Change of Subject: Contraception and insurance

Noah Millman of the American Conservative asks us to perform a thought experiment: Pretend it?s not the Catholic Church at the center of the current controversy over the rights of religious institutions to exercise moral judgments regarding their employees? health care plans.

Instead, Millman suggests in a recent commentary, pretend it?s the Church of Scientology.

And pretend that the flash point of controversy isn?t coverage of contraception, which violates Catholic teachings, but coverage of mental-health services ? psychology, psychiatry and mood-stabilizing drugs, all of which violate the teachings of Scientology.

If the Scientologists operated a network of schools and hospitals, would the pundit classes be rushing to the ramparts bellowing about religious liberty in defense of the right of these schools and hospitals to deny mental-health coverage even to employees who don?t belong to their faith?

More likely, Millman suggests, the dispassionate public-policy question would be, ?Should it be OK to systematically disadvantage employees of Church of Scientology schools because that church has a weird hang-up about mental-health services??

We?d set aside the origins of this belief (?weird hang-up? is Millman?s phrase, not mine) and weigh the overall pros and cons, the social and medical outcomes, of mandating such coverage.

We?d recognize that our government is, thank goodness, in no position to referee the validity of particular moral claims of faith groups, and that participation in society sometimes requires people, for the greater good, to set aside their weird hang-ups/divinely ordained beliefs and get with the program.

The difference?

Slightly more than 25 percent of American adults are Catholic, according to the 2008 American Religious Identification Survey, while the same survey lumped Scientologists into the 1.2 percent, grab-bag category of ?new religious movements and other religions.?

In other words, it?s easier to be coldly analytical, even dismissive, of beliefs that aren?t very popular, even though, technically, one of the founding principals of our nation is that religious truth isn?t a popularity contest.

My view is that it?s sound public-health policy to expand low-cost access to contraception. But I?m sympathetic to the idea that, as a matter of conscience, people shouldn?t be compelled to pitch in and pay for products or services they find morally objectionable.

How to resolve these feelings?

First, let?s change the terms of the debate.

Popular usage and appearances aside, employers don?t ?provide? health insurance. Employees earn it ? at (a shrinking number of) American businesses, insurance is a tax-free part of a benefit package that?s included in overall compensation. Since World War II, tax laws and insurance-industry conventions have made it cost-effective for employers to facilitate and contribute to the purchase of health-insurance packages, leading to the illusion that it?s some kind of gift.

But it?s not a gift, and employers? moral judgment should no more shape health-insurance options than they should shape employee vacation destination options. And the true threat to freedom of conscience is not a mandate on employers to facilitate the purchase of contraceptives, but a waiver that allows employers the right to deny employees the right to make the decision about what sort of contraceptive coverage they want in the insurance coverage that they?ve earned.

In this light, the issue here is a clash of rights rather than a simple assault on them. And the resolution becomes clear both to me and to my brother from a conservative mother, Noah Millman:

Get employers out of the health-insurance business.

The current system disguises costs, is unfair to the self-employed who must pay for insurance with after-tax dollars, decreases job-to-job mobility and diminishes the practical and moral options for customers.

Translate that fringe benefit to cash on payday. Rewrite the tax laws and offer subsidies to smooth out the transition.

Set a baseline of required, basic services covered by every policy, but otherwise let the insured decide if they want to join risk pools that cover one another for contraception or other medications or care that some find objectionable.

The thought experiment yields an obvious result: For their sake and ours, keep the churches out of it.
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SOURCES:

Noah Millman's essay in the American Conservative, 2/2/2012

The Decline Of Employer-Sponsored Coverage Under Health Reform: Good, Bad Or Ugly? (Kaiser Health News) by Austin Frakt, Assistant Professor of Health Policy and Management Boston University?s School of Public Health

Scientology?s war on psychiatry (Salon)

Many Catholic Universities, Hospitals Already Cover Contraception In Their Health Insurance Plans (Think Progress)

American Religious Identification Survey, 2008 table:

Something I didn't know that annoys me:

November 03, 2009 By Tom Hamburger and Kim Geige. Backed by some of the most powerful members of the Senate, a little-noticed provision in the healthcare overhaul bill would require insurers to consider covering Christian Science prayer treatments as medical expenses.

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Earlier, blog-post version of this idea:

Noah Millman? in the American Conservative offers a provocative take on the birth-control / insurance kerfuffle.

Imagine that we live in a world where the Church of Scientology runs a substantial network of charter schools that do a remarkably good job educating poor students. Imagine that, in this world, employees pretty much have to get their health insurance from their employer (one of the things that the Affordable Care Act is supposed to change, by the way, which is a non-trivial fact). And imagine that the Church of Scientology refuses to provide mental health coverage for employees in these schools. Should that be acceptable?...

By the way: what?s special about the Catholic Church in this regard? Does the strictly Catholic sole proprietor of a national pizza franchise lack a conscience? Why is it okay to coerce him into providing services he deems immoral, but not okay to coerce a Catholic hospital?

Like Millman, I understand and even have sympathy for the position of those employers who feel that a legal requirement that? they facilitate the purchase of products -- in this case contraceptives -- that violate their moral principals amounts to a legal assault on those principles.

This question is complicated a bit in my view by the fact that, while employers negotiate for and arrange for health-insurance coverage, each employee in effect "pays" for his or her own coverage since that coverage is a fully earned benefit of employment.

Perhaps this is a fiction of sorts, but, in theory, an employer never "gives" or "provides" an employee any benefit -- everything from vacation time to retirement plans to health coverage is "earned" as condition of employment, and the cost of these things is baked into the compensation cake.

?My thought is that that moral choice here ought to belong to the individual employee -- that he or she ought to have the opportunity to participate in a health plan that provides free contraception or to decline to participate in such a health plan on any grounds, moral or otherwise.

No government entity ought to be in the position of refereeing moral or religious claims or feelings like this for their validity, popularity or sincerity.? And no employee ought to be denied the right to participate in a risk pool or his or her own choosing simply because of the religious inclinations of his employer.

An employer should have no more right to tell an employee what form of insurance and health care coverage to enroll in than an employer should have the right to tell an employee which legal products he may purchase with the money he earns at work.

Which brings me to the same conclusion Millman reached:

Either you need to give up on the idea that health care is a right, or you need to give up on the idea that health coverage will be provided primarily by private employers. I vote for giving up the second idea.

I have reflexively scoffed at this idea in the past, but this controversy is among the situations that, to me, illustrates its virtues

There are certainly many wrinkles and complications to be puzzled out -- I'll let commenters get a start on that.

Source: http://blogs.chicagotribune.com/news_columnists_ezorn/2012/02/contraception-and-insurance.html

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