Over the weekend I got into an argument with a friend who was contending that, in fact, Republicans aren’t against sex, they just don’t want to pay for it. Of course, this is in reference to the latest religious debacle about whether employers should have to provide health insurance coverage for female employees that includes birth control as a measure of preventive care.
My first argument was simply that preventing a pregnancy is much cheaper than paying for one, so the idea that Republicans just want to be tight-fisted with their money is silly, because if employers wanted to buy insurance that paid for pregnancy, but not for birth control, the per-unit cost of that type of insurance would be far more expensive than the alternative.
But then, this is the problem for Republicans in general with government programs. Yes, paying for Social Security, Medicare, education, roads, etc., all have substantial costs, so on the face of it, if we just cut those programs, we save the taxpayers a lot of money. However, and this is what Republicans and conservatives fail to do time and again, what happens if we consider the consequences of cutting those programs? What if we follow through? You’d find senior citizens sleeping on park benches and dying in the streets—no not everyone, but it would happen, because not everyone saves enough money for retirement, and there is NO insurance company that would freely choose to cover the elderly. And, if we stop providing a free, public education, we’d ensure that the poorest, most impoverished kids had no chance to better themselves, just as if we stop paying for roads (as the Republicans are threatening to do with their latest transportation bill), they’d eventually deteriorate to the point where shipping goods around the country became difficult, expensive, and dangerous. So in all of these cases, “an ounce of prevention is worth a pound of cure,” as Benjamin Franklin said, and health care is no different.
Still, another friend asked an interesting philosophical question about what should and should not be covered by health insurance: what if it cost more? In other words, what if it cost more to provide birth control than to pay for a pregnancy? I had to take some time to think about this, but in the end, the answer is that it should still be covered, or at least, that employers ought not be able to simply cherry pick what they are willing and unwilling to cover based on cost, just as they should not be able to dictate what an insurance plan provides based on moral principle.
The first reason is that employing someone is not akin to owning them, which apparently is something that the Republicans are forgetting here. Health insurance coverage is a form of compensation, and in many cases, employees pay heavily from their salaries to have insurance. Oh, and if indeed employers do have the right to decide coverage based on morality, shouldn’t they have to disclose that during interviews? Thus, whether the employer can dictate, morally, what the plan does and does not provide, isn’t so cut and dry.
Second, it would seem, reasonably, that health insurance ought to cover nearly everything that could happen to a person’s health that is non-elective. Sex is a part of life—almost as inescapable as eating—and if you don’t do something to prevent a pregnancy, it is going to happen. Here, Republicans are going to say, “well you can use condoms,” and “sex isn’t necessary for survival—you can choose to have it or not.” Both of these are true, technically, but they’re also disingenuous. People can screw up using condoms, but it’s damned difficult to screw up an IUD. As for whether sex is optional, sure, technically it is, but then so is what you eat and drink. Should employers be able to prevent someone from eating meat because it would be cheaper to cover that person’s insurance? Should employers be able to force people not to smoke, or use that as a reason not to hire them? Not unless we want to start policing every decision people make in their life, and unfortunately, that’s where the Republicans have this conversation headed.
In the end, health care is an incredibly complex and difficult issue, because we are talking, in some cases, about whether people live or die, and at the same time, there is a limited amount of health care that can be provided. This is not a profound conclusion, which is why the idea that health care shouldn’t be rationed is completely absurd—it has to be, just like any other good or service.
All of this is why I’m not a huge fan of the Affordable Care Act (Obamacare): it is too complex to be an elegant solution to our nation’s health care woes. However, being that health care now represents about 17% of our GDP, and that health insurance premiums rose by 8% a year between 2000 and 2009 (and continue to rise), I applaud President Obama and Congress for passing this legislation. Something had to be done, and though it is far from perfect, the ACA is, without a doubt, better than nothing.
The interesting thing is that since more Americans disapprove of the act than approve, Republicans have a huge opening. If they had a more elegant solution to how our country can reign in health care spending, while at the same time expanding coverage, they’d probably get a huge following on the issue. I’d certainly listen. But they don’t have a solution—all they know is that they don’t like Obamacare, and at the end of the day, that doesn’t get us anywhere, and it isn’t going to get traction among the constituents Republicans need to win: independents and conservative Democrats.
Think of it this way: there’s a group of people on a hike in the wilderness. On the way back, they come to a place where the trail splits and they can’t remember how to get back to their camp. They also know that the chances of being rescued are non-existent, because of how far into the wilderness they’ve traveled. In the discussion that follows, two leaders emerge. Leader A pulls out a map and a compass, and says that, given the direction of the camp, they should take the trail heading west, then cut through the forest if necessary, because as long as they head in the correct direction, they’ll eventually get back to their camp. Leader B says that they hate Leader A, and that they really don’t believe that taking the trail heading west is the right thing to do, but they also don’t offer an alternative. The sun begins to set. Which leader do you follow?