Medicine and the War on Religion

For people who like political spin, President Obama’s “War on Religion” may seem like Valentine’s Day candy: it is flamboyantly packaged and there’s a lot less to it than meets the eye. The Republican pundits and presidential candidates claim that President Obama is disrespecting the first amendment by requiring Catholic Institutions (universities and hospitals, for example) to carry health insurance that covers birth control pills. American Catholic bishops argue that taking birth control pills is against the tenets of the Catholic faith and they should have the right to offer health insurance without that option.

The bishops have a point. The vast majority of Americans get their health insurance through their employer. The employer gets to decide which health insurance policies they will purchase and that in turn dictates the details of the plan such as which doctor they can see, how much their deductible costs and which, if any medications are covered under that plan. The individual patient has relatively little say in their own health care coverage — but you knew that. So why shouldn’t the Catholic Church dictate which health care plan they want to offer their employees? Isn’t President Obama stepping on the first amendment rights of the Catholic Church?

If you’ll forgive the pun, the devil is in the details. The First Amendment “prohibits the making of any law respecting an establishment of religion or impeding the free exercise of religion.” The amendment applies not only to religious entities such as the Catholic Church, but to individuals who wish to practice their religion as their conscience dictates.

Since Catholic hospitals and universities employ people of all faiths (it would be illegal to do otherwise) the Catholic bishops insistence on providing health insurance that is religiously biased is an infringement upon the freedom of religion of their employees.

The First Amendment was written because faith and the adherence to religious doctrines were often compulsory in the eighteenth century. Most modern religious leaders would agree that true faith is the product of personal choice, not coercion. It is archaic to ask a non-Catholic working at a Catholic hospital or university to pay more for birth control simply because their employer dictates it.

As a physician I have my own reasons for wanting the president to prevail on this issue. Currently, I have patients who have various types of insurers and many of those insurers have several types of “insurance products.” It is an absolute nightmare when it comes to prescribing medications. It is not unusual for different insurance “products” to covers different medication variants, leaving a doctor to write a prescription several times until they finally prescribe the right variant for that insurance “product.” Some insurers require prior authorization even to get a generic prescription. The bishops’ position will create another set of rules complicating an already muddled situation.

If the bishops prevail, will it stop there? Will the Bishops impose other restrictions on a doctor’s ability to see patients and prescribe medications? Will other groups be allowed to impose their restrictions on a physician’s ability to examine and diagnose patients? Should there be a separate set of rules for Muslims, Jews or Protestants? What about the patients themselves? When will they have a say about their health care?

With all the problems that the Catholic Church has had to face recently, it is surprising that American Catholic bishops should draw “a line in the sand” here. Recent polls show that the majority of Catholic women use birth control pills and disagree with the position taken by the Bishops. In over twenty years of practice, I’ve yet to meet a woman who told me: “No thanks, doc, I don’t want birth control, I’m a Catholic.” If a Catholic woman doesn’t want birth control pills, she shouldn’t get them, but she shouldn’t have to pay a penalty if she did simply because she worked at a Catholic hospital or university.

Spinning this issue into a “war on religion” might help stir the political base, but it sets a dangerous conflict between individuals and institutions. The United States has a predominantly privatized health care conglomeration. It is bloated and costly in part because of the fragmentation of the various entities involved. When our options become more consistent, it is easier to compare costs and remove unnecessary tests and medications. That, in turn, would give all of us more freedom and more capital.

James Fieseher MD
Portsmouth