The notion that one's employer should not influence one's health care

Great Debates
1

In the wake of the recent Supreme Court ruling that restored religious freedom to some, though not all, employers in the choice of their health care, we’re hearing a lot of Democrats saying things like this: “No woman should have her health care decisions made by her boss. Period.” As it happens, I agree. I think no adult, man or woman, should have health care decisions made by their boss or by anyone but themselves. (Democrats seem largely silent on the question of whether a man can have his health care decisions made by his boss.)

But, there appears to be disagreement about what this means. The decision in the Hobby Lobby case does not allow any boss to make health care decisions for employees. Employers only offer health insurance plans to employees. No employee is required to take the employer’s health insurance offer. And even if an employee takes the offered health insurance, he or she can still acquire health care services beyond what the insurance covers. In the particular case of birth control, this would be easy since birth control is so cheaply and readily available everywhere in this country. So obviously, when an employer does or doesn’t offer insurance that covers contraception, that doesn’t constitute “making a decision” for any employee.

Some folks, however, don’t seem to get this. First, some in other threads have complained that being offered the opportunity to buy insurance that doesn’t cover contraception constitutions a violation of their right to religious freedom. None have been willing to explain the logic behind this claim, though.

Others seem to think that no employee’s health insurance should ever be influenced by anything their employer does. This is a ridiculous belief. Obviously everyone has the freedom to decide whether or not to take a job. Anyone who dislikes anything that his or her boss does can demonstrate his or her displeasure by quitting the job.

But if I agree to be hired by a particular employer, I’m agreeing to be influenced by that particular employer. Whatever choices that employer makes as far as offering health insurance will influence the choices that are available to me. Whatever salary the employer offers me influences the amount of money I have, which therefore influences everything I do that involves money, including my health insurance choices. Whatever benefits my employer offers as far as vacation time, pensions, and so forth also influences me. The notion that I can be employed by a company and not have them influence my health insurance and everything else is plainly absurd.

Of course, while I can always choose to not take a particular job or to take a job but not choose the health insurance that’s offered with it, I can’t escape the government’s claws nearly as easily. If women shouldn’t have their health care decisions made by bosses, shouldn’t they also not have health care decisions made by Presidents and Congressmen? So if Democrats have all of a sudden discovered a newfound respect for freedom in the area of health insurance, does that mean they’re now going to support repeal of that little piece of health care legislation they passed a few years back?

2

So if your employer makes health insurance part of your compensation, your employer can do whatever he wants because shut up, freedom.

3

If you have that choice, you’re luckier (or more independently wealthy) than most. Most people don’t have a huge choice of jobs (especially the last seven or eight years), and most people won’t reject a job because the health insurance plan only pays 70% of in-network coverage (or whatever the technicality is.) People NEED health insurance, and the employer is the only reasonable way to get (unless you’re independently wealthy.)

The situation over-all is terrible: like it or not, our employers ARE making health care decisions for us, usually in conjunction with the insurance companies. They’re deciding how much of what treatments to cover, what percentage to pay, which doctors you can and can’t use (in- vs out-of-network), and so on.

Why should my health care depend on my employment? So if I get fired or laid off, I lose health care too? That’s absurd.

All other developed countries have a national (or regional/provincial/state) health care. Decisions are made (typically) by boards that represent consumers/patients, health-care-providers, and government/financial side. While no system is perfect, the others are a lot less hypocritical.

4

The way I see it, I take a job in exchange for money. The company doesn’t get to tell me how I spend the money after it’s mine.

If the job also offers me health care, it should be treated the same way as the money. What I spend it on after I get it from my employer is my business, not theirs.

Not following the logic on your customary gratuitous swipe at Obama at the end there. But I suppose that’s par for the course.

5

The Republican view of employment is that they own their employees like cattle. They get to decide when and if you get to breed.

6

Yeah, I’m having trouble seeing why is this is a beneficial for anyone besides the owners of the companies in question. (I’m ignoring the legal issues of the Hobby Lobby decisions and focusing only on its ramifications, since the OP is doing the same.) If I had a serious illness (which I haven’t), I wouldn’t want to have to quit a job in order to find one with an acceptable plan; and if I were hiring people (which I have), I would want to hire the best candidate without worrying about whether they will turn down the job because they might die if they accept it. It’s simply not the case that people have complete job mobility and can happily flock to a better job if they get sick or think they’re going to get sick. (Though I don’t know, aside from smoking, how you’re supposed to predict that, say, you’ll get cancer.) Even if it were, what’s the benefit in arranging the system so that someone with, say, cancer has their economic livelihood and literal livelihood dependent on whether he works at a company with decent health insurance?

