Let’s say you are a smart high school student who is learning about the American healthcare system for the first time in a civics/social studies class and considers herself unbiased, non-partisan, and open to a variety of perspectives and solutions. You are given an assignment to read this article about how we aren’t getting what we pay for in healthcare – we have the most expensive healthcare system in the world, yet we aren’t any healthier than other developed countries.  You learn about the ACA and all the workarounds that have been implemented in its wake (voluntary Medicaid expansion for states, for example) and finally, today’s Supreme Court decision. That a private corporation that provides health insurance to its workers is exempt from having to provide coverage for birth control – a basic preventive form of health care that allows women to decide when/if to start families, even though birth control is included in the required forms of mandatory minimum coverage.

Would you look at this law and think:

A: “Wow, glad that’s settled. No one will ever challenge the ACA again and this is a great example of religious freedom in America.

B: “This system just allowed a small group of people exemption from the law because these people held an opinion that other people that they have power over (ie., their employees) shouldn’t do something (in this case, take a medication) that they disagreed with.”

It doesn’t take too much imagination to think that this is just one of the many future battles to be waged on the ACA. Because special interests (ie., certain employers) are still intimately involved in seeing that a good deal of the public has access to healthcare thanks to the ACA, the implication is that our system is going to get more and more complicated, exemptions for special groups will continue to be made, and as a result, the public will NOT have the expanded access to affordable, comprehensive healthcare the ACA was (supposedly) designed to promote.

If I were that high school student, I would say – scrap the whole thing and start over.

I would want a system that provided certain mandatory minimum coverages to ALL people, regardless of their bosses’ religious and political inclinations. I would want a system that didn’t jeopardize my ability to plan a family because of my employers’ convictions.

When we have these arguments about whether certain groups should be exempt from certain parts of the law, we are getting mired down in details and missing the bigger picture – that we have “designed” a bizarre and perverse system that has now incentivized employers to take such interest in our sex lives that the SUPREME COURT has to get involved.

A solution – get rid of employer-sponsored health insurance and extend Medicare (with mandatory minimum coverage requirements!) to everyone.


Good article about some more philosophical considerations…