The Real Lesson from the Health Reform Contraception Battle


The recent battle over Catholic institutions being required to provide contraceptives and abortion services over their objections is illustrative of what is coming as various aspects of the law come into effect.  Nobody is really sure about what the effects will be, and we should not forget that we were told, “We have to pass the bill so that you can find out what is in it.”

The takeaway point from the contraception conflict may not be about religious freedom, constitutional protections, or women’s rights of self-determination over their own bodies.   What the contraceptive fight shows us is this:  with health reform, people will be told one thing, and they are going to get another.  As Rob Halford noted, “You’ve got another thing comin’!”.[1]

To enlist their support for health reform, Catholic leaders were assured that their beliefs on contraception and abortion would be respected.  And then they were ordered to do something quite the opposite.

In order to forcibly reorganize one-sixth of the economy, some tough tactics will be required, and that is exactly what was attempted in this case.  The ultimate success or failure of the reform effort will be influenced by the responses from the various industry segments as they get targeted by the law.

Doctors, healthcare executives, insurers and state governments have some idea what the changes will mean, but most of this experiment will be subject to improvisation as various consequences – intended and otherwise, come to light.

Patients may be less aware of the implications, because only the positive elements have been emphasized; no lifetime insurance limits, no pre-existing condition exclusions, and so forth.  But they will be the last of the stakeholders to realize the likely downsides of reform; less physician-provided care, long waits for appointments, difficulty accessing specialized services, and much higher cost-sharing.

The decision to tackle the health care problem with greater expansion of government-control rather than seeking market-determined solutions will lead to many interesting days ahead.  One positive element of the law is that it runs a number of experiments, and in theory this will lead to a trial-and-error process of coming up with workable solutions for the various problems.

Another positive is that more and more physicians are realizing that in order to best serve patients, they need to take control of their businesses and work on creating real value for consumers, both in quality and cost.  In some way, the great expansion of a non-market derived reorganization of the system may be the spark that leads to the creation of a more transparent,  private system emerging parallel to the current one (as has been seen in countries with national health systems).  This may be the most lasting legacy of the reform law.

[1] The author apologizes to readers unfamiliar with the work of the Judas Priest vocalist.

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