“Fungibility” and Abortion in Health Reform: Irrational… But Effective and Dangerous

In their zeal to block virtually all coverage of safe, legal abortion services in health care plans, the U.S. Catholic Bishops are using the flawed argument of “fungibility.”

In their zeal to block virtually all coverage of safe, legal abortion services in health care plans, the U.S. Catholic bishops – and their organization, the U.S. Conference of Catholic Bishops – apparently will stop at nothing. They are now using the bizarrely flawed argument of “fungibility” to make their case. In brief, they claim that unless abortion is specifically, broadly and totally excluded from health care reform, taxpayers really will be paying for abortion services. This argument is so weak that it’s hard to believe a rational person would accept it, but it has worked in the past and may well work again.

According to dictionary definitions, “fungibility” is a property of a good or a commodity whose individual units can be mutually substituted. For example, crude oil, wheat, orange juice, precious metals, and currencies are highly fungible commodities.

How does that apply to women’s reproductive health services? In a recent letter to U.S. senators, Cardinal Justin Rigali, head of USCCB’s pro-life committee, stated that “federal taxpayer funds will subsidize the operating budget and provider networks that expand access to abortion" unless abortion is specifically banned.

In other words, funding any health care service – anything at all – could free up dollars for abortion services, unless abortion is specifically and across-the-board excluded from health care reform.

According to the Women’s Health Policy report of October 19, Amy Sullivan, writing in the October 18 issue of Time, explained:

In July, Cardinal Justin Rigali, then the head of USCCB’s pro-life committee, said the bishops wanted health reform that lacked "direct federal funding for abortion." Sullivan wrote that this "language was important because it seemed to match an amendment" by Rep. Lois Capps (D-Calif.) under which no federal dollars could directly fund abortion procedures. "An individual could obtain an abortion if her insurance plan covered it," Sullivan explained, "but the procedure would be paid with segregated dollars from a pool funded by privately paid premiums." Democrats felt confident that the Capps amendment would clear the way for the bishops’ support of health reform, but a few weeks later, Rigali sent a second letter claiming that funding to insurers is "fungible, and federal taxpayer funds will subsidize the operating budget and provider networks that expand access to abortion."

The fungibility doctrine has been used successfully before, to restrict U.S. taxpayer dollars from going to clinics in the poorest developing countries that provided family planning services. The argument was that by funding birth control, the U.S. would be freeing up money for abortion. The reality is that 70,000 women a year die in developing countries from unsafe abortion and there are five million cases of severe complications each year. By funding birth control, we would limit unintended and unsafe pregnancies and save lives. “Pro-life” legislators and groups such as the Catholic bishops’ conference that put forth the fungibility doctrine were – whether they meant to or not – contributing to the death of women from preventable, pregnancy-related causes.

In the U.S. health care reform debate over covering abortion services, “fungibility” is a doctrine being used by those who have no medical, health or moral grounds to stand on. It is a doctrine born of fear. It is difficult to imagine any religious or ethical sentiment that could justify it.