You might think pro-fetus candidates should demand guaranteed health care for those moms and babies. But they say churches and charities should take care of that. Hmm. (More)

Fertilization and Philanthropy

Republicans have tried to pass ‘personhood laws’ in several states, by constitutional amendments or state legislatures. The bills would expand the legal definition of “person” to include “every stage of human development,” including fertilized eggs that have not yet implanted in the mother’s uterus. The American College of Obstetricans and Gynecologists say pregnancy doesn’t begin until implantation is complete, several days after fertilization, and at least half of fertilized eggs never implant or implant so late that the uterus rejects them.

In short, most fertilized eggs are never born. Sometimes that happens because the woman uses a birth control method like a hormonal implant or IUD. Both implants and IUDs inhibit ovulation, thicken cervical mucous to block sperm in case an egg does drop, and thin the uterine lining to stop implantation if an egg is fertilized. Because they prevent pregnancy in so many ways – and because the woman doesn’t have to remember to use them – these methods are over 99% effective. A two-year study in St. Louis found that giving teenage girls free contraception and recommending long-acting-reversible (LARC) methods like implants and IUDs reduced pregnancies, births, and abortions by 70%. In fact, none of the teens in that study became pregnant while using a LARC method, and both the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics recommend LARC methods as the best contraceptive choices for teenage girls.

Some fertilized eggs aren’t even in the mother’s body. With in-vitro fertilization, doctors take eggs from the woman and sperm from the man and put them together in a lab. They then inject fertilized eggs back into the woman and hope they implant. That happens less than half the time, so clinics usually collect and fertilize lots of eggs, injecting a few and freezing the rest, in case they need to try again. After they have a baby, the couple may donate the leftover embryos for implantation in other couples, or for medical research, or the clinic may keep them frozen indefinitely, or dispose of them.

Because LARCs act in part by blocking implantation, ‘personhood’ bills would outlaw them. The bills could also criminalize in-vitro fertilization, and Newt Gingrich said states should consider doing that. That helps explain why no state has yet enacted a ‘personhood’ law.

But ‘personhood’ advocates are pressing Republicans for public support, and 2014 GOP Senate candidates Joni Ernst (IA), Cory Gardner (CO), and Thom Tillis (NC) have supported (and tried to deny their support for) ‘personhood’ bills.

So you’d think they’d all be on-board to guarantee health care for all the extra moms and babies ‘personhood’ bills would generate. And you would be wrong. Here’s state Sen. Ernst speaking to a conservative group last year:

What we have to do a better job of is educating not only Iowans, but the American people that they can be self-sufficient. They don’t have to rely on the government to be the do-all, end-all for everything they need and desire, and that’s what we have fostered, is really a generation of people that rely on the government to provide absolutely everything for them. It’s going to take a lot of education to get people out of that. It’s going to be very painful and we know that. So do we have the intestinal fortitude to do that?[…]

We’re looking at Obamacare right now. Once we start with those benefits in January, how are we going to get people off of those? It’s exponentially harder to remove people once they’ve already been on those programs […] we rely on government for absolutely everything. And in the years since I was a small girl up until now into my adulthood with children of my own, we have lost a reliance on not only our own families, but so much of what our churches and private organizations used to do. They used to have wonderful food pantries. They used to provide clothing for those that really needed it. But we have gotten away from that. Now we’re at a point where the government will just give away anything.

In other words, if you can’t afford reliable birth control and you also can’t afford prenatal and well baby care when you get pregnant … ask your family or a church or a charity for help. Jonathan Chait is stunned:

I happen to find this belief morally bizarre. People who cannot afford their own insurance either don’t earn much money, or have health risks, or family members with health risks, too expensive to bear.

All of us non-socialists would agree that there ought to be some things rich people get to enjoy that poor people are deprived of. Access to health care is a strange choice of things to deprive the losers of – not least because one of the things you do to “earn” the ability to afford it is not just the normal market value of earning or inheriting a good income, but the usually random value of avoiding serious illness or accident.

Economic blogger Brad DeLong thinks Rep. Ernst doesn’t understand why market mechanisms fail for health care:

But if there is one thing that all students of health care finance agree on, it is that health-insurance markets do not work: they are riddled with adverse selection and moral hazard to an extraordinary degree, and maintaining an equilibrium in which the market actually works – a “pooling” rather than a “separating” equilibrium – is very difficult and requires skillful and delicate regulation. The fact that the market can’t deliver derails the chain of contribution-purchase-consumption that (some) conservatives identify with desert and fairness. And if a market equilibrium is, as it is in health care, not just inequitable and unutilitarian but also unjust according to libertarian lights, why plump for it?

This is the reason that many of us non-communists go for single-payer: equity an utilitarian greatest-good-of-the-greatest-number are good things, and single payer can get us to them even though the health-insurance market cannot deliver on what it is supposed to do. And this is the reason that others of us work very hard to try to find a way to fix the health-insurance market so that it will work, somehow – with Obamacare being the latest attempt to make it work, for a while at least. Bluntly: the exchange marketplaces will not work without the mandate, and the mandate cannot work without the subsidy pool.

Doesn’t Joni Ernst have any friends on her side of the aisle to educate her about health-insurance markets?

Both Chait and DeLong miss the conservative moral goal. Forcing the needy to rely on charity lets philanthropists decide who ‘deserves’ help. Our federal and state governments are bound by the Equal Protection Clauses of the Fifth and Fourteenth Amendments. If you meet the legal requirements – based on need – then you’re eligible for benefits. The government can’t say “Well sure you need that, but you’re not the kind of person I want to help.”

But families and churches and private charities can say that. In the conservative worldview, if you can’t afford birth control and no family member or local church or charity will help with your prenatal and well baby care … that’s because you’re a slut and they want to make an example so other girls know what will happen if they spread their legs.

Because fertilized eggs should be ‘persons,’ but girls and women aren’t.

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Happy Saturday!