Jean Marbella: On health care, freedom for or from religion?

I once met a smart and delightful young woman who was making her way through a demanding college program despite being a single mother of two.

From what I could tell, she was quite a loving mom and her kids seemed happy. But just watching her juggle their school schedules along with her own was exhausting enough; I couldn't imagine how she actually did it.

I kept asking her, several different ways, why she hadn't just used birth control and gotten her degrees, then started a family. Maybe we were talking across too vast an age or cultural gulf, but I don't think the question even made sense to her. The best she could explain was that she wasn't like a "regular" lady who had a "regular" doctor.

There was something sad about that, of course, that she saw regular medical care as the province of some other kind of people, more middle-class, I'm guessing she meant. That just wasn't her reality.

Maybe she could have gone to a Planned Parenthood or a city health clinic and gotten birth control pills, but I think if you're not regularly in a physician's care — as many of the uninsured aren't — you're just not in that world, that mindset. No one is looking after you in that way, or asking the basic questions: Did you get a flu shot? Do you smoke? Are you sexually active?

One of the promises of health care reform was that more women, and men for that matter, would join this "regular" world, where they would have the full range of the kind of routine health services that the rest of us take for granted.

And yet there are those who want to chip away at that. I get that there may be sincere, legitimate reasons to oppose the reform act — it's far from perfect, which nothing hammered out in today's fractious Washington could ever be.

But for whatever reason, we never seem to talk about actual health care when we talk about health care reform. For a while we were talking about death panels, the mythical component of the reform act that would have bureaucrats deciding whether granny would get lifesaving care.

And now, we're talking about religious freedom, courtesy of the Obama administration's recently announced rule that contraceptives would have to be covered by employee health care plans — even those offered at schools, hospitals and charities run by the Roman Catholic Church, for which birth control is anathema.

After a drawn-out uproar featuring defiant bishops and opportunistic politicians, President Obama announced a compromise on Friday in which the insurance companies would pay for the contraceptives, rather than the Catholic institutions, a plan that at least initially met with some — although far from universal — approval.

Let's stipulate that the whole uproar seems entirely unnecessary. I don't know if the White House underestimated the kind of pushback it would get and how gleefully the whole war-on-religion crowd would pounce on the issue, or, as has been speculated in some quarters, whether President Obama purposely created the storm to put himself on the side of a progressive cause, equal access to contraceptives, during an election year.

I have no idea why the administration's compromise plan wasn't the one they came out with it the first place, saving much angst. But in any event, the new plan strikes me as a decent balance between ensuring that women who work for Catholic hospitals and the like (actual churches are exempt) get the same kind of access to contraceptives as employees at non-religious institutions, without sticking the bill to a faith organization that opposes birth control.

It's part of this country's heritage that we respect religious policies even if they run counter to what the majority believes — and Americans, polls show, generally believe health insurance should cover contraceptives.

I don't think, though, that anyone's religious freedom is being violated by allowing women who choose to take birth control to be able to avail themselves of it. The church may have a policy on birth control — and one that is routinely violated by its members, given that the vast majority of all American women, Catholic or otherwise, use contraceptives as some point in their lives — that's a matter of religion rather than employment.

It's funny to think that it was not so long ago that people feared electing the first Catholic president, John F. Kennedy, because he might do the Vatican's rather than the country's bidding.

I doubt this controversy is over. There are those who have and will continue to argue, for example, that there's no way to avoid "commingling" the premiums that are paid by those who are opposed to contraception from the funds that ultimately go toward providing pills or IUDs for other employees.

Too bad.

I'm sure premiums I've paid over the years have gone to pay for the medical bills of, say, those who smoked or ate terrible diets or didn't exercise or otherwise engaged behavior much more unhealthy than, say, a woman seeking to control when or even if she gets pregnant.

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