Not at all. But universal coverage does imply some floor of coverage beyond which the individual is free to supplement as little or as much as he pleases by either paying OOP or buying additional coverage. Policies will never be exactly the same as people have different tastes in terms of the various things they want in a health plan (i.e. some will take higher co-pays in order to never have to worry about a doctor being out of network, other’s want the smallest copays possible and if that means only 20% of doctors within an hour can see you they’ll take it). But while we are willing to tolerate diversity of coverage, it has to be within limits. No one wants to discover the really cheap policy they got is, in fact, so cheap because surprise it doesn’t cover chemotherapy!

It doesn’t get rid of every policy having a different deductible, in-and-out-of network provisions, variable lifetime limits, varying rules about precertification and referral, and a whole host of other things that actually create the complication of insurance policies.

Indeed it doesn’t, but then no one really knows what the market will do. I personally suspect insurance is more like a commodity than a highly value added service. Once you get rid of filtering the risk pool (trying to make a policy that appeals to cheap, healthy people and put off people likely to be sick), they do tend to all end up looking very much like each other (kind of like cell phone plans). In a world where policies are very much like each other, with minor variations here and there, an exceptionally cheap policy will have a huge advantage if people assume it is more or less just like all the others. If it’s cheap because of some radical innovation (such as datamining medical data to eliminate unnecessary procedures), that’s great. If its cheap because its a bait and switch, then it’s not.

So most regular insurance in the US covers both child birth and contraception and even abortion. I’m perfectly fine with an exemption made for abortion because of the intensity of the issue. IMO the benefits of additional exemptions start dropping pretty fast after that and the costs mount. So it’s not that I think any great earth shattering collapse will happen if plans didn’t offer coverage for contraception. It’s more along the lines of what merits yet another favor here? And you’re not really giving me a reason to support another favor, esp. for a lobby that seems to have a rather over expanded sense of entitlement for favors already!

What you’re calling for then, is one-size-fits-all mandated policies. Besides being constitutionally reprehensible and a bad idea overall, mandating contraceptive coverage gets us no closer to this in any practical way. It just mandates *one thing* being universal. It doesn’t get rid of every policy having a different deductible, in-and-out-of network provisions, variable lifetime limits, varying rules about precertification and referral, and a whole host of other things that actually create the complication of insurance policies.

Besides, unless you have “100% universal coverage for all conceivable things that someone might want to have covered,” you’re still going to have patients and administrators faced with the necessity of reading, understanding, and complying with the specific provisions of policies. And that is not made any more complicated by the fact that the policy that Widgets, Inc.’s offers is different from the policy that Captain Morgan’s Home for Extremely Frustrated Internet Posters offers. Each person still has to understand their own policy; each benefit administrator has to understand the policy offered.

But there are good reasons to resist the exemption. Health coverage is confusing enough already with its changing deductibles, in and out of network doctors, rules for what needs and doesn’t need precertification etc. It’s good to have a standard policy that covers a set of known things which can then be compared and contrasted in the market in terms of things like price, co-pays, doctors in network and so on.

Most people do not share the Catholic Church’s objection to contraception and see no reason why their health decisions should be dictated by it, anymore than they would appreciate their decisions to have another baby being nettled by a micromanager whose on a kick about the merits of population control, or small families or whatnot.

So the question isn’t why not give an exemption but why give one? Why make everythone else more confused, more burdened by making an already complicated product more ‘Swiss Cheese like’? Well the assertion here was first it’s a right because if you say something is based on your ‘conscience’ you are entitled to a blank check from everyone else. Now that argument has collapsed here we hear it’s because it’s very important to people who take these things seriously. OK but an exception has already been made for the case of abortion because it’s a highly emotional issue that peolple have very strong feelings about. In exchange for that, rather than seeing demands satisfied we see them escalated and by people who seem to have been rather lax about enforcing these supposed demands of conscience in the shopping they’ve done up until now. I’m not seeing a case for making an exemption here. I’m seeing yet another demand for tit for tat trading where one side gets their tat but doesn’t bother to give the other! Show me why this time going along will actually produce anything positive and I’ll reconsider.

So your position on whether something is good policy is formed by your opinion of the sincerity of the people with an interest on one side of it?

That sounds like the politics of a bad marriage, not clear thinking about sound policy.

The parallel is still not as dramatic as you would make it. Consider a slightly different case. Suppose this whole ‘gift cards as pay’ thing took off big time and we have a slew of special stores all with their own convoluted set of products issuing gift cards to employers who did want to steer their employees lives. Let’s just say at some point people get fed up and Congress enacts a law saying that employers have to pay their workers in cash. Now the alarms go off….

What about me! Says the vegan employer who was giving out gift cards good for veggies only.

What about me! Says the prudish employer who gave out gift cards to B&N and Blockbuster because he hates the thought of his workers buying hardcore pornography with the money he used for wages!

What about me! Says the population control freak who was giving out cards redeemable for birth control and sterilization procedures.

All these employers will scream that this new ‘cash law’ will let their workers buy anything they want with the employers own money! What about their consciences? What will you say to these poor souls?

You’ll probably have to say what I said. Knock it off! As far as society should be concerned, your right to be granted accomodation to your conscience ends with the stuff you own. When someone works for you, you cease to own their wages and it becomes their wages. Does that mean we’re telling you what to do with your conscience? Hardly. If you absolutely feel that you are morally responsible not only for what you do with your own money but what other’s do with the money you pay them to do things and provide things for you, then don’t buy things from anyone. Do it all yourself if that’s what you conscience feels is demanded of you. But society is under no obligation to entertain the notion that your ability to act in what you think is a moral manner must be enhanced by bossing anyone else around.

with that in mind, return to your passage:
The parallel is the government insisting that the employer give gift cards to a certain store that carries things that the employer finds objectionable, even if the employer is perfectly willing to give them gift cards to one of the other existing stores that do not carry those items.

