Contraception, health-insurance reform & religious freedom
From the editorial, “An Illiberal Mandate,” just posted on the homepage:
In August, the Department of Health and Human Services issued a “draft” ruling that would mandate coverage of contraception and sterilization in health-insurance plans, including those provided to employees of Catholic institutions. The ruling offers an exemption from the mandate only to religious institutions that primarily employ and serve coreligionists, and whose work is strictly religious. As HHS sees it, access to contraception is a fundamental component of any health-care plan, especially for women. That claim seems commonsensical to many people, including many Catholics. The USCCB argues that compelling the church to pay for plans that cover services the church has long held to be immoral violates the religious-freedom guarantee of the First Amendment. Catholic hospitals, universities, and social-service agencies see their mission as caring for people of all faiths or none, and they employ many non-Catholics. Given this understanding of mission, inevitably there will be a degree of entanglement between any large religious institution and the modern state. That should not be an excuse, however, for imposing secular values on more traditional religious communities. Religious diversity is impossible without a degree of autonomy from the state. Is there any evidence that such autonomy poses a serious threat to liberal democracy?…
[E]xcept when life or limb is at stake, it is hard to see what is “liberal” in coercing religious individuals and institutions. There are other ways that contraception can be made available to employees of Catholic institutions, should they choose to use it. One does not need to oppose contraception to see that, in this case, it’s far less important than the principle, and practice, of religious freedom.
I couldn’t have said it better myself!
The stated goal of the Obama-healthcare program is making sure that most or all Americans have affordable healthcare.
Because they already have contract-negotiated healthcare plans, most labor unions and union employers have already been granted exemptions to the health care mandate.
Since most, if not all, Catholic institutions already provide healthcare coverage for their employees, I can’t see why the government would force a Catholic university (for example) to specifically broaden their healthcare policy to cover birth control pills and/or abortions.
If the employees of a Catholic hospital or university, insist on using contraception pills or on having an abortion, why don’t they just pay for it themselves?
Besides, birth control pills and abortions are not “healthcare” they are extras; electives.
Nobody ever got sick because they did not get birth control pills or because they had to pay for their own abortion.
I am paying for braces for my son’s teeth, paying cash. Why? Because my dental insurance plan does not cover braces, because braces are deemed cosmetic and optional; that’s why. Since it is true that one need not have your teeth straightened and also, that only a minority of kids need braces, I can see why all the participants of the plan would not want to orthodontics included in the plan. I do not expect the federal government to mandate that my employer change the dental plan to cover braces.
And so back to medical insurance, or healthcare. It is one thing for a union to negotiate a healthcare plan (policy) with an employer that covers abortions and BC pills. If the majority of labor and management agree on the cost, so be it. It is quite another matter however, when the federal government dictates that an employer who already offers its employees healthcare, in addition must also offer and pay for something to which they are religiously opposed (BC pills and abortion).
Why would the federal government not simply grant a waiver to institutions that already offer healthcare plans to their employees?
HHS’s attitude is another example of a large institution unnecessarily assuming the function of smaller ones. This is a violation of the principle of subsidiarity. It is also an example of an institution assuming that individuals are incapable of assuming responsibility for themselves when they have the means, which is another sort of violation of subsidiarity.
The editors’ reasoning reminds me of what employees at a Jesuit university used to say: “The Jesuits take a vow of poverty, and their employees live it.”
The rules in question are about the employees, many of whom are not Catholics, as the editors themselves correctly note.
So if Catholic employees at Catholic institutions want to exercise their free choice not to use contraceptives, the rules in question would not stop their exercise of their free choice not to use contraceptives.
But the rules in question would stop Catholic employers from interfering with the possible free choice of non-Catholic employees to freely choose to use contraceptives.
So the rules in question are about protecting the non-Catholic employees at Catholic institutions from the religious convictions of the Catholic employers.
Besides, birth control pills and abortions are not “healthcare” they are extras; electives.
Contraceptives are prescribed for medical conditions too, and the health plans at Catholic institutions are probably paying for them under those circumstances.
Yes, that’s got to be how most non-Catholics would see it. And in the absence of a united Catholic front, that attitude will probably carry the day. Even if Catholics were united on this, though, I’d guess a religious exemption wouldn’t last long. The Church may stand firm, but societies don’t. What the Obama people will probably do is come up with a position that sounds to wavering Catholics sort of like an almost fair compromise. That will isolate the “extremists”. Politics and principle don’t go well together.
“But the rules in question would stop Catholic employers from interfering with the possible free choice of non-Catholic employees to freely choose to use contraceptives.”
This is incorrectly formulated.
The rules in question would *force* Catholic employees to *subsidize* non-Catholic employees’ (and Catholic employees’) contraception.
Catholic institutions have never interfered, and lack the means to interfere, with the choice or ability of any of their employees, whether Catholic or non-Catholic, to obtain and use contraception.
Contraception is inexpensive and widely available. There is no overriding reason of public or personal health that employers must subsidize it.
The Catholic institutions are asking for nothing more than that the status quo be maintained.
Thomas – Please. That is like saying if I took a job at a Jewish hospital and then demanded the hospital cafeteria serve ham sandwiches for lunch, or if I went to work for an Islamic institution and demanded their cafeteria serve non-Halal food, just for me.
Nope – If I took a job at a Jewish firm, I would not expect ham sandwiches and likewise, if I went to work for an Islamic institution, I would not expect non-Halal food.
Awhile back we had a Mormon boss, and at the annual employee Christmas luncheon and the spring-summer BBQ lunch, while he was here, he always only bought non-caffeine sodas. He did not remove the coffee pot (we had always chipped in for coffee anyway) and he did not get upset if guys brought their own Pepsi or Coke, but he did not buy that kind of soda. Likewise for the summer picnic (on a Saturday) he did not furnish beer, but was not opposed to us bring beer if we wanted some.
That was fine; he was the boss and he was paying for those lunches and picnics, and we all had good times and enjoyed the lunches.
Later, when he moved on and we got a new boss, he bought beer and Pepsi – Yeah!
So far, I haven’t seen an explanation from the bishops of whether they see this as a moral issue or or a teaching issue.
Regarding abortion, we don’t stop at saying that Catholic Hospitals shouldn’t perform abortions – we go on to say that Catholic doctors shouldn’t perform abortions even outside of Catholic institutions. It is a moral issue.
I haven’t heard the bishops say that Catholic business owners should not provide employee health insurance that includes contraceptives and sterilization as part of the overall menu of covered items.
So, is the issue one of teaching? – that he bishops are concerned that if Catholic institutions provide that coverage people will think that they endorse contraception and sterilization?
If so, perhaps the best strategy is to fight it kicking and screaming, as the bishops are, but when the final decision is made, to accept it and make clear that Church institutions are only doing it because the government forced them to do it, not because we endorse contraception and sterilization.
The alternative, short of closing the institutions would be to stop providing any health insurance for employees and pay the government a penalty of $2,000 per employee. If the issue is only to make clear the Church’s teaching, I don’t thnk it is necessary or desirable to go that far.
On the other hand, if the bishops feel there is a moral reason why Church institutions and individual Catholic business owners cannot provide this coverage, they need to start making an argument that they haven’t made yet.
Why would the federal government not simply grant a waiver to institutions that already offer healthcare plans to their employees?
Ken,
I am not an expert in the new requirements, but I believe they apply only to new or substantially changed insurance plans. So there would be no need to grant a waver to institutions that already provide health insurance. They are “grandfathered” and don’t need to add new coverage.
To avoid confusion, i should have explained that oganizations with fewer than 50 employees don’t have to pay the $2,000 penalty. However, most hospitals an universities are bigger than that.
This is a difficult issue, but—and I am not the first person to point this out—the number of Catholics of childbearing age who don’t use contraceptives is miniscule. The position of the Church on contraception appears quaint to Catholics and non-Catholics alike. If the issue were abortion, it would be quite another matter. But contraception? Perhaps a government panel should be set up to study Humanae Vitae, and agree if they find it persuasive to allow broad exemptions for Catholic employers.
Whatever “the Church” may think, the overwhelming majority of sexually active people who don’t want children, or want to space out their children, use contraceptives. So to accommodate the Catholic Church here, it will not merely be non-Catholic employees of Catholic institutions who will be paying for their own contraceptives. It will also be 95% of the Catholics of childbearing age.
(Having said all that, I have to admit that I am of two minds, and I would not really be opposed if the Obama administration offers a broader exemption. )
Regarding waivers.
The Healthcare Act doesn’t come into full operation until 2014. The waivers that have been granted are for limited terms during this transitional period.
Regarding contraceptives being inexpensive: For a mother with three teenage to age 26 daughters, contraceptives could run to $4000 per year. We may not approve, but telling people they can easily afford to pay for it out of their wages isn’t a convincing argument.
John Hayes raises a key point (7:27pm). The editors refer to institutions and individuals. It is hard to think of a Catholic subject by which the two are more sharply separated than contraception and on which the bishops have so little credibility. This effort appears to be a symbolic attempt by bishops to state again their opposition to contraception, something they have generally failed to convey for forty years to most Catholics. Wrapping their position in religious freedom arguments is the convenient means at hand. Explanations might be difficult if the bishops were to be challenged on details.
I never cease to learn something new here.
Contraceptives and abortions may be considered to be the same as cosmetic procedures and, therefore, not “healthcare”?
Will Viagra and Cialis be covered – or are they cosmetic? (In some cases, yes indeedy)
And how about vasectomies?
Jimmy Mac says “And how about vasectomies?”
I guess that’s part of the “sterilization” the bishops are opposing in “contraception and sterilization”
Women with polycystic ovaries (PCOS) need to take hormone pills, the same as the birth control pill, in order to have regular menstrual periods. If they don’t have periods, they’re more likely to develop osteoporosis, diabetes, and heart disease. These pills may in fact protect their fertility, so that they can get pregnant when they get married. This disorder is very common.
“The position of the Church on contraception appears quaint to Catholics and non-Catholics alike.”
Quaint is not a moral category. But it is the sort of word one hears in politically correct statements.
Well, presumably the bishops are completely serious about contraception. Their problem is that they teach but few learn. The cultural appeal is too strong. But they control the Catholicity of Catholic hospitals, as they don’t the behavior of the faithful.
This is just one of the areas, of course, in which the Church and its putative members have parted company. The politicians’ dilemma is, can they afford to risk the displeasure of the official Church, even though the faithful in great number have, effectively, discarded it? Obama will try to find a way to displease everyone just enough so that any possible backlash will be rendered ineffective. Thus does culture change belief. I wonder how many generations it will take for the Church to come around. I imagine that it will, on contraception if not on abortion.
But culture lag may, indeed, turn the Church into a small flock of believers living in opposition to a thoroughly hedonistic world. I suppose it could be that there will always be enough people disposed to turn away from self-indulgence to keep it running, but there may never again be the equivalent of Medieval cathedrals and Gregorian Chant. History may show that the Church flourished for a thousand years and then shrank drastically.
“Wrapping their position in religious freedom arguments is the convenient means at hand”
No, defending their right to exercise their own consciences is a condition of keeping Catholic hospitals open. We might not like their official belief, but it’s their consciences, and the very existence of the Catholic hospitals hangs in the balance.
