One of the reasons I oppose government-run health care is that it automatically politicizes every aspect of medical treatment, lifestyle, and more. When taxpayers are footing the bill, they rightly have an interest in what gets funded and what doesn't. Should human-growth hormone shots for short kids be covered? Viagra for old men? And what sort of research should be conducted? It takes a situation that is already full of moral an practical ambiguity (one doctor's experimental treatment is another's quackery on a cracker) and puts it on steroids (which I'm guessing shouldn't be covered, unless it's for a "good" cause). God, what a tedious conversation!
Which brings us to the latest imbroglio involving President Barack Obama's health-care reform: the administration's insistence that most employers provide coverage for things that many religious organizations oppose, especially when it comes to reproduction. There seems little doubt that the law will have very few exemptions in its coverage for contraceptives and elective abortions. So while Catholic dioceses may not have to shell out for IUDs for nuns, Catholic hospitals and other closely-related outfits may well have to offer insurance plans that cover birth control and more that's against church doctrine.
Indeed, here are Democratic Sens. Jeanne Shaheen (N.H.), Barbara Boxer (Calif.), and Patty Murray (Wash.), three champions of the new law, trumpeting that
It was a historic victory for women's health when the Obama administration changed the law to require private health plans to provide preventive services including breast exams, HIV screening and contraception for free. This new policy will help millions of women get the affordable care they need.
They note "it can cost $600 a year for prescription contraceptives. That's a lot of money for a mother working as a medical technician in a Catholic hospital, or a teacher in a private religious school."
It sure is a lot of money. And there's something obviously wrong with forcing an employer—say, the Catholic church—to cover contraceptive or abortion services that it patently objects to. Indeed, there's something wrong with forcing employers and employees to offer or buy coverage in the first place. We all know that it's monstrously stupid—and an artifact of idiotic wage-and-price controls enacted during World War II—that health insurance is tied to the workplace. Way back when, separating work from health coverage was supposed to be one of the goals of reform, wasn't it? For god's sake, most businessess can't make good decisions in their chosen area of competition. Why should they be picking people's insurance?
Writng in National Review, the libertarian, pro-life Sen. Rand Paul (R-Ky.) says that Obamacare's rules are nothing less than a "war on religious freedom":
[The] Obama administration's recent edict requiring nearly all employers — including Catholic hospitals, schools, and charities — to cover sterilizations and contraception in their employees' health-care plans. Because "contraception" includes abortifacients, this decision — made under the powers granted to the executive branch under Obamacare — also threatens many Protestant employers.
I'm an admirer on Rand Paul, who I think is without reservation the most libertarian member of the Senate (and I don't mean that as a backhanded compliment, given the generally low level of freedom-loving in the Senate!). He's the real deal when it comes to limiting the size, scope, and power of the federal government, and I'm glad he's gonna be around for a long time.
Yet I'm not convinced that Obamacare is the equivalent of a war on religious freedom. The individual mandate is unambiguously a war on freedom, for sure: the requirement that you buy coverage as a condition of being alive is clearly that. But as long as various health-care providers pull money directly from the federal government, it seems to me that they can be required to follow certain regulations. And most hospitals, whether private or public, religious or secular, are getting chunks of money from the federal government, through Medicaid and Medicare payments at the very least.
That's a strong argument, of course, for getting the government out of areas such as health care and education, where a similar problem obtains: Shouldn't K-12 schools and colleges that get government funding have to follow certain government rules? If you want that money, say, you shouldn't be allowed to discriminate on the basis of race or gender, right? And if you don't want that control, then opt out of the system, as colleges such as Hillsdale and Grove City have done by setting up replacements for Pell Grants and federally guaranteed student loans.
When it comes to education, though, most conservatives and libertarians challenge the idea that public money necessarily means strict government control. Indeed, the preferred argument when it comes to state-funded voucher programs is that as long as the money is being used by the individual, the state shouldn't be allowed to bully the schools that ultimately get paid into following a particular curriculum.
So I'm left wondering: If Obamacare was structured in such a way that it gave individuals vouchers to cover all or part of the cost of a health-care policy of their own choosing, would that solve this particular objection? I think such a policy would cause all sorts of problems, including a general increase in health care costs (just as easy, government-backed student loans have given rise to a "higher education bubble"). But would switching to a voucher plan for health-care obviate the issue of religious freedom? It seems to do the trick when it comes to education.
Of course, looking over what I've just written really drives home two different but related points:
First, that any health-care reform which doesn't de-link insurance from the workplace is really not serious in transforming a system that everyone seems to hate but won't fully jettison.
Second, even if Obamacare is booted by the Supreme Court later this spring or repealed upon the ascension to the White House of his royal highness Newt Gingrich, we'll still be facing a situation in which government at all levels is already spending about 50 cents out of every health-care dollar. Which means that reform will still be a top priority come 2013 whoever is actually getting sworn in.