Abuse of Management Power: Women’s Access to Contraceptives

You might think this is a political post. It is not. This is about management power and women’s health at first. Then, it’s about employee health.

Yesterday, the US Supreme Court decided that a company could withhold contraceptive care from women, based on the company’s owner’s religious beliefs. Hobby Lobby is a privately held corporation.

Women take contraception pills for many reasons. If you have endometriosis, you take them so you can have children in the future. You save your fertility by not bleeding out every month. (There’s more to it than that. That’s the short version.)

If you are subject to ovarian cysts, birth control pills control them, too. If you are subject to the monthly “crazies” and you want to have a little control over your hormones, the pill can do wonders for you.

It’s not about sex. It’s not about pregnancy. It’s about health. It’s about power over your own body.

And, don’t get me started on the myriad reasons for having a D&C. As someone who had a blighted ovum, and had to have a D&C at 13 weeks (yes, 13 weeks), I can tell you that I don’t know anyone who goes in for an abortion who is happy about it.

It was the saddest day of my life.

I had great health care and a supportive spouse. I had grief counseling. I eventually had another child. Because, you see, a blighted ovum is not really a miscarriage. It felt like one to me. But it wasn’t really. Just ask your healthcare provider.

Maybe some women use abortion or the morning-after pill as primary contraception. It’s possible. You don’t have to like other people’s choices. That should be their choice. If you make good contraception free, women don’t have to use abortion or the morning-after pill as a primary contraception choice.

When other people remove a woman’s right to choose how she gets health care for her body, it’s the first step down an evil road. This is not about religious freedom. Yes, it’s couched in those terms now. But this is about management power.

It’s the first step towards management deciding that they can make women a subservient class and what they can do to that subservient class. Right now, that class is women and contraception. What will the next class be?

Will management decide everyone must get genetic counseling before you have a baby? Will they force you to abort a not-perfect baby because they don’t want to pay for the cost of a preemie? Or the cost of a Down Syndrome baby? What about if you have an autistic child?

Men, don’t think you’re immune from this either. What if you indulge in high-risk behavior, such as helicopter skiing? Or, if you gain too much weight? What if you need knee replacements or hip replacements?

What if you have chronic diseases? What happens if you get cancer?

What about when people get old? Will we have euthanasia?

We have health care, including contraception, as the law of the United States. I cannot believe that a non-religious company, i.e, not a church, is being allowed to flaunt that law. This is about management power. This is not about religion.

If they can say, “I don’t wanna” to this, what can they say, “I don’t wanna” to next?

This is the abuse of management power.

This is the first step down a very slippery slope.

About Johanna Rothman

I help managers and leaders do reasonable things that work.
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23 Responses to Abuse of Management Power: Women’s Access to Contraceptives

  1. james ward says:

    I fully agree with you. I do think that people should refuse to patronize Hobby Lobby and should refuse employment with them. However, I do know that there are enough people who agree with their ownership’s stance that it probably wouldn’t hurt them much.

    This was purely a political, rather than legal, decision on the part of the Supremes. I hope that Democrats can capitalize on this in the fall.

  2. Harper Shelby says:

    Actually, the only reason management has this power is because of poor government policy that made employer-provided health insurance attractive to employers and (at the time) employees. The distortion of the insurance market by that change has caused a horde of issues, including the current one.

  3. Hi Harper. Yup. I happen to believe in a single-payer system. I guess that makes me a–gasp–communist :-) The problem is that health care is not a free market. Not at all.

  4. Thanks, James. I am appalled. It’s a bad legal precedent. It says that managers can do what they want, with the Supremes behind them. Grr.

  5. Scott says:

    I appreciate your post and at the same time disagree strongly with it. I feel passionate about this but I don’t want it to sound like a personal attack. I don’t mean it that way.

    1. “If you make good contraception free, women don’t have to use abortion or the morning-after pill as a primary contraception choice.”

