Considerable excitement, controversy, and name calling is being generated by a government decision to require religious employers who regard contraception to be sin to provide insurance coverage for contraception to their employees. 

I have sympathies on both sides of the argument over whether this decision is correct, but here reflect on the whole question resulting from the crazy concept of our paying indirectly for services we need or want.  Certainly I may wish to purchase contraception even if I work for a Catholic hospital and I don’t want my employer making decisions about my health care.  But why should contraception be paid for by insurance at all?  This is a simple question, but the answer is enormously complicated and suggests the problem of the government being in the health care business.

Health care is a a special service.  Without it we may face discomfort or death.  With it we suffer the same fate, but certainly good health care provides a longer and more comfortable life.   For this we may be willing to make considerable payment.  More, we hate to see those suffering from poverty denied health care.  Therefore we have increasingly devoted our labor to providing for medical benefits to ourselves and the poor.   This is a good thing.

Medical care has, however, become more intense, somewhat better, and enormously more expensive in part to do with increasing resources provided by our society.  A popular view that everyone, regardless of the ability to pay, should receive the same level of care is making health care unaffordable to everyone.  

During World War II when wages were “controlled” (always a bad idea) businesses began providing health insurance to employees to evade the law.  Employer provided insurance was seen as good in part because it resulted in more people having insurance.  Congress institutionalized the practice by allowing employer paid premiums not to be counted as employee income when income taxes became significant.  So even after wage controls were lifted, many employers continued to provide health “benefits.”  We may not remember that once upon a time income taxes were imposed only on “the rich”  and we still ignore the gross unfairness of exempting health benefits from income.

Still, after all this, many workers were not provided insurance by employers.   As may be expected, some of these people purchased hospitalization insurance.  Others did not and risked for themselves and their children denial of care, bankruptcy, or only charity care if stricken with a serious illness.  This was viewed as unfortunate and to solve the problem laws were passed to require hospitals to treat patients regardless of their ability to pay. 

Hospitals swallowed hard and tried to recover losses from uninsured patients by increasing charges to patients who did pay.  Hospitals also demanded that government begin to provide compensation for this charity care.   Medicaid was born. 

As a result, medicine became a peculiar business.  Most patients have insurance paid for by others (employers or government.)  The patients want the best of care, and hospitals provide it.  Wards gave way to semi-private rooms and finally private rooms.  New treatments were developed.  Cost didn’t matter.   Insurers had to pay the reasonable cost even if the cost was obscene.  Organ transplants became common, and drugs were developed that are needed by only a few patients.   Today the cost for a round of chemotherapy may be $30,000, but insurance or the government will pay it. 

The cost of medicine skyrocketed.  Today it is estimated at about $8,000 per person or $32,000 for a family of four.  This is simply ridiculous.  Most people would undoubtedly settle for a level of care that cost much less if they had to pay out of their own pocket.  Certainly the poor would prefer much lower cost care if they were purchasing it directly from welfare benefits provided as cash to them.   

But neither employees nor welfare recipients are given much of a choice.  Increasingly the government is telling insurers what must be covered, and now government proposes to require everyone (most employers and individuals not insured through an employer)  to purchase insurance.  What is to be included is to be decided by the government. 

So the government decides that contraception must be included and the church school must provide it to its employees. 

Why should contraception be included.  It is a routine cost and one incurred by a relatively small group.  Poor children don’t need it and the elderly don’t need it, but the cost of their insurance will go up if it is in the policy.  Including contraception in insurance really amounts to a welfare payment to reproductively active adults. I do suggest that becoming sexually active is a declaration of adulthood. 

Why is contraception to be included in insurance?  One argument is that most users of medical contraception are women.  That is correct, but usually there is a man involved if contraception is needed.  Another argument is that poor women need access to contraception.  That may be true, but some don’t, so would it not be much fairer to let them decide how best to use their welfare check?   Some may argue that the welfare check is not enough.  That may be, but then address the amount of welfare, don’t make health insurance unaffordable as a roundabout way to provide welfare benefits to all women.  Most women (and their men) are fully capable of affording contraception. 

Another awful argument for having society pay for contraception is that poorer women will risk sex without it, and society will have to provide welfare to their children.  No, society does not have to pay for poor children.    With all the welfare programs in place from public housing and food stamps to medicaid and school breakfasts, lunches, and in some cases suppers, there are still hungry children.  As with health care, the best of intentions has lead to a mess.  We seem to be worse off than when parents were responsible to pay for their children.

Society is no more responsible for paying to grow people’s children than it is to provide our medical care; and its efforts to do so have, if anything aggravated the problem.  People have become accustomed to others paying the cost of their children, even the cost of their college educations.  As a result we make poor decisions and become dependent on government.  Do we want to again become vassals and return to the glories of medieval society? (Read Thomas Moore’s bizarre Utopia for a description of a horridly prescribed society presented in a favorable light.  Decide if it is grand satire or if the author really believed that his utopia would be a good thing.)  I count my blessings as coming from a mercantile society.    I want the same opportunities for my descendants.

Can it be that contraception is provided not or the benefit of the insured, but for the convenience of a society that feels obliged to care for people’s children but does not want so many?  Is that perverse? 

For whatever combination of reasons, the government says that insurance must include contraception and that employers must provide insurance.  Thus a church employer must pay the cost of contraception.  If churches were exempted, their employees would have to pay directly for their own contraception.  The church provided insurance without contraception would be a little cheaper than insurance providing for contraception, but  church employees wouldn’t see this benefit because they don’t directly pay for health insurance.  They would likely feel somehow cheated.  What a tangled web we weave.