Maybe this would be the case if the gov’t was mandating ‘gift cards’ to a store that sold only one type of thing (say an adult bookstore). The B&N example, though, is a better illustration because what an employee would do with the card is mostly up to them…they can spend it very wisely or very stupidly but the responsibility to do so is on them, not you. Health coverage would likewise be quite like that.

Now what about the Christian Scientist employer who thinks that no one should use any professional healthcare? Or even better, the Scientologist who thinks psychology is evil? HMMMMmmmmmmm….

IOW, okay, maybe it’s fine in theory for the government to do this. But why *shouldn’t* they exempt employers who do this? What is so absolutely wonderfully important about all employers providing contraception coverage to their employees …

Well I’ll note a few:

1. Since an exemption is now owed, it should be asked for, not presumed as a right. If its presumed as a right, then you open th door to ‘swiss cheesing’ any real reform by the army of frivious ‘conscience holders’ (the vegans, pop. control freaks, scientologists, ‘HIV doesn’t cause AIDS’ conspiracy theorists, and so on are all eagerly waiting to be enlisted as the next to be entitled to special rights).

2. An exemption was already done, for abortion. And in return we (meaning those who think the bill is worth a shot at serioiusly trying) got a whole bunch of nothing (see the ‘Strict Faith’ thread). Herein is a teacheable moment. If you come to me and say “give me this one thing or I’ll give you nothing, your choice” and I go along with what you want and you spit in my eye….then the next time you say this to me I’ll grin and remind you that ‘nothing’ is very much what you may end up with when you play that game. So how about this, in exchange for the exemption the right will drop efforts to repeal the bill either thru courts or legislation for, say, ten years. Certainly this is a deal they will be happy to make, if the agenda really is just standing up for the right of Catholics and others to follow their conscience! Of course, if the agenda is something else this won’t look like such a good deal.

I know….what if employers paid employees in magical pixie dust that could be construed as a contraceptive on the third Tuesday of months ending in the letter “y”. And then they could all go to Barnes and Noble and enjoy a nice cup of tea with a tasty scone while reading Alice in Wonderland but only if the Secretary of Health and Human Services gave it an official seal of approval and then…..and then….and then….and then…..

Again you have no parallel here. The parallel is the government insisting that the employer give gift cards to a certain store that carries things that the employer finds objectionable, even if the employer is perfectly willing to give them gift cards to one of the other existing stores that do not carry those items.

The employer is not trying to control what portions of a something available to the employees that the employees use; the employer is trying to exercise *their own choice* about what to offer the employees from actual, available options.

“At the end of the day it is sensible and proper for our society to say there’s a ‘morality firewall’ between actually doing something yourself and simply cooporerating with others in a way that might indirectly facilitate someone *else* behaving in a way you disapprove of.”

In theory, that has a limited validity as a principle. However, you’ve yet to explain any compelling reason why this *must* be mandated in this way and why it is unreasonable to ask the government not to impose this on anybody, let alone give exemptions to those who express an objection.

IOW, okay, maybe it’s fine in theory for the government to do this. But why *shouldn’t* they exempt employers who do this? What is so absolutely wonderfully important about all employers providing contraception coverage to their employees that we can’t just say, “You know, we don’t actually HAVE to do this if it is objectionable to a significant segment of society?” Why so insistently defend the rightness of this, and argue so vigorously against those who say, “No, it’s better not to”?

True but so what? Suppose the employer gave employees 10% of their pay in the form of Barnes and Noble gift cards. Certainly there are some books you can’t get at B&N and some you can. So what? The employer can’t claim that employees shouldn’t be allowed to buy certain books at B&N because they ‘violate their conscience’. The gift cards belong to the employees and it’s their business to deal with B&N’s selection.

So now with this in mind what about the employer whose very sensitive to unwed motherhood. If the employer decides what is and isn’t covered, why not just offer coverage that doesn’t include pregnancy for unmarried women (or pregnancy period for the employer whose into population control)? The answer is such an employer can, indeed, provide such a neutered policy.

But just because this is a social goal (motivated by religion or not) of the employer doesn’t mean the employer should get exemption from a health bill meant to provide a standardized package of coverage to everyone simply because they wave their hands and declare that a particular concern happens to be religious in nature. At the end of the day it is sensible and proper for our society to say there’s a ‘morality firewall’ between actually doing something yourself and simply cooporerating with others in a way that might indirectly facilitate someone *else* behaving in a way you disapprove of.

That is a really convuluted mess.

Every employee that uses health insurance that is in some ways provided by an employer cannot simply “use” that insurance as they please. Any health insurance policy or plan comes with a long list of things that are covered and that that are not covered. Elective plastic surgery is not covered under most policies. Neither is corrective surgery like LASIK. The employer and the health insurance provider negotiate the terms of the coverage provided within the governing laws of the geography that is applicable. The employee has to use the policy in keeping with the terms and conditions involved or there is no coverage, period. (And the employee can’t just use “pay” as they please, either – they can’t for example, use that pay to hire an assassin to murder their spouse)

Contraception and abortion aren’t the main issue with this ruling. It is the proper scope and limits of governmental involvement/interference with conscience and free exercise of religion. Do you think for one minute that the editorial board of the Washington Post is really against contraception or abortion on demand? But they rightly recognize that the government needs to tread lightly on this ground (and they likely recognize that a government that doesn’t respect the free exercise of religion clause of the First Amendment isn’t likely to be all that trustworthy regarding the freedom of the press, either).