Remember Voltaire’s defense of freedom of speech, “I disapprove of what you say, but I will defend to the death your right to say it.” This is also a matter of respecting the right of someone to act according to his conscience if he is not thereby forcing others to act against
It is simply nonsense to say that if I don’t pay for your contraceptives I have thereby forced you to do without them. All you need is the price of the contraceptives, and you don’t have a right to get that price from the bishops hands.
I’m certainly not one to defend indefensible actions by the bishops. But in this matter, I’m with them.
As far as I know, St.Joseph’s Hospital, Phoenix, continues honorably without help from the bishop.
Voltaire did not actually say that but had something almost as good for present purposes. “Not only is it extremely cruel to persecute in this brief life those who do not think the way we do, but I do not know if it might be too presumptuous to declare their eternal damnation.” (Treatise on Toleration – 1763)
http://public.wsu.edu/~wldciv/world_civ_reader/world_civ_reader_2/voltaire.html
Jack B. –
Sorry to be so passionate about this, but if I can’t force you to do something against YOUR conscience, then I don’t see how you can force me to do something against MY conscience. It seems to me that this is the essence of the Enlightenment notion of freedom that our Constitution requires. And, yes, the Enlightenment notion of political freedom is one of the great things about the Enlightenment. This is why I think it is so ironic that American Super-liberals whose patron saint is Tom Paine, want to coerce the bishops in such matters as these. What they really are are closet totalitarians.
“Regarding contraceptives being inexpensive: For a mother with three teenage to age 26 daughters, contraceptives could run to $4000 per year.”
A mother with three teenage to age 26 daughters, all of whom smoke, could spend upward of $13K annually on cigarettes. Our life choices usually are not free of charge.
If this hypothetical family of four women and girls are able to use Mirena, an IUD, which I believe is reputed to be among the very most effective birth control devices, the price seems to be about $220 per device. Each device lasts up to five years. That works out to about $175/year for the family. It is true that other methods, particularly the pill, are more expensive. If budget issues are important, that might be a compelling reason to choose less expensive but equally (or more) effective options like Mirena rather than the pill. Women have a lot of options.
So-called family planning clinics subsidize birth control. Government subsidies from federal, state and local agencies are also available.
This example has crystallized something in my mind. If the purpose of Obamacare is to permit parents to subsidize the birth control(!) of 26 year old, able-bodied and employable women, with no strings attached, then I am opposed to Obamacare and will vote for any politician who will fight to substantially revise it or repeal it.
If the purpose of Obamacare is to permit parents to subsidize the birth control(!) of 26 year old, able-bodied and employable women, with no strings attached, then I am opposed to Obamacare and will vote for any politician who will fight to substantially revise it or repeal it.
Jim,
Of course, that is not the purpose of “Obamacare.” If you will recall, even the USCCB supported the bill except when it came to the issue of abortion. The purpose of “Obamacare” is to try to achieve near-universal health care coverage for all Americans at an affordable price.
No Catholic institution is being forced to provide contraception, no Catholic person is being forced to use contraception, yet much of the marketing campaign being waged on this issue inded makes it sound like that is what’s happening. The notion that Catholic hospitals would stop providing services if they purchase insurance benefits that cover contraception is such a hysterical and overwrought reaction that it’s almost comical.
Employee benefits are a form of employee compensation. Do Catholic employers feel they have the right to prohibit their employees from using ordinary income to purchase contraception? (No) Do Catholic hospitals and universities obtain significant benefits from the tax advantages of providing income in the form of health benefits? (Yes) Why should the moral matrix be different if compensation is being provided in the form of employee benefits, particularly when, in this instance, the employer receives significant funding from all levels and types of government health benefit and education programs, and most of their employees are not Catholic?
If Catholic hospitals and universities don’t want to dirty their hands with arranging the details of contraceptive coverage, all they have to do is contract with an insurer to provide the benefits. This is about money, economic advantage and using employee benefits as a stick to beat people over the head when they have long since stopped listening to reasoning that seems to be at once illogical and self-interested. It’s as good an argument for abolishing employer provided insurance and moving to a nationally administered payment regime as I can think of.
Strong editorial.
” Do Catholic employers feel they have the right to prohibit their employees from using ordinary income to purchase contraception? (No) ”
What employees do with wages is their own business, but that doesn’t mean that the employer needs to arrange all the details of how employees make personal purchases. Anyway, the notion that insurance should cover contraception is as stupid and asinine as thinking car insurance should be required to pay for every tank of gas.
Stu–
As Barbara Rusnak points out above, many women take the birth control pill to stave off more serious conditions later on (I know several women who do this). And, as far as I know, the Catholic Church has no objection to this practice. But how on earth is it supposed to be able to tell the difference between this and simple contraceptive use? Are those who may need the coverage for themselves and perhaps several in their families (John Hayes on 12/20) forced to pay for potentially life saving products because others (perhaps the majority) misuse them in the opinion of the bishops?
Anyway, the notion that insurance should cover contraception is as stupid and asinine as thinking car insurance should be required to pay for every tank of gas.
Studebaker,
It is in no way clear to me why car insurance should be the model for health care coverage.
Jim P. —
Before you cost-estimate proposals like Mirena for those who do not think as you do, you might care to find out what you are talking about: http://berlex.bayerhealthcare.com/html/products/pi/Mirena_PI.pdf
Simplistic “solutions” for others do more to hurt the bishops’ case than help, since they show the weakness of the arguments being offered. Similarly, invented misrepresentations of the purpose of Obamacare, the way insurance works, and who is _forcing_ whom to do what fail to help support the position they claim to favor, whether it is a moral issue or or a teaching issue.
Do you know why “insurance” exists and what function it serves?
(It’s not to add a bureaucratic layer to everything that you buy in life . . . think about disasters vs. routine expenses.)
Per Barbara; 1}“No Catholic institution is being forced to provide contraception, no Catholic person is being forced to use contraception yet 2}much of the marketing campaign being waged on this issue inded makes it sound like that is what’s happening. 3}The notion that Catholic hospitals would stop providing services if they purchase insurance benefits that cover contraception is such a hysterical and overwrought reaction that it’s almost comical.”
I will take your points in order;
1 – True, Catholic institutions are not being forced to hand out BC pills or IUDs, but the federal government is now preparing to force Catholic institutions to PAY for contraception measures (pills, IUD, sterilization, etc.).
2 – That you would call this discussion a “marketing campaign” speaks volumes about how you view our constitution and civil liberties in general.
3 – The notion that the Catholic Church will be given only two choices; comply with a federal law that violates Church teaching, or sell the hospitals (perhaps to the government) and get out of healthcare and social services is obvious; straightforward enough for anyone to understand.
There is no wiggle room on this. The point is not what will happen “if” Catholic hospitals pay for employees’ contraception; they won’t. That you think they will consider complying with that illustrates that you do not fully understand this situation.
Since the Catholic Church cannot go against such fundamental things as this, if they are forced – as they were forced in MA or one of the east coast states to close their adoption services – they will accordingly, consider selling off the hospitals etc..
And so the question is not whether or not Catholic institutions will start paying for contraception; they won’t. This goes to the question of whether or not we want the Church at all involved with society; whether we will allow it in the public square. Do we want the priests and nuns sequestered in the church buildings and monasteries, like oracles, with limited contact with society, only to speak (pronounce) publicly on Sundays and special occasions?
I would add that other religions have hospitals; Jewish, Mormons, Baptists, maybe by now there are even some Islam-affiliated medical or social service institutions in the US. In this discussion, they should not be forgotten.
Stuart Buck: Are you capable of being less obnoxious? You know what’s stupid? Saying something is both stupid and asinine.
Do you know why “insurance” exists and what function it serves?
Studebaker,
Insurance, according to Webster’s, is “a device for the elimination or reduction of an economic risk common to all members of a large group and employing a system of equitable contributions out of which losses are paid.” Health care coverage partly does that, but it does other things as well, and I can’t imagine many Americans would like to see their health-care coverage modified to become pure insurance. I think one might make a better case for coverage or contraception than for the costs of hospital delivery of a baby that the parents deliberately conceived. Planned children are not unforeseen risks. They are just as elective as Lasik eye surgery. Car insurance doesn’t pay for routine maintenance. Health care coverage does.
You might make an argument that health-care coverage should be like automobile insurance, but currently it isn’t, and I think the vast majority of Americans would prefer health-care coverage the way it is today rather than a system that kicked in only for truly unexpected expenses.
I thought we had discusssed this previously at length, but the context then was the impact on the administration going forward.
Am I wrong abou trecalling that?
At any rate, the thing that struck me was why this editorial now in a world and cChurch so dysfunctional?
Probably the issue of the meaning of the “mission of the Church” will be important to how one perceives this – and, it goes back, to the whole view of voice in the public square and its effectiveness.
For carrying out a mission should be based on how effectively it influences behavior.
( A note on secularism and putaively liberal society:
Sunday’s paper here had a lengthy article on a Georgetown professor’s seminar on disentagling secularism from socialism/atheism and disabusing some students that secularism equaled socialism/atheism. etc. I think that’s the right way to go and that the mission of the Church must operate in the public sqaure in terms of the medernity we live in.)
What the editorial needed to my mind is how a stance “on principle” contributed to the mission of the Church.
Of course, it can be that what is really important at bottom is teaching authority (right or wrong) and the need to have foofaraws like the recen tcartdinal George “woodshed/” of gov. Quinn in Illinois.
Did that help the Church?
Does the editorial help the mission of the church?
I think that’s the question.
Ken, I view a full-length page in the New York Times as marketing. And no, Catholic institutions are not being forced to arrange the details. That’s what insurers and other specialized vendors do. Indeed, I will go out on a limb and state that it will be easier to go with an off the shelf product than to ask a vendor to customize their system to deny coverage for a given plan.
Contraception isn’t controversial. If people were more honest they would stand up in church and say they use it. It’s still hard for me to be equivocal about what I see as the utterly hypocritical and dishonest status quo of the relationship between the institution and its individual members on this issue. Why don’t priests berate members weekly over their clearly contracepting membership? Because maybe even they don’t agree with the official position (of course they can’t SAY that)? Because they are afraid people will leave? So they are happy simply to buy silence with occasional public hand wringing like this, which is directed at their mostly non-Catholic employees while leaving the people who are supposed to be obeying in peace. It’s corrosive.
Great! Catholic-run institutions don’t have to pay for contraception. And let’s add a rider: those who opt not to are then required to provide free day care for employee children up to, say, age 12? Free parochial school tuition through high school? Maternal/paternal paid leave through, say, age 5? Contraceptive choices have real-world, expensive consequences, and those who wish to exercise their rights of conscience by not paying for contraception should be willing to bear the cost for that choice.
I think contraception is a gray area, somewhere between dietary choices (as noted above,) and directly medical needs. And I’m all for religious freedom, if we wish to apply it even-handedly. If you make this argument on grounds of religious freedom, then everybody’s religious freedom counts, right? No coverage for blood transfusions (so, realistically, no serious surgery) if your boss is a Jehovah’s Witness. No medical care at all if your boss is a Christian Scientist, but time off for “reading.” (Good luck if you’ve got cancer and are sent home to read.) No psychiatric care if your boss is a Scientologist. (But this argument brings good news for those who work for Rastafarians… :-) ) Health care can change dramatically when a new boss buys the factory. Underlying the “religious freedom” argument is, I think, a presumption that Catholic principles on this matter are somehow reasonable, and those of the JW’s, et al, are not.
