Raw majoritarianism, department of regulation
Imagine a large institution that provides free meals to the poor, and imagine that the institution is run by Jains, who are vegetarians. None of the meals offered by this institution include meat, though many of the people to whom the meals are offered are neither Jains nor non-Jainist vegetarians. Now imagine that the federal government (never mind under which agency) issues a rule that requires any organization that offers the poor free meals to include meat on its menu, with the single exception of religious organizations that offer only coreligionists free meals. In the statement announcing the new requirement, the government points out that most people do eat meat, and that most doctors believe meat is good for you in the right amounts, since it provides important nutrients that are difficult to find in other foods. The statement does not mention that most people find the Jains’ arguments against eating meat bizarre and irrelevant (it doesn’t need to). Like other vegetarians, Jains are eager to point out that it ‘s possible, though more difficult, to get the proteins meat provides from other foods, and that eating meat involves other health risks. Defenders of the new rule insist the government is being asked to indulge a sectarian scruple at the expense of public health.
Now, does one have to believe it’s wrong to eat meat — for the reasons adduced by Jains or for any other reason — to believe that the government should not force Jainist soup kitchens to offer it? I don’t think so. I don’t agree with Jains about vegetarianism (though I do think there are formidable moral arguments against eating meat), just I am not persuaded by the reasons offered by my own church for its teaching about contraception (though I think there are formidable non-moral arguments against the pill). But I also don’t believe it’s the federal government’s job to decide whether Jainism’s arguments for vegetarianism or the Catholic Church’s arguments against artificial contraception are worthy of respect or accommodation. Nor does it matter how small a part of the general population is vegetarian, or even how many Jains quietly ignore their religious community’s doctrine. (Let us stipulate, for the sake of this imperfect analogy, that Jainism teaches not only that Jains shouldn’t eat meat, but also that it is wrong for them to be complicit in the meat-eating of other people; perhaps it doesn’t.)
If the only permissible expressions of religious freedom are those that do not conflict with the surrounding secular culture, then religious freedom is an empty phrase. If religious freedom means only that everyone is free to have different religious reasons for doing what the state expects everyone to do anyway, whatever they believe — or if it means only that one may worship a god of one’s choosing however one likes so long as one serves one’s chosen deity in a way that neatly corresponds to the priorities of the state — then the principle of religious freedom is no more than decorative.
By not serving meat, the Jainist soup kitchen isn’t forcing anyone to become vegetarian, or withholding something to which the people they serve have a right. The right to eat meat does not entail the right to be served meat by Jains. The Jains’ willingness to serve hungry people food that will keep them alive and healthy does not oblige them to serve them every food approved by nutritionists, even if the nutritionists are confident that the people the Jains serve would be healthier at less expense if the Jains expanded their menu. If the government thinks the free provision of meat is an urgent public good, the government must arrange for that provision itself, and not simply mandate that other institutions provide it (or provide nothing).
Long ago Americans decided that education was something that all children in this country were entitled to, whether their parents could afford to pay for it or not, and so we created a public-school system. Call it the default public option for education. The government also regulates private schools, but it does not insist that they have exactly the same curriculum as public schools; it doesn’t need to, precisely because public schools are available to everyone.
If we are going to speak of health care as something to which all are entitled, no matter how much money they have (and I believe we should speak of it this way), then we need to make sure a default public option for health care is available to everyone. This option could cover whatever the government believes health insurance ought to cover — including, perhaps, some things that certain religions disapprove of. People could still get private insurance that covered a little less or a lot more, just as people can still send their children to private schools. But the government would no longer be in the awkward position of demanding that other institutions offer some public good only on the government’s terms while failing to provide this good itself.
Excellent analogy, Matthew. Excellent. Thanks.
Outstanding.
Tangential, but this reminds me of a controversy in France over a private association that had a soup kitchen serving soup to the homeless people in Paris, but the soup had pork in it and they served it with wine, thus excluding Moslems and Jews.
http://archives-lepost.huffingtonpost.fr/article/2010/11/15/2304854_paris-les-identitaires-continuent-a-servir-leur-soupe-au-cochon-interdite.html
(As to the analogy to private school curriculum: in France the government only subsidizes the private schools that follow the basic official curriculum. Other schools are free to exist but are necessarily more expensive for students, since they do not receive that financial help from the government.)
This analogy doesn’t really hold up any better than the would-you-expect-pork-chops-at-a-Jewish-barbecue one. (A) nobody is asking the bishops to “serve” contraception — they don’t have to hire doctors that will write the prescriptions, they don’t have to fill them, they don’t have to come into contact with it at all. (B) There are a number of valid medical (non-contraceptive) uses for contraceptives, and as far as I’m aware, it’s not just “more difficult” to get those from other types of medication — it’s impossible. Did you not read about the girl who lost the ovary? I personally know dozens of women who have been on the pill at one time or another in their lives to deal with one aspect or another of their menstrual cycles. I myself was on it for four or five years in high school and college. I wasn’t sexually active for any of that time, as it happens. But something went wrong in my system and for nearly a year, before I finally saw a gynecologist and got on the pill, I had periods that lasted for weeks, mostly with fairly heavy bleeding. It just went on and on, and I got anemia (of course). The pill brought me to a regular cycle. I can’t imagine what I would have done without it — looking back, I can’t believe I waited that long to go see someone, but I was only about 13 or so, and I guess I just thought it was “normal” or something. I don’t even know.
What I’m saying is, ask around your female friends. This really can be medically necessary, for all sorts of reasons (even reasons that don’t have to do with having abortions — which believe me, our undergraduates definitely are), and it’s scandalous that we’re making such a big deal out of this.