But you were referring specificially to birth control, which is not particularly expensive (though it isn’t OTC). Nevertheless, it is an expense, and one that the government ordinally requires companies to cover. You were talking about health care as part of a general compensation package, and it’s certainly not unreasonable to expect that the owners of a company will have input on the financial exigencies of the situation. Why, though, should their religious beliefs matter?

Also, as to why it’s better if that the government handle such situations rather than individual companies: Because I would like to be able to take or offer a job without worrying about whether it will allow me or the person I’m trying to hire to continue to live. Health insurance isn’t in the same class of compensation as vacation days or bonuses. You can go bankrupt or literally die if you don’t have sufficiently good coverage.

7

It benefits you by providing you with health insurance coverage - which also benefits your employer because healthier employees can work more and better - but the value of that benefit becomes more and more dicey if your employer can refuse to cover anything he or she deems objectionable on religious grounds and you’re just expected to pay for that out of your own pocket, which you may or may not be able to do. Or else you can quit your job, which does exactly solve the affordability problem. Maybe you have a strong expectation of getting a new job that will give you the benefit you want in short order, but that also sounds like an uncomfortable position to be in.

8

Well, there’s freedom from and freedom to. You may not have the freedom to remain healthy and have decent health care, but your employer has the freedom from being forced by the government to pay for things it doesn’t want to. And that’s just as good. If you don’t like it, just find a job elsewhere. (And this is a terrific economy for it, as it has been for the last eight years or so!)

Anyway, as to the OP: People don’t like being at the whims of their employers for health insurance, particularly as you don’t know when you start with a company what state your health will be in over the next five or ten or twenty years. Health care is not merely a benefit; it can determine whether you live or die. Maybe if people had perfectly job mobility and we lived in a libertarian paradise where employees and employers were negotiating mutually-beneficial contracts as equals without any government intervention, then it would make sense to have the current system of health insurance tied into employment. Until then, I’d like to have some influence in the process besides just choosing which employer to work for. (And it is usually a binary decision; aside from uppermost, C-level positions, health insurance— unlike vacation, bonuses, base salary, and other benefits---- usually isn’t on the table; the company negotiated with an insurance company, and they have a few packages from which you can choose.)

9

Vermont’s about to experiment with single-payer. I look forward to the results.

10

I’m glad to hear that you disagree with the present system where everyone’s health care decisions are made by insurance company bureaucrats who intrude between the patient and his doctor.

The solution to that problem also solves the problem of employers having to be responsible for basic health care at all.

But I digress. Under present conditions, all I can say is that it’s not appropriate for employers to be intruding their particular ideologies into health care plans. Employer health care plans should cover everything that a doctor deems medically necessary, period, whether contraceptives or abortions or whatever other hot-button topics religious employers want to dredge up. Employers should have the option of choosing policy options like co-pays and maximum payouts that determine their costs. Employers are a business, not a freaking theocracy.

11

What sucks under the current system is that your employer can essentially bait and switch you in a sense, in that you can be hired with one set of health insurance benefits, and they can turn around and unilaterally change that, and you have no recourse.

Your out-of-pocket may change, which doctors you can see may change, what’s covered may change, and there’s not a damn thing you can do, other than cough up for (usually) much more expensive private insurance, or quit and try to find a job with a company offering better insurance, and hope they don’t do the same thing.
My company did exactly what I’m talking about- I think we’re on our 4th plan in 6 years. We went from having no deductible and a co-pay, and free mail-order maintenance prescriptions to having what amounts to a high-deductible plan.

Plus, somewhere in there, we switched carriers, so our provider network changed drastically, and we had to switch a couple of doctors.

They say some silly stuff about Obamacare making it more expensive, and then go on to say some breathtakingly moronic stuff about how this high-deductible health care plan is going to make us more aware of our health because we’ll shoulder a higher part of the cost up front.

Bullshit. I suspect that most of the health care costs where I work are due to children and people with chronic problems unrelated, or only tangentially related to lifestyle. Nobody seems to work here long enough to actually get old enough for serious health problems, but we all have children, and they get sick, busted up, etc…

12

If you don’t like being at the whims of their employers for health insurance don’t buy their health insurance. You can buy a individual plan from any of a number of insurers depending on your state. At one job I had they paid more because there was no health insurance offered. The only difference is you have to pay premiums in after tax dollars whereas you have to pay in pre tax dollars for your company’s plan.
People would die without food and shelter but that does not mean you will die if your company does not provide a free cafeteria and dorms. People are used to having health insurance from work but that is a benefit, not a right. Every company I have ever worked for had a health plan that for me was sub-optimal, but that is the price I paid for having a cheaper plan than I could have bought on my own. There are trade offs in life, if you want a health care plan that includes IUDs and the morning after pill you have to find work at a company that includes them in their healthcare. That may involve tradeoffs, welcome to adulthood.

