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Birth Control, Religion and Medicine

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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.

 

Obamacare – Exchanges, Optimism and Irony

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The New Year brings us optimism, good spirits and hope that America will be one step closer to equality in health care. Over the holidays, states and the Department of Health and Human Services were hard at work developing the health insurance exchanges, or in other words, an easier way for certain individuals and small business owners to purchase health insurance.

The exchanges must be ready by October 2013 for enrollment and be fully operational by January 2014. Yes, that’s optimism at its finest. In mid-December 2012 states had to decide if they were going to run the exchanges themselves or use the government plan. Though, until February 15, 2013 states can still opt for a federal partnership. So far, 19 states decided to operate the exchange themselves, seven decided to receive some help from the government and 25 have defaulted to a federal exchange.

Basically, exchanges are going to be organizations (either a government agency or a non-profit) that will help make finding health insurance simple and straightforward and will keep prices competitive among plans. Massachusetts already has had a great functioning exchange since 2007 called Health Connector. Utah also has had a functioning exchange since 2009 for small businesses but will need to expand to individuals.

All exchanges, state-run or not, will need to meet minimum standards set by the Affordable Care Act which includes hiring ‘navigators’ for assistance, client education, basic health benefits, maintaining a website, and rating health insurance plans. All exchanges must offer two plans and one must be from a non-profit. Ideally, if you are looking for insurance you’ll be able to go onto a website, browse plans, have all your questions answered either online or by phone and be enrolled with an affordable plan that fancies you within 30 minutes. Good thing it’s January so we’re all feeling extra optimistic! By 2014 people who don’t have employer health insurance (those with lower incomes will receive subsidies) and small business with up to 100 employees will be able to find health insurance plans through an exchange.  By 2017, states can decide if they want to offer exchanges to larger employers.

Originally, the intent was for exchanges to all be state-run since state legislatures probably know what works best for them as far as setting eligibility, plans and funding. It was expected that only states with small populations would default to a federal exchange, but the two most populous states with 20 percent of the nation’s uninsured, Texas and Florida, have opted for the default.

Most states that chose to have a federal Exchange did so early in advance claiming that the exchanges would be too expensive or to try to sabotage Obamacare since they don’t agree with the law. All but four states received grants to help offset costs which mainly went to hiring IT work. The states with partnership exchanges will be able to manage plans and customer service and the hope here is that the Department of Health and Human Services will try to work with states as much as possible to individualize the exchanges so that all states will have the opportunity to move to a state-based model in the future.

The irony here is that the Republican states that chose a federal exchange are going against their fundamental Republican ideals. They complain that Obamacare is big government but they certainly don’t seem to have a problem making government’s role bigger in this case. I’m staying optimistic though, the world didn’t end, Obamacare is in full effect, Republicans can still flip-flop on exchanges and I’m hoping people will remember once again George Washington’s warning in his farewell address of damaging divides due to partisan political spirits.