to abandon "cultural" issues like gender and racial equality. Hey, Peter, Representative Stupak and your sixty-four Democratic supporters, Jim Wallis and other antichoice "progressive" Christians, men: why don't you take one for the team for a change and see how you like it?

Is this a Solomon's Choice? Which choice would you make? Would you make any choice at all?

Begging for more:

This post at The Blogometer is a great round-up of reaction.

Planned Parenthood's dissection of what Stupak's affect will be.

Rep. Diana DeGette's letter to Speaker Pelosi.

RNC's health care plan covered abortions until today - when Chairman Michael Steele said nope, can't have any of that. One conservative blogger wants to take no prisoners in this "horrific" (my sarcasm, not the blogger's) inclusion of women's health in the RNC's coverage.