Lesbians who want artificial insemination should rally to support greater choice in health care. That’s the real story of the recent California Supreme Court decision Benitez v. North Coast Women’s Care Medical Group.

In Benitez (pdf), the California Supreme Court was forced to decide which is more important: the ability of a lesbian to receive artificial insemination at a particular health clinic, or the religious views of her fertility doctors that a child shouldn’t be brought into the world without a mother and a father. To its credit, the Court saw that this was a conflict. The lawyers for the lesbian wanted them to brush aside the conscience claims of the doctors, but the Court instead faced the issue head-on. Unfortunately, the Court decided that the state’s interest in promoting access to fertility treatments regardless of sexual orientation outweighed the religious liberty interests of the doctors. The whole conflict could have been avoided, though, if only Guadalupe Benitez had better insurance which allowed her greater choice in health care providers. According to her lawyer’s brief (pdf), “Benitez’s health plan offered just one in-network provider of infertility care—the obstetricians/gynecologists of the North Coast Women’s Care Medical Group.” Perhaps that’s the real problem here. If Benitez could have chosen from a wide variety of health care providers and could have easily changed among them, then she could have walked out of the situation she was not happy with. She could have found a lesbian-friendly fertility clinic, and the whole lawsuit would not have been necessary.

This is an overlooked advantage of market-based health care reform over single payer health care reform: In a society in which people have different moral and religious views about what medical procedures are or are not ethical, it is important that control over health care decisions be in the hands of the patients, rather than centralized in the government or third parties.

Most people receive their health insurance through the government or their employer, and do not have the power to change insurance companies. If more people controlled their own health insurance, and could easily switch insurance companies whenever a better deal became available, then the entire health care system would become more flexible. Furthermore, if health insurance could be purchased across state lines, then small groups with special needs could band together from all over the country to buy specialized insurance. There aren’t enough lesbians in most states for the insurance companies to cater to their special needs (their desire that artificial insemination be covered, for instance). But if there were a national market for health insurance, insurers would be more likely to tailor specific plans for lesbians, to gain a competitive advantage.

Giving the patients control over health insurance dollars, rather than employers and insurance companies, would lead to a health care system more responsive to people’s wishes—including their wish to have health care providers who agree with their moral values, whatever they may be.

Any reform that gives patients control over the health care decisions for their families has to embody some key principles:

  • Patients, rather than employers or government bureaucrats, should be able to choose their health insurance coverage for themselves and their families.
  • Patients must be able to change insurance companies easily, without having to change jobs.
  • Patients should have a variety of insurance plans to choose from, which reflect their different situations and respects their different values.
  • Patients should be given ownership over their health insurance coverage, so that a third party does not have control over its contents and quality—and the values it embodies.