The Supreme Court’s announcement of its final decision of the season was a barn burner: The Court ruled, 5-4, that closely-held corporations cannot be required to pay for health insurance coverage of contraception for their employees. Among the wide-ranging reactions to the decision, the smartest have noted that the culture wars moved to the health insurance front mainly because our system is structured around employer-provided coverage. Take, for example, this WaPo piece, by Paul Waldman:
The fact that most Americans get their health coverage through their employers is something that we all take for granted but has no logical purpose behind it whatsoever. No other industrialized country in the world does it this way, and the system didn’t develop in the United States because it made sense from any standard of efficiency, cost or providing superior benefits to citizens. It was an accident of history […]Why should you have to pay for insurance with post-tax dollars if you work for yourself or for a small company that doesn’t offer insurance, but with pre-tax dollars if you work for a larger company? Why should your employer’s preferences — including, as they do now, their preferences on what kind of birth control you should use — be more important than your own? And why should your insurance have to change if you get a new job?
As the United States becomes more and more culturally pluralistic we will see more disagreement in all areas of society—including over what the federal government deems “essential health benefits.” Here, as elsewhere, promoting decentralized and individualized decision-making can tamp down conflict and respect everyone’s freedom to live according to their principles. An employer-provided system can pit employers and employees against each other; a fully nationalized system can likewise ignite culture wars over taxpayer funding for this or that objectionable health care benefit.Instead, a system in which individuals purchase health insurance within a private, competitive market would allow everyone to choose and fund only those benefits they want—and would bring down costs in the meantime. Instead of fighting each other over contraception coverage, we should spend time thinking how to make a system like that viable.