Category: Health
Their Religious Freedom v. Your Healthcare
Objections over birth control coverage in employer-provided health insurance are no more than an attempt by employers to intrude upon, control the lives of, and impose their religious beliefs on their employees, outside the course and scope of their job. No one can stop a private employer from posting the 10 commandments in your cubicle, installing Vishnu as your screensaver, or (Christ have mercy) leaving “A Clay Aiken Xmas” on an endless loop on the factory floor. But insinuating their beliefs into an employee’s family planning decisions – medical matters reserved for consultation with one’s doctor – is offensive.
Imagine an employer is a Jehovah’s Witness – and he objects to providing health insurance coverage to his employees for blood transfusions. (Faith prohibits Jehovah’s Witnesses from donating, storing or receiving blood – though I’ve never heard of a Jehovah’s Witness making such an objection as an employer, so this is strictly hypothetical.) Next imagine that Jehovah’s Witnesses sued the US Government so they could exclude transfusions from health insurance coverage mandated of large employers by the ACA.
This is not intended to be a slippery-slope argument – that if we permit employers to deny certain kinds of health insurance coverage to their employees, it would open the door to all manner of 11th century healthcare policies. Rather the illustration is meant to highlight the absurdity of allowing one person’s religious beliefs to impinge on another person’s access to modern medicine. Few would quarrel with Jehovah’s Witness’s choice to die for their religious beliefs – but most would have a problem with their expectation that other people should die for them.
Employers, under the Civil Rights Act, cannot discriminate in hiring on the basis of a job applicant’s religion – nor can they fire an employee for practicing their religion. (Churches are exempted, and can hire and fire based on an employee’s religion alone.) This means, among other things, that an employee is free to donate a fraction of his salary to the Church of Satan, or use it on Friday to enjoy a philly cheesesteak, or purchase a condom from the corner pharmacy – and his employer cant do anything about it.
Health insurance is just another form of compensation. Whether an employee acquires birth control with salary, or with employment-based health-insurance, in either case the employer is providing the compensation, and the employee is making the final decision on how he will use that compensation – to obtain birth control, or not. Distinctions between the two cases are spurious. What an employee does with the compensation he earns is up to him – not his boss.
The company at the center of the controversy – Hobby Lobby, an Oklahoma retailer – claims to be very much concerned about employee compensation being used to obtain birth control. But it has no compunctions about sending money to its Chinese suppliers, from whom it gets the vast majority of its merchandise. China’s abortion rate is TRIPLE that of the US, with more than 13 million abortions per year – and that doesnt include another 10 million morning-after pills sold annually. Abortion in China is effectively REQUIRED by law under the one-child policy. When a woman who’s already had a child becomes pregnant, she may face fines and other sanctions if she does not obtain an abortion.
If abortion were a serious concern, Hobby Lobby could not send money to China, knowing that it’s far more likely to finance abortions there, compared to the same money being sent practically anywhere else on earth. One can only infer that their preoccupation with abortion does not rise to the level where it might cut into their profits. Hobby Lobby is happy to force its employees to make sacrifices for the firm’s religious beliefs – but the firm is unwilling to make sacrifices itself – and happy to turn a blind eye to make a buck.
Religious freedom is a good thing, if only because the alternative is so noxious. But that liberty in a polyglot society is about an individual’s freedom within his or her defined individual sphere – such freedom does NOT include an employer’s right to reach into his employees’ private lives, to impose his religious beliefs on them.
Refs:
http://www.hobbylobby.com/our_company/
http://en.wikipedia.org/wiki/Abortion_in_China#Statistics
http://en.wikipedia.org/wiki/Abortion_in_the_United_States#Number_of_abortions_in_United_States
Originalist Abortion
Conservative justices – Thomas, Scalia, Allito, Roberts (in descending order of extremism) – take issue with abortion rights because they believe, among other things, that they require us to “rewrite” the Constitution to gain a modern reading – that the Constitution’s 18th century drafters and ratifiers; and-or the 14th amendment’s 19th century drafters and ratifiers would not have subscribed to women’s reproductive freedom. These conservatives dont treat the Constitution as a “living document” – but instead would freeze it in time, holding its meaning constant since it became law, which occurred in 1791 for the Bill of Rights, and 1868 for the 14th amendment. Since people in 1791 and-or 1868 would not have regarded abortion as a right, they will argue, then we should not. This style of Constitutional interpretation is called “originalism.”
