Written by Jay Hollman, MD
The ethical issue for a pro-life employer (as discussed in the majority opinion) is that of complicity. The issue of complicity is a subject often surfacing in the charity clinic in which I work. As I discuss the reasons for patients to stop using illegal drugs we discuss health risks if applicable. This is unconvincing to some who regard marijuana as no more dangerous than alcohol. But as we discuss complicity with the drug trade and how drug use has made many Mexican border towns effectively war zones with thousands killed, many of innocent bystanders, they get the concept of complicity. If all Americans stopped using illegal drugs, we would not only reduce crime in the U.S. but also in Latin America. Since most of our patients live mostly in dangerous neighborhood where violent crimes are common, they can easily understand how buying drugs can make life difficult for many innocent people.
With their understanding of four of the twenty mandated contraception methods, the owners of Hobby Lobby believe that by purchasing group insurance that offering these options might facilitate one of their employees to engage in an immoral act. But if Hobby Lobby did not offer these 4 contraception methods they would be subject to fines of almost 20% of their annual sales, an impossible burden. It is presumptuous and arrogant for any one group in our pluralistic society to think that they know the moment when human life begins. It is not unreasonable for a person to believe that human life begins at conception. If this is believed then it is wrong to fund methods of birth control that would act to end nascent life.
An American capitalist might disagree with his daughter who believes that it is unethical for her to purchase certain products from China because these companies are excessively polluting the Chinese water and air. But he should be tolerant of her view and, if indeed, there is some truth to the pollution claim, he should be proud that his daughter is willing to forgo certain products or pay a higher price to obtain the product from a less polluting company. In the same way, if we desire a strong pluralistic society, we should laud individuals and companies that are determined not just to the correct thing themselves but are also striving to help others do the correct thing. Hobby Lobby demonstrates that the owner’s religious convictions by not being open on Sundays which cost the company millions.
The tone in the media following the Hobby Lobby has been strident. If this is continued, likely nothing positive will happen in health care reform in the current Congress. Most in health care are ready for some real health care reform. Physicians are struggling with electronic medical records systems that decrease their efficiency and invite fraud. All providers and hospitals are strapped with complex regulations that defy common sense. Millions are still uninsured. Most of the patients in my charity clinic cannot afford even the cost of Bronze Plans on the Exchange. All the while we are wasting an estimated $910 billion dollars per year on medical diagnoses, treatments and overhead that do not provide any benefit. Reduction of waste should be a high ethical priority upon which we all should agree. The ACA has started the process of reform by such measures as eliminating lifetime caps on health insurance, allowing young adults to remain on their parent’s health plan and eliminating the pre-condition clause that made insurance unaffordable for those with chronic conditions.
It also must be remembered that ACA is, from its very beginning, a partisan act. Continued litigation will not unite the country but compromise can. Forcing individuals and their companies to act against deeply held religious belief should not be done and will only inflame partisan rancor. This issue in itself is small compared to the large task of completing health care reform. One could hope that both sides might see this decision as an opportunity to change the rhetoric and sincerely work on a compromise plan that would extract waste from our current system and make health care available and affordable to all.