Should Your Boss Play Doctor?

Here’s a preliminary take on the temporary injunction that lets The Little Sisters of the Poor cut birth control coverage from their employee insurance policies.

The order, which employs hundreds of workers at 30 homes for the elderly throughout the United States, would have faced substantial IRS fines beginning on Wednesday.

Those fines are now on hold after Supreme Court Justice Sonia Sotomayor issued a temporary injunction late Tuesday to grant exemptions to the Little Sisters and the Illinois-based Christian Brothers Services.

They are not really ‘Little’, they employ a large, mostly-female work force in the US and have missions in 31 countries. They run nursing homes that accept Medicare and Medicaid. The service they provide, elder care, is very labor-intensive and requires around-the-clock staffing.

Why this controversy? The fact that our bosses provide our health insurance is an accident of history more than an Act of God. Our modern health care system goes back to the 1920’s and evolved during the Great Depression and WWII. Through the decades, profit and special interests pulled in different directions, leaving us with an overpriced and underperforming duct-taped mess. Americans listened to warnings not to let some socialistic government get into our personal lives. So now we have Big Boss claiming the right to pick and choose what kind of health care employees can have on their plan.

Because religion.

What might have happened if the gap in social service that was filled by Catholics and Lutherans and Baptists had instead been filled by Jehovah’s Witnesses? Would they have the right to cut blood transfusions out of their employee health insurance plans? Refuse to perform blood transfusions at their hospitals?

Scientology is officially a religion. What’s going on with mental health coverage if your boss is a Scientologist? Can they put the money into E-meters and call that equity?

And for real cost savings, the Christian Scientists. Oh ye of little faith, think positive.

The difference here is that these are minority religions that have little political power. Historically, Americans were content to label essential public services as charity
and leave it to organized religious groups to meet the need. Later, when the cost of medical care soared, hospitals and facilities became dependent on government money, Medicare and Medicaid. This sets up a potential conflict when essential service providers, like hospitals, decide to deny certain services to patients whether they are co-religionists or not. Some Catholic hospitals, for example, won’t offer emergency contraception to rape victims.

Although we are all supposed to be equal under the law, the political reality is that religion gets special treatment. The other side is that Americans really do value religious freedom and freedom of conscience is woven into our national identity. I have 2 views on this that might help to reconcile competing values.

1. Integrity–putting your money where your mouth is. When an individual stands for a belief, knowing they will experience the consequences, that is an act of conscience. Forcing a nonbeliever to suffer the consequences is an act of power. There are Catholic couples who abstain from sex periodically, or indefinitely because that is the only kind of contraception the Church endorses. There are Evangelicals who raise and support large families because they believe that only God should control how many children they have. For for a politician or religious leader to cut a basic health care benefit from women is a cheap way to feel virtuous at someone else’s expense. A lot of this going around, and we need to call it for what it is.

2. Privacy– Do employers have a right to pick and choose among basic health benefits? Does an organization like Little Sisters of the Poor, that hires many women of childbearing age in a low-wage occupation, have a right to create a financial barrier to birth control? Is this respectful of their employee’s privacy?

If the Supremes decide that a religious organization that takes government money and hires people of all beliefs can change the basic standards of benefits at will, where will it end? If your right to wave your religion doesn’t end where my nose begins it’s not faith we’re talking about, but force.

Some experts speculate that the Affordable Care Act might ultimately disengage health insurance from employment altogether. This would liberate workers from being locked-in or controlled by employers, and it can’t happen soon enough as far as I’m concerned. This mess is just one reason why.

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