The Hobby Lobby case reminds us that when it comes to health insurance coverage, it's not simply about science. Medical care and how it is covered is infused with ethical values. The recent Supreme Court decision about the Affordable Care Act and Hobby Lobby is a great example of this often forgotten truth. Healthcare as a whole is not only about applying scientific knowledge and technology to the healthcare issues which confront us. Healthcare decisions are framed by the moral values we hold.
Contemporary Americans often forget this interplay between healthcare and ethical values, assuming that medical practice is simply the application of medical knowledge. Many of the famous cases in end-of-life care are great examples of the interplay between medical practice and ethical values. When we make decisions at the end of life, for example, those decisions are not only medical decisions. They are decisions shaped by a person's moral views and understanding of what makes for a good life and a good death. The truly tragic cases come when there are strong, differing views on what is ethically appropriate in medical care. One only has to recall the tragic case of Terri Schiavo in Florida. For many people, our decisions about sexual practice and reproduction are ethical decisions in a similar way.
The recent Supreme Court ruling in Burwell v. Hobby Lobby is an example of the interplay of medical healthcare and ethics. The owners of Hobby Lobby view contraceptives as an ethical issue. Many other people also understand contraceptives as an ethical issue, but think it is an issue of personal choice. The ethical complication, provoked by the Affordable Care Act, is that family-owned businesses, like Hobby Lobby, would be forced to act against their moral values.
Most Americans want to respect the moral values of others, even if they disagree with their views. Americans believe it is important to respect people's conscience. But, the structures of healthcare insurance in the U.S. make respect for differences difficult. In health insurance, we list services that will and will not be covered. But, as we see in this case, there are many services in healthcare which are freighted with moral values.
An alternative response to this dilemma is to structure health insurance in a way that allows individual patients to make decisions about what they do or do not want covered. In such a system, like a voucher system, employers would contribute to the health insurance of employees, but employees would make decisions about how they want to use their benefits. Such a structure would have the virtues of respecting the conscience and rights of employees and the conscience of an employer rather than proscribing what is or is not covered under the policy. Individuals could make such choice -- not insurance companies or the employers for whom they work. Also, I believe that such a voucher system might also make Americans more aware of another ethical issue: the cost of healthcare.