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Birth-control flap shows the need to abort employer-based healthcare

February 14, 2012|David Lazarus

It wasn't a retreat. Nor was it a compromise. It was an "accommodation."

That's how the White House spun President Obama's attempt last week to tamp down the political brush fire that had erupted over requiring all health insurance plans — including those offered by Roman Catholic universities and hospitals — to include free birth control for women.

Even though birth control is perfectly legal, and this is therefore a decision that is a woman's alone to make, religious leaders and their Republican friends professed bewilderment that Obama would launch an assault on freedom of faith.

As House Speaker John Boehner (R-Ohio) put it, the contraception requirement "constitutes an unambiguous attack on religious freedom in our country."

Actually, what it did was highlight, yet again, the pitfalls of tying health insurance to one's job.

Our employer-based healthcare system — a historical anomaly — is more trouble than it's worth. Yes, it provides coverage for about 55% of the population, according to the Census Bureau, and polls show that most of those with employer-provided insurance are happy with their plans.

But the number of people with employer-based coverage is steadily shrinking. In 2000, 64% of Americans were insured through their jobs.

Meanwhile, the number of people in this country without health insurance keeps rising. At last count, about 50 million people had no coverage.

Fifty million. That's more than twice the combined populations of New York, Los Angeles, Chicago, Houston, Philadelphia, Phoenix, San Antonio, San Diego and Dallas.

"The employer-based healthcare system is the reason we don't have universal coverage in this country," said Paul Ginsburg, president of the Center for Studying Health System Change, a nonpartisan Washington think tank. "It does a halfway decent job of insuring people. But with 50 million uninsured, it obviously doesn't do a complete job."

And it probably never will. Even with the changes envisioned by Obama's healthcare reform law — assuming they pass judicial muster — as many as 20 million people will still lack coverage.

Moreover, the employer-based system will keep adding unnecessary complications to medical care. For example, healthcare will remain a contentious issue between labor and management every time a contract comes up for renegotiation.

This latest kerfuffle over contraception illustrates the point.

Catholic authorities were outraged that their hospitals and universities would have to include birth control for women as part of employer-provided health plans. This was a slap in the face of their religious beliefs, they said.

Mind you, that's beside the fact that 98% of Catholic women have used contraceptives, according to a report last year from the Guttmacher Institute, and nearly two-thirds of Catholic women support requiring employer-based health plans to include contraceptives, according to a poll this month by Fox News.

As soon as Republican pols piled on (Newt Gingrich called this "the most outrageous assault on religious freedom in American history"), it became clear that Obama needed to throw some cold water on the situation. So he announced Friday that he was tweaking the requirement as "a citizen and a Christian."

Now it won't be up to Catholic employers to include birth control in their health plans. Instead, insurers will have to provide contraceptives on their own, at no additional cost.

If we didn't have an employer-based healthcare system — if, for example, this country extended Medicare coverage to everyone — the question of birth control wouldn't be an issue. Catholic institutions could remain aloof over the matter and their female workers could decide on their own whether to use contraceptives.

Meanwhile, the shameful (and costly) problem of having tens of millions of people uninsured would vanish. Universal coverage would be the norm, just as it is in all other developed nations.

Ginsburg at the Center for Studying Health System Change said he was once an unabashed believer in a Medicare-for-all system. But even though such systems work in Europe, Canada and Asia, he said he now believes it's just not feasible in the United States.

"I don't think our government could pull it off because of all the special-interest lobbying and political polarization," Ginsburg said.

He added: "The success of a government-run healthcare system depends on the capabilities of the government. Our government doesn't have those capabilities."

Maybe he's right. But I'm an optimist. I have to think that sooner or later, the political and economic powers that be will acknowledge that our current healthcare system is unsustainable and unaffordable, not to mention utterly inequitable.

When that happens, they'll cast about for alternatives and we'll begin a slow and cautious transition to something like what the rest of the world has. Not that we have to mimic other nations' systems. Rather, we can learn from their successes and mistakes, and fashion an American approach that addresses American needs.

Until then, I'll just have to keep the faith.

David Lazarus' column runs Tuesdays and Fridays. He also can be seen daily on KTLA-TV Channel 5. Send your tips or feedback to david.lazarus@latimes.com.

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