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By Joel A. Harrison, PhD, MPH

December 11, 2013 (San Diego)--The Obama administration has asked the Supreme Court to decide whether for-profit companies can be forced to provide full contraceptive coverage for their employees despite religious objections from their owners. Many people believe that health insurance is something offered by employers, a sort of bonus.  In fact, it is part of what I have known as one’s “wage package.”

Wikipedia calls it “salary packaging: a term used to refer to the inclusion of employee benefits (also called fringe benefits) in an employee remuneration package in exchange for giving up part of monetary salary. Such arrangements are entered into most commonly if there are tax or other benefits to be derived by the employer or employee from the arrangement.”  Employers calculate the total cost per employee, including salary, benefits, Workers’ Comp, unemployment insurance, employer’s share of FICA and Medicare, etc.

As health costs go up, employers have compensated by freezing or reducing increases in wages and/or cancelling health insurance, switching to reduced coverage and/or increasing employees’ share of premiums. While there are benefits to employer-sponsored health insurance, e.g. tax benefits, better coverage and lower rates for group coverage, the health insurance is paid for as a part of the employees’ overall remuneration package.

If employers can exclude birth control from health insurance coverage, an absurd thought would be if they somehow became aware that employees were purchasing birth control on their own could employers deduct the amount paid for the birth control from their salaries? Since health insurance is part of what an employee has earned, I see no difference. Carried to its logical extreme, could an employer who is a Jehovah’s Witness exclude blood transfusions? How about an employer who is a Scientologist excluding psychiatric coverage? Or what about a Christian Scientist covering only the faith’s own healers?

This is not about First Amendment freedom of religion. It is about employers deciding how the earnings of an employee should be spent. It is about an employer imposing his or her religious values on employees. How much control over employees’ personal lives and choices should an employer have?

The opinions in this editorial reflect the views of its author and do not necessarily reflect the views of East County Magazine. To submit an editorial for consideration, contact Joel A. Harrison, PhD, MPH, a native San Diegan, is a retired epidemiologist.  He has worked in the areas of preventive medicine, infectious diseases, medical outcomes research, and evidence-based clinical practice guidelines. He is currently active in supporting the adoption of a single-payer health care system in the U.S. For more information on single-payer go to Physicians for a National Health Program’s website at .

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Responding to: "the bottom line is the"


The taxpayer already pays for over 60% of health care costs, including many people who either lack health insurance or are underinsured (see my paper "Paying More, Getting Less" at Our fragmented dysfunctional health care system organized to benefit health insurance companies and hospitals takes more than 25 cents of every dollar. This 25 cents does not improve our health care or give us more choices. Instead it makes things more complicated and, often, leads to worse outcomes. 75% of bankruptcies are by people with health care insurance, some because of high copays and deductibles and some because an extended illness or injury results in losing their employment and health insurance.

While government doesn't dictate earthquake insurance it does dictate auto insurance. Uninsured and underinsured people, many who are working, flood our emergency rooms. Result is that many emergency rooms are closing their doors due to lack of reimbursement which puts us all at risk. Insuring everyone will keep emergency rooms open, which is only fair in that many who are working pay taxes that subsidize others.

Also read the Constitution, both preamble and Article I Section 8 where it states:"provide for the Common Defense and general Welfare." In the U.S. we have less choice than many other countries. In France, one can choose any doctor and any hospital. Most of us can't even choose our health insurance companies because we take what our employers offer. U.S. has less access to health care, higher infant mortality, lower life expectancy, lower survival from chronic conditions such as diabetes, higher rates of hospital-based infections, etc. than several other countries. We pay more and get less. Our health care costs makes our industries less competitive internationally.

But you missed the entire point of my OpEd. It wasn't whether the government should mandate health insurance  or not; but whether an employer can impose their own religious values on their employees by determining how their earned "salary package" should be spent. If the health insurance offered by an employer is part of what an employee has earned then the employer no more has the right to determine what it should cover than to tell an employee how to spend the monies they have earned.

Almost every country that has universal health care allows more choice, has as good or better outcomes, and all cost far  less than our health care system. But, my OpEd focused on the intrusion into private lives by employers. Believe it or not, in many other countries employers only have the right to receive the work they pay for and would never presume they have the right to impose on ones personal life choices.

the bottom line is the

the bottom line is the federal government does not have the Consitutional or moral right to dictate healthcare or what should be in insurace coverage.  the individual, even if covered through the employer, should still be able to purchase additional coverage similar to car and home owners.  not everybody has earthquake coverage, nor does government dictate it.

sadly the authors desire to rule over the public via single payer tell me a lot.  stay away from my health and life please as I will stay away from yours.