    – where is this magic contraceptive fairy? There is no such thing as “free”. Whether you pay out of your pocket or through insurance or your “employer” pays, you will pay. You will pay in the form of higher insurance premiums or in the form of lower salary at your company. You will pay. Somebody will pay. Maybe you want ME to pay so you can have it “free”. Just know – there is no “free”. If the women who get it “free” doesn’t pay for it, who is paying? Who do you want to pay? When companies “pay” more for health care, salaries can’t go up as much when raise time comes around. There is no magic money here. When health care goes up, salaries don’t. This is the #1 reason there is wage stagnation the last number of years. If we want every health plan to cover everything, who should pay? Someone has to pay. Who?

    – Did you know that Hobby Lobby’s health plan already covers the pill and a total of 16 different contraceptive options (out of 20 FDA approved), including male condoms, female condoms, diaphragms w/spermicide, sponges with spermicide, cervical caps w/spermicide, spermicide alone, birth control pills (both “combined” and “mini” pill versions, and std pills extended/continuous use), patches, rings, progestin injections, implantable rods, vasectomies, females sterilization surgeries / implants.

    Yes, Hobby Lobby will pay for all these options if an employee chooses them….. Even with this ruling, they won’t remove it from their health plan. Hobby Lobby is not an extreme company with extreme beliefs. They aren’t trying to control anything. They have sincere religious beliefs and it’s not fair or just that you would force them to put those beliefs aside.

    3. “When other people remove a woman’s right to choose how she gets health care for her body, it’s the first step down an evil road.”

    – who is choosing how a woman gets health care? Hobby Lobby isn’t. They offer most contraceptive options as outlined above. Either pick from the available options and have the health plan pay for them (including the pill), buy them yourself, or find another company that will fund them for you. Hobby Lobby isn’t saying “you must use a cervical cap”………….. No products are being removed from the market. Access is there 100%…….. even from Hobby Lobby for the pill and 80% of the other contraceptive options.

    4. Wait……… I just realized that my company does not pay for my lunches. Instead they give me a paycheck in which to buy lunches. What that clearly means is that I’m going to starve to death. I no longer have access to food………….. and guess what, food costs a lot more in a year than birth control. If I don’t have food, I will eventually die, almost 100% guaranteed………. Can we attack this one next?….. Why is this analogy any different?

    6. “This is the abuse of management power.”

    – the largest, most monopolistic, controlling management in the world is the US government…….. and they have guns to ensure their growth and existence. This case was not about management power. No woman will have any less access to health care after the ruling as before. Nobody is taking anything away from women. You are drinking the Kool-Aid. This was a narrow court ruling about religious liberty in certain situations. It doesn’t even apply to all companies.

    This is about freedom of choice & religion…….. for all Americans. Your desire to have someone else pay for your abortifacients (the 4 drugs Hobby Lobby doesn’t cover) tramples on my rights to freedom of religion if I was a Christian business owner. You win, I lose. However, my desire not to offer 4 of the 20 approved contraceptive drugs does NOT limit your access to them. They are readily available in the market. You can buy them. Hobby Lobby pays a salary to its employees. Birth control pills are cheap. If you are offended at having to spend your own money, you have freedom of choice to find a job at a company that will offer that coverage. You win and I win.

    Last point again – there is no “free”. You WILL pay one way or another. If you want this stuff, I want you to have it, and I want YOU to pay for it. Don’t make me pay for it. As Margaret Thatcher famously said “The problem with Socialists is that they eventually run out of other people’s money”……… I’m not calling you a Socialist, but just reinforcing the point that there is no “free”.

    Insurance companies cover new drugs every year and remove coverage for many drugs every year. Do I run off to the courts every time they remove coverage for other drugs? No………. I suck it up and go buy them myself, or find a company that will cover them.

    ————————–
    On a side note, I have many websites I read for business intelligence and insight. Yours is one of them. When they inject political views into their posts (whether I agree or not), it always taints my view of the site. I feel like there’s no getting away from the political opining. Just a note. Your freedom and your platform and I respect that.