13

[ETA: Replying to bump]
Behavior like that should be illegal, since health care is essential. It’s no different than laws that govern workplace safety. But such health care coverage laws will never be passed because… Freedom! More precisely, because if health care were properly regarded as a basic human right, the entire system of private insurance would be abolished as a totally unworkable quagmire. The political machinery that prevents that from happening is vast and powerful indeed.

14

Assuming that works for you economically, which it might not, because as you note…

I seem to recall hearing about a law that required health insurance plans to meet some minimum standards, which alleviates this problem somewhat. However that law was a terrible idea for reasons I can’t remember right now.

15

That’s the problem - Obamacare said that everyone had to buy health insurance, and those who don’t want to support abortion must be forced to do so. That’s what Hobby Lobby objected to, and exactly why the pro-abortion side was determined to shove it down their throats.

With a private company you have a choice, even if it is just not to work there. With the government, you don’t.

Regards,
Shodan

16

It doesn’t. But just like Hobby Lobby decided it was opposed to abortion and that certain types of birth control were abortion, ‘they were being forced to support abortion’ now qualifies as a religious belief.

17

You take the job in exchange for money - and possibly other things. Work environment, vacation, sick leave, the company car, gym membership, etc. And one of those things that is subsidized at many places health insurance. While they do not get to tell you how to spend your money, they do exert control over many other aspects that are included in your total compensation package, including what types of items are in that compensation package.

If you exclude the impact of the ACA (mandating minimum coverage characteristics), complaining that an employer plan doesn’t cover an item you want it to cover is like complaining that you only get gym membership at the one across town, or the one without a pool. When you elect to work at a certain place, you accept that these limitations exist and that they are at the discretion of the employer. If you aren’t satisfied you can acquire insurance through other means.

If you want the health care that is provided by the employer to be treated like the rest of your cash compensation, then work for an employer that will compensate you for not taking the benefits. Of course, then it’s taxed, and you are not able to participate in the group discounts available to your employer. I’m sure if you cancel your employer sponsored plan and purchase a plan on your own, your employer will care not one bit what levels of coverage you purchase.

This isn’t correct.

The reason the insurance company is involved is because the consumer (patient) has elected to pay the insurance company to do so. That’s intruding in the same way the waiter at a restaurant is intruding on the cook’s ability to provide you food. If you want to have a relationship with your doctor without the hassle of going through the insurance company, don’t engage the insurance company to do so. Feel free to pay the doctor directly out of pocket.

18

Kind of, yes. If you don’t want employers to care about what healthcare coverage is offered, then don’t require them to offer it. It’s a stupid system having employers provide Health Insurance, and we should be doing everything we can to dismantle it. But if someone suggests eliminating the tax preference given to employers when they DO provide Health insurance, they are treated as if they just pulled the IV drip out of dying kids arm. On top of that, it’s stupid to require insurance to provide something that almost all women of childbearing age are going to need. Insurance is for pooled risk against unforeseen expenditures. Contraception is not in that category. So, it’s a doubly stupid system that we would be better off getting rid of.

But everyone seems to be oversimplifying. Here we have a conflict of statutory requirements (ACA vs RFRA), and the SCOTUS has told us hoe to resolve it. Pretending RFRA doesn’t exist is just silly, and the folks who passed the ACA should have seen this coming.

19

I don’t understand why this isn’t a much larger issue than free and universal contraception coverage (which is actually relatively inexpensive for the most part). Yes, my insurance will cover my annual “wellness” physical at no cost, assuming that I can get my doctor’s office to code it properly. But thanks to my high-deductible plan (which apparently is fine under the ACA), the first $4500 worth of health care comes from me. As it should so happen, I make a pretty good living and so I can afford to pay it but I think that a large percentage of the population couldn’t. Why isn’t there more gnashing of teeth about this? Is it being discussed on other message boards and other media outlets and I’m just missing it? ISTM that contraception is something of a smokescreen.

20

A “choice” of what? I live in Canada, where the evil socialist communist government provides universal health care – it provides it unconditionally, for all, for all procedures that the patient wants and that his or her physician deems medically necessary. That includes elective abortions. Which any woman can elect to NOT have. Or to have. That’s “choice”.

Health care is not about “choice” of freaking different “health plans” with a variety of “options”. It is most certainly not about having profit-incentivized insurance industry bureaucrats intervening in medical decisions to deem whether or not they’re willing to pay for it, or religiously inspired theocrats refusing to fund things they don’t “believe” in. Health care is about getting the health care that you need, when you need it, unconditionally, period. This is not complicated. It’s the basis of a civilized society.