US/ Thinking about the HHS mandate and health care

In an article in Monday’s Wall Street Journal, Harvard Law professor (and former U.S. ambassador to the Vatican) Mary Ann Glendon stated: “The main goal of the mandate is not, as HHS claimed, to protect women’s health. It is rather a move to conscript religious organizations into a political agenda, forcing them to facilitate and fund services that violate their beliefs, within their own institutions.”

I’ve been trying to think about the HHS mandate from a broader perspective. If designed well, I would support something like an extension of Medicare (government provided payment, individually selected physicians) to everyone. It’s not perfect – but most people over 65 prefer it to the health insurance they had as employees.  That made me wonder what I would mandate – and what I would not – and how I would decide amongst competing claims.

If not universal coverage, then…
In the absence of that kind of universal plan, the question arises: are there certain situations which every type of medical insurance should cover. There are a few obvious ones – emergency trauma or heart attack/stroke treatment, immunizations to protect public health, cancer and heart disease therapies. Most people would probably agree that treatments should be covered if they directly save lives or prevent disability.

But opinions become mixed as soon as one moves away from the central core. I would be willing to forego coverage for most hair transplant, viagra, and botox treatments, but others could argue their necessity for mental health and well-being. I would promote a wide range of health-promotion services (exercise, smoking-cessation) because of the potential win-win: a healthier person with high well-being and low medical costs. Reasonable people could disagree on either of these.  In these areas, the basis for supporting or opposing coverage clearly rests within the moral and ethical framework of the individual or organization.

Health care legislation options
The Obama health care reform could have taken a very narrow path – trying to make sure that all Americans had insurance to cover those situations in which loss of life or the possibility of disability was apparent. This isn’t as easy as it sounds; the early manifestation of some conditions (an abscessed tooth, for instance) may not seem life-threatening, but are seen as such when someone dies for lack of care.

If coverage is not going to be universal for every condition – a budgetary impossibility – then either a governmental agency will decide on a single list, or individual insurers will be able to put forward plans with different coverage and deductible provisions. The consumer can choose what mix of coverage and payment meshes with their income and their ethics.  Even in this scenario, though, the government would have an interest in making sure that “save life / avoid disability” coverage was included.