We dodge the traffic as best we can at this crossroads of science, medicine and law, accepting compromises that seldom please anyone completely. Abortion remains legal, but citizens generally are not compelled to support it with federal tax dollars. Difficult end-of-life decisions are left to families, advised by doctors and supervised by courts in the hardest cases.
It is increasingly clear, however, that Democratic health reforms would disrupt this rough equilibrium.
Take abortion. The House approach to the coverage of the procedure in federally subsidized insurance plans is presented as a compromise: Abortions would be funded out of the premiums that come from individuals, not money from taxpayers. But this is a cover, if not a con. By the nature of health insurance, premiums are not devoted to specific procedures; they support insurance plans. It matters nothing in practice if a premium dollar comes from government or the individual -- both enable the same coverage. If the federal government directly funds an insurance plan that includes elective abortion, it cannot claim it is not paying for elective abortions.
In fact, any national approach to this issue is likely to challenge the current social consensus on abortion. The House bill would result in federal funding for abortion on an unprecedented scale. But forbidding federal funds to private insurers that currently cover elective abortions (as some insurers do) would amount, as pro-choice advocates note, to a restriction on the availability of abortion. Either way, government will send a powerful, controversial social signal.