Employment-Based Medical Insurance and Ethical Concerns

A member of the US Congress proposed a law (now defeated) that any employer should have the right to refuse to pay for any kind of health benefit for moral reasons. It was argued, accurately, that this in effect would have given bosses power to decide whether their female employees get contraceptives.

As Orthodox Christians, we should oppose the use of abortifacient contraceptives. That said, it occurs to me that no health coverage paid for by an employer for any procedure, treatment, or medicine, is really being paid with the employer's money. Rather, it is being paid by the employee, since it is a benefit they receive for their employment and work. Isn't this true? Looked at this way, shouldn't this entire controversy have been avoided from the start? It is not the employer who pays, it is the employee who pays. In the same way, when the employer pays part of the employee's wages into Social Security and Medicare, we do not say that the employer is paying that. Rather, the employee is, since he or she earned it by their labor.

What if the law requires that medical insurance include payment for voluntary suicide? Christianity does not permit this. Christians should oppose it, and work for it to be illegal. But if the law allows it, and mandates that employees have medical insurance that covers it, the employers are not responsible for it. And it would not be their money -- it would be the employee's money, i.e. a "benefit" that he or she "earned" by working for the employer.

Some people will elect to do praiseworthy things with their medical insurance -- for example, donate a kidney to save someone's life. Others will do foolish things -- like breast augmentation. Some will want to do what others regard as wrong. For instance, some have a medical need for blood transfusions that the religion of the Jehovah's Witnesses does not permit. On that belief we Orthodox Christians would disagree with the Jehovah's Witnesses. On the other hand, we would agree with the Roman Catholics that abortifacient contraceptives are wrong, while again disagreeing with their view that all contraception is wrong. Also, abortifacient contraceptives are sometimes prescribed as medicine to women with some conditions.

It would be chaotic and senseless if, in all these cases, the employer held the power to decide what procedures, what medical care (or what he may, rightly or wrongly, regard as medical abuse) he would permit to be dispensed to his employee. But in fact there is no reason for him to hold such power, since in each case, it is not his money that pays for the procedure; it is the employee's money that he or she earned on the job. Thus the employer's conscience is not, or ought not to be, troubled by the employee's decision as to how to use (spend) his own benefit that he earned.

In general, medical insurance is praiseworthy, paying for treatments that heal and preserve life. This good should not be lost because some persons, by their choice, decide to do what Christians would consider to be misuse or abuse of the skills of medical practitioners.

Some persons kill their family members to collect insurance. To oppose mandated medical insurance because some would misuse it would be like banning the sale of life insurance, car insurance, fire insurance, or boat insurance because some people misuse these services in order engage in insurance fraud.

It appears that some of those who are opposed to universal medical coverage are using what appear as moral ambiguities to derail such coverage. But there is no ambiguity: employment-based medical insurance is purchased by the employee (or by the employees collectively), being paid for by their labor; it is a benefit of their employment, earned by them on the job. It is not something paid for by the employer.

Americans hold different views about which procedures are permissible and which are not. Among Americans, Orthodox Christians hold the opinions taught by our Church. But regardless of what procedures the law allows, the treatments or procedures are not purchased by the employer, but by those he employs. For this reason, it would make sense to allow the individual employee to opt out of being provided those components of insurance coverage that he or she may deem objectionable. This would, in fact, result in a system not unlike what some conservative voices are calling for: a system in which each employee purchases his own medical insurance.