Thus far, the fight over whether insurance plans must offer free birth control has been presented (and presented itself) as a two-sided struggle. On one side -- people who want to encourage preventive health care by making it free and consider birth control a form of preventive health care. On the other side, people who consider it vitally important not to compel people to do anything that goes against their religion. Both sides have presented their parade of horribles that will happen if the other side prevails. My side believes that the religious freedom argument is largely a smoke screen for people who don't want any form of contraception made available to unmarried women, who would like very much to require women to present a marriage certificate before being allowed to buy it. And the other sides believes (no doubt sincerely) that this is part of an overall government war on religion.
But following comment threads (and sometimes Republican candidates), I reach the conclusion that there is a third side here as well. This is the libertarian side that regards all economic regulation and all requirements for any insurer to cover anything at all as acts of illegitimate tyranny. In this latest uproar, they have seen an opening to attack one particular mandate, but their ultimate goal is to sweep aside all economic regulations of any kind.
I base this on comments on the threads and the fall-back position of Republican candidates. Commenters on the threads are eager to see employers (and universities) given maximum "choice" in the benefits they offer. The possibility that their choices might have a harmful impact on employees (or students) is dismissed out of hand. If you don't like it, get another job (or go to another school). It is quite clear that these people don't see employees, as workers, as having any sort of moral claim. So long as you are free to quit, your employer, by definition, cannot wrong you, because if it was really bad enough, you were always free to find another job. The same rationale has been offered as to why there is no need to require insurance companies to cover any particular condition, or really to do anything at all. If you don't like it, get another insurance company.
Republican candidates, when called out, have said much the same thing. In response to the argument that Obama's new compromise does not require the employer to cover birth control, but lets the insurance company and the woman work that out, they reply that they want to protect the economic freedom of the insurance company. Rick Santorum, after his famous statement that insurance companies should not be required to cover prenatal testing because it would lead to more abortions, backtracked. Yes, he said, he favored prenatal testing, he just didn't want the economic freedom of insurance companies to be infringed.
The same argument gets implicitly made when Republicans are asked why they formerly supported the mandate and subsidy system that is, after all, the basis of Obamacare. Apart from some sneers about 2700 page bills, the usual answer is that Obamacare is a complete government takeover of healthcare, and they did not favor a complete government takeover of healthcare. No one ever seems to ask in what what Obamacare is a complete government takeover. So far as I can tell, the big difference between this mandate and subsidy and what the Republicans formerly proposed is that the current plan requires all insurance companies to offer a standard benefits package, and a fairly substantial one. Republicans generally favored a mandate and subsidy of a bare bones coverage, with the option to buy more out of one's own pocketbook. The argument does not strike me as all that convincing. After all, once you agree to the mandate and subsidy format, the exact contents of the mandate should be negotiable. But then again, I am not one of those people who thinks that any and all economic regulations are acts of tyranny.
What is interesting, though, is that, although Republicans sometimes use the libertarian argument as a fallback, they have generally avoided it. It is not hard to see why. The argument that employers should be free to deny employees coverage for anything they want no doubt has considerable appeal among Evangelical small business owners and aspiring small business owners, who make up a substantial portion of the Republican base. But its appeal is apt to be more limited among the broader public. And the argument that insurance companies should be free to deny coverage any time they want is unlikely to have much appeal outside the Cato Institute.
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