Clearly, if the Constitution’s protection of privacy evolves with modern sensibilities, then a woman’s dominion over her reproductive organs cannot be seriously questioned – almost every rich, modern country – including the US – has resolved this issue to permit abortion on demand, without significant limits. But a woman should also have the same rights to early-term abortion under a conservative, originalist reading of the Bill of Rights and 14th amendment.
Few people know that when the Constitution and Bill of Rights were ratified in the late 18th century, early-term abortion was legal in EVERY state – and had been legal under the common law for centuries. In fact, abortion was legal in every US state from colonial times up until 1821, when Connecticut passed the US’s very first anti-abortion law.
The roots of legal abortion predate American history. The Christian philosopher St. Augustine (4th century AD) adopted Aristotle’s moral reasoning (4th century BC), sanctioning abortion until the “quickening” – when the fetus is felt to kick, which doesnt happen till after the 1st trimester. Thomas Aquinas (13th century) adopted Aristotle’s belief that the soul entered the male fetus in the 40th day (90th day for females!) – and so also permitted early-term abortion. The Catholic Church followed these prescriptions, and permitted early-term abortion until 1869.
What even fewer people know is that early 19th century anti-abortion laws were adopted NOT to protect fetuses or embryos, but to protect women from a potentially dangerous practice. Such laws did not necessarily address abortion per se, or women, but the drugs that induced abortion, and the druggists who dispensed them. The Connecticut law is a good example – it outlawed “abortifacients” – poisons which were used by women to induce an abortion – and subjected apothecaries to prosecution for distributing them. Like most early 19th century anti-abortion laws, the Connecticut law did NOT subject women to penalty or punishment for abortion. Most of the early laws did not apply to early-term abortions in any case. And despite such laws, abortifacients were widely advertised in major US cities throughout the mid-19th century; during which time abortion remained quite common in America – most frequently practiced by married Protestants, right through the 1860s, when abortion laws first targeted women.
Some of the founding fathers objected to adding a Bill of Rights to the Constitution. One specific fear was that if we had a discrete list of rights, someone could argue that a particular right’s absence from the list was evidence that it was not a right. To cure this problem, the 9th amendment was included in the Bill, expressly stating that “The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people.” it’s primary purpose is to prevent one specific legal argument: you cannot construe the absence of a “right to abortion”, for example, in the text of the Constitution as indicating that the right doesnt exist. (The charm of conservatives is their fondness for seizing on the one Constitutional interpretation that the Constitution itself forbids!)
Even if the 9th amendment evidences the existence of other rights, one cannot argue that everything a person was allowed to do in every state in 1791 (and-or 1868) is a human right. But abortion is special – it’s hard to imagine anything more intimately personal – nor an interest into which the intrusion of the state is more noxious.
Early anti-abortion laws were meant to regulate the practice of medicine, and protect women, not fetuses. Laws aimed at forcing women to take pregnancies to term were quite uncommon before the 1860s. An originalist reading of the Constitution must incorporate the fact that early-term abortion – from colonial times, right through the mid-19th century – was an entirely acceptable part of mainstream American life. A law outlawing the practice entirely would likely have shocked an 18th or 19th century sensibility. For these reasons, abortion should be regarded as a Constitutional right, whether you give the Constitution a modern or an originalist reading.
Refs:
good articles on the history of abortion in the early US:
https://www.prochoice.org/about_abortion/history_abortion.html
http://www.theatlantic.com/past/docs/issues/97may/abortion.htm
other background info:
http://en.wikipedia.org/wiki/Abortifacient
http://en.wikipedia.org/wiki/Incorporation_of_the_Bill_of_Rights
19th – early 20th cent. ads for abortion drugs:
PS Roe v. Wade’s holding is based on the due process clause of the 14th amendment, which has been interpreted to require the states to respect most of the explicit and implicit rights in the bill of rights. In the case of Roe, this is the right to privacy – that states cannot insinuate themselves into such personal decisions made by a woman in consultation with her doctor.
Prior to the 1920s, the states were NOT bound by the bill of rights – in state court, you had no constitutional right against self-incrimination, privacy, counsel, speech, etc. This changed primarily during the 1960s, and today states are bound by most (not all) of the rights specified or implied in the Bill of Rights.
Whence the ACA
Compared to Europeans, Americans are more likely to die at any age, from birth till about age 75. For their trouble, Americans get to pay double the OECD average for healthcare, spending more than $8000 per person, per year. Switzerland and Norway rank 2 and 3 – and the US outspends them both by about 50%.
