Taghealthcare

conservatives and health care

In his influential “The Road to Serfdom,” the economist Friedrich Hayek argued that the state should “assist the individual in providing for those common hazards of life” — among them poor health and unexpected accidents. And in his illuminating analysis of Ronald Reagan’s legacy, “The Working Class Republican: Ronald Reagan and the Return of Blue-Collar Conservatism,the political scientist Henry Olsen uncovered some timely insights. “Any person in the United States,” Reagan said in 1961, “who requires medical attention and cannot provide it for himself should have it provided for him.”

These sentiments conflict with recent iterations of Republican health care reform. The “full repeal” bill is nothing of the sort — it preserves the regulatory structure of Obamacare, but withdraws its supports for the poor. The House version of replacement would transfer many from Medicaid to the private market, but it doesn’t ensure that those transferred can meaningfully purchase care in that market. The Senate bill offers a bit more to the needy, but still leaves many unable to pay for basic services. In the rosiest projections of each version, millions will be unable to pay for basic health care. This wasn’t acceptable to Reagan in 1961, and it shouldn’t be acceptable to his political heirs.

J. D. Vance

Our organizations, and we ourselves, do not all share the same view of the moral acceptability of the contraceptive drugs and services that comprise the contraceptives mandate. We have varied views on the adequacy of the “accommodation” that the administration has promised for religious organizations with deep objections to the contraceptives mandate but that are not eligible for the narrow religious employer exemption. Our organizations are involved in different areas of service. We belong to different faiths.

But we are united in opposition to the creation in federal law of two classes of religious organizations: churches—considered sufficiently focused inwardly to merit an exemption and thus full protection from the mandate; and faith-based service organizations—outwardly oriented and given a lesser degree of protection. It is this two-class system that the administration has embedded in federal law via the February 15, 2012, publication of the final rules providing for an exemption from the mandate for a narrowly defined set of “religious employers” and the related administration publications and statements about a different “accommodation” for non-exempt religious organizations.

And yet both worship-oriented and service-oriented religious organizations are authentically and equally religious organizations. To use Christian terms, we owe God wholehearted and pure worship, to be sure, and yet we know also that “pure religion” is “to look after orphans and widows in their distress” (James 1:27). We deny that it is within the jurisdiction of the federal government to define, in place of religious communities, what constitutes true religion and authentic ministry….

Secretary Sebelius, we believe that there is one adequate remedy: eliminate the two-class scheme of religious organization in the preventive services regulations. Extend to faith-based service organizations the same exemption that the regulations currently limit to churches. This would bring the preventive services regulations into line with the long-standing, respected, and court-tested provisions of Title VII of the 1964 Civil Rights Act [§§702, 703(e)] which provide a specific employment exemption for every kind of religious organization, whether they be defined as “a religious corporation, association, educational institution, or society.”

I had been planning to write something about why I support my employer’s decision to join lawsuits against the HHS contraception mandate, but this excerpt from a letter sent today by the Institutional Religious Freedom Alliance makes the case clearly. My concern is not about the use of contraception, but about the government’s claim of a prerogative to decide what is and is not intrinsic to the free exercise of religion. The government’s position suggests a move to confine freedom of religion to freedom of worship, but all authentic religion is far more than worship: it is also a set of practices in the world, practices which the U.S. Government is constitutionally bound to protect. Moreover, as the letter points out, the two-tier system established by HHS clearly violates Title VII of the Civil Rights Act.

So the mandate is, in my judgment, both illegal and wrong. It threatens to confine religion to a disembodied, Gnostic realm of private worship and thought. Even those who support abortion and contraception should not want to see the government defining religion maximally as private thought and belief. The social costs of that restriction will, in the long run and perhaps even in the short, be catastrophic, because churches and other religious institutions have long been attentive to “the least of these” — the ones that government habitually neglects or even tramples underfoot. Again, contraception is not the key issue here. Contraceptives of all kinds were available in the U.S. before this mandate appeared and they will continue to be; many social service agencies distribute them freely. The key issue is the freedom of religious organizations to define and carry out their own missions in the way that they have throughout most of American history. That is a freedom worth contending for.


P.S. I am anything but a policy wonk, but the one policy issue I have read a good deal about is health care, and especially the plusses and minuses of a universal single-payer health care system. I believe that while all systems are flawed, our current one is shamefully neglectful of those most in need, and a national system resembling the ones used in France and Canada would be far better. Such a system, by taking the responsibility for providing health care out of the hands of employers, would make this current dispute completely unnecessary. But we’re stuck, for the time being, with the current system, and therefore with the current debates.

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