Americans are deeply concerned about health care. By nearly all accounts, rising health care costs are contributing to their anxiety about health care financing, while complex and impersonal administrative systems leave many feeling personally disenfranchised when it comes to making key health care decisions. The current system of third-party payment, which governs government- and employment-based insurance arrangements, undermines personal decision-making in health care while increasing the difficulty of individuals and families in coping with employment decisions and the transitions that accompany changes in life. Meanwhile, technological and biomedical advances present troubling ethical implications for millions of individuals and families.

These various problems are interrelated and require systemic solutions. Reforming health care is about more than reducing costs and expanding individual coverage, important as those are. A primary goal of reform should be the achievement of compatibility between individuals' personal values and their health care choices. Healthcare reform should create a real free market in which Americans are free to choose health coverage that is consistent with their ethical, moral, and religious convictions.

Personal Freedom: Conscience and Dollars

Freedom of conscience ought to include the freedom to choose health care coverage that reflects one's ethical or moral values, physicians who respect one's values, and courses of medical treatment that embody those values. But while legislatures and courts debate such controversial issues as the use of embryonic stem cell research and physician-assisted suicide, individuals and families remain almost powerless to spend their own money on health plans that respect their most deeply held beliefs.

Most Americans are on the receiving end of third-party payment decisions and do not directly control the dollars that finance health benefits and medical treatment. If, for example, a person believes in the sanctity of human life from conception to natural death, he may still be required to finance benefits and medical practices he considers morally wrong through health insurance premiums. In fact, many states mandate that insurance companies provide benefits that include controversial treatments, such as in-vitro fertilization, sterilization, and contraception.[1]

Every year, Americans pay hundreds of billions of dollars in premiums to health insurance plans over which they have often little to no personal control. Most Americans today receive healthcare coverage through either private insurance, usually purchased by their employer, or government programs, such as Medicare and Medicaid. In both cases, the person is not the primary decision-maker when it comes to benefits. Instead, insurance executives, managed care networks, employers, and government officials choose the health plans that will be available and what benefits they will include. In fact, most Americans do not have a personal choice of health plans, and the choices they do have are often superficial, with different plans having the same delivery networks. This must change.

The Biomedical Revolution: The Promise and The Peril

As medical researchers explore new biotechnologies in search for path-breaking treatments for ailments and diseases, they are redefining medicine. Tomorrow's doctors will have far greater means at their disposal to improve and extend the quality of human life than doctors do today.

Progress and promises are not without complication and moral dilemma, however. The hot-button issues at the intersection of health, technology, public policy, medical ethics, and individual morality will multiply. Currently, controversial practices such as abortion and emergency contraception divide the American public, even as new ethical challenges are developing. In laboratories across the globe, researchers harvest stem cells from human embryos, and tomorrow human cloning will no longer be the province of science fiction thrillers. With advances in biotechnology, nanotechnology, and genetic engineering, Americans will face challenges that even policymakers have not even begun to imagine. While the general public wrestles with the moral implications of these new developments, they are routinely translated into new medical treatments and procedures-and sooner or later covered as benefits under health insurance policies. While these issues are debated in the public square, individuals and families should be free to make their own decisions and exercise their own conscience in these sensitive matters.

Toward Greater Personal Freedom

Congress can take two important steps to promote greater personal freedom in healthcare:

• Liberalize the tax treatment of health insurance for individuals and families. Hundreds of billions of dollars in federal and state tax breaks for health insurance largely favor employment-based plans. The current bias in the tax treatment of healthcare means that workers who purchase health insurance through their employers enjoy an unlimited tax break for that coverage, while workers who purchase an individual or group plan on the open market have to do so with after-tax dollars. For many middle class families, this inequity in the tax treatment of health insurance makes the purchase of a personal health plan prohibitively expensive. To rectify this unequal treatment in the federal tax code, Congress should, at the very least, provide the same tax breaks to those who choose to purchase health plans from sources other than their employers, such as unions, fraternal organizations, and faith-based associations.
   
• Open access to new health plans through interstate commerce in health insurance. Unlike many goods and services sold in the United States, health insurance is mostly regulated at the state level, and different states' plans are subject to different rules and benefit mandates. Practically speaking, families' health plan choices are often limited to those available in the states in which they reside. Opening the health insurance market to interstate commerce and creating regional or national markets in which families could choose from a wide variety of health plans-including values-driven plans-would increase consumer freedom and empower individuals and families to enroll in health plans that fit their needs and values. Creating a national market for health insurance would also reduce family costs because insurance providers would face broader and more intense competition. Rep. John Shadegg (R-AZ) and Sen. Jim DeMint (R-SC) have introduced legislation, The Health Care Choice Act, to expand family choices and bring down health insurance costs.[2]

Conclusion

Health care reform should give individuals and families the freedom to make values-driven decisions about their care. Personal decisions about health and medical treatment touch the core of our beliefs about life, death, and morality. Individuals are far better equipped than government officials and private employers to make decisions that reflect their consciences. Values-driven healthcare reform would empower individuals to make such decisions, by putting them-rather than government or corporate officials-in control of their health care.

Robert E. Moffit, Ph.D., is Director of the Center for Health Policy Studies, Grace V. Smith is Research Assistant in Domestic Policy Studies, and Jennifer A. Marshall is Director of Domestic Policy Studies, at The Heritage Foundation.