Health Insurance and Coercion

Contraception Experts before the House Committee on Oversight and Government Reform

Today I am uncharacteristically writing about a current social issue in American politics–the controversy over U.S. Health and Human Services mandate on contraceptive coverage which has erupted over the course of the last fortnight.

For anybody reading this from the remote future (which will be next week, considering our 24 hour news cycle), the dispute can be summarized as follows.  The current presidential administration attempted to compel religious (particularly Catholic) schools, hospitals, and charities in the United States to provide health insurance which covers contraception for their employees.  These institutions balked at this demand, claiming that the president was trampling on their freedom of religion (Catholics authorities indeed have a well-documented history of objecting to people being able to make health choices and moral decisions for themselves).  Since it is an election year, the president seems to have backed down.

Hi! I can still intrude in American politics!

There has been a great deal written about this from different political/moral/religious perspectives and it is already the subject of much posturing and political theater. Leaving aside the obvious boon which effective contraception provides for individuals and for society (and the fact that the vast majority of American women, whatever their religion, use some form of contraception), I don’t intend to write about the dust-up per se.  If the Catholic Church wishes to force women back to a benighted era of limited reproductive freedom, well, they can make that their (abusive and wrong-headed) position [although the Church has argued that these hospitals, charities, and schools are not solely religious whenever questions of public funding and government assistance have arisen].  There are ways around it, and it doesn’t seem like a long-term winning strategy.

I am troubled instead by the implicit assumptions about health insurance and healthcare which are revealed by this controversy.

The religious (and quasi-religious) organizations claim to be angry because they are forced to pay for a service which is against their conscience.  This implies that they are paying for the service!  Whatever employers claim, health insurance is really ultimately paid for by employees.  It is part of compensation. This is one of the reasons that wages have stagnated in the United States for such a long time. Our salaries are not rising because our health care costs are going up. There is a strong incentive not to leave a job which provides health insurance because an employee can not be guaranteed to find coverage elsewhere, particularly if that employee has a pre-existing condition or works in a field with limited employment options (which is pretty much every field).  Ideally all employees adversely affected by the Church’s paternalistic overreach would quit and move to new jobs.  Raise your hand if you think that is likely or even possible.

Health costs are rising precipitously while health outcomes are getting worse.  People are understandably afraid to leave their jobs in search of better options or to start businesses of their own.  The stagnation of job mobility is hurting the American economy and society as a whole.

The reason that people should be mad is not because health insurance allows Catholic institutions coercive control over the lives of people who work for them.  People should be angry because the structure of health care in this country gives all large employers an undue hold on the people who work for them.  Americans are becoming vassals of their employers thanks to perverse incentives of a broken healthcare system.

I have no answers but here's some bland clipart.

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