Let's start with several obvious facts. Abortion isn't the only issue in the health care debate -- de facto, it isn't even the central issue, whatever anyone makes of that.
But to proceed as if abortion weren't an issue at all or were something to be conceded without a fight for the sake of reform, as some people, Catholics among them, would apparently like to do, tragically misses the point. Win or lose, there's a fight here that must be made.
But a fight about what?
In his University of Notre Dame commencement address in May, President Barack Obama declared support for a "sensible" conscience clause to excuse those who object to abortion from being involved in the procedure.
Soon after, two friends, both pro-life, were arguing about what that meant.
One said Obama had made a big concession. The other denied that proposition. He pointed to pro-abortion steps already taken by the Obama administration that violate the consciences of pro-lifers by using their taxes for that purpose, as well as the president's declared intention to rescind Bush-era regulations affirming and clarifying conscience clause laws on the books since 1973.
Then he added:
"I've spent some time figuring out where Obama really stands on abortion, and now I think I know. He believes that every woman has an unconditional, intrinsic right to it. No obstruction or impediment can be allowed to get in the way of exercising that right.
"Within that framework, a 'sensible' conscience clause is acceptable. But a conscience clause that in any way inconvenienced a woman in having an abortion -- for instance, by requiring her to go to the next hospital over instead of the hospital nearest her home -- would not be allowable."
His friend was unconvinced. "We should exploit the political potential of Obama's pledge," he insisted. "With so much at stake, including the integrity of the medical profession and the livelihood or conscience of Catholic physicians, his words can't be neglected on the plausible ground that they're meaningless. They should be wielded like a club over his head, and if he fails to honor them, the club should strike a blow to his halo."
Both points of view will be tested in the months to come. Congress and the Obama administration are moving full steam ahead on health care reform, with October the admittedly optimistic target date for enactment.
By contrast with former President Bill and first lady Hillary Clintons' bumbling in their failed attempt at health care reform, Obama & Co. have acted with great subtlety and skill. They enjoy the advantage of widespread agreement that reform of some sort is needed (but opinions differ on what will work and what won't).
And, to top it all off, the mindless killing of late-term abortionist George Tiller late last month by an anti-abortion zealot has given the reform campaign a martyr. Enactment of some version of "reform" may not be a certainty, but it's a very good bet.
There's little doubt that Obama and the congressional Democrats will seek to include abortion coverage in the plan, and given their dominance in Washington, they're likely to succeed.
Very soon, we may all be debating what a "sensible" conscience clause looks like.
Meanwhile, the complex perils of finessing the abortion issue are on painful display in Massachusetts, where the Archdiocese of Boston has agonized for months over an attempt to find an acceptable way for Catholic hospitals to participate in a state health care scheme that includes abortion, without complicity on the hospitals' part.
Good luck to them -- but maybe they should try something easy, like squaring the circle instead.
Russell Shaw is an OSV contributing editor.