Lost amid the din of election coverage were reports on two
events with long-term implications for American health care. One
illustrates an emerging problem, the other signals a potential
solution.
The problem concerns freedom of conscience - or the lack
thereof. On Oct. 4, the U.S. Supreme Court let stand a California
state court ruling that compels the state's Catholic Charities to
include coverage for contraception in its employee health-insurance
plan.
Almost simultaneously, the federal government announced that next
year an important new health-care option will be available to
federal workers through the Federal Employee Health Benefit
Program. Included among the 11 national and 200 local plans they
can choose from is one sponsored by the Order of St. Francis that
excludes coverage for medical services deemed incompatible with
Catholic teaching on such issues as abortion, sterilization,
contraception and artificial insemination.
Essentially, the court rulings advance the principle that employers
cannot be "conscientious objectors" to health-plan regulations that
violate an employer's religious or ethical beliefs. By contrast,
the government's decision advances the principle that workers
should be able to choose health coverage that conforms to their
beliefs.
While both decisions will have limited short-term effects, both are
freighted with long-term consequences. The court rulings affect
only one employer in one state, but more such cases can be
expected. Similarly, the OSF plan will be available next year only
to federal workers and retirees in the plan's service area of
Northwest Illinois, but in coming years, other "ethical" health
plans could be offered elsewhere.
Furthermore, while both instances involve Catholic ethics and
reproductive medicine, similar, future cases involving individuals
with different principles and other medical practices are likely.
For example, one can easily envision disputes arising over the
ethics of treatments for the terminally ill or the uses of new
genetic-engineering technologies.
As medical science advances, ethical considerations multiply and
the likelihood of any uniform consensus on ethical norms
diminishes. Was it ethical when Medicare denied reimbursement for
hospice care to patients who live longer than six months? Under
what circumstances is it acceptable to refuse a patient an organ
transplant? Is "family counseling" a "non-medical" service, or is
it a benefit consistent with good mental health and a "pro-family"
ethic? What success rate must an "experimental" treatment achieve
to become "medically appropriate" and covered by insurance?
Questions like these have spurred some in Congress to push for a
"Patient's Bill of Rights." But it's highly unlikely Congress could
legislate an acceptable solution.
The government has embarked on the better solution - consumer
choice in a competitive market - and FEHBP is the perfect
place to start. For more than 40 years, FEHBP has let federal
workers select the coverage that best meets their own needs and
preferences. Competing FEHBP plans already offer different coverage
types (indemnity, HMO, PPO, etc.), with different benefit levels
and premiums. Allowing choice based on different ethical guidelines
also makes sense.
A precedent already exists. Today, investors can choose among
hundreds of "ethical" mutual funds. For example, funds targeting
Catholics or conservative Protestants won't invest in companies
involved with abortion, but pro-life agnostics are also free to buy
shares. Pacifists can buy funds that won't invest in arms
manufacturers. Indeed, funds with opposing ethical views on a
particular issue (such as domestic partner benefits for employees)
will include or exclude a company for the same reason.
Meanwhile, there are also plenty of funds that ignore these issues
entirely and make investment decisions solely on financial
considerations.
Ethical health plans can offer a similar solution to disagreements
over medical ethics. For the vast majority of health services, such
plans likely would differ little from their competitors. But on the
contentious issues, they can offer customers the assurance that
their practices are consistent with a customer's beliefs.
As for employers, if Congress changed the tax-treatment of health
insurance to recognize that employee health benefits are really
part of workers' wages, then the employer's ethical dilemmas
disappear. After all, how workers spend their cash wages isn't an
ethical problem for employers.
Also, by giving any health-care tax relief directly to workers,
government could similarly avoid contention. As with tax deductions
for charitable giving, government could broadly encourage a social
good (buying health insurance), while allowing individuals to chose
the recipients based on their own beliefs.
Let's not allow the problem of "conscientious objector" cases to
fester. The solutions - consumer choice in health care and
ethical health plans - are close at hand.
Edmund F. Haislmaier is a visiting research fellow in the
Center for Health Policy Studies at The Heritage
Foundation.
First appeared on FOX News