Health care and culture wars

Creation of a public plan for health care has the potential to open a new front in the culture wars, by forcing the nation to decide whether coverage should include controversial procedures like abortion.

The potential for conflict does not necessarily mean that we should avoid the public plan; sometimes struggle is inevitable when deeply-held values clash. However, our eyes should be wide open as we decide, because a public plan may unnecessarily intensify all sorts of battles over medical ethics, also including fertility treatments, sex-change, euthanasia, and definition of family coverage.

On the other hand, a cooperative plan is less likely to become embroiled in a long-term stalemate mirroring the larger struggle. There are already a variety of faith-based health care cooperatives available, and these could diminish the need to fight over what is included in health care reform. Those who want nothing to do with practices they see as immoral can join other cooperatives that do meet their needs and their values.

Already, five states restrict coverage of abortion and twelve forbid it in policies available to public employees.  Abortion in the health care debate has already been on the GOP’s radar for more than a month, and even before the election, was warning readers that President Obama is planning to include abortion coverage in his reform plans. As government becomes more involved in health care, it seems likely that these controversies will intensify, and may even undermine the success of a public plan.

 Fights over whether to provide controversial coverage will weaken and distract progressives, who will also need to fight off perpetual attacks by medical industry lobbyists. And conservative activists who seek to stop abortion for religious reasons will be sucked further into the trap of using unbiblical tactics to further their aims.

The latter claim demands a bit of explanation.

Christian arguments for banning abortion access often rely on biblical arguments. The problem is that the Bible doesn’t support imposing morality on believers, and doesn’t even raise the issue of using government to legislate against non-believers. As I have noted in my book and in the relevant section of this paper, Jesus taught that conflict is to be solved through mediation within the church, with expulsion the worst possible punishment. (Matt 18:15-20)  The only passage about government and morality is a warning not to take other believers to court. (1 Cor 6:5-7) People may certainly oppose abortion on biblical grounds, but they can’t claim that it is biblical to use the law as their tool to do so.

On the other hand, a case can easily be made that people should (ideally) not have to pay for that which they find immoral. This reasonable concern was expressed in the article cited above: “Obama would fund abortions with federal taxpayer dollars and make people in private insurance plans pay for abortions because insurance companies would pass on the additional costs to customers.”

A co-op plan could sidestep this controversy by creating an insurer that is democratically run and accountable to anyone who voluntarily joins, without relying on continued involuntary support from taxpayers. This would probably not satisfy those who will not rest until abortion is wiped off the face of the earth, but pro-life moderates may be willing to accept this compromise.

But what would stop anti-abortion co-op members from organizing to stop the co-op from providing abortion coverage? Couldn’t they simply use the cooperative’s democratic process in the same way that they would use governnment processes? They absolutely could, but it is unlikely they would duplicate the stalemate of the public sector. Here’s why:

There are already options for people who want health coverage based on biblical principles. These are not technically insurance, but they have still provided a way for people to share each others’ burdens based on their religious values. The three largest are Christian Healthcare Ministries, Medi-Share, and Samaritan Ministries, which have collectively covered close to a billion dollars in medical expenses of thousands of members over about 15 years. These might form the foundation for a whole separate cooperative system of faith-based insurance.

The further development of  faith-based counterparts to a co-op plan would provide an alternative through which people with strong moral views can get coverage. Hopefully the dialogue on the government-supported cooperative will prompt faith communities to take another look at how they could use cooperatives to take care of each other without reliance on government. Cooperatives won’t magically solve the abortion issue, but they might reduce its intensity in this field.

The potential co-op advantage comes with a big caveat: There could be some sort of policy requirement inserted by Congress, and the co-op may be forbidden or forced to provide controversial services. That would be deeply unfortunate, as it would diminish the value of having an independent and democratic insurer. A national health care co-op would be started with government support, so there is still likely to be controversy over its policies. However, once the co-op leaves the start-up phase, its members should have the freedom to set their own policies.

A co-op scenario is not perfect, and not without obstacles. But assuming that it is feasible, it seems to be the best way for people to work with those who share their values, rather than struggle against those who don’t.

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