  6. Nathan says:

    I hope you know Hobby Lobby covers 16 of the 20 forms of contraception in question. This ruling was not about denying access to ANY birth control methods. The only question before the court was whether Hobby Lobby would be required to cover the 4 they see as abortifacients.

  7. Scott, thank so much for your thoughtful and thought-provoking answer.

    I was certainly reacting to an early experience I had. In my very first job, on my first day of professional work, I had to fill out a then-illegal health form. They asked me what forms of birth control I used and how many children I planned to have.

    The questions were illegal then and are illegal now.

    At the time, no one paid for any contraception for women. Health care plans paid for Viagra before they paid for any birth control, regardless of why you needed the pills.

    I agree with you on the lunch part :-)

    Thank you for your readership.

  8. Nathan, thank you for your answer.

  9. Scott says:

    Johanna

    I agree with your comment – what happened to you years ago in your first job should not have happened. A company should not intrude on your rights just like the government should not intrude on a business owner’s rights.

    When companies started covering Viagra, many men AND women were happy, not just men (particularly older couples). Personally, I was upset at coverage for Viagra, because as a young person it would only increase my premiums for something I didn’t need. Certainly don’t go the opposite direction and legislate plans have to cover everything. Don’t pile on more in the name of “fairness”……. But the market took care of it. Many companies backed off covering Viagra and others expanded coverage to women’s “similar” drugs. There are mechanisms in place.

    Personally I wish insurance companies were allowed to more effectively tailor a plan to my liking (middle aged families with kids, older married couples no kids, young single people right out of school, etc). Make them compete for my business and let them develop plans to cater to people with different needs. Develop a truly competitive market. That doesn’t exist today. Instead what’s happening is the federal government is mandating a one-size-fits all, which really means a one-size-fits-nobody and the cost is going up and up and up. I have to pay for “your” birth-control and I don’t need it, you have to pay for some older guy’s Viagra and you don’t need it……. and on and on.. It’s insane.

    Here’s something else that would improve the system – reconnect people to the price of the services. My office visit didn’t cost me a $10 co-pay. The visit cost $175…… my company or insurance picked up the rest. That money never had to pass through my hands. Make people pay for the service upfront and get reimbursed (with practical limits for expensive services).

    How many people ask their doctor how much a test will cost? How often do we “shop around”? We should. Does my primary care physician want to send me to a specialist? Give me a list of recommended Dr’s and how their reimbursals compare. Of course our current system cannot do that. They cannot tell you what something of significance will cost up-front. I ask my doctors how much things cost and they look at me cross-eyed. But I make them answer. Somehow we have to better connect people with the price of the service so they will act responsibly. It funny how people’s behavior changes when they think it’s their money.

    Let 50 states be labs of innovation and develop their own health plan offerings. Some will succeed and some will fail. That’s fantastic. We will learn and modify and find MORE success this way. We have one plan for the nation. One structure. With one master-plan, it will almost assuredly fail……….. and when it does, the answer will of course be…….. more federal government involvement and more money. It’s a vicious cycle.

    Lastly, we should stop all this craziness about who wants to take away women’s rights or access to healthcare. It’s just not true. It’s a tactic used to divide people and create angst….. and it works…….. and again….. the solution is always for our good ‘ole government to step in and take more control. It’s a tactic used by government officials on both the left and the right to advance and grow the behemoth that is our federal government.

    I am conservative, but not a whack-job the media wants many to believe. I just truly believe that the bigger the government, the smaller the people. I believe our government should provide a safety net, but it should be for those who CANNOT help themselves, not for those who won’t. I believe in a federal government, but a limited one. Fiscal responsibility. Balance the budget.

    I love the separation of powers concept. Why do people get so upset when Congress can’t pass laws. It is a relief to me. It is the mechanism that ensures the “majority” don’t trample the rights of the minorities. Heaven help us all if it were easy to pass laws. Wow.

    Why do we demonize companies as full of corrupt & greedy managers and yet we assume that the government is full of all these angels. Where are all these virtuous people running government. I don’t see them on the right or the left.

