Bart Stupak

After Michael Moore claimed credit for changing the health care vote of his congressman, I was so confused I looked up the boundaries of Bart Stupak’s first Michigan district.

It does not include Flint, but does include the entire upper peninsula, as well as the northeast quadrant of the lower one. It has more land and more counties than any other and probably the lowest population density in the state.

Its boom times came with logging and mining, exploitive industries that moved on when the resources were gone, leaving environmental eyesores that time and the CCC reforested. The soil’s too thin to support farming, the summer’s too short. The region now lives on tourists, seasonal residents, retirees, the neighboring lakes and what natural resources are left.

As I looked at the map, I realized both health insurance and abortion are problems of areas with reasonable, if not now healthy, economies. In Stupak’s district, I imagine the major health crisis is simply finding a doctor.

A study done for the Michigan Medical Society in 2005 listed three counties Stupak represents as having the fewest number of physicians per 100,000 residents: Arenac, Keewenaw and Oscoda. The last two have only one physician. He also represents three counties with high ratios, but such small populations the numbers are probably misleading: Emmett had 32,741 people in 2003, Dickinson 27,186, and Marquette 64,616.

In contrast, Kalamazoo and Genesse counties, some of the hardest hit by the state’s deindustrailization, were still in the top ten best counties for physician availability. Both had grown on lumber, but Kalamazoo replaced the paper industry with a pharmaceutical company and Genesee includes Flint. The drug company was sold, and its operations slowly closed. Even the new research center in Washtenaw county’s Ann Arbor was shut as redundant. Moore has documented what happened to his home town.

The place where I grew up, bordering Kalamazoo and Ingham counties, home of Oldsmobile, was never as rich as Kalamazoo, Flint or Lansing, but had three factories making parts for automobiles, refrigerators and televisions, as well as a community hospital built in 1924. The hospital was sold to private investors in 1967, and closed in 2002, the same year the last large factory moved operations to Mexico.

The town is better off than Keewenaw and Oscoda counties. There are still hospitals in cities 30 miles away, and it still has physicians. The roads, including an interstate, are clear most of the year, unlike the far north, but most of the doctors have Indian sounding last names.

Stupak’s district does not include a single county with an abortion rate near the state’s 12.5 per 1,000 women of child bearing age. Some have numbers so low, they can’t be reported statistically.

With so few physicians, there may be areas with no abortion provider. Women have to go elsewhere, as the residents do for any kind of specialized medical service. Some abortions may be buried in the statistics for young people who leave the region every year, and others may use unlicensed practitioners or folk remedies.

Young, unmarried teenagers, however, aren’t the only ones who seek abortions. When you read oral histories of poor areas or descriptions of folk medicine, you realize that abortion has always existed, regardless of cultural values, among women who felt there was no way they could feed another person. In areas with no self-sustaining economies, perceptions of malnourishment and deprivation may differ, but the edge of subsistence is still there.

The areas with abortion rates above Michigan’s average are all ones that have seen their industrial economies threatened since I graduated from high school: Detroit with 29.2 per 1,000 women, the rest of Wayne County with 17.1, Genesse with 15.2, Kalamazoo with 15.0, Saginaw with 14.3, Ingham with 13.7, and my home county with 13.2.

The high abortion rates seem to reflect the sense of economic desperation of people who see their incomes falling or disappearing. The health reform bill doesn’t address that root problem, only the consequences.

People, like his primary challenger, Connie Saltonstall, ask how Stupak could be against health care reform when there are 44,000 uninsured people in his district. That’s more people than live in many of the constituent counties. The bill doesn’t address the problem of shortages of doctors and nurses, only creates more demand on the existing ones and keeps the Medicaid reimbursements lower than those paid in more affluent areas with lower doctor-patient ratios.

Stupak’s views on abortion probably not only arise from his Roman Catholic background, but from the fact one of his sons committed suicide in 2000. Anyone who’s lost a child that way is likely to have a more emotional view of the value of children.

Moore may like to take credit for helping convince Stupak that many more of his voters and contributors supported health care reform than he may have thought, but Moore’s self congratulations don’t recognize that for Stupak, more than political calculation was involved, and the benefits to his district are not as great as they are to Flint or Saginaw.

Notes:
Michigan Department of Community Health. “Abortion Rates by County of Residence, State of Michigan, Michigan Counties and Detroit City, 1998 - 2008.”

Moore, Michael. “How the People in My District Changed Stupak's Mind and Saved Health Care Reform,” Huffington Post 22 March 2010.

Public Policy Associates, Inc. “The Future Supply and Demand for Physicians in Michigan,” 2005.

Saltonstall, Connie. Campaign website.