Otoh, if you want to make this argument on grounds of contraception not being strictly “medical,” then, yes, let’s cut viagra, cialis, and a host of other non-essentials in pill form. And of course the pill will be available for other, non-contraceptive purposes, so if a woman wants the pill, she basically has to get a note from her doctor that she’s medically “qualified.” And, just as one in my neck of the woods can easily get a script for medical marijuana on pretty flimsy grounds, as well as serious medical need, I suspect the end result would be pretty free access. And what do you say to a woman who is fertile but has, say, low-grade kidney disease, for whom pregnancy would be a serious risk? Would she qualify or not? In sum, in cases like these, the physician is then put in the role of “enforcer” of Catholic doctrine, a situation that would discomfit many docs and infantilizes women. So a lot hinges on how you make your argument.
Easy enough to say “then don’t work for a Catholic/JW/CS/Scientologist.” And perhaps easy enough for the financially secure to switch jobs. But these delicate issues of salving the consciences of bishops who cannot even convince their own flocks of the “evil” of contraception hurts worse those on the financial bottom rungs, who must take whatever jobs they can get.
But the mandated free day care will certainly help…
The failure of the vast majority of married Catholics to accept the the teaching of Humanae Vitae on contraception stands firm after all these years. And according to their own standards, such a failure should have signaled long since to the Magisterium that the matter should be re-thought, like the church’s teachings on interest, slavery, and religious freedom. How is it that people trained in moral theology don’t see that including the case of contraception in their argument diminishes it by making them seem not acting according to properly formed consciences on the subject?
Lisa and Barbara – You do not understand the situation at hand.
Regardless of your individual views of the Catholic Church and all its faults, or what you or anyone thinks about contraception and planned families, Catholic institutions will not pay for contraception measures for its employees – period. That much is clear.
The question on the table is, whether or not our federal government is going to turn that fact – the fact that Catholic institutions and organizations are not ever going to pay for contraception measures for its employees – into a controversy.
The religious freedom issue seems to have come as a surprise. It’s importance didn’t seem to have been thoroughly considered in the debates of the last few years. We should learn a lesson and brace ourselves for more of the same unexpected results.
Familiar political processes can be foreseen if we are attentive. For example, mandates are extremely unlikely to remain modest. Coverage broadens almost inevitably because it’s easier to impose small diffuse costs on an inattentive majority in order to benefit a motivated minority. Medical special interests benefit from lobbying and there is no effective group lobbying for less comprehensive coverage. As coverage becomes ever more comprehensive costs can only go up.
There’s another twist in a populist electorate. If the upper middle classes are willing to spend 20-25% of their income on health care and the government decides that the same coverage should be available to all as a basic human right, then we will soon be spending 40-50% of our national income on health care, only a small portion of which can be paid for by taxing the rich. Even if many have better uses for their money, health costs will explode, inevitably crowding out other equally important needs (education, housing, welfare), the result of a program where each individual thinks that someone else should and will pay for his premium medical treatment.
Grant — your argument is as compelling as always. But turning back to the subject, do you understand anything about what “insurance” even is?
Ken, never is a strong word. Indeed, in places like California and New York Catholic institutions are already doing this (unless they fully self-fund, which most do not). Nanny-nanny boo-boo.
Lots of options here, Ken: they could estimate the cost of contraception and deduct it from people’s salaries so they won’t be “paying” for it. Lots of options for institutions that benefit greatly from taxpayer largesse, as Catholic institutions do. Indeed, it’s fair to say that the employees of these institutions are already paying greatly to keep the institution going, through their own state, local and federal taxes. Who owes what to whom?
Insurance, according to Webster’s, is “a device for the elimination or reduction of an economic risk common to all members of a large group and employing a system of equitable contributions out of which losses are paid.” Health care coverage partly does that, but it does other things as well, and I can’t imagine many Americans would like to see their health-care coverage modified to become pure insurance.
If so, it’s because they’re not thinking clearly. Insurance is supposed to cover risks that are 1) expensive, and 2) unpredictable. This is because expensive unpredictable risks can be impossible to afford at the moment — few people have enough cash on hand to rebuild their house or buy a new car, if disaster strikes. The same is true in the case of medicine: insurance, true insurance, is needed in the case of risks that are expensive and unpredictable.
Should car insurance cover every fillup at the gas station? Obviously not. And why not? Because that is an expense that is relatively cheap and perfectly predictable. If you know you’re going to spend $50 a week on gas, there’s no reason you’d want to add a layer of bureaucracy by filtering all of the gas payments through an insurance company.
Should home insurance cover every time you pay to have the lawn mowed? Again, obviously not. And why not? Because that expense is cheap and predictable. It is not a disaster that strikes once in a lifetime, if at all, and that would be impossible to afford without pooling your money ahead of time with thousands of other people. If you’re going to pay someone to mow your lawn, there’s no reason you’d want to add a layer of bureaucracy by getting an insurance company involved.
The same is true for trivially small “medical” expenses like contraception, routine checkups, and the like. These are not expensive disasters that almost no one can possibly afford. They are routine and predictable expenses. There’s no rational reason to think that “insurance” companies need to be involved.
Catholic-run institutions don’t have to pay for contraception. And let’s add a rider: those who opt not to are then required to provide free day care for employee children up to, say, age 12? Free parochial school tuition through high school? Maternal/paternal paid leave through, say, age 5? Contraceptive choices have real-world, expensive consequences, and those who wish to exercise their rights of conscience by not paying for contraception should be willing to bear the cost for that choice.
The only consequence of my not subsidizing someone else’s contraception is that they pay for it themselves. It’s absurdly paternalistic to treat people generally as so irresponsible that unless I give them $.75 to buy a condom, it’s somehow my fault that they went out and bore a child instead.
And Grant, if I was harsh, it’s because it’s frustrating to see the contraceptive/insurance issue discussed so many times by people who seem unable to grasp the simplest point about where the concept of “insurance” is useful and where it’s not. Some people, instead, have the juvenile idea that “insurance” means nothing more than, “Me getting free stuff! Awesome!,” accompanied by a sense of irrational entitlement and outrage if there’s anything in the world that “insurance” doesn’t cover (because how dare somebody not give me all the free stuff that I wanted?!?).
Catholic institutions will not pay for contraception measures for its employees – period. That much is clear.
I don’t think that’s clear. If the outcome of this dust-up is that Catholic institutions are required to provide health insurance covering contraceptives and sterilization, I think the bishops will decide that it is, at most, remote co-operation and something that can be done in order to preserve the good that Catholic institutions do.
I live in Massachusetts where we have a state operation called the “Health Connector” which is the equivalent of the exchanges that all states will have in 2014 under the Healthcare Act. The State requires that all policies sold through the Health Connector must include coverage for abortions. In the several years it has been in existence, I haven’t heard any word from he archdiocese saying that Catholic individuals or business owners should not purchase health insurance through the Health Connector.
If the good bishops at the USCCB do not obtain an exemption, they will need to start selling off Catholic hospitals; selling them to the government would probably be the most logical. The government will need those facilities (the brick and mortar) and that sort of sale would be charitable in that selling those hospitals to the government rather than to various private for-profit firms, would help ensure continuity of operation and generally minimize the impacts to certain folks of the middle and lower classes.
Taking a bigger view, establishing and maintaining a strict separation (an apartheid) between Church monies and government monies will definitely clarify things/roles. Seems it is a first, but key step toward a smaller and purer Catholic Church.
Please help me get clear aabout this editorial and the subsequent comments.
1. Am I correct that the religious freedom issue here is both an issue of public policy and one of Catholic moral teaching? As a public policy issue it would be a matter to be determined by practical wisdom. How does it fit into the complex of public policies that govern our political interaction with our fellow citizens? That’s an issue to be settled through normal political processes. As a matter of Catholic moral teaching, that is something that Catholics ought to be guided by, whatever the public policies.
2 If this is a matter of catholic moral teaching, am I correct that the reason it is prohibited is that it would require “proximate material cooperation in evil?” If so, let me ask:
(a) What is the precise scope of this prohibition? I have to confess that this notion of proximate material cooperation strikes me as too vague to apply in many cases.
(b) Would this prohibition extend to my donating money to charitable organizations that do provide the kind of health insurance that is in question here? For example, could I in good conscience contribute to Care? If I must avoid doing so, then what is my obligation to ferret out the details of the health care insurance in question?
These are not idle questions. I know for a fact that Catholic Relief Services has been stopped from seeking some grant money because, had it gotten the grants, it would have had to enter into contracts with entities that do provide their employees with health care coverage that includes contraception and access to abortions.
These are serious questions that I earnestly seek answers from competent people. I don’t need responses that are uninformed.
The Catholic bishops are not credible for more reasons than attacking the Obama administration on dubious grounds. They have proven themselves to be spineless, calculating politicians for far too long on so many moral issues it defies imagination.
Religious freedom is not at stake on this issue of contraception and sterilization. Contraception is a sin in the eyes of the bishops alone. The vast majority of Catholics around the world left the bishops behind on that issue a very long time ago.
Please explain to me,Editors, how a woman is to easily get contraceptives if she is denied coverage as the Catholic bishops desire?
When I saw the full page ad from the Catholic bishops in today’s N.Y. Times I thought ,my God these people are so out of touch with the important issues of today’s world. They should all get married, get jobs and get a life!
I just had to pull this quote from David Nickol: “Perhaps a government panel should be set up to study Humanae Vitae, and agree if they find it persuasive to allow broad exemptions for Catholic employers.”
I cannot think of a more clear violation of the First Amendment than having the government hold hearings to declare whether particular religious beliefs are reasonable or not. Next you will be asking the FDA to determine whether the Catholic Church should be punished for false advertising by claiming the bread and wine (whether in a cup or chalice) are truly transformed into the body & blood of Christ. Does the faith in the benevolence and wisdom of government and corresponding animosity to Church teaching know no bounds among the commentariat here?
Nobody’s being coerced into anything.
If you don’t want to provide tax-subsidized medical services, don’t.
“There are other ways that contraception can be made available to employees of Catholic institutions, should they choose to use it.”
No, not rilly. The hieracrchy will twist and turn and sneak through loopholes and resist anything expect a flat demand.
It seems we have two lines of discussion on this thread. The first involves whether or not the federal government to force Catholic institutions – institutions by the way, that already provide health insurance for the employees – to revise their existing insurance plocies to include contraception meansures and abortion. The second issue being discussed on this thread is whether or not the Catholic Church ought to change its teaching on contraception.
Since I am confident that most on this blog can agree that abortion is wrong, let’s start where we all agree. Let’s go back to the first line of discussion and by way of simplifying, clarifying this, leave out the part on contraception measures:
Q – Should the federal government force Catholic hospitals and universities (for example) to change the health insurance they provide their employees in order to cover abortion?
I just had to pull this quote from David Nickol: “Perhaps a government panel should be set up to study Humanae Vitae, and agree if they find it persuasive to allow broad exemptions for Catholic employers.”
MikeD,
That was, of course, a facetious comment. Do you really think a government panel would find Humanae Vitae persuasive when Catholics do not?
However, as the Commonweal editorial itself points out, religious exemptions are not always granted, nor would it be appropriate for them to be. Government ultimately had to decide whether Mormons got to practice polygamy, or whether whether people who used an illegal drug (peyote) for religious purposes should suffer consequences for it.
Ken,
Abortion is irrelevant to this discussion.
