July 8 2014

Leave the Bosses Out of It

U.S. News & World Report

Hadley Heath

The Supreme Court ruled recently in the Hobby Lobby case that "closely-held" corporations with religious objections will be exempt from a government requirement to provide coverage for all Food and Drug Administration-approved contraceptives. While the narrow ruling represents a victory for conservatives, it doesn’t address deeper tensions that remain in our health care system.

It’s no surprise, given America’s large and diverse population, that many disagree about the morality of certain health care treatments. These conflicts would be limited if individuals were allowed to make choices based on their own conscience. However, public policy has placed employers squarely in the middle of the system, making different preferences and moralities come in conflict.

Defenders of the mandate seem blind to government’s role in causing these tensions. Many pro-Obamacare protesters at the Supreme Court carried signs that said “Not my Boss’s Business” in reference to birth control. Unfortunately for most people, their health insurance coverage is their boss’s business, given America’s long history with tax advantages for employer-sponsored health insurance.

We should have worked long ago to change that by making it easier for individuals to purchase insurance on their own rather than to favor employer-based coverage. But, instead, in 2010, Obamacare became law and doubled down on the employer-centric system with mandates like the one challenged by Hobby Lobby.

Yes, the contraception mandate is troublesome because it raises religious and moral questions. But there are other, less-controversial matters that similarly would be better left to individuals to decide. Why should your boss influence what type of plan you have, what deductible you might pay or what treatments are included for coverage?

The Supreme Court case exempted some closely-held corporations from the mandate to require all types of FDA-approved contraceptives. This is good, but a better policy would be for Congress to repeal the employer mandate altogether.

Better yet, Congress could disconnect health insurance from employment by working to equalize the tax treatment of employer-sponsored and individually purchased insurance plans. This would truly remove bosses from decisions about what should be included in health insurance.

Government interference has also muddied the definition of health insurance, to the detriment of affordability and efficiency. Congress and state governments could work against this trend by removing coverage mandates.

“Insurance” according to Merriam-Webster’s is “an agreement in which a person makes regular payments to a company and the company promises to pay money if the person is injured or dies, or to pay money equal to the value of something (such as a house or car) if it is damaged, lost, or stolen.” Insurance is something we buy to protect us when something goes terribly wrong. Unfortunately, this is not true for health insurance in the United States.

Expected expenses, like routine checkups and contraceptives, are not surprise events that require insurance. No, this is the equivalent of insuring a car to cover gasoline fill-ups and oil changes.

Many mistakenly support mandating these routine health care treatments, like birth control, for health insurance coverage, believing that doing so makes such services cheaper. Yet contrary to popular fiction, using a third party to pay such costs doesn’t make health care more affordable, but less affordable. It discourages consumers from seeking efficient products and services and allows providers to jack up prices, and we all pay more as a result.

Americans want greater access to health care and greater individual choice in private health care decisions based on their own beliefs. Part of the solution is to refocus on the very concept of what insurance was supposed to do — to help people shoulder the costs of unexpected health care needs — and to take employers out of the equation.

Giving people plenteous options in a private, free market would be the best way to make health insurance accessible and affordable. And as an added bonus, this would avoid culture clashes like the one we’ve seen in the Hobby Lobby case. 

Hadley Heath Manning is the director of health policy at the Independent Women's Forum (www.iwf.org). Twitter: @HadleyHeath

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