Very good, Matthew. I know some Jains, and I plan to share it with them to get their reaction, too. ;)
Imagine a large institution that provides free meals to the poor, and imagine that the institution is run by Jains, who are vegetarians.
—–
Free?
Like the hospitals and universities run by Catholics?
Easy solution to both problems: get out of any business that makes you uncomfortable about rendering unto Caesar.
Jesus founded no hospitals. His healing was free.
He established no schools. His teaching was free.
The Church has ventured far from the gospels. Time to get out of the business of business. If the bishops had no employees, they would not have to provide insurance, and the government could not force non-existent employees to use birth control.
Catherine O:
All analogies are imperfect. (A perfect analogy — one without a remainder of dissimilarity — is not an analogy at all, but an identity.) Still, I don’t think your points tell against the analogy I’ve offered.
It’s true, as you say, that Catholic institutions are not required to provide contraception to their employees, only to help pay for it by funding an insurance plan that explicitly includes it (or else pay a penalty for not offering health insurance). Of course, Catholic institutions can hardly avoid some kind of remote material cooperation with contraception, as long as they pay their employees anything at all in a country where contraception is legal and available for sale. But when it comes to remote material cooperation, the more remote the better. It is not irrational for the bishops to draw the line here, even if it is not the only place where the line could be drawn.
The Catholic Church teaches that “artificial” contraception is immoral, not that any particular pill is. So far as I know, no bishop or Catholic theologian has suggested that the church could not help pay for a contraceptive pill when it is being used to treat some real pathology. Of course, this is a difficult distinction to apply in practice. If the health insurance offered by Catholic institutions covered contraceptive drugs only when they were prescribed for a non-contraceptive purpose, some doctors, scornful of this moral restriction, would help their patients get around it. It would be almost impossible, not to mention repugnant, to enforce the distinction rigorously. That does not make it useless.
“If the only permissible expressions of religious freedom are those that do not conflict with the surrounding secular culture, then religious freedom is an empty phrase.”
Yep.
Matthew: Yes, of course many doctors would write around the issue — they would prescribe contraceptives for “medical reasons” when there isn’t one. (It seems to me that this makes it a matter of the doctors’ and patients’ consciences, rather than of the bishops’.)
I don’t see why that invalidates the real need of many people for this medication in the way that your vegetarian analogy does.
Last time I checked — which was two years ago — Fordham’s health clinics wouldn’t write prescriptions even for really validly medically necessary reasons. (I’m a student there, making this a matter of somewhat pressing interest for me.) And, again, did you read about the woman at Georgetown who lost the ovary? This is a real-life problem for a non-trivial number of women and it goes beyond the question of whether contraception used, as it were, contraceptivally, is against the natural law.
To be clear, my main problem is with the way these food analogies utterly trivialize the situation women find themselves in. We’re not talking about optional fun recreation (=barbecue) or even about perhaps less optimal but still totally fine sustenance (=vegetarianism).
(The solution, obviously, by the way, is single-payer, but that’s not the world we live in, unfortunately.)
No analogy is perfect, indeed, but some are downright silly. The provision of free food to the poor is a materially different undertaking from the provision of health and education services for a fee, largely funded by government programs and provided by non-adherents. If the Jains undertook to carry out a government program to feed the poor and accepted federal funds and employed non-Jains to carry out the contract, then, indeed, it would not be improper for the government to put some minimum standards on how the Jains could fulfill that contract, including the serving of meat where meat is indeed important to a given population, for instance, a population that has allergies to common vegetarian foods like nuts or milk, or just because, you know, the government’s interest is in FEEDING people and making sure the poor will actually show up to take advantage of the service — and, perhaps, they know that homeless people in need of food are particularly likely to be deficient in protein, and thus, they want to fund a stable source of protein in the diets of the poor. Whatever the policy reasoning, the government’s insterest, assuredly, is not in paying for the promotion of the philosophy of the Jains, however noble it may seem to the Jains. And add to that, how the government might feel if it found out that, notwithstanding the professed creed of the Jains not to eat meat, in fact, 95% of Jains do in fact routinely eat meat, making the whole debate seem more like an effort to gain the government’s coercive power in enforcing the Jain creed than promoting the original public interest of the government program.
Now that would be a more accurate analogy.
“Yes, of course many doctors would write around the issue — they would prescribe contraceptives for ‘medical reasons’ when there isn’t one. (It seems to me that this makes it a matter of the doctors’ and patients’ consciences, rather than of the bishops’.)”
I agree completely. The distinction will often be overlooked in practice. That does not mean it’s a distinction HHS should not accommodate in its regulations.
And the accommodation must work both ways. If the Church is opposed to the use of contraceptive drugs only as contraceptives, it must carefully target its opposition against that use alone. The Church’s teaching against contraception is debatable (even among Catholics). A policy of withholding support for the use of therapeutic contraceptive drugs to treat serious pathologies is indefensible.
Finally, I expected some people to say such an analogy trivializes women’s health. Jains and people like Peter Singer would disagree. (A trivial analogy would be to some association of dietary faddists who, say, don’t eat carbs for nonethical reasons and run a soup kitchen where carbs aren’t available.)
Matthew, here is how it seems to me: USCCB wants to be part of the mainstream but can’t stand the institutional compromises that are inherent for ANY institution that wants a seat at the political table. Other people’s interests count, and when your own position on an issue, such as contraception, is such an outlier that even your own adherents ignore it, it is not going to gain mainstream acceptance. The Amish understand this, as do the Amana, and yes, even Jehovah’s Witnesses. I am not saying this with any kind of satisfaction, because I think HV really took the church off the rails and has created all of these needless conflicts that keep people from uniting for some really positive common purposes — but if you want to locate the core of your beliefs in outlier principles you are going to be put in impossible positions when you try to gain influence for them in a majoritarian, representative democracy, if not now, then later, if not with this policy decision, then the next one.