    —————————

    Ok, clearly my commenting is out of control. I appreciate you posting the previous rant and do enjoy your site.

  10. Scott,

    We actually are closer in spirit than you might believe. I happen to have a condition that requires substantial doctor’s visits and monitoring (my vertigo). Every time I have to go into Boston (Mass General or Brigham & Women), I groan. I know the doctor’s visits are more expensive. It’s the same co-pay. It’s the same plan. Why does Partners Healthcare charge more for me to see a doctor in town than to my normal suburban hospital? (So far, I still don’t have a diagnosis. Sigh.) It doesn’t matter if I have the same blood tests or the same MRIs—everything costs more in town. I can’t see those docs anywhere except in town. So shopping around is difficult when you have a strange condition.

    There was a great article in Time Magazine about the out-of-control costs of health care. See Bitter Pill: Why Medical Bills Are Killing Us. It’s subscriber content.

    Don’t worry, I’m back to a management myth tomorrow. All will be normal!

  11. Scott says:

    Johanna

    I feel for you. My wife has vertigo. Not fun at all. She deals with hit through the year, but it hits her bad a few times a year and she can’t move without throwing up.

  12. Bob Wescott says:

    Well said Johanna!

  13. Scott,

    Oh no, that is horrible. I have a bunch of tips on my personal blog. It turned into a little community. See Inside a Vertigo Attack. I have a link to tips that work for me. With vertigo, everyone’s mileage definitely varies. Other people have chimed in with what works for them. I am lucky, and have not had a major attack since I wrote that.

    My best wishes to your wife.

  14. Robert C. Martin says:

    Johanna, The SCOTUS decision tries to resolve a conflict between two laws: The ACA (Obamacare), and RFRA, the 1993 Religious Freedom Restoration Act. If you follow one, you break the other.

    To thread this needle, the SCOTUS decided that the government is allowed to override RFRA iff there is a compelling societal need, and there is no less burdensome remedy. The court agreed with the societal need to cover abortifascient drugs, but felt there were solutions available to the government that were less burdensome than violating the religious freedom of the owners of Hobby Lobby. For example the government could provide tax credits to those employees who need the abortifascient drugs.

    I consider this decision to be both fair and safe. Companies that “don’t wanna” pay for one of the mandated coverages must show that they are tightly held by a group of people who share sincere religious values; that the coverage violates that religion, and that there is a less burdensome solution available to government. It is difficult to see how this leads to euthanasia of the elderly.

    It seems to me that Kurt is on to something. Health care monies paid by employers on behalf of employees should simply be paid directly to the employees so that the employees can choose the health care options that are best for them. The one-size-fits-all strategy of the ACA is bound to cause more and more problems as time goes on.

  15. Bob, I suspect that you and agree more than we disagree. Let’s get employers out of the middle. I don’t want any manager in the middle of my health care decisions. You and I may not agree on choices, but they are ours to make.

    Scott and I are in different places in our lives. Just 10 years ago, I was in his shoes. Now, my kids are grown, and Mark and I are just a few years away from being the only ones who need health care. The kinds of care we need are different from a growing family.

    I wish we could disassociate health care from work. That would allow us to have a more decent conversation. It might change the economics of healthcare also.

    Thank you for your comment.

  16. Scott says:

    Johanna

    Actually, I agree with you. I would like to see health care “divorced” from people’s jobs. The fact that people “lose” their health coverage when they lose the job is not a great situation.

    However, it would be worse to have it in the hands of the federal government. If that’s the alternative, then PLEASE keep it at my workplace. I would much rather have an open market that’s truly competitive…… Let companies tailor plans for different groups of people and compete for my business. You want a plan that caters to your lifestyle, age, family situation…… great – go to a company that caters to that group of people. If I want a plan that caters to middle-aged people with kids that covers well-checks for kids, etc, I go there and pay for what I need. If a senior citizen wants a plan that covers Viagra and doesn’t cover well checks for kids, they pick the plan and I go buy it with their money. My company will pay me more in salary because they don’t have to subsidize my health care and I get to go buy the plan I want.

