A letter in this morning’s paper summed up the whole debate over employers’ rights to pick and choose which health benefits they offer by stating, in essence, birth control is a private matter and should be kept that way. Meaning, of course, that individuals should simply pay for it themselves and not expect it as part of an insurance plan. Certainly an interesting perspective, but, if applied uniformly, wouldn’t it be equally logical to assert that pregnancy, birth, and child-rearing are equally private? Should health insurance distribute these costs over the broad population of rate payers?

If employers can elect on moral or religious grounds to deny birth control as a benefit in their plans, shouldn’t their rates go up to absorb the additional costs of increased pregnancies? After all, absence of birth control seems like a pretty certain guarantee of an increased number of pregnancies. Why should those outside the employer’s realm be forced to pay for the increased cost? Those costs – from prenatal to pediatric – should be absorbed in a risk pool limited to the employees of that business. Now, the employer could opt to pass those costs along to the employees as their share of the premium and could do so based on the number of pregnancies and children of each person in the firm. That would certainly make the cost of birth control seem less onerous.

As an aside, does this same benefit denial extend to vasectomies, tubal ligations, or hysterectomies? Back on track, allowing employers to cherry-pick benefits in the plans they offer employees opens a world of unpleasant opportunities – what if your employer states a moral objection to large families? Or to alcoholism? Or to cancer? Or to HIV?

It seems to me that some important points are being overlooked in the health care debate. First, health care and other benefits were originally offered to employees to attract good people and retain employees who had gained valuable experience. Unions pressed for these benefits for their members as well. Apparently, employers no longer believe that retaining  qualified and experienced employees steeped in corporate culture and keepers of the corporate memory is as important as it was – or, perhaps the economic situation is so bad that they think they don’t have to worry.

At some level, all health care costs (except for the very wealthy) are employer-paid. The advantages of a group plan offered to employees are a presumed discount for the group premiums and the general acceptance of pre-existing conditions. When an employer opts not to provide benefits, the employee either does without health insurance, tries to save sufficient money to pay his own way, or buys an individual plan using money out of his paycheck. So, we might expect that a company which provides benefits can hire employees at both a lower salary and a lower total cost (given the group discount on premiums) than a comparable company which does not. Should the second company be able to hire people at the same salary as the first, we would expect to see higher turnover, increased absenteeism, and generally less commitment to the company (reflecting the lack of commitment of the company to the employees).

Does this really happen?