Catherine, Humanae Vitae and most Catholic-approved health insurance policies make explicit exception for oral contraceptives to help with medical issues. So if Fordham wasn’t writing that scrip that’s a problem of them abiding by Catholic teaching, in a way. What is a “medical” issue is of course a matter of prudential and expert judgment, and there is a lot of latitude.
A very good analogy.
@David Gibson: It may not be in line with official Catholic teaching, but it’s what happens–and often–when the default presumption is against rather than in favor of writing the scrip. The question for Catholic colleges is too often not “what is medically necessary” but rather “how many barriers can we throw up in the way of this.”
And Matthew, you should have expected people to say that this analogy trivializes women’s health–because it does. That is a feature, not a bug, of these arguments.
I’m not a terribly articulate blog commenter; I think Barbara has put the case better than I could, so I’ll stop.
Great analogy. Those complaining about government funding and fee for service are missing the point. The government is not funding this activity; it is trying to mandate that the bishops fund the service. Thats the problem.
Btw, do you realize that the cost of these pills is largely trivial running $15-50 per month. There are very few women, or their male partners, who could not afford to pay for these out-of-pocket.
Matthew:
If it could be shown that the meatlessness of the Jainist soup kitchen was a material detriment to PUBLIC HEALTH, then, Yes, not only should the Federal agency be allowed to insist on non-meatlessnes, it would be the agency’s duty to insist on it.
This really isn’t that hard. I’m glad you supposedly-liberal supposedly-Catholics have a chance to get in good with your supposedly-conservative supposedly-Catholic colleagues for once, but seriously–do you think you can win the policy point?
Even dispensing with the policy arguments (which I believe are dispositively on the Obama Administration’s side), culturally, do you really think in the world we live in now you’re going to win an anti-contraception argument? Really?
I think it is a poor analogy, because there is really nothing significant at stake whether the Jains serve meat or not. I think it is fairly hopeless to try to make this a better analogy.
The major problem is that the IOM identifies unintended pregnancy as a significant problem for women, and a health problem, not just an inconvenience. There’s too much information to try to present here, so I urge people to read the section titled Preventing Unintended Pregnancy and Promoting Healthy Birth Spacing beginning on page 102 of Clinical Preventive Services for Women: Closing the Gaps.
Of course, one of the consequences of the huge numbers of unintended pregnancies in the United States is well over a million abortions a year, something which the Catholic Church finds shocking and shameful, but something for which the Church has no realistic proposals to deal with.
As I have been saying, I believe the current situation is unacceptable, and some compromise must be found that will satisfy both sides. But the contraceptive mandate is not just a matter of handing out free contraceptives to women. It is about a public health issue which is very real.
David — there are other and safer ways to prevent pregnancy (safer for the women, that is, if that matters). Why is it so important to you that women use a less safe method?
I appreciated the analogy for its starting point, but largely agree with the many who have critiuqued it. Neverthelesss, i appreciate the dialogue you continue to comment on, Matthew,
Although it was a good starting point, I hope you can see that it has served its purpose and can be retired,
Together, the meical, practical, and philosophical reasons seem to me to point out that this kind of “carve out” cannot work and that a greater exploration of the Madison expereince and Hawaii model may be more fruitful to explore.
And Matthew, you should have expected people to say that this analogy trivializes women’s health–because it does. That is a feature, not a bug, of these arguments.
Agree. The far-fetched allegory is offensive not only to women, but to Jains. Why drag them into it? Why not speak plainly?
I’m not a terribly articulate blog commenter; I think Barbara has put the case better than I could, so I’ll stop.
I hope you’ll reconsider. Men know how easy it is to silence women, and powerful men (bishops, editors of Catholic periodicals, et al.) are particularly eager to do so.
Did you notice that the question you asked twice about the woman who lost an ovary went unanswered? Yesterday Commonweal dismissed the article in which that was reported as an “op-ed”. “The bishops and the New York Times are made for each other!”
Barbara — your modifications make the analogy much worse. E.g., we’re not talking about anything here that is “largely funded by government programs,” the overwhelming majority of artificial contraception isn’t being used for any actual medical reason (it’s disabling a healthy body, not healing a disease), and the “government’s coercive power” is completely irrelevant except insofar as you and your ilk are trying to wield it to force people to subsidize stuff that you like but they object to.
Btw, do you realize that the cost of these pills is largely trivial running $15-50 per month.
This is beginning to get tiresome. The regulations do not require fee birth-control pills for all women. Many women should not (or do not want to) take oral contraceptives. The regulation is for “the full range of Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling for women with reproductive capacity.” It seems many of the opponents of the mandate want women to get, by hook or by crook, a prescription for the cheapest generic oral contraceptives available from discount stores rather than have the ability to talk the whole matter of contraception over with their doctors and find the method (and, if it is advisable) the particular drug that best suits their own personal needs.
This seems to offensive to me that I can’t begin to imagine how disgusted I would be if I were a women of childbearing age.
Once again, though, I do think there must be a compromise acceptable to both sides. There is a real issue of religious freedom involved here.
I am not going to attempt to make my own analogy, but it seems to me one pertaining to vaccinations would be more illuminating than one about vegetarianism.