    Key is that companies compete for my business. Today they don’t. I’m not even the customer. The transaction is between the insurance company and the hospital/doctor/etc. I’m not the customer in today’s system.

    Johanna – I guess you and I agree on many things. Key difference is for me is that strong control by the federal government will make it worse. They have proven that over years / decades / centuries. We are seeing it again with the ACA.

  17. Marie says:

    Johanna, wonderful post and I applaud the rational and respectful comments on this blog.

    My concern is that we are now granting corporations the status of personhood and this goes way beyond campaign contribution and free speech. Hobby Lobby is a corporation, now matter how closely held they are. They have the advantage of not having personal liability as a corporation, but then want “personal beliefs” to override that corporate status in this case. Sorry, but the Constitution never talked about “We the Corporation”.

    In addition, corporations generally have more money than people do. They can wield that powerful incentive to Congressman and others much easier than people can.

    The argument about “you use more than I do” doesn’t hold. Where you drive more than I do, I want to pay less local or highway taxes (and if gasoline taxes actually paid for roads, we’d be driving on diamond-encrusted highways now), or I take advantage of the National Park system but you never go so you don’t want that included in the Federal budget which increases your taxes.

    Being part of a society requires that you give some and you lose some. Imagine the cost of developing and administering individually customize insurance plans (see the tax code and the cost of accountants to figure this stuff out!)

    And lastly, what ever happened to the HIPPA laws where your employer shouldn’t know what you are being treated for or what drugs you are taking in the first place?

  18. Marie says:

    One more comment: The ACA is not the government managing healthcare, it is a law. It guides the requirements of insurance companies/plans. It’s just like every other law.

  19. Marie, the whole situation is a problem.

    If we stopped having healthcare as a “benefit” of working, we would stop having this problem altogether. Corporations would not be seen as people. Scott, Uncle Bob, you, and I could create our own health insurance plans, much as we do car insurance plans.

    What I don’t understand is why we don’t have the same choices in health insurance as we do in car insurance. I have many fewer choices for “good” healthcare. I have many more choices for good car insurance—yes, even in Massachusetts :-) The free market works in car insurance. It does not for health care. There are major conglomerates in healthcare that make it impossible for me to shop around, to see how good doctors are, to see the prices of meds, to see anything. There is no transparency.

    If you and I ran projects the way our healthcare runs, we would be out on our ears. No senior manager would allow us to continue. But, we, as consumers have no choice. All of healthcare runs this way. It makes me nuts. (For those of you who don’t know, Marie is a great project management consultant.)

    Back when I was president of our condo association (many years ago), one of the residents wanted a break on his association fees. Why? Because he didn’t use the elevator. I explained that he lived in the building, and that even though he didn’t use the elevator, the elevator was for the benefit of all of us. No one uses everything evenly.

    This decision was about the access of women to use some forms of birth control that the owners of Hobby Lobby objected to. I don’t mind that they personally objected to things such as IUDs. They don’t have to use them. Their wives or daughters don’t have to use them. They can even disagree with me about whether they abortifacients or not. But to impose their will on their employees because of their religious beliefs? That is the problem I have.

    Even if it’s just four types of birth control, that’s four types too many for me.

    That said, I do appreciate the reasonable discourse of the comments here. I am sure that Scott, UncleBob, and Nathan heartily disagree with me. That is their right. I appreciate their tolerance of my ideas and the fact that they have taken the time to comment.

  20. Scott says:

    Funny. Could this be the only site on the net that doesn’t devolve into irrational rantings, name-calling and attacks?……. is this actually rational debate? Couldn’t be :-) .. that’s not possible.

