The missing contraception question
The Washington Post, February 22, 2012
Can we please get one moment of contraceptive clarity Wednesday night in what may be the final big GOP debate of the year? All it will take is a simple line of questioning pressed by moderator John King.
Here's what King should say: "The reason we've had a fight over the so-called contraception mandate is because we're the only wealthy nation in which group health coverage can be obtained only from your employer. If individuals were able to buy group coverage outside the employment setting—without risk of being denied coverage or priced out of the market due to preexisting conditions—this entire blowup would never have happened, because the idea of requiring employers to offer specific kinds of coverage would be irrelevant. To avoid this in the future, and to free American business to focus on competing with China and India rather than on administering a corporate welfare state, do you support moving beyond employer-based health coverage? If so, how specifically would you propose we get there?"
That may be a mouthful, but you have to admit it's a classier opener for King than, "Do you want to comment on what your ex-wife said today about your desire for an open marriage?"
It's important not to let this contraception clash pass without understanding the true source of the problem. It's not President Obama's debauched liberal drive to shower teens with condoms and morning-after pills. It's not the bishops' urge to enforce a moral code from which most of their flock dissents. A sane America would never deny women who work for Catholic employers access to the contraception that every other health plan offers—but it also wouldn't force Catholic employers to offer coverage that violates their beliefs.
Instead, a sane America would solve this whole problem by moving into the 21st century and making sure people can buy group health coverage on their own and not tied to their employers.
There was a time when Republicans knew employer-based health coverage was an outdated relic. In fact, that time was 2008, when John McCain made a transition to individually purchased coverage the centerpiece of his health plan in the campaign.
In the end, McCain's plan was fatally flawed for two reasons. First, he didn't propose insurance market reforms that would enable people with preexisting conditions to be assured coverage as part of a larger pool. And second, McCain didn't offer the subsidies that millions of poor workers would need to help buy such coverage. But the basic idea of moving past employer-provided care was spot on.
Mitt Romney knows this but pretends not to in his impressively soulless quest for religious voters. Wouldn't it have been refreshing if he or another GOP candidate had simply said, "Hey, we could avoid this whole contraception mess if we moved past employer-based health care?" Or if we gave employees of Catholic institutions who want access to contraception publicly funded vouchers they could use to buy policies at the new private insurance exchanges Obama's health reform sets up?
It's a predictable pity, but a pity nonetheless, that the only reason these common-sense fixes can't be mentioned by Republicans is that they would be an admission that Obama's private health insurance exchanges are a step in the right direction—as were Romney's.
The real shame was that Obama didn't steal and improve on McCain's idea and push boldly beyond employer-based care in his own reform. Most people know how crazy the current system is—how it locks people into jobs they'd rather leave for fear of exposing their family to ruin from costly illness; how it hurts entrepreneurship as a result; and how it gives big companies (which can afford ample coverage) an unfair advantage in the war for talent over the newer, smaller firms that drive innovation and job creation.
The long-term hope, assuming the Supreme Court doesn't send us back to square one in June, is that once the new exchanges are up and running, employers and politicians will eventually come to their senses and expand access beyond the tiny group allowed to seek coverage from the exchanges at the start. But that will still defer for a decade or two a result that should have been implemented much sooner. It will also mean taking on both big business and big labor, which perversely conspired to kill any meaningful move past employer-based coverage right now.
Why America's CEOs fought to keep soaring health costs on their payrolls in an era of global competition remains a mystery for the ages. Almost as incomprehensible, perhaps, as Republican logic on health care—which, from Romney to Rick Santorum to Newt Gingrich to Ron Paul, is almost entirely devoid of honest problem solving or coherent principle, save for a principled determination to warp the facts to wound the president.