There’s been plenty of argument over proposed federal regulations requiring employers to offer health plans covering contraception for women. But few people bring up the basic question: Why is it considered normal for your boss to determine your healthcare options in the first place?

Relying on employers for healthcare means the company has more leverage over the worker. If you’re out of work then you might be out of luck when it comes to your health. And if the boss decides what kind of healthcare the employee can get — at issue in the current discussion of religiously-affiliated institutions and contraception — this can mean an extension of the boss’s control outside of work hours.

How did we get to where it’s typical to rely on employers for healthcare?

As Roderick Long describes in his article “Medical Insurance that Worked — Until Government ‘Fixed’ It,” it was once common for workers to join a friendly society or fraternal society. These were essentially mutual aid organizations where monthly fees created a pool of resources that participants could draw on in time of need. They often negotiated contracts with doctors to serve members for a reasonable expense paid by the organization. Regulation and government programs prevented these organizations from continuing to serve the public.

Certainly, there are more advanced and expensive medical techniques today than in the fraternal societies’ heyday of the 19th and early 20th centuries. But without government interference, consensual organizations could certainly have grown and adapted to the needs of a wealthier, more sophisticated membership.

New technology could make such organizations more dynamic and responsive, with improved ability to network and access and evaluate information. Not only could consensual organizations offer more security for the worker who today has an employer health plan, they could also make healthcare more accessible for the worker who does not, reducing incentives to take an otherwise less desirable job for the benefits.

Today, however, the tax structure incentivizes employer health coverage while an economy oriented toward business elites and political privilege raises barriers to alternatives.

Healthcare, taken out of the people’s hands, then becomes a political issue. Politicians aren’t good at addressing problems of economic stratification and stagnation — they’re typically part of the elite that is struggling to stay on top. What they are good at is making stands in culture war issues, and this is where they want to get attention, regardless of how many backs they stand on behind the podium. When federal funding can be given out or taken away based on which demagogue holds power, personal health becomes a campaign issue.

A free society would allow more personal autonomy and choice. Taking power away from politicians involves determining how to rely less on the boss economy and invest more in personal autonomy. The surest way to keep bosses from determining your access to healthcare is to get rid of the need for bosses altogether.

When you rely on bosses for healthcare your body becomes a campaign issue.