Friday, February 10, 2012
More on Medicine and Religion
Today President Obama attempted to quell the protest by the Catholic bishops and Republican politicians regarding the administration’s decision that women employed by Catholic affiliated institutions (e.g. hospitals, schools, and charities) be provided contraceptive services at no additional charge as part of their employer provided health insurance.
President Obama, while fortunately not backing down on providing contraceptive services to women, proffered a lawyerly solution. He announced that while the women would receive the free contraception coverage, the institutions would not have to violate their religious beliefs by paying for it - the insurance companies would have to provide the service at no charge! Of course insurance companies derive their revenue from premiums so one might think that ultimately some purchasers of health insurance will end up paying for the service. However, in this particular situation, it might be the case that providing contraceptive services at no charge actually ends up saving the insurance companies money because the insurance companies will have reduced expenses related to pregnancy, complications of pregnancy and child health care.
With a few calming words President Obama attempted to soothe all parties, without really changing anything at all.
Employers should not be deciding what type of health insurance their employees receive. There will be no end to the game of attempting to accommodate the religious beliefs of each employer. The federal government is not allowed to determine which religions are “reasonable” and which are not. The federal government has to treat all religions equally. There is no limit to what type of religious beliefs one can subscribe to. In my previous post I mentioned religions that proscribe blood transfusions. How will the government handle employers that refuse to provide health insurance that covers blood transfusions? What if a religion objects to antibiotics because they “kill” living creatures – bacteria? What if the employer has a sincere religious belief that pain is cleansing and refuses to pay for anesthetics and pain-killers? What if the employer is a Christian Scientist and objects to all medicine except for faith healing?
All employers have to abide by basic labor law that is neutrally applied. Religious employers cannot refuse to pay payroll taxes or unemployment insurance. The government provides a tax exemption for employer provided health insurance and is entitled to regulate it. Coverage should be based on science and not the religious beliefs of the employer. The beneficiary may of course decide not to take advantage of certain covered procedures if he/she has a moral or religious objection to them, but that decision should not be made on the basis of the religious beliefs of the employer. The Catholic Church is free to attempt to convince its followers and anyone else not to utilize contraception (they are not very successful in this regard inasmuch as 98% of Catholic women in the US use contraception at some point during their lifetime). But the Catholic Church should not be allowed to force its views on its employees.
What this episode highlights is what an awkwardly constructed health care system we have in the United States where employers are the purchasers of health insurance. All of the above issues could be avoided if individuals obtained their health insurance independently of their employer. I think we should adopt a universal basic health care system. To maintain the benefits of competition, I personally favor testing a voucher system where the voucher would cover the full cost of basic health care. In a non-employer based system people would not lose their healthcare when they lose their jobs – often the time they are in greatest need of health services. At the very least people would not have to change their health care plans every time they change jobs. The religious views of employers would no longer be an issue. Employers would not choose the health care plans and providers, individuals would choose for themselves.
I am pleased that President Obama did not back down on providing contraceptive care to women. However, we have a lot of work yet to do to restructure the health care system.