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June 30, 2014 3:50 PM The U.S. Welfare State’s Troublesome Intermediaries

By Ed Kilgore

One of the first and best reactions to today’s Hobby Lobby decision is from TNR’s Jonathan Cohn, who reminds us that this whole issue is yet another complication arising from the very American habit of providing significant social services via private sector intermediaries—in this case, employers.

The fundamental problem here is the way the U.S. has decided to provide its new entitlement to health insurance. In many other countries, the government takes on this responsibility directly, by creating its own insurance program or regulating insurers as if they were public utilities. We do the same here in the U.S., for the elderly, through Medicare. But for the non-elderly, we’ve decided that most working-aged people should get coverage through their employers, with the employers retaining lots of latitude over how to do it….
The obvious solution to this dilemma is to take health insurance away from employers altogether. In a very, very limited way, the Obama administration has already done that by arranging for separate contraception coverage, via third party insurers, for churches and other truly religious organizations that object to such coverage. In principle, it could do the same here. And, over the long run, it’s easy enough to imagine a world in which employers were truly out of the health insurance business altogether—a world in which all people got health insurance directly from the government or tightly regulated insurers.

So there’s an obvious compromise available in theory: conservatives could give in on their opposition to “government health insurance” and progressives could give in on making private employers insure kinds of health care they oppose. But there’s an equally obvious problem:

The people and groups who oppose government’s providing insurance directly tend to be the same people who object to the contraception mandate. That’s not a coincidence. While I don’t doubt the religious objections to birth control are sincere, I do think they are masking another belief conservatives bring to this debate: As a general rule, conservatives don’t think government should be compelling them to pay for other people’s medical expenses. Voluntary insurance arrangements are fine, they say. But government shouldn’t be making them pay for other people—or for services they might not like, want, or use.

Take it another step further, truth be told, and an awful lot of conservatives aren’t too friendly to the very idea of risk-spreading—i.e., insurance, whether public or private—because it involves redistribution. So there are layers upon layers of conservative resistance to the contraception coverage mandate that progressive concessions can never entirely break down.

Ed Kilgore is a contributing writer to the Washington Monthly. He is managing editor for The Democratic Strategist and a senior fellow at the Progressive Policy Institute. Find him on Twitter: @ed_kilgore.

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