Stu, this may come as a surprise but health benefits are largely if indirectly funded by the federal government. The Jain analogy as posted was truly and purely a private charity and the analogy focused on the actual services provided by the Jains. In this case, the mandate has nothing to do with the actual services provided by Catholic institutions, who are free not to provide contraception tomorrow just as they are today. The mandate involves the definition of a qualifying benefit plan for purposes of certain governmental advantages. No employer has to provide benefits (they do so to “compete” with other institutions in the commercial sphere for employees). No employer has to provide benefits for which the employer obtains significant financial advantages (they do so to obtain financial parity with their competitors). To pretend that this has nothing to do with federal funds is a form of denialism, almost as much a form of denialism as pretending that condoms are more effective than OC or IUDs (even if, under Church Doctrine, they too are just as anathema).
The Church has a choice to make. It’s not the fault of women the choice is so hard and it’s certainly not our duty to ditch our own interest in self-determination to make it easier. Smaller and purer doesn’t just mean within the confines of the sanctuary, it has repercussions for the Church’s participation and role and influence within society at large.
David — there are other and safer ways to prevent pregnancy (safer for the women, that is, if that matters). Why is it so important to you that women use a less safe method?
Studebaker,
The HHS requirements do not mandate any particular method of contraception. If a woman in consultation with her doctor determines that NFP is the most effective, most healthful method, then Kathleen Sebelius isn’t going to intervene and demand the woman be given a prescription for oral contraceptives.
safer for the women, that is, if that matters
Women will not be forced to do anything they don’t want to. Let’s operate from the premise that women are not stupid and gullible victims of list-driven men who do not want to use condoms. I would suggest that it is your position, not the position of HHS and the Obama administration, that respects women. It is generally agreed that for many women, the benefits of oral contraceptives outweigh the risks. If you and the Catholic Church could successfully sell abstinence or NFP, it would be one thing.
One of the criticisms of certain birth control methods, particularly condoms, is that they are highly effective if people use them consistently and correctly, but many people do not use them consistently and correctly. It’s true enough. But how consistently and correctly do people use abstinence or NFP?
As I said about, the Church has no practical or realistic solution to the problem of unwanted pregnancy. This puts them in a very weak position fighting against contraception. I still believe a compromise must be reached, but the Church has no realistic solution to the problem of unwanted pregnancy, and medical science does.
It has occurred to me that the Bishop’s holding that they would be spending funds of the religious institutions, is arguable. Aside from government funding, there is another aspect, ISTM .
First of all, the hospitals would not be offering these services to the public , as does the storied soup kitchen. They are dealing with employees. Benefits, including payment of health insurance premiums to a group plan, are part of a wage package. So the employee has accepted these in lieu of cash. The government has a limited right to regulate wages and terms of employment in terms of what it judges to be fairness, equality and employee welfare. In essence, the end provider of the payments is the employee him/herself. It is that individual who should make the moral choices.
Question: I have a strong aversion to the slippery slope, reductio ad absurdum (I think) line of argumentation, which is everywhere exploited. But…could the same arguments being made on behalf of contraceptive funding not be made on behalf of abortion funding? In other words, it is a proven benefit to women’s health to have abortion as an option, etc. Abortion is a constitutionally protected legal right. So why shouldn’t Catholic institutions cover it?
If the widely quoted 98% figure for contraceptive use among Catholic women of child-bearing age is at all accurate, what is the problem? After all is said and done I’d be surprised if that percentage reached 98.5% even with all the Obamacare carrots and sticks.
Is cost the problem? Let the government provide contraception stamps.
It’s funny that contraception availability wasn’t seen as a pressing problem before Obamacare. And to our shame we have entirely overlooked the high price of Aspirin. It’s beyond the reach of all but the top 97%.
We have a Rent Is Too Damn High” party in New York but what we really need is a “Contraception and Aspirin Are Too Damn High” party.
the overwhelming majority of artificial contraception isn’t being used for any actual medical reason (it’s disabling a healthy body, not healing a disease)
Studebaker,
Should insurance, then, not cover Natural Family Planning?
I think the analogy would only work if HHS had required every hospital (including Catholic ones) to perform sterilizations and elective abortions – but they have not.
Jains prepare vegetarian food because they believe they should not cause the death of animals or (in the case of strict observers) root vegetables. Requiring them to prepare food containing meat would would require their formal cooperation in evil.
Requiring Catholic hospitals to perform sterilizations and elective abortions would require their formal operation in evil.
However, providing health insurance that includes coverage for contraception is, at most, remote operation in evil and permissible in order to secure a proportionate good – providing health insurance to employees.
The diocese of Madison has included contraception in its insurance since 2010, Fordham University does, also, making the distinction that it will provide the insurance but will not provide services itself.
It’s funny that contraception availability wasn’t seen as a pressing problem before Obamacare.
Patrick Molloy,
Actually, what is funny is that 28 states have some form of a contraceptive mandate, and yet mandating contraceptive coverage is just now becoming a hot-button issue. Also, please note the following:
And of course the United States promotes family planning not just domestically, but internationally through USAID.
The idea that “insurance” would cover natural family planning seems ludicrous (that perverts the whole concept of “insurance”), but at least natural family planning doesn’t involve taking drugs that disable a bodily system.
Jains don’t kill insects, either. Is the free kitchen free of oversight by the health dept.?
Re Matthew’s 8:28 this morning:
“It is not irrational for the bishops to draw the line here, even if it is not the only place where it could be drawn.” i agree that it “is not irrational.” But if it is “not the only place,” then reasonable people can disagree about the practical wisdom of where the line is drawn. If that’s the case, then harsh denunciations of one’s opponents in this matter are not only unwarranted, but are likely to be defamatory.