Some people, instead, have the juvenile idea that “insurance” means . . .
Studebaker,
I don’t see that you can keep pushing this point of what insurance “really” means when we all know that most health care coverage is not limited to being insurance in that sense. People with good insurance basically expect for it to pay most of their medical bills, and in many cases these bills are for routine, expected costs. In this one particular instance involving contraception, you want health care coverage to be thought of as “real” insurance, but I can’t imagine you are consistent.
Note: “Although some plans don’t pay any maternity costs, federal law requires companies with more than 15 employees to supply coverage that includes pregnancy-related medical expenses.”
This violates the principle of subsidiarity! Who is the federal government to make this requirement???
I don’t see that you can keep pushing this point of what insurance “really” means when we all know that most health care coverage is not limited to being insurance in that sense.
David, you’re getting the positive confused with the normative. I know very well that “most health care coverage” does pay for routine expected costs, but that’s PRECISELY why I think it’s a matter of intellectual confusion that anyone calls it “insurance.”
Look, if you want, you can just blindly accept whatever the world comes up with. If car and home insurance cover certain types of expenses (emergencies) and not others (routine small expenses), while health insurance seems to be expected to cover everything anyone can imagine no matter how small, you can just shrug and say that’s the way it is, and who cares what the concept of “insurance” is anyway.
Alternatively, one can rise above merely looking at the world and seeing what exists, and think more deeply about why insurance exists and what purposes it serves. Only then can one even understand the questions that are raised whenever someone claims that insurance “ought” to cover something that is no more a proper subject for insurance than deodorant or toothpaste.
“Why should the moral matrix be different if compensation is being provided in the form of employee benefits,. . . ”
Barbara –
Because the Catholic bishops and other administrators see providing certain employee benefits as against their own consciences. Their consciences might be wrong, but that is irrelevant when the issue is freedom of conscience. I think that the Jewish prohibition with regards to ham is irrational, but they have a right to preclude serving it in their cafeterias.
I have just read the USCCB submission to HHS explaining its objections to including “contraceptives and sterilization.” I did not find anywhere a statement that it would be sinful for Catholic individuals or institutions to provide such coverage, but I did find this:
“When a religious organization in particular pays for private conduct, the inescapable message is that it does not disapprove of that conduct. As noted above, a religious organization cannot communicate an effective message that conduct is morally wrong at the same time that it subsidizes that conduct. In particular, Catholic organizations cannot effectively and persuasively communicate the Church’s teaching that contraception and sterilization are immoral if they simultaneously pay for contraceptives for their employees or (in the case of colleges and universities) for their students.”
As I suggested in an earlier post, Catholic institutions could counter that impression by stating clearly that the Church teaches that contraception and sterilization are immoral and we include coverage for them only because the law requires us to do that.
As a separate issue, the letter notes that some contraceptives are, in the Catholic view, also abortifacients
At the end, the USCCB explains what it would be willing to settle for:
<i
David N, I beg to differ. All of the digging and squirming around and using sophist weasel wording to describe everything associated with trying to avoid child birth; it always leads eventually to abortion.
On the basic chronology of legal contraception, one need only follow the arc to discover where it leads. In America, we took a slight detour to accommodate the mad and racist eugenics “doctors” (ugh what a stretch that is), but otherwise we followed this sequence
- Condom
(eugenics, at least until old Hilter screwed that up for the secularists)
- BC Pill
- Abortion
- Euthanasia
If we stay on this course, we will probably round back to Eugenics with all its horrors.
This all works together you see, it is an integrated system important to any purely secular society. In some corners it is known as “the culture of death”.
At the end the USCCB explains what it would be willing to settle for:
III. Conclusion
The HHS mandate should be rescinded in its entirety. If HHS refuses to do that, then it must address the most grievous and intolerable aspects of this misguided mandate by (a) excluding from the mandate those drugs that can cause an abortion, and (b) exempting all stakeholders with a religious or moral objection to contraceptives, sterilization, and related education and counseling.
My guess is that the administration will probably get rid of the abortion-producing (by Catholic definition) contraceptives and will broaden the exemption to cover most Catholic institutions but not so broadly as the USCCB proposed.
The USCCB letter is at: http://www.usccb.org/about/general-counsel/rulemaking/upload/comments-to-hhs-on-preventive-services-2011-08.pdf
David N – Think of it this way. What good is the right to BC pills if (in case you forget the pills one day) you don’t have the right to have a state-funded abortion, and what good is the right of an abortion if you cannot also have the State pay to put old grandma or some handicapped person down?
Jeez – You don’t understand anything!
;-)
Oh and how could I forget eugenics: Why do our sons have to fight and die in wars when our government can fund research to allow us to clone and/or genetically engineer (read breed) special people who would be ‘especially suited’ to be warriors? Just look at the jobs that sort of research program would create! I guess it really would be a brave new world.
I do not know why the Catholics are so against science.
“David N, I beg to differ. All of the digging and squirming around and using sophist weasel wording to describe everything associated with trying to avoid child birth; it always leads eventually to abortion.”
There you have it, folks: chastity and NFP (both “associated with trying to avoid child birth”) are all part of one big trend that always leads to abortion.
Nor is this the only deadly trend that ought to alarm us. Just look at the chronology of the following inventions, the “arc,” if you will:
– the wheel
– the printing press
– the steam engine
– nuclear weapons
This all works together, you see. All of these inventions are part of an integrated system important to any secular society. Start using carts to carry things you used to carry on your own back and before you know it there are mushroom clouds appearing over Japanese cities. Some call it technology; others, the culture of death.
Their consciences might be wrong, but that is irrelevant when the issue is freedom of conscience.
Ann,
No one in the United States has the right to absolute freedom of conscience based on something their religion or they disapprove of.
Ken’s slippery slope:
- Condom
(eugenics, at least until old Hilter screwed that up for the secularists)
- BC Pill
- Abortion
- Euthanasia
How did you fail to interject homosexuality in that linkage?
Come to think of it, homosexuals don’t have any need for any of these practices in order to prevent births. All we do is adopt children unwanted by their birth parents.
David N,
Of course you were being facetious, but in your response you make the strange analogy between the Catholic position on contraception (which this particular Catholic finds perfectly pursuasive – regardless of your insistance on knowing the private conduct, fertility cycles and consciences of all married Catholics in the world) which is a prohibition on conduct and the position on poligamy and peyote use of other religions. For religious acomodation and exemption issues there is a big difference between a government policy that involves a generally applicable prohibition on conduct (like the ban on poligamy and peyote use) and a government policy requiring conduct in direct violation of a religious belief. Do you think the government can force the kosher deli to serve BLTs because it is open to the public the vast majority of which finds the jewish and muslim prohibition on eating pork to be utterly unpersuasive (even when the message is delivered by Samuel L. Jackson http://www.youtube.com/watch?v=c0zJSgHDnpw).
” What employees do with wages is their own business, –”
Far from the truth. Wages and benefits are a tax deductible business expense; hence there are some forms of justifiable control. Discriminatory practices based on gender and race are prohibited, among other things. 401K plans have to pass certain discrimination tests that measure the benefits to the highly compensated versus the rest of the employee group and prohibited disparate impact. ERISA comes into play with medical and retirement benefits plans.
What employees do with wages is far from their own business!
“It’s absurdly paternalistic to treat people generally as so irresponsible that unless I give them $.75 to buy a condom, it’s somehow my fault that they went out and bore a child instead.”
Studebaker —
For once I agree with you completely. In spite of my strong liberal leanings I think that we have turned the U.S. into a nanny-state. What confirms this for me regularly are the little signs at exits from USPO’s that say “Fasten Seat Belts”. Dammit, that money could have been spent on better things, but noooo, we little children need to be reminded to maintain our own safety. #$%(&*& !!!
Support from that other publication:
http://ncronline.org/blogs/distinctly-catholic/kudos-commonweal
a government policy requiring conduct in direct violation of a religious belief
MikeD,
Catholic organizations will not be forced to provide insurance coverage to employees that pays for contraception, since Catholic organizations will not be forced to provide insurance coverage at all. There are cases where some employers are required to pay a tax if they do not offer insurance to their employees, but as I recall, many who object to “Obamacare” claim that it will be to companies’ advantage to pay the tax and let their employees buy their own insurance. The concern is that employers will stop providing insurance coverage.
So the government is not forcing Catholic organizations to do something against their will. It is saying if they want to provide insurance coverage, it must meet certain requirements.
“No one in the United States has the right to absolute freedom of conscience based on something their religion or they disapprove of.”
I never even hinted at denying this. My very narrow point was that this issue is one of freedom of conscience. The particular issue (requiringRC hospitals to pay for contraceptives, etc.) is already a very muddy one, and introducing extraneous issues only muddies the waters further.
Ken –
Your arc from condoms to euthanasia is a great example of associative thinking which claims to embody a causal sequence. Just because you have images of people buying and using condoms associated with images of people buying and using BC pills followed by images of people having abortions does not mean that there is any sort of causal relationship between what the images represent. True, we sometimes find that associations turn out to be causal one, but the mere association in your mind and your subsequent judgment (“See? Allowing the druggist to sell condoms results in people buying and using other contraceptives!”)
This sort of associative thinking seems endemic among fundamentalists. Consider: ” My morality is dependent on belief in God. Atheists do not believe in God, so atheists have no moral codes”. Or, “Rock music is what contemporary musicians love to play. Rock musicians love to use heroine. Rock music causes drug use. Rock doesn’t belong at Mass.”
Associative thinking (some people call it “common sense”) can be worse for a culture than a plague. It corrupts the mind.
“. . . but the mere association in your mind and your subsequent judgment (”See? Allowing the druggist to sell condoms results in people buying and using other contraceptives!”
should have ended:
“. . . but the mere association in your mind and your subsequent judgment do not justify your assumption that your images represent real causal relationahips among actual things. No matter how strongly you have convinced yourself, the vividness of your associated images does not guarantee that they represent facts in the real world.”
I’ll be quiet now.
By the way, Grant, awesome editorial.
I find the policies of the Church in contradiction and inconsistent, especially the recent USCCB condemnation of the proposed HHS requirement of covering contraceptive services.
1. The Church does not want to be required to pay for contraceptive services or be required to offer these services as a covered expense in their healthcare plans. However, they allow contraceptive couples to receive the Eurcharist under the principle of gradualness for habitual sinners without a realistic firm purpose of amendment. The real fact is that virtuall all Catholics don’t confess contraception as a sin. The Church knows 97% of married couples use contraceptive methods of birth regulation stand online each week to receive Holy Communion. Yet, they do nothing about this issue but find it offensive to be required to cover such expense in healtcare plans. This is called hypocrisy.
2. If Catholic instiutions (i.e., hospitals, universities) are allowed to excluded certain healthcare services from a covered expense in their healthcare plans (which would cover catholic and non-catholc members), then other religious instiutions should be able to do the same. Unfortunately, this would be discriminatory and non-uniform public policy.
No one is forcing Catholics or non-Catholic members of Catholic institutions to seek contraceptive services. If Catholics abide by the Church’s teachings, there would be no contraceptive expense for the Catholic institution to pay for. The Church wants to force its teachings about contraception onto Catholics and non-Catholics who work for a Catholic institution, while igoring the contradiction of allowing contraceptive couples to receive the body of Christ. This is called the silent pulpit.
