Did you know that the Federal Employees Health Benefits (FEHB) didn’t cover contraception until 1998—decades after most Americans had accepted “the Pill”? FEHB did cover other prescription drugs and devices, but not birth control. Congress just didn’t approve.
The government does not provide insurance to federal employees directly. It contracts with hundreds of private sector insurers to provide a menu of policies—some good, some not so good.. But Congress does lay done some rules. As Naomi notes in her post below the plans cannot pay for abortions—even though many other private sector plans do provide coverage.
This is one reason why I like the idea of a hybrid health care system, private sector alternatives competing with Medicare E (for everyone).
We have no way of knowing who will be the majority leaders in Congress ten years from now—or who will be in the White House. It’s not a stretch to assume that if legislators are willing to ban abortion for federal employees they might refuse to cover it in a single-payer health plan that covered the entire nation..
In the first budget that he sent to Congress President George W. Bush even tried to remove contraception from a list of products covered by FEHB. If Jed Bush became president would he nix covering contraception under a single payer insurance plan? (Remember Governor Bush’s role in the Karen Schiavo case) Or maybe he would only ban contraception for women who aren’t married. I don’t want to find out.
Of course, even if we had single-payer national health insurance, it’s likely that private sector insurers would sell “supplemental policies” –covering extras that aren’t included in the government plan. Perhaps private insurers would offer abortion insurance– for those who could afford a supplemental policy—assuming that those insurance companies weren’t too squeamish about bomb threats. If Congress refused to include abortion in a national plan, I have to think that anyone trying to sell what would quickly be labeled “abortion insurance” would become a special target.
As regular readers know, I firmly believe that President Obama’s hybrid plan for universal coverage should include a government plan that is modeled on a new, improved and reformed version of Medicare. And I am quite sure that this Congress will include contraception in any government plan. . (I doubt President Obama would sign the plan if they didn’t. But I wonder—will government health insurance cover abortion?)
As Naomi points out: “Abortion opponents and the religious right are worried that Obama’s campaign call for coverage of ‘comprehensive reproductive services’ will mean that abortion—along with contraception and non-abstinence based sex education—will be part of the plan.”
We’ll see what happens. But I do think single-payer advocates should consider the fact that in a democracy, we really don’t know who will be running our government down the road. Sometimes American voters make excellent decisions. Sometimes they don’t.
Finally, even if legislators never try to impose their moral values on national health insurance, a fiscally conservative Congress might decide to take an axe to health care spending—slashing without thinking. Think of what Margaret Thatcher did to the UK’s National Health Service. It’s still recovering. . This is one reason why I would like to have private sector alternatives (preferably non-profit insurers) to a government plan—just in case we run into another bout of “bad government.”