Monday, March 12, 2012

Contraception decision: War on religion?

Is the decision of the Obama administration on contraceptive insurance coverage a "war on religion?"
"The Catholic Church objects to being told to pay for something that it morally objects to. Why should the government make Catholic schools, hospitals and charities pay for abortion inducing drugs, sterilization and contraception? ... There is no reason it has to involve the Catholic Church other than pure spite." -- Washington Post commenter
I don't think it's "pure spite" or "war." Lots of people seem to want to ramp up the rhetoric, a problem not confined to one side of the dispute.

There are many non-spiteful reasons for wanting insurance plans to cover contraceptives. Here are a few: People like to control when they have children without foregoing their sex lives. To many, it doesn't make sense to carve out a special exception for birth control when many other medications/procedures are covered. Some women (a few) need hormones to control diseases like ovary cysts. None of these are spiteful or war-like reasons to cover contraceptives.

The decision about covering contraceptives pits two worthwhile goals against each other: 
  • The usefulness of contraceptives is similar to the usefulness of hypertension medicines, and perhaps should be treated in the same manner by insurers. 
  • Religious employers don't want to be forced to pay for medications that they have a long-standing doctrinal objections to. 
This is a difficult matter of deciding which of the conflicting interests is more important. It is not spite or war.

That the government and employers are involved is an artifact of our ridiculous health care insurance system where the employer pays. If we could transition to private/individual-funded choices, then we could pick our own insurance based on our own consciences.
That would be much better. Amen.

 Praying . . . that the contraceptives keep working. 

Update 3/14/12. The Obama administration isn't trying to end religion or shut down the Catholic Church. But it sure feels like some alliances of conservatives are trying to completely shut down Planned Parenthood. If the Catholic Church was trying to do this directly, people would be up in arms.


Anastasios said...


I understand where you are coming from. The employer-based system is riddled with all kinds of problems, and one wishes we had avoided falling into that trap. But we didn't. In a supreme irony, we were trapped by our own success. Faced with the problems of World War II and economic reconstruction, most other industrial democracies were forced to make hard choices long ago, and are thus in a much better place. We were rich, able to get by on an incredibly wasteful combination of employer plans, charity, government support for some people, and individual savings. And since we could afford the waste, we indulged it, as rich people do.

But now we are up against hard facts, and we can't make the U-turn back again, much as we might like to. People are used to the employer-based system, and comfortable with it. They simply accept it as the natural way of doing health-care. I remember my mother, not at all a stupid woman, reacting with outrage when she heard about jobs that didn't offer insurance -- after all, how were people supposed to get health care? Didn't these employers understand that was part of their purpose? Why was the government letting these employers get away with this destructive behavior?

So, I don't think that any move to unravel the employer-based system is in the cards, at least not directly. Maybe various reforms over time can have that effect, but woe-betide any politician who would openly talk about such a change, at least on any major scale. Even the relatively minor tinkering involved in the insurance exchanges has proven incredibly controversial (yes, in part due to demagoguery, but that isn't going to change, either).

On another note, I'm not at all sure that we should completely trust people with their own care, either. The average person is, well ... mediocre. That is they are not informed about health care and not an expert or even very knowledgable about the implications of their choices. Given that poor choices are often going to end up with socialized costs in one way or another, I'm not at all willing to say that "ordinary" people should be totally free to make up their own minds in accordance with their own values (much less that they should be completely free to make such choices for other people, such as children or other dependents).

Now, I know you can go too far the other way, and I don't automatically laugh at questions about broccoli and mandatory callisthenics. I also don't automatically laugh at horror stories about social workers flooding into hospital rooms and accusing parents of child abuse because of choices they make about their children's health care. Finding the line and drawing the limits, for both individuals and governments (and employers too, given that they aren't getting out of the picture anytime soon) is hard and controversial. Given the sad world we inhabit, there will, I am sorry to say, be unfairness and hurt involved. But, to make a very bad pun, we are going to have to swallow our medicine, no matter how bitter it tastes. We Americans don't handle complexity very well, but we are going to have to get a lot better at it, because there is a lot more of it coming straight at us.

Couves said...

MP, well said -- I expect the health care debate to provide you with much equally-bizzare blog-fodder in the years to come.

Anonymous said...

It is VERY important to point out that the Catholic Church or any other party is not actually "paying" for the coverage. If someone works for them as an employer, and received benefits as part of that employment arrangement, then payment of the policy premiums is actually the employee's money. This is particularly true since nearly all employers now require some sort of copay from employees for the premium, but it holds even if they don't.

Further, so-called religious organizations RECEIVE special treatment for their financial activities, so in exchange for that they must follow the laws and not impose their faith in conflict with anyone else's rights.

Lastly, let's not forget that the money to pay the insurance company comes from a variety of sources, so that concerned party can easily rationalize that they aren't actually "paying for" things covered in an insurance policy. The insurance company is actually paying for the product or service from their funds,, and they are doing so by the actions and decisions of the insured, not the employer or the party that remits the premiums in whole or in part. That is, once the premium is paid, its an asset of the insured.

Opposed to a rationalization like this? Aw, you can live with it. As Jeff Goldblum's character in The Big Chill said: "Who couldn't get through the day without two or three really juicy rationalizations? Rationalization is more important than sex. ... Have you ever gone a week without one?"

ModeratePoli said...

@Anon, I definitely think that the Catholic Church has the weaker argument here. I don't see why contraceptives should be treated differently from hypertension drugs. If a Catholic hospital wants to give a drug benefit, then do it. Don't micromanage this and that, or you open the door to a great deal of arbitrariness.

Leave the arbitrary decisions to the individual.

Rose said...

I'm really torn on this one, but I think this latest conflict is just a symptom of the fundamentally unfair situation of expecting employers to provide insurance to much of the population, as MP said.

Ultimately, the objective is to make low-cost or free birth control available to all women, not to make churches violate their conscience. But if the one can't be accomplished without the other with the near future ... which is worse, violation of deeply held religious principles, or letting a few low-income women working for obstinate employers (I doubt that Catholic-affiliated hospitals and universities account for a substantial percentage of U.S. jobs) fall through the cracks?

Perhaps, as an alternative, the government could create a very low-cost, public alternative for prescription coverage--and demand that opting-out employers pay an in-lieu fee to cover the externalities that they are imposing on the rest of society.


ModeratePoli said...

@Rose, I've thought along the same lines on the in-lieu-of fees. The institutions (or bishops) will probably complain bitterly about the fees too.

As for trusting the government-sponsored low-cost clinics, that becoming a less-reliable source due to the conservative push against Planned Parenthood (see this).