Update- Women's Preventive Health -Starting At The Wrong End

The health care system in this country is a reflection of our culture. The profit-motive is there, the amazing advances in medical science and technology is there, bloated costs are certainly there, inefficiency is there, and what the system decides to pay for and not pay for is decided by trying to weigh the costs and benefits of the marketplace with the needs of the society in general. It’s no wonder the system is so messed up. The pieces aren’t aligned.

The Obama Administration changed its tune on dealing with the preventive women’s health issue that was created by the Affordable Care Act; (specifically, requiring contraception services be provided at no cost to the individual). The original position and employer mandate was ludicrous (even to those not involved with politics) as the perception of infringing upon religious rights looked very real. The Administration should have known better on this one.

From a pure public health standpoint, the logic of the original mandate made some sense. Religious institutions provide a significant portion of health care in this country. Catholic hospitals make up twenty-percent of all hospital beds and in many geographic areas are the only hospitals around. To address the desire to reduce abortions and unwanted pregnancy, the Administration felt these institutions had to be included in the original mandate- women’s health is a large cost item in health care and whatever final rules were developed needed to include all major players.

The decision created an outcry and the Administration had no choice but to change their approach.

Now, instead of requiring employers to provide these services- the Administration shifted the responsibility to the health insurers. Nobody really knows how this is supposed to work but the “religious freedoms” argument for employers was theoretically resolved.

Instead, the new decision creates another administrative layer to add to an already confusing and complicated health care structure. And, don’t think anything is “free.” Somebody is going to be paying for it somewhere.

Our health care costs reflect our society. In many respects, the costs are a scorecard on how we live. A significant portion of our costs reflect our lifestyles and using contraception could be considered a lifestyle if you really want to get into it. Don’t get me wrong, reducing unwanted pregnancies and abortions is important. However, a large part of today’s unwanted pregnancies and abortions reflect lifestyle more than anything else. That's what really needs to change. Providing access to necessary health care services is one thing. Providing free access to health care services that encourage irresponsible lifestyles is another.

We need accountability in our health care system today- not encouragement to just continue what we’re doing because it’s free. Some may argue the Administration's decision was a "step in the right direction." Unfortunately, this was only a baby step if a step at all. As usual, we’re starting from the wrong end.

"Women's Preventive Health" We've Gone Too Far

Even though I didn’t agree with the overall concept from the beginning, I’ve tried to be a supporter of the Affordable Care Act. Since its passage in March, 2010 I’ve been a passive supporter- but an avid advocate for overall change in our health care relationships. I never did understand why the primary focus of the Affordable Care Act was to first get everyone insured (see previous blogs going back to 2009). I understand the theory of it- but getting more people into a broken system without focusing on what was broken made no sense. We should have learned a lesson from Massachusetts. However, the Affordable Care Act was the law we enacted, I was ready to get on-board to help make it work.

In the beginning, I respected Obama for using so much of his political capital to finally address a crisis that is coming (and is still coming) in health care. He’s certainly paying for it now.

I followed all of the legal challenges, watched as stakeholders grumbled, tolerated the huge government bureaucracy being created, and listened to the political rhetoric both for and against the legislation. All the while, I tried to continue to see the positives associated with what we had to do to address the crisis at hand.

And then the rules for “women’s preventive health” were released. Here again, I tried to look at the "bigger picture." I certainly understood the need for prevention and the use of our health care system to address broader social issues. I agree with the focus of the Affordable Care Act to address prevention as opposed to sickness.

But the legislation crossed the line for me with these new rules as it now infringes upon the fundamental religious beliefs and practices of others.

The idea of providing contraceptive resources to prevent unplanned or unwanted pregnancy certainly makes sense given the world we live in today. This is a huge cost to our society in many areas. However, to require religious organizations to now compromise their beliefs to comply with a government-mandated law is simply not who we are as a country.

The intent of the Affordable Care Act is to fix a major economic problem our country is facing. I had hoped, despite all of the complaints and criticisms, the Act could provide the framework from which to work. I tolerated all of the government rules and regulations as a necessary evil to incent stakeholders to finally begin work in different ways. I supported the cause because I know that change is necessary.

However, when the Act now is requiring individual citizens to compromise their religious beliefs for rules established by the government, it’s time for me to get off the bandwagon. The government has simply gone too far. I hope our legislative process is able to correct what I believe is a fundamental infringement on our personal rights. Until it does, the Affordable Care Act has one less supporter than it did before- and from the sounds of it, it can't afford to lose many more.