If you're a progressive like me, and you're upset by the Stupak amendment, which bars federally subsidized insurance from covering abortions, consider this: What if we had a single-payer health-care system and someone like Jeb Bush or Sarah Palin were running the country?

Many liberals remain angry and disappointed that single-payer legislation never stood a chance in Washington. To them, a government-run health-care system seemed an obvious way to put patients ahead of profits.

But a single-payer system would have put us at the mercy of whomever happened to take control of Washington. I'm very happy to have a public plan as an option. But since I don't know who will be in the White House in the years to come, I'm glad that government-run health care won't be the only game in town. If you're not happy about the Stupak amendment, imagine what other limits a conservative government could impose on our health care.

Parts of the country remain more conservative on issues of life and death than many progressives remember. When single-payer advocates imagine single-payer health care, they often look to Canada as an example of how it would work. But America isn't Canada; many of our fellow citizens are more conservative than the average Canadian. Moreover, in the United States we have let the dividing line between church and state blur. Christian conservatives are a political force in their own right, and the U.S. Conference of Catholic Bishops has felt free to weigh in on health-care reform. Under a conservative president, such beliefs might be reflected in single-payer health policies.

With such an administration in power, social conservatives might move to exert pressure on health-care decisions beyond abortion. For example, could women be told that their government insurance won't cover birth control? In 2001, President George W. Bush proposed eliminating the requirement that all Federal Employees Health Benefits plans include coverage for contraception. At the time, Susan Orr, who would later become Bush's deputy assistant secretary of health and human services for population affairs, applauded the president's suggestion, saying: ``We're quite pleased because fertility is not a disease. It's not a medical necessity that you have (contraception.)''

In fact, the private insurers who cover federal employees were not required to reimburse for birth-control pills until 1998. Congress didn't like the idea of making the pill part of the package. Until then, 10 percent of federal health plans offered no contraceptive coverage, and 81 percent of plans did not cover the full range of prescription contraceptives.

Or take end-of-life counseling, and hospice and palliative care. Do you remember how Jeb Bush, then governor of Florida, responded when Terri Schiavo's husband fought for her right to die? It's quite possible that under a single-payer system, conservatives would push to overturn laws that allow physicians to withhold food and water if this is what a dying patient has requested. Recently, Rep. Charles Boustany, R-La., raised this issue, objecting to the fact that the House's health-care reform legislation does not prohibit the use of federal funds to pay for end-of-life care that involves denying nutrition and hydration. Boustany, a surgeon, doesn't want patients to have that choice. So much for death with dignity.

And what about fertility treatments? This month, the Conference of Catholic Bishops plans to vote on a document reaffirming the Catholic Church's opposition to in vitro fertilization, or IVF. No one elected the bishops to Congress, but the conference has already made its influence felt in the debate over the Stupak amendment. Under a single-payer plan, would the bishops convince Congress that IVF should be prohibited?