health care reform

Religion and medicine were born together. From Asclepius, the Greek god of medicine, to Jesus to Christian Science to John Wesley to the Baptist Church. Few, I think would disagree that spiritual health is a key determinant in overall well-being. And religious groups have  often provided health care in their mission to serve the helpless. Recently, however, with the passage and upholding of the Affordable Care Act, religious values have clashed with medical reform, with the issue of birth control at the fore.

This past Friday, the Obama administration revealed a new proposal that would exclude religious employers from having to provide insurance plans with contraceptive coverage. The controversy will rage on; but it’s worth taking this moment when the issue is so forcefully in the public mind to explore the interwoven history of medicine, birth control and religion.

Pregnancy was one of the first non-diseases to be hospitalized and medicated. It supported the growth of the hospital and the authority of medicine (giving rise to the idea that “doctor knows best”).  The transfer of the birth to a hospital is thought by some medical historians to have been the beginning of our over-medicated society. That theory makes even more sense now that birth control is officially labeled as preventative medicine and can be covered by insurance. Medical authority in this regard has reached its apex.

But with that authority have come abuses. In the mid-1950s, clinical trials in Puerto Rico were held to test the efficacy of the first birth control pill. Most of the women had no idea they were partaking in a clinical trial or of the horrible side effects. In the 1960s, the women of this tiny island would again be coerced into population control, but this time through sterilization. Puerto Rican officials distributed media to encourage women to get “la operacion.” But ill-informed consent on sterilization happened on America’s mainland too. Around this same time, ten Mexican-American women sued the Los Angeles County General Hospital for giving them unwanted sterilizations. In the 1978 case, Madrigal v. Quilligan, the judge ruled in favor of the hospitals because the doctors “acted in good faith.”

Ironically, though, faith has been at the heart of the American medical system for decades, albeit religious faith. Indeed, beyond birth control, religious groups have been both a spur and a barrier to universal health care. It started at the turn of the twentieth century when hospital administrators usually gave away beds to wealthy friends or socialites. Religious and racial discrimination prompted faith groups such as Catholics and Jews to form their own hospitals, yet they still served the population at large and not solely their own denomination.

But as historian of medicine Paul Starr notes, “the denominations that do build their own schools and hospitals tend to be those that see themselves as deeply at odds with the dominant culture.” Because of this strong “cultural heterogeneity” or culture clash, hospitals in the United States have been harder to control by one entity, such as the government, as most universal health care systems are. In fact, in countries where there is one dominant religion, hospitals are far more likely to be run by the state.

And as the United States moves to a somewhat more state-controlled medical system, the age-old debate over the bounds of contraception still raises barriers to universal care. Even the Ancient Greeks struggled with the question of abortion – Aristotle countenanced abortion within forty days of conception for a male, and eighty for a female (women taking longer to gain a soul), but many Greeks opposed it completely because they conceived of embryos as nothing more or less than tiny people.

No doubt the controversy will persist long into the future. The Obama administration’s proposed amendment currently includes only non-profit faith employers, meaning the religious owner of a private company or the devout executive officer of a corporation will have no such exemption. So expect more exceptions to be made. For many women, birth control will continue to be free, but lower-income women working at religious institutions will be denied that access, meaning that our health care system will fall short once again of being universal.

IMAGE CREDIT. The Rag Blog.