In the furor over requiring employer-sponsored health insurance to cover contraceptives, access to birth control is not the issue, and religious freedom is only part of the picture.
It is of course appalling that the secretary of Health and Human Services is trying to seize the power to override religious authorities — and even to define what is and is not a religious organization, and to determine whether your belief is "sincerely held." If the federal government can force the Roman Catholic Church to submit — and a "compromise" spells submission — then all religious groups with less political clout (probably all of them) are at risk.
And the individual conscience doesn’t count at all.
But there’s more. As a Wall Street Journal editorialist asked, why should anybody have to buy contraceptives for other people? Old women, women who want to have a baby, nuns, small employers struggling to make payroll — why indeed should any of them be forced to help pay for birth control?
One caller to the Sean Hannity radio show revealed a type of thinking that is all too common. She said that she was forced to rely on her employer for health care, and if the health plan didn’t cover contraceptives, whatever would she do? The idea of buying them herself apparently hadn’t occurred to her.
Any drugstore has lots of products available over the counter. There are very inexpensive pills. They may be available at Wal-Mart for $9 per month.
And abstaining from sex when you don’t want to have a baby costs nothing at all.
Already, people are coming to accept the idea that coverage and access are one and the same. If radical reformers have their way, someday they might be. Once coverage is "universal" — both for everybody and everything that the health czar thinks people should be allowed to have — private payment could be outlawed.
It already is in Canada, except for cosmetic surgery and other unnecessary items. For many conditions, both elective and life-threatening, access means access to a long waiting list.
More startling to Americans is that Medicare beneficiaries are also forbidden to pay anything beyond small government-prescribed co-payments to any physicians who accept Medicare payments. If Medicare doesn’t pay enough to cover costs, services become unavailable. Many people haven’t noticed yet because physicians and hospitals have been shifting costs to commercially insured or self-paying patients.
Physicians are also, in increasing numbers, declining to accept new Medicare patients.
The contraceptive issue should awaken people to what the individual mandate in ObamaCare really means. Proponents may say it’s to fix the free-rider problem. They claim that since everyone will probably use medical care at some point, the insurance mandate assures that doctors and hospitals will get paid for providing it. Not exactly.
The insurance mandate means that only one form of payment will be allowed. You can’t satisfy it with high-deductible insurance, a health savings account, a health reimbursement account, a catastrophic illness insurance plan, a line of credit, or an innovative method.
Instead, you have to pre-pay for government-dictated health-related "benefits" (and the added-on profits and/or management fees of the health plan) that may or may not ever pay for the care you and your family need, desire, or use.
Government prioritizes those benefits, and those eligible to receive them. Contraceptives are near the top of the list. Payment for other people’s birth control reduces the amount of money available to pay for your kidney stone treatment, your hip replacement, or your cancer therapy.
Not only has government emptied your bank account by forcing you to pay for a very high-priced plan, but very likely you will not be able to use your own money to pay extra for prompt, state-of-the-art, or non-government-preferred care.
Don’t worry about the Catholic Church imposing its doctrine about birth control on you. It can’t.
Worry about the federal government imposing its control over every aspect of your medical care — and your very life. It might succeed.
Contraceptives are a first step. They won’t be the last.
Jane M. Orient, M.D., executive director of Association of American Physicians and Surgeons, has been in solo practice of general internal medicine since 1981 and is a clinical lecturer in medicine at the University of Arizona College of Medicine. She received her M.D. from Columbia University. She is the author of "Sapira’s Art and Science of Bedside Diagnosis" and "Your Doctor Is Not In: Healthy Skepticism about National Health Care," published by Crown. The AAPS was founded in 1943 to fight against a government takeover of medicine.