Re John Hayes’s comment at 4 pm today: What is the status of the USCCB’s “bottom line.?” What are we the faithful supposed to do with it? Their statement sounds like a prudential judgment, one that we the faithful ought to take seriously, but that we can rightly respectfully disagree with if we are so minded. Am I correct about this? If not, then what is the unshakable moral principle that would require me to accept the bishops’ “bottom line?” If the principle is something like the impermissibility of “proximate material cooperation…” then what is the scope of the applicability of that principle?
The ramifications of whatever answer one makes to these questions are far from trivial.
Please note that my questions concern matters of moral theology. They are not meant to defendor attack any statement either by USCCB or any particular bishop.
What Michael Barberi said – in spades!
Stuart Buck: Are you capable of being less obnoxious?
As usual, thanks for being so careful to include my full name. No one else, except perhaps Mollie, is so thoughtful as to be worried about whether I’ll show up in Google searches. And to do so while purporting to oppose obnoxiousness — well, that just shows what a stand-up fellow you are, always ready to take the high road and debate on the substance.
According to Michael Barberi: “The real fact is that virtuall all Catholics don’t confess contraception as a sin. The Church knows 97% of married couples use contraceptive methods of birth regulation stand online each week to receive Holy Communion.”
This is utterly rediculous since only 22% of self professed Catholics even attend mass at least once a week. Of that percentage, only 79% of those always receive communion. Also, the vast majority of those that do attend mass every week are too old to be needing contraceptives. http://cara.georgetown.edu/CARAServices/requestedchurchstats.html
But we should all disregard these statistics and listen to you and David Nichol who know the private sexual lives, confessional behavior and consciences of all those people in the pews each Sunday.
UND and HAS have proposed a compromise? That ghas the Cardinal Newman society all tied up in angst?
Does anyone know more? The divisiveness of the coments here make me think the agument here does litle to advance the”mission of the Church.”
And, also, way too much of “I know better.”
But we’ve had those approaches many times before (including, debes en quando, my own.)
MikeD, I’ll ignore those statistics when the Bishops stop saying that they represent __ million “Catholics” without qualifying the fact that it’s actually only less than 30% of that number, according to YOUR statistics. In any event, when you look at who shows up for weekly mass (at least around here) an awful lot of people are in the two parents plus two kids spaced perfectly two years apart category.
BTW, the Guttmacher (a.k.a. Planned Parenthood) survey that Michael Barberi and David Nichol are likely relying on for their “97% of Catholics use contraception” statements indicates that of the women (survey only looked at age 15-45) who claim to be Catholic, just 3 in 10 attend Mass weekly, 1 in 10 never attend Mass, and the remaining 6 in 10 attend monthly or “less frequently.”
Barbara, they are not MY statistics, they are from CARA at Georgetown (hence the link). Nice to know you are joining David N. & Michael B. in looking around you on Sunday and presuming to know the sexual practices, fertility cycles and consciences of everyone else. Maybe you should visit our parish where there are plenty of big families that take up enitre pews, including a few that are adopted because the couple can’t naturally conceive their own.
the Cardinal Newman Society all tied up in angst
The letters by Fr. Jenkins of Notre Dame and Sr. Carol Keehan of the Catholic Health Association were sent back in September and are available here:
http://president.nd.edu/assets/50056/comments_from_rev_john_i_jenkins_notre_dame_3_.pdf
http://www.chausa.org/WorkArea/DownloadAsset.aspx?id=4294969669
They both recommend adopting a definition of “religious institutions” that exists in the Internal Revenue Code. That is not enough for the Cardinal Newman Society because it wants to exempt every organization and individual person who objects to contraception from having to provide insurance that covers it.
I was interested by the following statement made by Sr. Keehan in her argument for excluding contraceptives that, in the Catholic view, are abortifacients because they may prevent implantation:
“For a Catholic employer to participate in abortion in any way, including by paying for an abortifacient drug through its health plan, is a grave violation of the moral teachings of the Catholic Church.”
As I said in an earlier post, I am not aware of any official position that the Church has taken on whether providing insurance that includes coverage of abortion along with other benefits is proximate or remote cooperation.
Since the state of Massachusetts, where I live, requires policies sold through the State program to include overage for abortions, I am pretty sure that I would have heard if the Church felt that Catholic individuals or business owners should not buy these policies.
I assume Sr. Keenan is not a moral theologian so i wonder what is the source of that statement.
MikeD,
First, on the really important issue, my name is spelled with a k (Nickol).
Second, I have no idea how many Catholics who attend weekly mass, are sexually active, and are of childbearing age, use contraceptives. I have consistently seen reports, whether from Guttmacher or other sources, that the number of Catholics who practice some form of fertility break down into those who use NFP (less than 5 percent) and those who use “artificial” contraception (over 90%). I do know the folks who write over at Vox Nova who practice NFP find themselves a very small minority, and I have never, ever heard anyone claim that it is not true that the vast majority of Catholics who are in an actual position to either user or not use artificial contraception actually use it. Of course, occasionally someone says that no Catholic uses artificial contraception, because to use contraceptives is to put yourself outside the Church. (No true Scottsman . . . .)
David,
First, sorry about the name (next time I will have to think “St. Nick” rather than “St. Nicholas” to get it right).
Second, I do not doubt that the majority of married Catholics of childbearing have use artificial contraception (sterilization seems more prominent than the pill in some surveys I have seen, which leads to an interesting discussion on reconciliation for what may be an irreversible procedure in some cases). I wouldn’t claim such a thing nor would I make the no true scotsman claim. I also would never presume that any of those married couples around me at Mass on Sunday were actively using contraception, whether they had 1, 2, or no children. I know enough couples that struggle with infertility and pray for children to assume that any particular couple is contracepting.
“Before you cost-estimate proposals like Mirena for those who do not think as you do, you might care to find out what you are talking about”
Hi, Jack, my cost estimate for Mirena was obtained the same way that I assume millions of women figure it out: I googled “birth control prices” and went to some pharmacy sites. If what I posted is factually inaccurate, perhaps you could set us straight. Perhaps you would also indicate the relevance, if any, of the link you provided to my comment.
I do think that Bernard and Barbara have raised an important question: how remote does the cooperation need to be in order to pass moral muster? Barbara, I don’t understand your proposal that Catholic institutions have insurance companies handle the contraception reimbursements. Isn’t this already what happens, unless the institution self-insures? I understood the USCCB’s objection as encompassing what you’re proposing, but perhaps I don’t understand your suggestion.
I don’t think he actual cost of contraceptives affects the issue, but when I gave a dollar vallue I started with the form most women choose – pills:
“Nearly half a century later, and despite the introduction of IUDs, patches, injections, and the female condom, the pill remains the No. 1 form of contraception. It’s used by an estimated 12 million women in the U.S. and 100 million women worldwide. According to Paula Hillard, MD, “When you say ‘birth control,’ most women think of birth control pills.” A professor of obstetrics and gynecology at the Stanford University School of Medicine, Hillard says that birth control pills are still widely popular, especially among younger women.”
I then checked what brand had the largest market her – that is Yaz.
Drugstore.com’s price for Yaz is $252.97 for a three-month’s supply
So I used $1000 per year as a nice round number.
Isn’t the cooperation quite remote? Bishop Lynch of St. Peterburg claims he will end insurance coverage for diocesan employees if HHS doesn’t broaden the conscience exemption. In order to keep employees, and not to run afoul of the demands of justice, he will have to offer them additional compensation to purchase coverage on the open market, plans that will likely be more expensive and less comprehensive, although they certainly could include contraception and abortion coverage. How clearly is he thinking? What happens when a diocesan employee goes out on the open market and buys coverage that includes abortion and contraception? What happens when an employee can’t get very good coverage because he lacks purchasing power, and ends up with a pile of medical pills he can’t pay? Or forgoes treatment because it could bankrupt him?
In the United States, benefits are part of a worker’s compensation package. To what extent is the institutional church cooperating in evil when its employees purchase contraceptives with their salaries? What is the difference between a diocese giving employees money they can spend freely and giving an insurance company money for coverage that may or may not include procedures and drugs the institutional church deems gravely immoral, or necessary to a gravely evil act? What happens if a diocese pays, say, Aetna for a plan excluding the pill and abortions, when other Aetna plans include such services? Is that diocese remotely cooperating in evil? If so, how might a bishop justify such a thing? Perhaps by weighing it against the good of health coverage for his employees–coverage individuals likely could not get for themselves on the open market?
“I have never, ever heard anyone claim that it is not true that the vast majority of Catholics who are in an actual position to either user or not use artificial contraception actually use it.”
Hi, David, I agree with you that it is well-established that a majority of sexually active Catholics of child-bearing age use contraception, or don’t object when the partner does.
What is the importance of this fact?
One aspect of its importance could be that the Church (conceived of as all of the People of God) is voting with it’s, er, feet: that widespread contraceptive usage represents an emerging (or even already-emerged) moral consensus – that this is what the church actually *thinks*.
If we wanted to test that hypothesis, we’d need to break down the numbers according to the following:
* Those who don’t understand what the church teaches on this matter
* Those who do understand what the church teaches, but have a genuine conscience objection on this particular topic.
* Those who do understand what the church teaches, know what they are doing is wrong, but do it anyway – i.e. have chosen to live with what they know is sinful.
I don’t know what how the percentages break down among those three categories. My suspicion is that the first bullet – those who are Catholic but don’t know what the church teaches about contraception – is pretty high, probably surprisingly high for folks around here who are old enough to remember HV and the conflict that surrounded its issuance. To put this as gently as possible: many of those folks are no longer of child-bearing age, and their children and grandchildren have grown up in a culture in which the use of contraception is not seriously contested. (I take as a symptom of this reality the phenomenon that a number of commenters here genuinely seem to have a difficult time wrapping their heads around the fact that the church objects to contraception and would even establish policies and take actions pursuant to that objection). I believe that a lot of young Catholic adults, especially those who are relatively casual about their Catholiciscm, would be truly surprised to learn that in the opinion of the Magisterium, contraception is a sin.
My expectation of the second bullet is that it is a relatively low percentage of Catholics in general, but a relatively high percentage of Commonweal Catholics.
My expectation of the third bullet is that it is probably the highest of the three possibilities. This is, from a pastoral point of view, perhaps the most interesting/worrisome thing: that people know something is wrong, do it anyway, and just live with it. Contraception certainly isn’t the only example; one need look no farther for another example than the numbers of Catholics who divorce and remarry without bothering to get the previous marriage(s) annulled.
And this points to the other possible importance of the fact under consideration, that is, of the widespread use of contraception of Catholics: that it reflects the Magisterium’s lack of credibility on this matter. To explore that aspect, we’d need to inquire why the Magisterium doesn’t have this credibility, particularly when it seems that, as recently as 2-3 generations ago, its authority *was* recognized on this matter. I have thoughts on that, too, but I’ll save them for another comment if I have the time. I still have some Christmas shopping to do.
I don’t think Studebaker has come out and explicitly said so, but I’m gleaning from his distinction between “pure” insurance and other stuff that is included with insurance packages but isn’t really insurance that he might, conceptually, support health insurance that covers catastrophic events but doesn’t require taxpayers to pay for checkups, prescriptions, contraception and other non-catastrophic, relatively routine and inexpensive items.
I would, too.
I’d add that health savings accounts, which are owned by the individual rather than the employer, would seem to provide subsidies for routine items like contraception while maintaining the appropriate degree of remoteness from the Catholic employer.