I think Barbara makes an interesting observation. The reason Catholic employers are loath to just drop health insurance plans (and, one would hope, increase wages) and release their employees to take advantage of the tax credits available to subsidize their own coverage is because these institutions would take a hit recruiting non-Catholic (and some Catholic) employees. This makes Gerelyn’s WWJD point relevant. If you want to run a competitive business, you might find yourself having to compromise your principles to make a “profit.” Beyond this, I agree that the analogy falls too far short in many of the ways that have been mentioned.
The idea that “insurance” would cover natural family planning seems ludicrous (that perverts the whole concept of “insurance”), but at least natural family planning doesn’t involve taking drugs that disable a bodily system.
Studebaker,
If you can only get a nationwide (actually worldwide) reform of health-care coverage that fits your description of “insurance,” then you will have an argument. It seems to me your idea of health insurance wouldn’t cover any preventive care at all—vaccinations, routine checkups, mammograms, etc. Nor would it cover the cost of hospital deliveries. Having a baby is not a disease, after all. Why should I, as someone who will never have or father a child, be paying premiums so that some of my co-workers can have their babies delivered in the hospital at $12,000 a pop (if all goes well, which it often doesn’t).
Briefly put, your invoking of what “insurance” should be is utterly irrelevant to these discussions, because that is not what health insurance is.
A lot of drugs disable bodily systems in order to preserve the patient’s well-being, or, in some cases, life. People who suffer brain trauma, for example, will be given steroids to control swelling — the body naturally sends fluid to the affected area of the brain. If you aren’t able to control intercranial pressure, you could die. That’s one reason doctors induce comas in patients. So let’s dispense with the criterion of “naturally occurring bodily functions.”
A lot of drugs disable bodily systems in order to preserve the patient’s well-being, or, in some cases, life. People who suffer brain trauma, for example, will be given steroids to control swelling — the body naturally sends fluid to the affected area of the brain. If you aren’t able to control intercranial pressure, you could die. That’s one reason doctors induce comas in patients. So let’s dispense with the criterion of “naturally occurring bodily functions.”
Your response is irrelevant: disabling the natural process of swelling in your scenario is medically necessary to prevent the greater harm of DYING from some medical dysfunction that has already occurred.
Yes, there are a few cases where artificial contraception is being used to cure some medical dysfunction, but we all know that in the vast majority of cases, it’s just being used to prevent children from coming along. And it does so not by remedying a dysfunction, but by creating one that didn’t exist before.
If this were being done in any cause other than preventing babies, no one would be so utterly lacking in common sense as not even to wonder about the safety of such a drug.
David Nickol:
“Should insurance, then, not cover Natural Family Planning?”
No, thank you. I have practiced NFP for 15 years and it never cost me a dime.
I wonder what people would say if it were being urged that tens of millions of men should (voluntarily) chemically castrate themselves, that the government should mandate coverage, and that moral objectors should be forced to subsidize chemical castration. If it were shown through dozens of studies that a significant increase in prostate cancer would likely result, would we have so many people trying to denigrate or ignore that evidence?
There you go again, Stuart. I wonder what people would say, or whether they would even recognize you, if you created a new account with a name like, oh, I don’t know, Buart Stuck, and you wrote in such a way that didn’t make you sound contemptuous of those who disagreed with you. Do you suppose regular readers of the blog would recognize you? I don’t.
“I think it is a poor analogy, because there is really nothing significant at stake whether the Jains serve meat or not.:
David N. –
Tell that to the Jains. (You still don’t get it.)
Grant — if you don’t like people to use anything other than their full names, make that a Commonweal blog policy, and apply it across the board to everyone (not just to 1 of the many dozens of commenters who either use pseudonyms or first names, which are just as effectively anonymous).
To be so obsessed with my name in particular, and to keep bringing it up a propos of nothing, is really weird.
Tell that to the Jains. (You still don’t get it.)
Ann,
Actually, I think I have made it clear a couple of times that the current situation is unacceptable because the allowances for religious freedom are insufficient. The problem with the Jains analogy is that there is nothing significant at stake for society if the Jains don’t want to serve meat. There is no good reason to expect them to serve meat.
Now suppose instead of contraceptives, there is a religion whose adherents employ millions of people across the country, and that religion doesn’t believe in antibiotics (or, alternatively, pain killers, or anesthesia, or vaccinations, or chemotherapy). It may be very important to that religion not to support one or more of those, but it is also important to society that people with insurance coverage are covered for all of those things.
Religious freedom is important, but so is public health. That is what’s missing from the vegetarian analogy. Now, suppose the Jains were the exclusive source of food for a group of homeless people, and the food they served did not merely exclude meat, but excluded protein altogether. The objects of their charity work were coming down with protein deficiencies. It would be the business of government to do something. It might not necessarily be to force the Jains to include protein in their meals, but I don’t think the government could stand by and watch a charity, no matter how benevolent, be the cause of malnutrition among the people they served.
Grant,
In fairness to Studebaker, we all have access to his e-mail address, which is stuartbuck@gmail.com. If it were his intention to hide the fact that he is the person who once used the name Stuart Buck, he could have used a disposable e-mail address. I don’t think is name is an issue.
Catholic institutions aren’t providing free health insurance to the poor. They are compensating their employees with health insurance.
I think we could complete the circle by embracing the proposal of the Oklahoma legislator who wants to pass a law banning the use of fetuses in food:
http://www.theatlanticwire.com/national/2012/01/oklahoma-legislator-doesnt-really-think-were-eating-fetuses/47936/
Yech? Yes. But don’t worry, it’s not really happening. He just wanted to make a point. Not sure what. And he didn’t want to take any chances.
But that’s the way they are in Oklahoma — you can never be too careful. Which is why they banned Sharia law, which could take over our actual laws:
http://www.foxnews.com/politics/2012/01/11/court-oklahoma-ban-on-islamic-law-unconstitutional/
This gross infringement on religious freedom is supported by folks like Newt Gingrich, who thinks Obama is at war with religious freedom (and Mitt Romney too, natch.)
