Tuesday, July 26, 2005

Will Courts Decide What Our Healthcare Rights Are?

A U.S. District Judge has ruled that Union Pacific Railroad is unfairly discriminating against women for not including prescription contraceptive coverage in the company’s health plan.

This is a very interesting ruling because it raises the issue as to whether or not courts can force private companies to provide a certain level or a certain kind of healthcare.

According to the judge in the case, Union Pacific is in violation of the Civil Rights Act which prevents companies with 15 or more employees from discriminating on the basis of gender of pregnancy. The ruling says Union Pacific’s policy is discriminatory “because it treats medical care women need to prevent pregnancy less favorably than it treats medical care needed to prevent other medical conditions that are no greater threat to employees' health than is pregnancy.”

But to me, this seems like a medical rights case masquerading as a civil rights case. What if the company decided not to pay for treatment of diseases caused by obesity? Would that also be a violation of an employee’s civil rights? How about the very real case of the company that routinely tests employees to see if they’ve been smoking and fires all smokers, even if all the smoking is done outside of work?

As healthcare costs rise and as medical knowledge grows, we could see more-and-more cases of workers suing for specific kinds of health coverage. I'm sure some smart lawyers and well-funded interest groups could figure out a compelling argument as to how we are constitutionally guaranteed healthcare from our employers.

This is yet another reason why I support reforming the healthcare system so that Americans don’t rely solely on their employers for coverage. We have simply progressed to a point that we no longer consider healthcare a benefit. It is a right. Or at least a necessity. And we need to figure out how to get all Americans a basic level of care. And we need to do so outside of the courts.

I don’t think we want court cases determining what coverage we are and are not entitled to.


At 4:05 PM, Blogger Maggie said...


I have not read the ruling in this case, but I was suprised to see that the CNN article did not mention that the issue of denying contraceptive coverage to women was actually taken up in Dec 2000 by the EEOC and decided to be in violation of Title VII of the Civil Rights Act of 1964, as amended by the Pregnancy Discrimination Act. You can find the link at the EEOC's webiste by searching on "contraception" (I'm not HTML savvy enough to embed the link here.)

I do disagree with your position that this is a civil rights case masquerading as a medical rights case, however. The other groups you mention are not protected classes under any civil rights laws.

Now you know that I too believe our healthcare system to be in shambles and I do not disagree that employer based coverage should no longer be our primary source of insurance. However, I believe the most important issue you raise here is whether we (American citizens) believe health care to be a right or a privelege. Until we answer that question, we shall not come to a rational system of providing health care services.

At 4:43 PM, Blogger Alan Stewart Carl said...

I certainly support all healthcare programs providing coverage for contraception. And I don't really know if denying coverage is a violation of civil rights--I'm sure there's good arguments for and against but I chose not to dwell on that aspect b/c, well I was looking to make a bigger point. And my point is, this is a matter of healthcare and if denying one kind of healthcare can be considered a violation of rights, why not all the other kinds of care people are denied?

Interesting fact in this case. Only the unionized employees are denied contraceptive coverage as part of the union agreement. Non-union workers have contraceptive coverage. Odd, huh?

At 5:04 PM, Blogger Maggie said...


I think we need to differentiate between denying insurance coverage and denying treatment. I know that fundamentally (especially for large ticket items like transplants) denying coverage leads to no treatment, but neither insurance companies nor employers make treatment decisions -- those decisions are between patient (family) and doctor.

In response to your question about whether denying healthcare is paramount to denying civil rights in the case (or in the future), I believe that the civil right that is violated here is women being treated differently than men based on their sex (a protected class). I do not believe this ruling, nor the EEOC ruling, suggest healthcare to be a right in and of itself, the denial of which would be a civil rights violation. So to the extent that healthcare coverage is an instrument of violating someone's civil rights, then I believe those issues should be decided by and those groups protected by the courts -- that is their job, to enforce laws.

If at some point in the future our society chooses to view access to healthcare as a right, then new laws would need be enacted to ensure equitable acess. Only then should the deinal of specific healthcare services be considered civil rights violations across the board. But this really is the can of worms in my opinion, if healthcare is a right, what level (service and quality) of care is our right? And how do we draw the line between right and privelege?


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