Health Care Rights

Have you heard about the SCOTUS decision in the Hobby Lobby case? If you live in American and haven’t heard about it then you might live in a cave, but here’s the gist of it:

The U.S. Supreme Court has upheld a decision whereby closely-held companies can request exemptions the Patient Protection and Affordable Care Act (ACA) coverage provision for some contraceptives because of the corporations’ founding family’s religious beliefs…

Much of the controversy over today’s decision derives from the fact that Hobby Lobby and Conestoga are not in the business of conducting religious services or overseas humanitarian missions as their primary business. They are for-profit companies. The ruling allows the corporations to refuse coverage because of the religious beliefs of individual leaders.

Beyond selectively singling-out women’s reproductive care, the decision raises the question of whether corporate leadership elsewhere might refuse coverage of other drugs due to religious beliefs.

A lot of the reaction I’ve seen online has focused on a couple of points: the weirdness of bestowing religious rights on closely held corporations using the argument that the corporation is an extension of the owners (that’s simplistic but I think gets to the heart of it); that the religious rights of the corporation/owners trumps the reproductive rights of their female employees.

I’d like to focus on the second point for a minute because I think the argument is a bit off and, quite frankly, misses the larger point. While it is regrettable that employers like Hobby Lobby would refuse to pay for insurance that covers all of their female employees’ contraceptive choices it doesn’t mean that those same employees can’t go out and get those contraceptives if they’re willing to pay for it themselves. Thus they aren’t denying them anything, they’re just not paying for it. That might seem like semantics, but I think it’s important because what it exposes is that corporate health insurance in this country is not a right for anyone.

Health insurance as we know it came into being in the World War II era as an incentive companies used to attract and retain employees who were in short supply at the time. As such, health insurance was never a “right” but was a benefit that came to be so commonplace that most employees started to view it as a right. Then something funny happened – companies realized they could shift the cost of health insurance back to employees and not suffer too many dire consequences and so they starting jacking up premiums and co-pays or simply doing away with health insurance all together. The result is a growing percentage of our population without access to health insurance, which means they forego preventive care and rely on ERs when they get sick, helping drive up health care costs for everyone.

The Clinton administration’s effort to deal with the rising health care problem twenty years ago was a notorious failure. ObamaCare started out as an ambitious plan to provide health care coverage for everyone, fought the “socialized medicine” stigma, went through a negotiation phase involving the health insurance cabal that resulted in the imperfect system being fought out in the courts today. You’d be hard pressed to find anyone happy with the system, except maybe for the millions of people who had NO access to health insurance pre-Obamacare and now at least have the option to buy it.

Long story short, while it’s easy to get hung up on the reproductive and religious rights arguments raised by the Hobby Lobby case, it would be a mistake to limit the scope of the conversation. The bigger question is why we can spend so much time and energy talking about our religious rights, women’s reproductive rights, our right to bear arms, etc. but we never seem to debate whether we should have a fundamental right to affordable, adequate health care and whether or not relying on private companies to provide it is the best way to approach it.

2 thoughts on “Health Care Rights

  1. Leatherwing

    Jon, you point out that “health insurance was never a “right” but was a benefit that came to be so commonplace that most employees started to view it as a right.”

    I’d like to add that it was so commonplace that health care providers began operating on the assumption that everyone had insurance, and raised prices. The end consumer rarely paid the full price, so they got away with it (much like colleges and universities are able to raise tuition and fees, since most students are paying via some type of loan and don’t begin paying until much later).

    The artificial buffer that insurance creates between provider and consumer allowed prices to get out of control, as well as overly complicated (why is a hospital bill actually half-a-dozen or more bills?). I grew up without insurance. When we needed a doctor, we paid out of pocket and it was relatively affordable. Now any routine visit “costs” several hundred dollars but the consumer pays only 25.00.

    One other thing is that health insurance became a perk of employment due to wage freezes imposed by the War Labor Board. So it was an unintended consequence of government action in an area that government should not have been involved in.

    1. Jon Lowder Post author

      Great points Leatherwing. I truly believe we’ll never have true health reform until we make it a truly transparent experience. If I don’t know what the real cost of a procedure is then I have no incentive to find out if I either truly need it, or if I can find a more affordable solution. Many moons ago I wrote about my experience with having a health savings account (HSA) when those things were brand new and it was literally impossible to find out ahead of time how much something would cost. Without that knowledge it was impossible to know if I was better off having an MRI done at the hospital the doctor sent me to, or going to the trouble to get it done farther down the road but at a 20% lower price. As it ended up I would have been better off flying to Iowa where I could have had it done at a third of the cost and saved a couple of hundred bucks even after accounting for the airfare. But, until we have a transparent market there won’t be any way for us, the end consumers, to affect the market.


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