Stuart: You’re changing the subject, which is your tone.
(David N.: His username is not an issue. If it had been, I would have blocked his account after he changed his username, making it more difficult for Google to find comments written under his real name. Our policy is to allow persistent pseudonyms, even though we prefer real names, mostly because people who write under their real names tend not to be quite so nasty as those who don’t. Of course, there are exceptions.)
I am disappointed that none of the defenders of the newly enacted policy have addressed David Gibson’s cogent comment at 10:34. Consequently I’m taking the liberty of restating it:
“Question: I have a strong aversion to the slippery slope, reductio ad absurdum (I think) line of argumentation, which is everywhere exploited. But…could the same arguments being made on behalf of contraceptive funding not be made on behalf of abortion funding? In other words, it is a proven benefit to women’s health to have abortion as an option, etc. Abortion is a constitutionally protected legal right. So why shouldn’t Catholic institutions cover it?”
On another matter, I am pleased with Grant’s implicit challenge at 11:41 that we write “in such a way that (doesn’t) make (us) sound contemptuous of those who disagree with (us).” Were this challenge widely adopted, the altered tone would be welcome.
Mike: It’s an important question, and it’s one we’ve been wrestling with in-house. The logic seems no different. I’ve seen it suggested that politically it would be unsustainable to push elective abortion coverage as part of standard care because there isn’t the public consensus on abortion that there is on contraception.
Mike McG,
I don’t like raising the slippery slope question. It seems to me that most of the critics of the contraceptive mandate (even the ones who deny it) are looking at this issue as purely one of religious freedom rather than an issue of balancing religious freedom and the public good. Religious freedom is not absolute, and although the opponents of the contraceptive mandate claim to acknowledge that, they argue as if it were absolute.
I doubt that the contraceptive mandate in its present form will stand, and I think there is zero chance of it being followed up by a mandate to cover abortion.
It is interesting (and I personally find it encouraging) that those who are so upset about the contraceptive mandate are assuming Obama will win a second term.
David Nickol:
“But…could the same arguments being made on behalf of contraceptive funding not be made on behalf of abortion funding?”
Even though I’m on the other side of the spectrum on this issue, frankly: Yes.
On the other hand, the way our political system is structured and the arrangement of constituency blocs within that structure, as a practical matter there’s brake on that slippery slope for the indefinite future.
That’s one of the reasons I’m so infuriated at the USCCB and beyong disappointed at the supposedly-liberal supposedly-Catholics like E.J. Dionne feeding the ammunition to the wrong side of this public health issue.
You GOT abortion. You don’t get to get your way on everything. You just don’t. The USA isn’t a Catholic ciountry and we’re not going to construct our public policy so as to conform to every item of Vatican preference.
What supposedly-liberal supposedly-Catholics SHOULD be doing is ripping new ones for the USCCB for outright lying about the ACA in the first place, thereby earning the emnity of the Obama Administration. The Bishops probably could’ve gotten just such an “expansive” exemption for contraception as they’re now demanding had they been honest negotiators back in 2009. But they weren’t. They LIED and now they’re paying the price.
Or paying the premiums.
Between the black and white lines of the free exercise and establishment clauses rests a gray area in which legitimate policy trade offs can be made, so long as they are not overtly motivated by sectarian purposes. Mandating the coverage of contraception but not abortion related services is that kind of trade off. Once you adopt a neutral rule (coverage of contraception as a preventive service) exemptions from the rule also cannot be motivated by overt sectarian reasons. Accommodating the Catholic Church is not a legitimate public policy rationale. Refusing to provide coverage of services that are necessary to preserve life or health because they constitute an abortion related service might not be defensible, but refusing to cover elective abortions almost certainly is.
Senator Rubio has introduced this bill in he Senate. Now the issue can be resolved by the normal political process if two-thirds each of the Senators and the Representatives support the bill – or more than half each plus the President.
1 SEC. 3. AMENDMENT TO THE PUBLIC HEALTH SERVICE
2 ACT.
3 Section 2713 of the Public Health Service Act (42
4 U.S.C. 300gg-13) is amended by adding at the end the
5 following:
6 ‘‘(d) CONSCIENCE PROTECTIONS.—
7 ‘‘(1) IN GENERAL.—No guideline or regulation
8 issued pursuant to subsection (a)(4), or any other
9 provision of the Patient Protection and Affordable
10 Health Care Act, or the amendments made by that
11 Act (Public Law 110-148), shall—
12 ‘‘(A) require any individual or entity to
13 offer, provide, or purchase coverage for a con-
14 traceptive or sterilization service, or related
15 education or counseling, to which that indi-
16 vidual or entity is opposed on the basis of reli-
17 gious belief;
18 ‘‘(B) require any individual or entity op-
19 posed by reason of religious belief to provide
20 coverage of a contraceptive or sterilization serv-
21 ice or to engage in government-mandated
22 speech regarding such a service.
http://rubio.senate.gov/public/index.cfm/files/serve/?File_id=3c291825-857a-4b2d-b108-1ca8c983be94
This topic has become an obsession on dotCommonweal.
jfxgillis: you are indeed a brave soul to be taking your stand here – but good on ya, mate.
Grant — you’re the one changing the subject to make silly remarks about my name. It’s touching that you’re so concerned about my Google results.
I agree with Mike McG: if the bloggers here tried to lead by example (namely, by refraining from constant contempt and snark themselves, and by correcting the tone of all the commenters, not just 1 or 2), that would be a good thing.