America’s poor performance on infant mortality means 7,000 American babies die before age 1 simply because they werent born in France – and France doesnt even crack the top 10 for infant mortality.10,000 American babies die because they werent born in Japan. And France and Japan spend less than half what Americans spend on healthcare.
American kids who live to celebrate their 1st birthday still arent out of the woods. They’re over 50% more likely to die before age 5 than children in Estonia, Slovenia, Korea, The Czech Rep. and Cyprus – not to mention nearly every country in western Europe. American pre-schoolers have about the same odds of seeing their 5th birthday as kids in Bosnia and Uruguay.
Greater risk of death follows Americans though their adult lives, with American life expectancy lagging well behind almost every country in the developed world. Considering that life expectancy within a country is roughly predicted by per capita income – and given that American per capita income is among the highest in the world – Americans are dying about 5 years younger than they should be.
Few people on the right understand the size of gap between health in America and elsewhere – and the few who do like to write off poor American health outcomes to lifestyle: that 3 month olds eat too much TV and watch too many fried foods, that it’s those durn immigrants to blame, that Americans are rich, lazy and fat. There is scant evidence behind any of these beliefs.
Americans indeed are more likely to be overweight – however, the latest and best scholarship suggests that people who are slightly overweight (BMI 25-30) are LEAST likely to die. And while Americans are number 1 in caloric consumption, countries right behind on the list (Italy, Austria, Greece, Belgium) all enjoy relatively long lives.
The most comprehensive study of sedentism, published recently in Lancet, show Americans to be fairly active compared to the residents of many other developed countries. Italy and Japan are among the most couch-potatoey nations In the developed world – and among the longest-lived.
Of course, the notion that high US mortality rates are driven by lifestyle is dogged by the fact that American babies have particularly high mortality rates compared to their counterparts elsewhere in the developed-world – before lifestyle has had an effect.
Contrary to popular myth, the US does NOT have an exceptionally large foreign-born population. The other immigrant nations – Australia, Canada, NZ – all have proportionately much larger foreign-born populations; Sweden’s is similar in size – and all four of these countries rank very high in life expectancy. Even within the US, states with the shortest lives and highest infant mortality rates tend to have the fewest immigrants.
Conservatives, as we’ve learned, know the answer to questions before they do any research. Poor American health, they will tell you, is attributable to anything and everything EXCEPT American healthcare, which is simply awesome, no matter the cost or body count. That America has the MOST privately-financed healthcare in the world, and that America has the MOST expensive healthcare in the world, and that America was the WORST health outcomes in the developed world – well that’s just a coincidence, y’all. Move along now.
At long last there’s a comprehensive review addressing the abysmal state of American health, poetically titled “Shorter Lives, Poorer Health: Panel on Understanding Cross-National Health Differences Among High-Income Countries.” The investigators cast a broad net to find out why, among 16 nations, Americans came in 1st in spending, and last in living to tell about it. The healthcare system itself takes a large share of the blame. In America, primary care physicians are scarce. As people change insurers, they’re forced to changed doctors frequently, losing continuity of care. And Americans are more likely to say that they failed to seek follow-up care or fill a prescription because of financial burdens. It all points to the obvious: that poor American health is significantly attributable to poor American health care.
This is the backdrop to the ongoing national struggle of conscience that gave rise to the ACA. The status quo was untenable. Only conservatives could proffer pathetic excuses for dead children, shortened lives and financial ruin, in the name of free enterprise, or some other hazily-defined concept they dont half understand.
And in the 3 years since the ACA was passed, something bizarre happened: per-insured healthcare costs in the US grew at the slowest rate since records started being kept in the 1960s. It’s true that cost-growth had been slowing down for several years, but healthcare costs usually jump after a recession, as pent-up demand surges to be met – but under the ACA, following the Great Recession, it did not happen.
Only time will tell if the ACA delivers on its promise of insurance for (almost) all, and control over costs that have surpassed 17% of US GDP. (In no other developed country are they higher than 12%.) But – even as Congressional Republicans vote to repeal the ACA for the 50th time – there can be no return to the way things were before. Life is too short.
Refs:
why is america so unhealthy – study summary:
Click to access USHealth_Intl_PerspectiveRB.pdf
the full report:
Click to access IOM%20Report.pdf
costs since the ACA:
Click to access healthcostreport_final_noembargo_v2.pdf
http://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_%28PPP%29_per_capita
http://en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate
http://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy
http://en.wikipedia.org/wiki/List_of_countries_by_food_energy_intake
http://en.wikipedia.org/wiki/Health_care_compared#International_comparisons
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