Wednesday, February 08, 2012

An alternative approach to the contraception coverage issue

I don't have an ethical problem with Romneycare's support for mandating birth control coverage by religiously-run institutions doing secular activities like running hospitals, with similar provisions in many states, or with similar provisions in Obamacare.

Another way to handle this issue though is to require the same total level of financial commitment from religious employers and then let them choose something additional to cover, to make up for their decision not to cover contraception.  Their hospital employees can get breaks on plastic surgery, while other hospitals' employees get contraceptive coverage.  No financial reward accrues to a religiously-based resistance to coverage, and secular employees can keep the coverage differential in mind when deciding which jobs to apply to.

This could be done even more broadly:  rather than every insurance provider being required to cover the same standardized basket of services, just figure out how much that basket would cost for your average provider, and tell other providers that they can choose a different basket so long as that different basket, if paid for by the average provider, cost at least as much as the standardized basket.  If they can then figure out a way to do things differently and cheaper, then more power to them.

I doubt these solutions are allowable currently, but maybe that could change someday.  I generally prefer determining the fair cost approach for someone who wants to deviate from a standard, like requiring lifelong coma/quadraplegia insurance for motorcycle riders who don't want to wear helmets, rather than simply telling them what they can or can't do.

UPDATE:  Apparently I should clarify.  I was comparing replacement of contraceptive coverage with something trivial like plastic surgery not in order to indicate that contraceptive coverage is trivial, but that employers IMO are unnecessarily and significantly reducing the value they provide to employees if they really want to follow this unwise path.

UPDATE 2:  Just like I don't have a problem with the original proposal, I don't have a problem with the new one.  The cost issue is less than entirely clear to me - if it's really the case that it saves insurers money, then that's fine, but if the coverage costs money on net, then there's the question of who pays for it.  And the Catholic Bishops want to exempt not just the religious charities but any business run by Catholics from the same obligations as other business, which is a real race to the bottom if the exemption saves them money.  And there's self-insured Catholic charities, but they're getting ever further afield from religious service and being more like any other business entity in that case.  I still think the best approach would be to develop a basic cost basket, and a clear, mandatory disclosure of when the insurer deviates to add and subtract from the standardized basket.

What the heck, UPDATE 3:  my classmate Laura MacCleery battles it out on Fox News.


Pinko Punko said...

Sorry, no.

Perhaps a voucher that can be used for any health care costs, and this voucher is somehow transferable for certain services, or may be applied for your hypothetical services of equal value with the objecting provider.

Anonymous said...

Of course the individual's freedom of choice is not maximized by allowing an employer to impose a 'moral' position not shared by the employee. And the new rules don't apply to religious institutions-- just to institutions (universities, hospitals) with secular purposes that are affiliated with some religion; many of their employees don't belong to the religion in question, and many members of the religion's community don't share the official, institutional opinion on birth control. So I'd rather see the administration stick to their guns on this one. Freedom for authoritarian institutions to impose their sectarian convictions on all their employees, even when it comes to very personal matters, is not a kind of freedom I see any need to support.

Bryson Brown

Brian said...

Pinko - the "sorry no" was just a bit too concise for me to follow.

Bryson - I think there's a difference between banning contraception and requiring an employer to provide it. Another possibility though would be to require the employer to pay out to employees the annual per person cost of providing contraception.

Anonymous said...

I don't like the idea personally.

The idea of health insurance isn't to provide a set dollar figure amount of coverage, regardless of whether or not its medically useful or improves quality of life. The idea is that we spend this money with the aim of funding medical practices that improve the quality and longevity of life. Certainly plastic surgery can be beneficial for the patient's who undergo such procedures, but it doesn't provide nearly the same medical benefits, dollar for dollar, that the birth control pill does.

And it's pretty shameful that the Catholic Church is making a big issue out of this considering the fact that the birth control pill is frequently prescribed for reasons other than family planning.

I don't think it's a good compromise. Sorry.

Modest Mouse

Anonymous said...

An employee-employer relationship is subject to all kinds of regulation by the state. It's a relation in the public economic sphere, subject to reasonable conditions that serve key social values. If conditions of employment are regulated, why shouldn't certain benefits that are known to be important for public health be required? Employers who have religious connections may be entitled to an exemption, but (I would say)it's reasonable to limit that exemption to employees engaged in religious work-- which is roughly captured by distinguishing religious institutions and their employees from the universities and hospitals.

Bryson Brown

Anonymous said...

ISTM that these sort of ideas mostly come from men. Plastic surgery, really? So you can get some breast enhancements to gawk at? Anyway, one of the bishops let the cat out of the bag, saying that controlling reproduction for all is a goal. I suggest you rethink.

Worst post I've read here in all the years I've read Eli's blog.

- Roof Rat.

Anonymous said...

The best thing would be to separate health insurance from employment. Then this is a non-issue.

The Swiss have a pretty good system. Everyone has private insurance. Everyone is required to have private insurance. The government sets basic coverage requirements and negotiates pricing for that. Individuals can always add upgrades if they want.

Just doing this -- requiring everyone to be insured and then negotiating a group rate for the whole country -- their insurance per capita is about half that of the US. And I know from experience that their system is better for the average person in many ways.


KAP said...

The problem with the "alternative coverage" idea is that the alternative might be something only a very few people want or need. Plastic surgery is a good example. A 23-year-old woman seldom needs it, but she will pretty much always need contraception. The problem with giving people money for the difference is that individuals don't have the buying power of the insurance company, which makes deals with the drug companies. So it will cost the individual more, and perhaps a lot more, than insurance would. (There is also the problem of people in financial straits using the contraception money for other purposes.)

A church is free to impose its rules on its members. But it is NOT free to impose its rules on its employees. This has been federal law for years and nobody complained.

Brian said...

Roof Rat - thanks for your comment. Please read my update.

Anonymous said...

Dr. Jay Cadbury, phd.

This is one of Eli's best articles, however I think most have missed the Pandora's box that this foolish new mandate could open.

For example, I have 30 different allergies. I could easily start an uproar over the fact that sex is optional, while my allergies cannot be controlled. So when am I getting my Singulair, which is $50 WITH COPAY, for free?

Please note, singulair is primarily used for asthmatics, however it owns all other allergy meds.

Jeffrey Davis said...

I bet coverage for those women who receive contraception is cheaper than for women who don't. I know we were able to easily afford health insurance for our daughter when it lacked maternity coverage.

Anonymous said...

This is one of Eli's best articles...

It's probably a dastardly plan by Suzerain Rabett to take over the blogiverse, cos "Not Eli" never seems to get the recognition he deserves.

Cymraeg llygoden