The single most unifying idea to change Obamacare among conservatives is to eliminate the law’s “essential health benefits.” These burdensome mandates of which treatments insurance has to cover make Obamacare too expensive, conservatives say. Their problem is that the list of required essential health benefits includes actually only, well, essential ones. If the list did include any frivolous treatments, like cosmetic surgery or some goofy alternative-medicine quack scheme, that’s all you’d hear about. But it doesn’t. So the single example conservatives come up with, over and over, is maternity care. Today it appears in Charles Krauthammer’s column:
Even more significant would be stripping out the heavy-handed Obamacare coverage mandate that dictates what specific medical benefits must be included in every insurance policy in the country, regardless of the purchaser’s desires or needs.
Best to mandate nothing. Let the customer decide. A 60-year-old couple doesn’t need maternity coverage. Why should they be forced to pay for it? And I don’t know about you, but I don’t need lactation services.
The thing to understand is that mandating covering maternity care doesn’t affect the total cost of insurance. It only changes the distribution of the costs. It’s not like Charles Krauthammer’s insurance forces him to actually go through childbirth. It merely means that his premiums help pay for other people’s maternity care.
If health insurance could sell plans that did not cover childbirth, then young women of childbearing age would be the only people who bought plans that covered it. And having a baby would be extremely expensive. Indeed, in the unregulated market that existed before Obamacare, it was common for women to buy insurance they believed covered their childbirth but in fact did not. In 2009, Sarah Wildman described her not-atypical experience of getting a $20,000 bill from her insurance company for a standard delivery.
And it is true that, if we let Krauthammer buy insurance that didn’t cover maternity care, that change would, on its own, reduce Krauthammer’s premiums. That reform would make sense if you think of having a baby as some kind of yuppie extravagance. This notion was, not long ago, considered so self-evidently absurd that it could be the premise of a Simpsons joke:
Homer Simpson: I can’t fake an interest in this, and I’m an expert at faking an interest in your kooky projects.
Marge Simpson: What kooky projects?
Homer Simpson: You know, the painting class, the first-aid course, the whole Lamaze thing.
Now the entire Republican Party is Homer Simpson.
But while childbirth may be the GOP’s favorite and only example of an unnecessary essential health benefit, eliminating all the essential health benefits, as they propose, will do more than shift the costs of insurance onto prospective mothers. It will allow — and, by the logic of adverse selection, force — insurers to segment their coverage for all kinds of medical risk.
Krauthammer himself has been a paraplegic since the age of 22. That’s an expensive medical condition. Probably he has group insurance through the Washington Post or another institution with which he’s affiliated, allowing him to spread the cost of his expensive medical care onto a risk pool that includes healthier, cheaper-to-cover people. Or perhaps he has a different arrangement. I do not for one moment resent that my insurance helps cover either childbirth or mechanized wheelchairs, even though I personally need neither service, and nothing Krauthammer says would make me reconsider.
It is callous enough that Republicans apply their every-man-for-himself logic to health care, and land on the belief that those fortunate enough to be blessed with good health should not be burdened with the cost of paying for the medical needs of others. But when the advocate of this argument himself has expensive medical needs, the callousness rises to a level of solipsistic barbarism. A paraplegic man resents having to pay for women who need help breastfeeding their babies. Why should those women have to buy insurance that covers wheelchairs?