Our pro-life friends at Americans United for Life argue that we should “make birth free.”
Though most Americans have childbirth covered through private health insurance or Medicaid, Americans United for Life proposes a program to compensate hospitals directly from a national fund for any birth, at any time, under any conditions. This proposal, however well-intentioned, would socialize the costs of childbirth. The government would cover the good things that marriage and the family are meant to provide directly.
This plan might seem like mission creep for an organization focused on ending abortion. But it argues that it would not only help families but also reduce the number of abortions. Such a plan, it says, will signal our national dedication to life and encourage a “thriving future for the next generation.”
But this kind of plan concedes that “it takes a village” to have a baby—or at least endorses that it should take a village. Like other forms of socialism, however, this proposal has serious flaws. Here are the three big ones: It’s not free, it won’t work, and it’s unjust.
It’s Not Free
First, the language itself is misleading at best. There’s no free lunch. You can’t make scarce, valuable things “free.” You can only try to make someone else pay for it.
Childbirth in the United States today generally involves, at a minimum, an at-home midwife. And in many cases, it includes doctors, hospitals, and even surgery. These are costly goods and services. A more competitive market could reduce these costs to mothers who need them. But they can never be free.
It Won’t Work
Second, it won’t work, because when you think you have roped someone else into paying for a thing, the thing itself changes. Take K-12 public education, which has been “free” for a century. It has now morphed into babysitting with a cocktail of cultural indoctrination. Most people with an exit opt out. Entire schools in major cities have no students proficient in reading or math.
In proposing to “make birth free,” Americans United for Life is ignoring such obvious problems. The organization blithely suggests that a universal government-administered, Medicaid-style program will “address disconnects in the marketplace,” and “improve … outcomes while simultaneously reducing the price of childbirth.” But it hasn’t worked in education—or in medicine.
There are many reasons why, but the most salient one is this: The recipient of a service is in the best position to judge whether the service is worth paying for. A third-party payer is essentially blind to the quality of a service, but not to its costs.
So, cost-cutting that reduces the value of the service to the recipient will always win the day, eroding the race-to-the-top improvements provided by competitive markets.
Economists have recently estimated that physicians lose 18% of Medicaid revenue to billing problems, compared with only a 2.4% loss when billing commercial insurers. The expectation of this shortfall depresses doctors’ willingness to supply care to Medicaid patients. Common sense suggests that only doctors with poor reviews and lower demand will find it worthwhile to keep servicing Medicaid patients.
Do we really want to expand such poor service to every expectant mother?
It’s Unjust
Third, “make birth free” is an unjust wealth transfer. Making birth free is a $68 billion program. Its proponents say that we shouldn’t balk at the price tag since it’s about the same amount that the United States voted to give to Ukraine in aid. We throw that kind of money around all the time, they say! But two (or two trillion) wrongs don’t make a right.
At over 120% debt-to-GDP ratio, rising nominal interest rates, and growing instability in the banking sector, we have the variables in place for the type of crisis that crippled Latin America in the 1980s. The United States should not count itself immune from financial tragedy just because we’ve avoided it so far.
Wealth transfers without strings from married families with children to unmarried, fractured households through our current welfare system are probably unjust to begin with. And broken families are best served materially and spiritually by churches and charities, not government. But wealth transfers engineered by a bankrupt state to be paid for by the next generation are even more profoundly unjust.
We can assume the best intentions of our pro-life friends who propose to make birth free. But good intentions don’t necessarily shape the results of a good policy. Growing the entitlement state by taxing our children tomorrow to pay for today’s wealth transfers is not a sound approach to building “a thriving future for the next generation.”
But Would It Reduce Abortions?
Americans United for Life also argues that providing free births will prevent abortions. But the women at highest risk for abortion are already eligible for “free birth” through Medicaid. Half of all abortions are obtained by women in poverty, with another quarter by women close to poverty. If “free birth” doesn’t prevent abortion among poor women now, why would it be a game-changer to expand that coverage to everyone else? Forty-two percent of all births are already eligible for Medicaid.
Americans United for Life is making a common mistake of the Left. It supposes that a failed policy will succeed if only we expand it and spend more money on it.
Note that poor women (many without private insurance) are not more likely per pregnancy to abort than other groups. In fact, they’re considerably less likely to abort than wealthy women and upper-middle-class women when facing an unplanned pregnancy. The reason they make up such a high proportion of abortions is that they are two to three times as likely to get pregnant over the course of a year than wealthier women. Obviously, then, the high price of birth isn’t driving abortion rates.
And here’s something else the high price of birth isn’t driving: low birth rates, contrary to the organization’s assertion. The correlation between income and birth rate is one of the most robust domestic and international correlations on record. The more income people (and nations) have, the fewer births they tend to have. Vastly more important reasons for falling birth rates are reduced religious practice and people waiting longer to get married.
If Americans United for Life’s claim made sense, we should see high birth rates in places like Canada, Japan, Norway, and the U.K., or in any of the other 17 countries offering single-payer health care with “free” birth for all. On the contrary, these countries register the lowest birth rates ever recorded in human history, along with Italy, Spain, and Slovenia.
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