Despite the persistent focus on economic growth, jobs, and global competition in the Republican presidential primaries, many social issues with significant bioethics implications are also at stake in November’s election. Given the importance of science and health policy, it is worth exploring the positions of the four Republican candidates (Mitt Romney, Rick Santorum, Newt Gingrich, and Ron Paul) most likely to challenge President Barack Obama.
Health Care Policy and Reform
All four candidates have vowed to repeal the Affordable Care Act.
Romney has promised to grant waivers that allow states to opt out of the Affordable Care Act on day one in office, and repeal the health reform law on day two through a reconciliation bill. Despite many similarities between the Affordable Care Act and his 2006 health reform law in Massachusetts, Romney insists that his plan was intended for states, not as a national model. In the run-up to national health reform, Romney encouraged the creation of a conservative plan “based on free choice, personal responsibility, and private medicine . . . that doesn’t add massive federal spending.” He has supported strengthening high-deductible health savings accounts and block grants for Medicaid to give states the freedom to run the program as they see fit.
Santorum supports Medicare changes like those proposed by Paul Ryan, which would replace Medicare with a voucher system. He voted in favor of limiting medical liability lawsuits to $250,000. He strongly opposed more federal funding and involvement in health programs and has criticized Democrats for trying to get people “hooked” on health care benefits. Santorum has supported turning control of Medicaid over to the states.
Gingrich supports tort reform to decrease unnecessary and costly lawsuits and wants Medicaid and all other “welfare programs” to be turned to block grants. He believes that individual incentives and bonuses should be used to control health care costs by helping consumers make more cost-conscious decisions about health care. Gingrich has also called for the expansion of health savings accounts.
Paul believes that Medicare, Medicaid, and other entitlement programs create undesirable dependence on the government. He has voted against expansion of CHIP (Children Health Insurance Plan) and the stimulus package, which included a temporary enhanced federal Medicaid contribution. He has introduced legislation to create a market-based system that, he believes, better reflects consumer choices and more rationally prices services.
All four candidates want to overturn Roe v. Wade and oppose federal funding of abortions.
Although Romney was pro-choice when he ran for governor of Massachusetts, he now strongly opposes abortion, stating in a June 2011 debate, “I believe people understand that I'm firmly pro-life . . . I believe in the sanctity of life from the very beginning until the very end.”
Santorum opposes abortion in all situations, including cases of rape or incest. He said during the Iowa Straw poll debate in August 2011 that “to put [victims of rape or incest] through another trauma of an abortion I think is too much to ask. And so I would absolutely stand and say that one violence is enough.”
In 2011, Gingrich said, “Abortion is . . . testing the professed American principle that every human life is precious and entitled to constitutional protection.”
While he opposes abortion, Paul has consistently said that it should be up to the states to protect human life: “the federal government should never tax pro-life citizens to pay for abortions.” In May 2011, Paul cosponsored HR 3: No Taxpayer Funding for Abortion Act to prohibit taxpayer-funded abortions and to provide for conscience protections
Stem Cell Research and Cloning
Although most of the candidates oppose human embryonic stem cell experimentation, some of them support research on existing stem cell lines, embryos left over from fertility treatments, or adult stem cell research. Most also oppose human cloning.
Romney occupies a somewhat middle ground on stem cell research, supporting research using excess embryos created in fertility clinics through in vitro fertilization, but opposing human cloning or creating new embryos solely for stem cell experimentation. Romney has also expressed support for altered-state nuclear transfer research, which does not require the creation of novel human embryos.
Santorum strongly opposes all human embryonic stem cell experimentation, but he has authored legislation to advance adult stem cell research to “fight debilitating diseases without the moral implications of embryonic stem cell research that destroys human life.” He believes that the cloning of human embryos is morally unacceptable and cosponsored the Human Cloning Prohibition Act of 2005.
Gingrich also supports adult stem cell research, but strongly opposes “federal funding of any research that destroys a human embryo.” Gingrich has, on many occasions, likened embryonic stem cell research to “killing children.” He has said, however, that he would continue NIH funding for research using existing cell lines. Gingrich opposes human cloning.
Paul has stated that he could support embryonic stem cell experimentation but opposes taxpayer funding for it. He also believes that Congress should stop all federal funding of research for cloning, but thinks that the president and Congress have no authority to prevent or stop it or any other research. In his view, all research should be supported by the private sector.
Contraception and Family Planning
All four candidates oppose giving federal tax dollars to Planned Parenthood, but they have different views on contraception and other family planning issues.
Candidates have recently been asked about their position on the availability of contraception. In Griswold v. Connecticut, the Supreme Court ruled that the right to privacy prohibits states from banning contraception.
Despite fumbling his answer in a recent debate, Romney stated that he would “completely oppose any effort to ban contraception.” On the other hand, while Governor of Massachusetts, he vetoed a bill that would make the morning-after pill available over the counter and require hospitals to offer emergency contraception to rape victims.
Santorum disagrees with the Griswold v. Connecticut ruling and wants to gives states the right to ban contraception. He has also pledged to repeal all federal funding for contraception because of its “dangers,” calling it “a license to do things in a sexual realm that is counter to how things are supposed to be.”
Gingrich has recently reaffirmed his belief that “life begins at conception,” a position that many have suggested coheres with radical “personhood” advocates who want to ban many common forms of contraception.
Although Paul has said that he opposes restriction on emergency contraception, he also opposes federal funding of birth control. In 2005, he sponsored H.R. 4379, which would have prohibited the Supreme Court from ruling on issues relating to abortion, birth control, the definition of marriage, and homosexuality.
Whereas Gingrich believes that same-sex couples should not be able to adopt children, Romney has acknowledged that they might have a “legitimate interest” in adopting children, even though every child has a “right to a mother and a father.” Santorum recently suggested that an imprisoned father is preferable to a same-sex parent and that allowing a same-sex couple to marry and raise children amounts to “robbing children of something they need.” In 1999, Paul voted for legislation to ban adoption by same-sex couples in the District of Columbia, but generally believes that such a decision should be left up to the states to decide.
End-of-Life Care and Planning
In an October 2011 debate, Gingrich claimed that the Affordable Care Act includes “death panels,” the phrase popularized by Sarah Palin in reference to reimbursing health care providers for counseling patients on end-of-life care. He has more recently returned to his previous support for advance directives and called Medicare reimbursement for discussing end-of-life care, “terrific” as long as it involves “no bureaucracy from Washington defining the terms.”
Paul has condemned “death panels” and called on Congress to block any efforts to fund physician counseling on end-of-life care. Paul himself was accused of advocating for a kind of death panels by default when he asserted in a debate that a sick individual should assume responsibility for his own illness and not rely on others, or the government, for assistance.
With the presidential election, there is more at stake than the economy. Our next president will have a profound impact on the direction of medicine and science. These often controversial and divisive bioethics issues strongly impact how we live in sickness and in health, whether and how we choose to have families, and the extent to which we have control over our own bodies.
Ross White is the public policy associate at The Hastings Center and a graduate student in philosophy and social policy at George Washington University. Follow him on Twitter @rossswhite.