This is a very careful and well-written editorial. As should be evident from my previous posts, I do disagree with it at several points. However, the most puzzling statement in the piece was this:
“There are other ways that contraception can be made available to employees of Catholic institutions, should they choose to use it.”
Does this mean that while denying access to contraception to their employees with one hand, Catholic institutions might use the other to refer their employees to other organizations, like Planned Parenthood, that provide such services free of charge? This just seems like a way to get someone else to do your dirty work for you. If Catholic institutions are really morally against such reproductive health services, it seems strange for them to cite the availability of such services via other avenues in support of their argument not to have to provide them. Also, I don’t see Catholic institutions giving a lot of support, financial or otherwise, to their secular counterparts. Is the Church going to start referring people to Planned Parenthood as a pro-contraception alternative to its own health services?
Grant – well reasoned and makes the bishops’ argument weak at best. As a large employer, the church has a responsibility to provide benefits that are comprehensive (in US society, this includes access and coverage for contraception). If the church fails to do this, then it becomes a justice issue and the employees are penalized.
The church, universities, dioceses can provide comprehensive benefits as a human justice issue while at the same time highlighting that some access/benefits are not supported by catholic beliefs – it then becomes a “personal, ethical” decision and choice.
Jim P. (12:28pm) —
A price/device like the one you give can be found online ($218.20) at, for example,
http://www.birthcontrolbuzz.com/product.aspx?DrugName=Mirena+IUD+Device
The link I provided offers directions from the manufacturer intended for the consumer —
“• To be inserted by a trained healthcare provider using strict aseptic technique. ……
• Patient should be re-examined and evaluated 4 to 12 weeks after insertion; then, yearly or more often if indicated. (2.3)”
How do you cover that in your $175/year for the family? Trained health care providers are part of the cost if you choose to suggest better women’s birth control options, with or without insurance.
Jim, HSAs often turn out to be punitive to families, and especially, families with chronically ill members, who save nothing and often bear a disproportionate burden of how HSAs dilute the risk distribution and transfer component of insurance. Health plans/insurers play multiple roles for their members — most basically, of course, they transfer and spread catastrophic risk. In addition, they are power buyers who significantly reduce the cost of services and supplies for their members. They might do other things as well, but those two things are each important enough to justify the inclusion of non-catastrophic but very clearly health related expenses in a health insurance policy. It can be overdone, but $70 per month for Yazmin, versus, half that cost, is a lot of money for most people. BTW, HSAs themselves, definitionally under the IRC are permitted only when the attached health plans pays for preventive services with first dollar coverage, that is, when they are excluded from the deductible.
An IUD costs around $700-$1000 when both the device and insertion are included. It can be spread over 5 to 10 years, so works out to be cheaper than most BCPs, but it is not cheap up front.
In addition, they are power buyers who significantly reduce the cost of services and supplies for their members.
All of Barbara’s points are good, but I want to call attention to this one. If something is not covered by your insurance and you have to pay for it yourself, you are going to pay a lot more for it than the insurance company would have paid. I doubt that it would be acceptable to the Church, but if they don’t want to pay for contraceptives by having the cost included in insurance, the people who use contraceptives could reimburse the insurer for the cost of the contraceptives. That way they would at least be getting the discount that the insurance company gets, and the employer wouldn’t be paying for the contraceptives.
Jim,
I have a problem with the idea that people should have to read encyclicals and study moral theology to know right from wrong. Perhaps all people really need to know (and it is in Wikipedia) is that of the 72 members of the Papal Commission on Birth Control (“including 16 theologians, 13 physicians and five women without medical credentials, with an executive committee of 16 bishops, including seven cardinals”) the majority found “that artificial birth control was not intrinsically evil and that Catholic couples should be allowed to decide for themselves about the methods to be employed,” while only “4 theologian priests had dissented, and 1 cardinal and 2 bishops had voted that contraception was intrinsically dishonest.”
Show me where it is written in Writ that to be a Catholic one has to attend mass at least once a week?
Um, David and Barbara, it’s been more than 4 years since Wal-Mart announced that it was selling two contraceptives for $9 a month. http://www.nytimes.com/2007/09/27/business/27cnd-drug.html
If you really want to prevent births, you can even double up on condoms, and your overall birth control expense will still be cheaper than just about anything else that it’s possible to buy, except for maybe chewing gum and the like.
Studebaker,
Perhaps I am misreading you, but your essential message seems to be, “If the b_tches wanna have sex when they shouldn’t, let them go to the nearest gas station and buy a condom.”
The most widely used form of contraception in the United States is the pill, not the condom. Women get the pill from their doctors, as of course they should and must, because it is a prescription drug. Most Americans, including most Catholics, don’t see anything wrong with that. About 50% of major health plans do cover contraception, so on the one hand, admittedly the new regulation is a major change, but on the other hand, it is not so outlandish that half of insurance plans don’t already cover it.
I have heard good arguments in favor of high-deductible plans that pay for only unexpected medical costs, and I could probably do reasonably well with one myself. But many people—probably most people—would find it difficult to afford decent health care with a high-deductible plan. They just wouldn’t go to the doctor, wouldn’t take their kids to the doctor, and wouldn’t buy prescription drugs. According to one site I looked at, oral contraceptives cost about $30 a month. For many people, that’s not a lot, but for many people it is.
I do understand the religious freedom angle to this, but you tend largely to frame it as an issue of sluts who shouldn’t have sex at all, and if they do, they shouldn’t be freeloading off of good folks like yourself to get free contraceptives. Maybe it’s all unintentional on your part, or I am misreading you, but you simply sound scornful and contemptuous of women who use contraceptives (or maybe even women in general).
David — I haven’t said anything that even remotely justifies what you just wrote, and I’d thank you not to put words in my mouth. I’d be just as scornful of anyone who thought it necessary to have the federal government mandate that insurance companies cover the cost of all the drugs on Wal-Mart’s “$4 a month” program. Insurance companies probably already do just that, of course, but I think it’s silly to mandate “insurance” for such routine and cheap expenses. That’s not what “insurance” is for, and if you can’t afford $4 a month, you need cash transfers more than you need further regulation of whatever is labeled “insurance.”
Similarly, all I’ve said here is that it’s fairly absurd to think that the entire mechanism of the insurance industry needs to kick in gear to help people establish a payment plan for items that cost as little as $9 a month (30 cents a day). Name anything else that you can buy for 30 cents a day — the cheapest candy bar or can of soda costs more than that these days. Are we next going to hear demands that health “insurance” cover the cost of sugar-free gum?
The purchasing power argument is interesting, although I’d suggest that its implications seem morally wrong to me. If 1) people part of a large “insurance” plan get everything cheaper b/c of purchasing power, and if 2) people not part of a large “insurance” plan are, on average, less privileged in life, then the purchasing power of insurance companies merely serves to redistribute money from less privileged people to more privileged people.
Wal-Mart and Target seem to be doing a much better job of using purchasing power to give cheaper drugs to everyone, not just to the more privileged people with good jobs.
Studebaker,
I have excellent health insurance, but I have a $10 copay for generic drugs (90 day supply) and a $25 for brand name drugs. (And this is only if I use the designated mail-order pharmacy.) So let organizations who don’t want to pay for contraceptives have a $10 copay for generic drugs, require them to use Wal-Mart or Target to fill prescriptions by mail order, and cover only the inexpensive generics in the insurance plan’s formulary. Problem solved.
Grant (1:09pm) brings up worker’s compensation. In most cases discussed, the funds that an employer pays to an insurance company under contract are acquired through the work of the employees. For health insurance, both an employee-paid share and employer-paid share become fundable only because of the employees’ work and the money it brings in.
Such “benefits” are not gifts to the workers. They are compensation for labor. The benefit I receive is the enhanced buying power of the employer using money I worked to bring in. The employer is able to procure for me something valuable to my family and me, more efficiently than I could. Amidst the many legal constraints that apply, it is worth keeping in mind how and through whom the diocese, the bishop, or other came into control over the funds under discussion. Moral constraints remain the same, but their implementation might be more considerate of Catholics and non-Catholics who work.
Suggestion of limiting coverage to catastrophic events requires some definition of ‘catastrophe’. It is not hard for a sequence of events that are medically non-catastrophic but non-elective to accumulate in effects and costs over a year or ten and create an extreme financial burden on the family involved, independent of plans and income.
Grant Gallicho says: “isn’t this cooperation quite remote?”
If this article is correct, Fordham, Georgetown and DePaul universities think it is remote – or, at least, they don’t consider it proximate.
Fordham draws a distinction between providing insurance that covers contraception (which they do) and prescribing contraceptives in your own clinic (which they don’t).
many Catholic hospitals and universities have been covering contraception for their employees and students for years, and have managed to continue to serve non-Catholics and uphold their mission. Fordham University, Georgetown University, and DePaul University, for instance, all offer their employees health plans that cover contraception, as does Catholic Healthcare West, a large Catholic hospital system in California, Nevada and Arizona.
Fordham, which is forced to cover contraception because it is ineligible for the religious exemption in New York’s Women’s Health and Wellness Act, gets around the rule by refusing to prescribe birth control on campus….
A spokesman for Fordham University confirmed that the health center covers students’ birth control but does not prescribe it. “Fordham is a Catholic university and follows church teachings on reproductive issues,” he said.
A Georgetown University spokeswoman said that it offers employees “access” to outside health insurance plans that cover contraception and abortion, but that the school’s own insurance plan excludes those services. This way, Georgetown can comply with Virginia and Maryland’s state mandates (the health plans are licensed in those states as well as D.C.) while adhering to its Catholic values.
Catholic Healthcare West, which runs more than 40 Catholic hospitals, also provides birth control coverage options to its staff of more than 60,000, a spokesperson for Anthem Blue Cross confirmed in an email. CHW did not respond to calls for comment.
http://www.huffingtonpost.com/mobileweb/2011/11/29/catholic-clergy-bishops-birth-control-hhs_n_1119099.html
I guess my worry would be that some bishop(s) will teach that it’s proximate “because if we do that people will think we approve of artificial birth control.”
That would be similar to the approach taken in the minority report prior to he release of Humanae Vitae – i.e. to let worry about public perceptions become more important than the issue itself
“”If it should be declared that contraception is not evil in itself, then we should have to concede frankly that the Holy Spirit had been on the side of the Protestant churches in 1930 [when Casti Connubii was promulgated) and in 1951.”
“It should likewise have to be admitted that for a half a century the Spirit failed to protect Pius XI, Pius XII, and a large part of the Catholic hierarchy from a very serious error. This would mean that the leaders of the Church, acting with extreme imprudence, had condemned thousands of innocent human acts, forbidding, under pain of eternal damnation, a practice which would now be sanctioned. The fact can neither be denied nor ignored that these same acts would now be declared licit on the grounds of principles cited by the Protestants, which Popes and Bishops have either condemned, or at least not approved.”
http://en.wikipedia.org/wiki/Pontifical_Commission_on_Birth_Control
Will these good Catholic places offer insurance (if there is any) that offers NFP resources?
Unfortunatly, MikeD could benefit from correcly interpreting statistics The statistics on world-wide married couples who practice periodic continence (PC) was taken from the following legitimat source:
Population Reference Bureau, Family Planning Worldwide: 2002 Data Sheet (Washington D.C.: PBR, 2002), accessed July 14, 2011 at http://www.prb.org/famplanworldwide_eng.pdf
There have been numerous surveys that all conclude the same thing, about 3% of US Catholic married women practice PC-NFP. Ditto for married women internationally.