Also, Grant, I’ve commented as “Studebaker” for going on 3 years now. Isn’t that “persistent” enough? Perhaps by the 5 year mark you’ll have gotten it out of your system, and will be able to discuss the merits of an issue without being helplessly drawn to the subject of my name.
“You GOT abortion. You don’t get to get your way on everything. You just don’t. ”
Mr.Gillis–
You seem to view the American political process as most basically a balancing of wins and losses of interest groups independent of Constitutional restrictions on and guaranteed of individuals. It’s a count-the-noses theory of democracy. This was not the political philosophy of the founding fathers, and it seems to me that history has borne out their wisdom. Maybe we should have a few threads on the issue.
There seems to be another principle that some here subscribe to — that if an individual person has real needs, then the group is primarily responsible for fulfilling them. We could also look at that one.
I must say that this discussion is pushing this old liberal to see some merit in some of the conservatives basic arguments about what the really fundamental principles of a democratic government need to be if a democracy’s laws are to be wise and fair.
Stuart: I am not asking you to change your username. I am asking you to ease up on the condescending tone, which has been more persistent than your usernames. Is that such a tall order?
Ann, your comment I think sums it all up:
There seems to be another principle that some here subscribe to — that if an individual person has real needs, then the group is primarily responsible for fulfilling them. We could also look at that one.
As I understand it, that is not Catholic Social Justice policy. Social Justice policy is if an individual person has real needs AND cannot satisfy them on their own or within their family, then it is a somewhat larger group’s responsibility to see that they are supplied. The principal you describe violates subsidiarity, respect for private property and is pure socialism.
I highly doubt there are many women, working for any Catholic institution who are paid so little that they cannot afford the $10-50 month that birth control pills cost. In my estimation, this issue is certainly way too small to justify the use of the full coercive power of the Federal Government. It seems like you may be leaning that way as well.
BTW, like the others, I don’t expect an abortion mandate to be coming anytime from this or any administration, or this or any Congress, in any shape or form. There has been a Hyde approach to abortion funding since 1976, etc.
But I was obvously thinking that the thought experiment might be useful for teasing out the principles and issues at stake in the contraception mandate.
I highly doubt there are many women, working for any Catholic institution who are paid so little that they cannot afford the $10-50 month that birth control pills cost.
Why are so many people here obsessed with cheap, generic oral contraceptives? Oral contraceptives are not the only method of birth control. In fact, many women should not use them. Some here are arguing that no woman should use them, and in the same breath arguing that women should pay for them out of their own pocket. The contraceptive mandate does not require that all women get free pills. It allows a woman to discuss contraception with her doctor, and for both of them to choose the method best for the woman.
According to WebMD:
Of course, the Catholic Church is opposed to sterilization as well. And to all methods of contraception (condom, IUD, etc.). Why the obsession with cheap oral contraceptives?
From my understanding, the Catholic Church does not teach that “artificial” contraception is immoral, she teaches that it is immoral in marriage.
She does not teach that it is immoral outside marriage, for prostitutes, to limit HIV transmission, for nuns in the Congo at risk of rape, in Catholic hospitals treating rape victims, to treat medical conditions like heavy periods etc.
From the point of view of Catholic doctrine, this is a huge hole in the argument that providing insurance cover for contraception is even immoral.
God Bless
Is it really not a problem that 49% of pregnancies are unplanned? And is it not a problem that 22% of all pregnancies in the United States end in abortion? What practical plans do the bishops have for getting those numbers down?
Thanks, Chris. I believe that’s a key point that I’d love to see some spokeperson for the bshops defend or explain.
David Gibson,
You asked a fair “slippery slope” question. Let me offer 3 arguments:
1. Contraception is not the same kind of thing as procured abortion. That Church allows the former in some cases but not the later in any cases.
2. To kill a human being is much more serious than to contracept.
3. The supposed conscience “right” to kill someone ends at the point it infringes on the right of the one aborted to live. Similarly, the bishops right to impose their conscience on their employees ends at the point it infringes the conscience right of their employees, and the conscience right of the state authorities to uphold the Common Good as they in good conscience see fit.
God Bless
David Pasinski,
There is more detail here from the New Zealand Catholic Bishops. This was published as a special editorial in the New Zealand Catholic newspaper. It is an excellent presentation of the Catholic teaching on contraception.
http://www.pn.catholic.org.nz/dox/Bishops/More%20Catholic%20than%20the%20Pope%20-%20Comment%20on%20Card%20Martinis%20comments.pdf
God Bless
David – appreciate your approach but like Matthew’s original analogy – they all limp so badly that they do not seem to be very helpful.
Abortion does not compare to making contraceptives available
In the same way, Matthew’s analogy started off poorly by stating the the Jain’s would serve folks vegetarian but the HHS decision is not about catholic hospitals serving the public – it is about whether they need to include contraceptives in their standard benefit packages. It is really and only by extension about employee/member conscience decisions to use contraceptives.
Your earlier comments about “slippery slope” resonated with me not because of abortion but because the threat of a slippery slope is on both sides of the HHS decision. Supporting the “old” limitation of religious liberty or exemption can also be seen as a slippery slope going the other way – yet, very few have mentioned this.
Example – shouldn’t Mormoms be allowed to have polygamy because to restrict this is against their religious liberty? Yes, polygamy is not considered socially acceptable anymore but how is it much different from, say, restricting contraceptives? Contraceptives are documented as socially acceptable even by most other major religious denominations. Everyone agrees that >95% of all catholics use contraceptives – so, this HHS decision seems to only be a religious liberty issue for some bishops; for theorotical reasons; for possible future slippery slope reasons, etc.