    A comment on business imposing their beliefs on employees. Honestly, I would take it further. We don’t force companies to pay for our food, housing, transportation. Why is it that if a company decides to offer health care coverage they are forced to offer a specific menu of options the government dictates. Companies should be free to offer whatever they want. If individuals don’t find the coverage complete or compelling, they can work elsewhere or get supplemental coverage in a truly free market (if it existed). Companies will lose their best people if they don’t compete for labor. Nobody is enslaved to work for a company.

    I’ll take it further on another aspect of ACA. The pre-existing condition clause that says people cannot be denied health insurance…………. I have a problem with it. I know. I know. Another heartless conservative that doesn’t care about people. Not true at all. However, the fact that every insurance company now has to accept every applicant, no matter how ill, and those sick people will pay the same premium as all the perfectly healthy people is a problem for me. The moral high ground argument doesn’t change the math. The math says those people get sick more often, run up medical bills higher than the healthy people. Not rocket science, but if they are covered by the same company I’m covered by, and that insurance company is required to take those people and cannot charge higher premiums……….. well, my premium is going up to pay for those sick people. It has to. There’s no other way. We can’t buy insurance after a car accident. We can’t buy life insurance after we die. We can’t buy travel insurance after a travel accident. Why is this different? If you can buy insurance right after you get sick, it’s no longer “insurance”. It’s something completely different. Now, there should be some type of private exchange for people in those situations so they can get coverage………. but they should pay more for it.

    I am overweight. I have term life insurance but it costs me a lot more for the policy than it costs for people who are not overweight. Is that fair? Should the life insurance company have the right to charge me more for life insurance because I’m at higher risk for death? I think it’s perfectly fair, but we don’t let the health insurance companies do that. The simple consequence is that everyone’s premiums go up. The healthy people pay more to subsidize the sick people in the name of fairness because the math won’t work otherwise. That’s ultimately very “unfair”. It’s not fair that people get sick in the first place, but that’s called life. I tell my kids “fair is a place where you ride rides”.

    Last point – I keep seeing comments about Hobby Lobby “forcing their will” on people. I don’t see it that way. They don’t pay my mortgage. Does that mean they are forcing their will on where I live? They don’t buy my food. Does that mean they are forcing a certain diet on me? My insurance doesn’t cover a LOT of health services & drugs. Are they forcing those beliefs on me for those drugs? Heck, most insurance companies force you to use doctors in their network and charge double or more for using doctors outside those networks. Why aren’t we up in arms about them forcing their networks of doctors on us instead of letting us chose our own? Isn’t this also a company “imposing their will” on their employees?

    There are so many choices that are made in every insurance plan on what to cover and what not to cover, what doctors you can visit, how much they are going to charge you, etc. The only reason this particular contraceptive coverage is a national issue is that the federal government decided that religious freedom did not apply to this family business. Nobody was complaining about Hobby Lobby covering 16/20 contraceptive measures until the government said they had to offer all 20 and Hobby Lobby said “no”. Hobby Lobby’s coverage is incredibly generous when you compare it most plans. Hobby Lobby pays an average of over $14 / hour to full-time employees and almost $10 / hour to part-time employees. They are a family-run, Christian-based business that is amazingly generous to their employees. To suggest they are some evil greedy corporation out for control (like the media largely portrays) is disingenuous and wrong. These are good people with sincerely held beliefs. We should honor that just as they honor their employees with more generous pay and benefits than most corporations for similar jobs. The constitution, the law, and now the supreme court says they have a right to uphold and practice those beliefs in their workplace. I am sincerely pleased with the result, because everybody wins, even though many don’t see it that way.