In 2007, Dean Hoge’s research documented the opinions of Catholic generational chorts. 67% of Catholics who attend “weekly Mass” assert that you can be a good Catholic without obeying the Church’s teaching on birth control. In terms of cohorts, only 8-10% of all Catholics ages 18-39, and 40-62 say it is always morally wrong to use condoms or birth control pills.
The point is clear and substantiated that priests look the other way in distributing the Eucharist to the overwhelming majority of Catholics who practice some form of birth regulation condemned by the Vatical as intrinsicaly evil. While only a small percent of Catholcs attend weekly Mass, most of them who fall within the fertiilty cycle of married life practice contraception.
About what insurance is for ==
It seems to me that while it makes sense for companies to define it as sharing *risks*, it makes more sense for buyers of health insurance to define it simply as sharing total *costs*. In other words, my premiums are simply my share of my insurance company’s bills. While it is true the buyers share risks to some extent, they also share non-risky, expected costs, like flu-shots and other preventive medicines.
Yes, all sharing of total costs benefits the less affluent more than the well-to-do, but the well-to-do are also benefited because when the less affluent cannot afford premiums (ask Jean about this) the costs are greater for the well-to-do. Not to mention the fact that one of the greatest medical boons ever have been vaccines, and the wider their use the better protected even the very rich are. If Gordon Nordquist’s servant had scarlet fever, he and his kids would be endangered.
Moral: we’re all in this together.
I regret the apparent demise of high deductible, high co-pay, low premium, non-comprehensive health insurance. I’d like to see the reasoning of the board of scientific experts that led to this turning point in health policy, though I can’t help but think it wasn’t science alone that led to the Sebelius decision. To the extent that medical providers have major influence my expectation is that maximally comprehensive coverage will be deemed absolutely necessary and very little weight will be given to either cost considerations or religious concerns.
If that’s the way the game is to be played then the “comprehensive” coverage should include payment for counseling at pro-life centers and courses in NFP and perhaps many other programs that favor traditional family practices. The more choices, the better, and expenses be damned.
Jimmy Mac says: “Will these good Catholic places offer insurance (if there is any) that offers NFP resources?”
Maybe that’s the answer. Get the bishops to push for a requirement that health insurance plans cover all family planning supplies – NFP as well as contraceptives.
Then NFP users could buy that $500 computer/thermometer that some people are excited about.
It’s probably not covered now because you don’t need a prescription.
A candidate for Catholic insurance coverage — For $399, “New software offers high tech version of Natural Family Planning”. This would publicize the fact that the Catholic bishops do allow birth control if done properly.
Plus a unitive marital benefit, whether the couple’s goal is to procreate or avoid it: “We just started to see how the men enjoyed taking part, … The men really enjoy charting their spouses’ cycles.”
http://www.lifesitenews.com/news/new-software-offers-high-tech-version-of-natural-family-planning/
I regret the apparent demise of high deductible, high co-pay, low premium, non-comprehensive health insurance.
Patrick Malloy,
From the New York Times, September 27, 2011:
As the cost of health insurance continues to rise, workers can expect to see high-deductible plans, with ever-higher deductibles, becoming the norm, the president of the Kaiser Family Foundation predicts.
“It’s the biggest tool in the toolbox that employers have to hold costs down,” said Drew Altman, president and chief executive of the foundation, in a telephone call today with reporters.
Mr. Altman made the remarks while discussing the findings of the annual Employer Health Benefits Survey conducted by the foundation and the Health Research & Educational Trust. The study is based on a telephone survey of 2,088 randomly selected public and private employers with three or more workers, conducted between January and May of this year. The study found that the average cost of work-based family health coverage rose by 9 percent this year, after several years of more modest increases.
The survey reported that the number of employees covered by high-deductible health plans, and the number of companies offering the plans, jumped this year, “as employers seek more affordable coverage options and are potentially seeking to shift increased costs to workers.”
This year, 17 percent of covered workers were enrolled in such plans, compared with 13 percent last year and just 8 percent in 2009. And 23 percent of firms offering health benefits offer them, up from 15 percent last year. The plans, which typically are paired with health savings or reimbursement accounts, generally carry lower premiums for workers, but have higher annual deductibles than other plans. Plans that can be used with health savings accounts, for instance, must have a deductible of least $1,200 for an individual and $2,400 for a family.
Mr. Altman described the shift to high-deductible plans as a “quiet revolution” that was redefining employer-based health insurance in the United States, from a service that offered wide-ranging, comprehensive coverage to one that offered limited coverage: “The nature of what we call health insurance is changing, without a great deal of analysis or debate.”
The idea behind the high-deductible plans is to have consumers pay closer attention to costs when they seek health care. But, as one reporter on the conference call noted, it remains difficult for patients to get reliable up-front information about the pricing of health procedures.
Patrick, you are probably thinking of the first generation of such plans. The trend has been to greater and greater adoption of such plans, in some cases, by making it the only plan or otherwise structuring contributions to make it the plan of choice. In addition to what David N. said above, however, the current generation of HSA/HDPs must exclude preventive care from their high deductible component. Thus, what counts as preventive care is an important concept. This still makes it hard for families with children that have chronic conditions, for instance, asthma, for which the drugs are not considered to be preventive, but that must be paid for year in and year out in such amounts that the deductible more or less acts as an additional premium (all but guaranteed expense associated with health insurance).
Barbara and David,
I would not be surprised to see a temporary upsurge in these plans, in order to be grandfathered if nothing else. But I think Altman’s observation. “The nature of what we call health insurance is changing, without a great deal of analysis or debate,” is important. When the act goes into full force the definition of “comprehensive” will have changed (isn’t that what the editorial is about?) and my contention is that the change will be one-way. Which commissioner is going to say that what was once considered essential is no longer essential, against intense lobbying and in the face of horror stories in the press? So of course there may be more or less comprehensive plans allowed but the less comprehensive plans in the future will be more comprehensive than the less comprehensive plans of the past. An important option will have vanished in the name of reform. As one wag had it, the older less comprehensive plans will be thoroughly forbidden throughout the free world.
And as Nancy Pelosi wisely told us, we’ll just have to see what’s in this plan after it’s passed and in place. We await further word from Secretary Sebelius and her experts. For the latest convolution in this confusing drama see: Kathleen Sebelius’s Health Care Muddle
http://www.washingtonpost.com/opinions/kathleen-sebeliuss-health-care-muddle/2011/12/22/gIQArlUPCP_story.html?hpid=z3
David Nickol,
You recently corrected someone for misspelling your name. Allow me to do the same. My last name is “Molloy” not “Malloy” as you have it when you respond to me. A helpful hint — the middle letters “ollo” are symmetrical – that’s how I remember the way to spell my name :-).
More importantly there is a Rick Malloy, S.J. who blogs here occasionally and who would probably be deeply embarrassed to be associated with my views.
I defer to Samuel Beckett who spelled the name authoritatively in his novel “Molloy.”
You recently corrected someone for misspelling your name. Allow me to do the same.
Patrick Molloy,
Apologies!
For the latest convolution in this confusing drama see: Kathleen Sebelius’s Health Care Muddle
Note that that article is on the Post’s “Opinion” page. Samuelson doesn’t like Sibelius’s decision to let each state set the minimum level of benefits to be provided in that state.
“For the latest convolution in this confusing drama see: Kathleen Sebelius’s Health Care Muddle”
Note that that article is on the Post’s “Opinion” page. Samuelson doesn’t like Sibelius’s decision to let each state set the minimum level of benefits to be provided in that state.
Patrick, I don’t disagree with what you are saying, but the best way to deal with what you are talking about is to decouple more of what can be bought in the way of health care products from requirements for physician prescriptions. It can be done, it was done for Claritin, for instance, which we now all buy OTC, without a prescription, and without insurance coverage, but I am guessing it’s a topic for another day and probably another audience.
I like the other comments that some Catholic institutions offer several health plans to employes (Catholic and non-Catholic). This is common based on my experience as a health benefits consultant to health plans, governments (Federal and State), and large employers.
Sometimes the plan sponsor will set the price of the preferred or organizational plan as the benchmark. If another plan (with contraceptive coverage) is more, the employee pays the different in cost. This not always equitable since alternative plans can be HMOs or a Managed Health Plan, or an Indemnity Plan. Benefit levels are not always comparable and access is another issue as well.
There are many ways to “skin the cat” and a one-size-fits-all plan does not work.
I fall back on equity and non-discrimination criteria when it comes to plan design and employee contributions. The states usually control insurance law and many coverage rules. That is why we have a slew of state regulations, often different, in terms of mandatory coverage. We do not have a prefect system and the Federal Government will be implementing more of Obama Care next year, and that will likely make things worse.
In my 30+ years of consulting, my experience with government plans and actuarial cost projections tells me that the cost savings of Obama Care was over-estimated, and prices and utilization under estimated.
“How do you cover that in your $175/year for the family? Trained health care providers are part of the cost if you choose to suggest better women’s birth control options, with or without insurance.”
Sure, but the question at hand is, Should Catholic institutions be required to subsidize birth control? That is the scope of the HHS regulations under dispute, as I understand it.
I expect that employee insurance plans offered by Catholic institutions include gynecological care. Both women on birth control and women not on birth control need that care. I don’t know of any proposals or plans to discriminate in the delivery of gynecological care against women on birth control.
” It can be done, it was done for Claritin, for instance, which we now all buy OTC, without a prescription, and without insurance coverage, but I am guessing it’s a topic for another day and probably another audience.”
I’ve been using GERD “maintenance meds” for a number of years, and have had prescriptions to a variety of different medications as my employer has switched insurance carriers, and as costs have gone up and down. On at least one occasion, I’ve asked to switch because the medication I had been taking no longer required a doctor’s prescription – and by buying it over the counter, my costs went up substantially (no insurance subsidy for OTC).
Thank you to Barbara and all, btw, for this civil and informed discussion of a contentious and controversial issue.
The issue of employee cost sharing is a separate issue but one that needs to be part of the overall decision of providing coverage. Plan sponsors have been increasingly passing on a percentage of the total cost increase of healthcare plans for decades. This has beome problematic because there is a limit to passing on costs to employees. It is called affordability….which is you point. This is not lost on me.
These are complex issues. However, I have a big problem with the issue of discrimination because many employees of Catholic institutions are non-Catholic. Take the example of a woman whose life is threatened by a pregnancy where the fetus will not survive under “any circumstance” but the mother’s life could be saved if the pregnancy is terminated (e.g., the Phoenix case). Most hospitals consider this procredure medically necessary, and to many moral theologians in the Catholic Church this is “indirect abortion”. How does the plan administrator abide by their Erisa-type responsibilities in approving or disapprroving this procedure as a covered expense, when the Church and the Catholic institution says it is a “direct abortion” and the Catholic hospital and medical staff say it is not. Keep in mind that “medically necessary” is often the litmus test for covered expenses. It is a medical opinion, not an opinion of the plan sponsor. This issue of direct and indirect may be defined by the plan sponsor, but this is rarely spelled out in plan descriptions of plan contracts. This issue gets more complicated when the patient is not Catholic!!
As a public policy, non-discrimination rules benefit everyone.
