What determines coverage in your health insurance plan?

You might think it ought to be based on proven evidence about what works and what does not. If you are a real optimist, you might think coverage is shaped by what patients need and what their doctors think will work. Wrong. In America, insurance coverage is driven by religion and politics.

When it comes to your health care, it's as if you're being told to find a theologian, not a doctor. That is the frightening lesson of the battle over contraceptive coverage.

President Barack Obama threw the Catholic Bishops and Cardinals a smoke-and-mirrors bone Friday on the issue of whether to require religious-affiliated institutions to cover birth control for their employees. Under his revamped plan, religious hospitals and universities employers who see providing birth control as a violation of their faith don't have to pay for it, but if their employees want it they can call a secret hotline to an insurance company who will give them the coverage by amortizing the cost into the price of other services.

The bottom line is, by granting an accommodation on this issue the President shows he can listen, count, remember. But it also should make you nervous that he and his opponents are perfectly willing to ignore what patients say they want and what works in deciding what you can get from a doctor, hospital, nursing home or clinic.

The Obama administration clearly heard Republicans gin up the issue of contraceptive coverage as one more example of the alleged war the administration is waging on religion and did not like the sound of it. Obama can count because -- rightly or not -- he does not want to risk losing votes over this issue. And his decision shows he can remember because the Catholic Church, commendably, helped him get health reform done and he knows he owes them for their help.

What the President, and all the politicians who piled into the kerfuffle over contraception, have shown is that when it comes to figuring out what we should pay for in health care, ignoring evidence and need is just fine.

This does not bode well for the future of health policy as our society ages and costs inevitably escalate. Today it is contraception that has been put out to pasture purely for non-medical reasons. Yesterday, it was not paying for doctors to talk to their patients about end of life care. Tomorrow, it will be covering treatments derived from the use of cells obtained from embryos -- or something equally morally controversial.

Too bad. Americans deserve health care that is in line with their needs, not what religious leaders or politicians diagnose.

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More from Art Caplan:

Catholic Bishops' birth control stance harms employees