    —————-
    I just did it again. I was just going to write one paragraph. I think I might needs some insurance coverage for diarrhea of the fingers…………

  21. Scott says:

    One last point:

    Some insurance companies don’t cover braces
    Some insurance companies don’t cover breast pumps
    Some insurance companies don’t cover speech therapy
    Some insurance companies don’t cover weight loss surgery
    Some insurance companies don’t cover chiropractic services
    Some insurance companies don’t cover bariatric surgery
    Some insurance companies don’t cover viagra
    Some insurance companies don’t cover dental visits
    Some insurance companies don’t cover hearing aids
    Some insurance companies don’t cover hospice care
    Some insurance companies don’t cover drug addiction
    Some insurance companies don’t cover fertility treatments
    Some insurance companies don’t cover diabetes treatment
    Some insurance companies don’t cover kidney dialysis
    Some insurance companies don’t cover Ambulance services
    Some insurance companies don’t cover physical therapy
    Some insurance companies don’t cover durable medical equipment

    Are all these companies sponsoring these plans “imposing their will” on their employees? Why do people say a company is “imposing their will” by not offering abortifacients but we don’t say it for these other cases? There is only one difference. The “why”. The fact that Hobby Lobby ties their decision to their religious beliefs seems to change the standard of judgement people use. People don’t seem to have a problem with different coverage options by different companies and plans as long as the reason isn’t because of your religion. Why is contraceptive care a special category? It’s not.

  22. Scott,

    I was sleeping last night while you were commenting, trying to get rid of the summer cold I have had for the last month :-)

    There’s “sick” and there’s sick. All pre-existing conditions were treated the same before ACA. For example, cancer and pregnancy were treated the same. If you didn’t know you were pregnant, and changed jobs, and discovered you were pregnant (no, this didn’t happen to me), you could be denied all health care, because it was an existing condition.

    We have the ability to treat many cancer patients and get them to well. Should we do that? At what cost? I think that is your argument. You are worried that the cost of treating these people will increase your premiums.

    If you work in a small company, you have the right to be worried. Small to medium size companies share a much higher cost of the health care burden than large corporations do, because of the risk profile. That’s why they decide whether to cover any or all of the potential services you have outlined above. (Although, I thought physical therapy was always covered. Thank goodness my plans have always included PT. I have been a heavy user of PT!)

    The problem with denying health care for acute, albeit curable conditions, is that it can force people into bankruptcy. Why? Because people without healthcare pay the most expensive rates at doctor offices and hospitals. They pay rack rates. The Time article explains this better than I can. They pay at least three or four times what anyone else does. They use the ER as their primary care physician, which is crazy-expensive, if they don’t have healthcare.

    The problem with the company-in-the-middle, is that you and I want different things. What a surprise! . Of course we don’t want our companies to pay for our food or housing. We get paid a salary to afford that. Some companies who are in the middle of big cities (Boston, New York, Chicago), offer transportation subsidies to make it easy for people to take public transportation. That’s a benefit. Health care is a benefit, a pre-tax benefit. This is part of the problem.

    I think the problem you have is that we collectively pay for health care at work. You alluded to that when you said “my premium is going to pay for those sick people.”

    If we divorced health care premiums from work, it would be a different problem.

    As I said to Marie, we don’t buy car insurance at work, do we? We started to buy health insurance at work many, many years ago. Maybe this is an idea whose time has passed.

    One of the great things about ACA is that you don’t have to stay at a job to keep your healthcare. I stayed at a job many years ago, because I had the health insurance, even though it was a terrible job for me. I left that job and lost five pounds. As I said, you and I are more alike than not.

    Here are things I wonder about:
    1. What if everyone in the US was in the same risk pool? Yes, I mean everyone. Would that change how we eat? Would that change how we exercise? Would that change how we care about each other? Would that change our society?
    2. What if we took health care away from work as a “benefit”, and allowed corporations, at their discretion, to contribute pre-tax dollars to a health care fund, to fun health care premiums?
    3. What if we had actual transparency in health insurance, as we do in car insurance, with insurance companies explaining, “here’s what you get with this set of docs, this hospital, this is what this MRI would cost, etc.”

    I suspect that is what you and both are looking for.

    I don’t want the government making decisions for me, in my health care. I definitely don’t want any manager making decisions. That was the point of my post.

    I do understand that Hobby Lobby management has strongly held beliefs. I respect those beliefs. They are entitled to those beliefs, for themselves. It’s when they impose those beliefs on their employees that I have a problem.

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