Jim: Every time an employee of a Catholic institution buys birth control with her or his paycheck, that institution is subsidizing artificial contraception.
Studebaker wrote: “it’s been more than 4 years since Wal-Mart announced that it was selling two contraceptives for $9 a month.”
David N replied: “I have excellent health insurance, but I have a $10 copay for generic drugs (90 day supply) and a $25 for brand name drugs. ”
I admit I’ve never gone to Target or Wal-Mart to fill prescriptions (maybe I should), but I assume that it would be cheaper for a person on David N’s insurance plan to go to Target and pay for the prescription out-of-pocket for $4 or $9 than to pay a $10 or $25 copay and having a pharmacy submit a claim for the remainder to the insurance company. Yes?
That I don’t do this already (my insurance plan is not identical to David’s but sort of in the same neighborhood) illustrates that I’m not a very savvy consumer, which is not news to me nor to anyone who knows me. I wonder how many people like me there are out there? Or, I guess the answer is, If I’m too thick or lazy to shop for a better price, then I deserve to pay more.
“Jim: Every time an employee of a Catholic institution buys birth control with her or his paycheck, that institution is subsidizing artificial contraception.”
Morally and legally, this is not true. To illustrate with a common example: if my employer throws a Christmas party in which unlimited alcoholic beverages are served for free to the employees, and one of them drives home drunk and causes an accident, the employers I know believe that the employer may be liable – and I expect that most reasonable people would agree that the employer was morally negligent. On the other hand, if the employer serves no alcohol at the party, but an employee drinks too much anyway, drives drunk and causes an accident, the employers I know believe that their liability is substantially less, because they took reasonable precautions.
There seems to be a moral and legal difference between subsidizing and not subsidizing something.
To apply your logic to health care: Why should I offer my employees any health care insurance whatsoever? By your logic, I’m already subsidizing their health care by paying them a paycheck. What they do with their money is their affair. Every payday, it seems that I’m fulfilling my moral duty.
What do morals and laws have to do with the question of whether compensation for labor amounts to employer subsidies of what employees decide to do with their pay?
A little history and information.
1. Since the advent of some retail chains offering specific generic drugs for a flat retail price, that is often less than a member’s copay, Rx administrators have a provision in their legal contracts with pharmacies that call for the pharmacy to collect the “lower of” the copay or the usual retail price. This is sometimes very confusing and often prone to abuse or error on the part of the pharmacy is requesting the copay. If this issue is something important to you, you should talk to your Rx carrier about it.
2. Benefits are part of an employee’s total compensation. The issue is not about being responsible for the things employees purchase with their cash compensation, but rather the issue about benefits is about a state or federal regulation requiring plan sponsors to offer coverage in their health plans for contraceptive medicine/drugs because it conflicts with the plan sponsor’s religious beliefs as a “religious institution”. As mentioned, these are thorny and complex issues.
In the past, if a plan sponsor wanted to exclude certain expenses as a covered expense in their health plans, they would have to exclude it for all classes of employess. This varied by plan sponsor and also by state, since state laws govern health plans (as do some aspects of federal law). After so many years, we ended up with non-uniform coverage rules and regulations that were expensive and complex to administer. Some states required health plans to offer coverage regardless if the contract was issued in another state. This meant that an employers plan would have coverage for certain expenses in some stated and not in others. It forced some plan sponsors to make the coverage available in all states.
The federal government decided that “certain expenses” were required to be included in all health plans to make thing uniform, and cosistent with non-discrimination laws and medical necessary provisions. This is one example of how healthcare costs have been increasing.
How the Obama administration will handle the “religious institution excepton” is anyone’s guess.
“. . . one of them drives home drunk and causes an accident, the employers I know believe that the employer may be liable – and I expect that most reasonable people would agree that the employer was morally negligent.”
Jim P. ==
This is the sort of thinking that turns me more conservative than I used to be. I don’t think it is in the least bit “rational” to assume that employers *do* have the intelligence and virtue to avoid getting drunk when offered free drinks while employees do *not* have the requisite control to limit their drinking. Sure, if an employer pressured an alcoholic to take a drink, then he should be liable — and the opposite should also hold.
From what you say it looks like corporations are turning into nanny-institutions, just like the federal government. If the adult citizens of this country don’t have the brains and will power to accept responsibility for their own actions, how in the hell can we expect them to be good parents or to vote sensibly or do any of the things adults are responsible for? (Excuse my French, as they used to say.) Not only that, this sort of thinking seems to be just a projection of the old sort of paternalism based on medieval (in the bad sense) attitudes towards peasants.
Sure, because single policies are so very expensive it makes economic sense both for an employer and the employees to have a company health plan as part of employee compensation. On the other hand, if there were one insurance provider for everyone, the pool of insurees would be even larger and the premiums would be even less expensive. So a national health plan also makes great good sense for employers and employees (except for insurance companies, you can bet your bippie.). This is not paternalism, but sound business practice and governmental policy.
Grant, I thought the issue at hand was both legal (HHS regulations have legal force) and moral (subsidizing contraception violates Catholic institutions’ moral beliefs).
I apologize if I was too dismissive in my previous comment to you. You’ve raised an interesting question. I’m looking at it through the lens of what I believe to be your take on the overall issue, and one with which I agree: that at some point, the connection between the Catholic employer and the employee becomes remote enough that the employer can reasonably conclude that its not formally cooperating in the procurement and use of artificial birth control.
If I’ve correctly described your approach, then your comment that paying an employee cash which she can then spend as she wishes is the equivalent of a specific subsidy of the immorality in question really did confuse me. If that wasn’t the intent of that comment, perhaps you could clarify what you meant in claiming that a paycheck is a form of a subsidy. Because to me, the two scenarios – subsidizing contraception, vs. paying the employee a salary which she can choose to spend however she wishes – are, morally speaking, quite different. Very likely, the distinction between the two scenarios is the distinction between material and remote cooperation in the act under consideration (using contraception with contraceptive intent).
Once again, Ascension Health’s little primer on ethics is helpful. As laid out in the link below, I’d classify a subsidy for contraception as a form of mediate material cooperation, and I’d suggest that a forced subsidy of contraception fails to meet the three criteria given to justify mediate material cooperation in evil.
“Mediate Material Cooperation. Mediate material cooperation occurs when the cooperator participates in circumstances that are not essential to the commission of an action, such that the action could occur even without this cooperation. Mediate material cooperation in an immoral act might be justifiable under three basic conditions:
* If there is a proportionately serious reason for the cooperation (i.e., for the sake of protecting an important good or for avoiding a worse harm); the graver the evil the more serious a reason required for the cooperation;
* The importance of the reason for cooperation must be proportionate to the causal proximity of the cooperator’s action to the action of the principal agent (the distinction between proximate and remote);
* The danger of scandal (i.e., leading others into doing evil, leading others into error, or spreading confusion) must be avoided.”
http://www.ascensionhealth.org/index.php?option=com_content&view=article&id=82:principles-of-formal-and-material-cooperation&Itemid=171
Jim,
Here’s one of my points–the one responding to your claim that providing health insurance amounts to subsidizing an employee’s health-care purchases: In the United States, benefits are part of an employee’s compensation package. That’s why Bishop Lynch, after threatening to stop providing health insurance to his employees, said he’d offer diocesan workers more money on top of their base salary, which they could use to buy insurance on the open market. That means an employer is subsidizing, in one form or another, his employees’ purchases. Workers spend most of their wages on food and shelter, obviously. But there will always be employees who spend their money on things the church considers immoral–or things necessary for immoral acts. That is true whether the employee is spending cash on condoms or co-paying for birth-control pills mostly covered by the health insurance she earns by working for the diocese.
But even if you disagree with me about the nature of compensation in the United States–namely that benefits are properly construed as part of a worker’s wages (this is how employers think of it, by the way)–then you still have to figure out whether paying for a health-care plan that may result in some employees’ using it to purchase artificial contraception (for non-medically indicated reasons) necessarily involves the bishop in formal material cooperation with an act the church considers evil. I don’t believe paying for health-insurance that includes contraception coverage amounts to formal material cooperation with evil because the employee may or may not take advantage of the benefit, and the act of using artificial contraception is something an employee could engage in with or without health insurance.
Rather, when a Catholic institution pays for health insurance that includes birth control, it is–according to Catholic moral thought–remotely, freely cooperating with evil. Remote material cooperation is permissible when there are proportionate reasons. It seems to me that providing health care for someone who could not get comparable coverage as an individual on the open market (and at this point an individual could not) is sufficient reason to freely and remotely cooperate with an act the institutional church considers evil.
Another reason I believe bishops who threaten to stop providing health insurance to employees are not thinking clearly is that the nature of the act of paying for non-contraceptive-covering policies is not at all pure. As I mentioned above, when a diocese pays Aetna for a plan that excludes contraception coverage, does the bishop believe Aetna is not using diocesan funds to cover other plans that do include contraception? By such bishops’ logic, they are already formally cooperating with evil by paying insurance companies. (That curious way of thinking appeared in several forms during the health-care debate.)
“you still have to figure out whether paying for a health-care plan that may result in some employees’ using it to purchase artificial contraception (for non-medically indicated reasons) necessarily involves the bishop in formal material cooperation with an act the church considers evil. I don’t believe paying for health-insurance that includes contraception coverage amounts to formal material cooperation with evil because the employee may or may not take advantage of the benefit, and the act of using artificial contraception is something an employee could engage in with or without health insurance.
Rather, when a Catholic institution pays for health insurance that includes birth control, it is–according to Catholic moral thought–remotely, freely cooperating with evil. Remote material cooperation is permissible when there are proportionate reasons. It seems to me that providing health care for someone who could not get comparable coverage as an individual on the open market (and at this point an individual could not) is sufficient reason to freely and remotely cooperate with an act the institutional church considers evil.”
Let me just say first of all that this is defensible – maybe even persuasive :-) – moral analysis.
Also, as Michael Barberi has said more than once now, this is extremely complex.
I’ve suggested, and continue to hold, that the nature of the Catholic institution’s moral cooperation would be neither formal cooperation nor remote cooperation, but mediate material cooperation – which is still *material* (not remote) cooperation.
From an accounting and finance point of view, I agree that to an employer, compensation is compensation, whether it is paid as cash or as an insurance benefit. But even if there isn’t a monetary difference, there is a vast moral chasm between birth control being funded by the institution’s funds (as would be the case when it is subsidized by the institution’s insurance premiums) vs. when it is funded out of the employee’s own checking account. The institution is able to exert considerable influence over the use of funds in the former, and no influence whatsoever over the latter. If intention counts for anything, as it surely does in this case of a non-intrinsic evil like birth control medication, then the difference between the two sources of funds is the difference in the employer’s intention. When an employee pays for her own birth control, she is doing so *despite* the intention of the Catholic institution.
Having said all that: your point is very well-taken. As I’ve said before, there are many worse sins in the world than contraception. Procuring health care in the United States is not an even playing field between those who have employer-subsidized health care and those who don’t. If the choice is between a health care plan that includes birth control, and no health care plan at all, that seems to be a no-brainer. But best of all is a health care plan that doesn’t require a Catholic institution to cooperate in evil. Even if, for the sake of conversation, I agree with you that such would constitute remote cooperation, I would say that even remote cooperation should be avoided if it can be.
At any rate, Commonweal’s editors and I seem to have ended up at the same position. I agree with Paul Moses: it’s an awesome editorial.
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