So, many of the above arguments seem specious at best. The USCCB appears to be staking their argument on a “means” or “tool” that their own church accepts. It doesn’t make their arguments very reasoned; makes their principle or goal more difficult to understand; and, in the end, probably does more harm than good in terms of future decisions around religious liberty and what the public common good includes, protects, etc.
Ann:
“You seem to view the American political process as most basically a balancing of wins and losses . . .”
That’s pretty much what all politics always is.
“… independent of Constitutional restrictions on and guaranteed of individuals.”
Having said that, I flatly deny there’s any individual Constitutional right involved at all. The Bishops are whining because an INSTITUTION they oversee will be required to provide a legislatively enacted standard health insurance benefits package to certain categories of employees (but not all categories).
The Bishops’s individual rights are not implicated, and none of the employees’ rights are implicated. The non-Catholic employees get the standard package. The Catholic employees simply have to refrain from making claims for contraception.
Now the Archdioceses’ collective and corporate rights are restricted, but so what? To the extent those rights exist they are statutory, not Constitutional, and the obvious solution is to alter or repeal the controlling statute.
Go for it.
Grant — as to tone, I promise to follow your lead as best as I can. If you keep harping on my username, however, I might not be able to restrain myself from cracking a few jokes.
In addition to the example of Mormons and polygamy, there is also the issue of Mormons and black people. Mormon attitudes toward blacks were a matter of divine revelation!
There’s also the case of Bob Jones University losing its tax exempt status because of it’s racial policies, which were religiously motivated. Now, really, what skin is it off my nose if black people can’t get into Bob Jones University, or are treated differently if they are admitted?
David,
This thought is internally consistent:
1)Some here are arguing that no woman should use them, and in the same breath arguing that women should pay for them out of their own pocket. — If women should not use them, then if they choose to use them, why should someone else pay for them. It is exactly equivalent to saying you should not smoke, but if you choose to then you have to pay for your own cigarettes.
It is also within the financial and personal control of most, unlike say the cost and treatment for a heart-attack, stroke or cancer where outside support is clearly warranted.
I believe that this statement is erroneous
2)The contraceptive mandate does not require that all women get free pills. It in fact does require that they be made available at no cost to all who request them.
I believe that this statement is erroneous as well
3) the Catholic Church is opposed to sterilization as well. It is only opposed to sterilization as a method of birth control. If there is another medical reason, eg cancer, and the prudential treatment results in sterilization, then it is perfectly ok.
Finally you ask
5) Is it really not a problem that 49% of pregnancies are unplanned? And is it not a problem that 22% of all pregnancies in the United States end in abortion? What practical plans do the bishops have for getting those numbers down?
The Catholic policy is – ‘no sex outside of marriage’ which solves most of both issues and was the answer historically. Our current path of sex anytime you want, but make sure its ‘safe’ backed up by abortion-on-demand’ is a demonstrable failure just by the statistics you quote.
Bruce –
I mostly agree with what you say about subsidiarity. In the instance of the Georgetown student who lost an ovary for lack of a med, it seems to me that she could easily have gotten a prescription from, say, the D.C. public general hospital which is free for indigents. (She is pleading indigency, isn’t she?) It is simply incomprehensible to me that a young woman smart enough to get into Georgetown Law couldn’t find help paying for her meds someplace.
However, I disagree that there are few women who can’t afford contraceptives suitable to their needs. There are millions of poor people out there, Bruce, millions, no jobs for them. This is why government help for them is needed.
Bruce,
1. It seems to me the true anti-birth-control Catholic argument should simply be that no women should use contraceptives. How cheap or expensive the pills are is a peripheral issue if the argument against supplying them is based on religious freedom. The cost of contraceptives is relevant to other arguments against the mandate, but if there is a religious objection to them, their cost is irrelevant.
2. Women need a prescription for contraceptives. They can’t just ask for them. There are definitely some women who shouldn’t take them. I believe it is about 28% of women who use some form of contraception (including sterilization) who use the pill. Also, if I remember correctly, 50% of women who are prescribed the pill stop taking it within a year. So we are not talking about supplying every woman in America with the pill.
It seems to me that the mandate is important in part because it allows a woman to discuss contraception with her own physician rather than scrounge for a prescription at a clinic or from some other doctor who does not know her. It may be that her own doctor will advise her against taking oral contraceptives.
Discouraging sex outside of marriage would be an excellent way to deal with the 49% unintended pregnancy rate and the 22% abortion rate, if it worked. I asked if the bishops had a practical plan for getting the numbers down. You may be unhappy about it, and you may even be right to be unhappy about it, but preaching abstinence doesn’t work.
A lot of people, including me, find it bizarre that in light of the abortion rate, the Catholic Church fights against contraceptives. Nevertheless, as I keep saying, I think there must be a compromise between the Obama administration and religious groups on this issue. I agree that it is an important issue of religious freedom. I do not think, however, that the Obama administration should say, “Okay, whoever wants an exemption can have it.” Something needs to be worked out.
Hello jfx,
I’m glad you supposedly-liberal supposedly-Catholics have a chance to get in good with your supposedly-conservative supposedly-Catholic colleagues for once, but seriously–do you think you can win the policy point?
I think it’s a little insulting to Matthew, Mr. Dionne, or Mr. Winters, to suggest that they’re suddenly driven by some desire for approval by conservative Catholics in taking the stance that they’re taking on this.
Address the substance of the arguments – not their motivations.
Ann,
I might agree with your poverty argument if the situation applied to the general population. But the mandate that the Bishops are objecting to is that Catholic institutions must provide insurance with free birth control to their employees and families (or perhaps a student at a private Catholic college). So the women affected are all either employees or closely related to an employee which is a population which is by definition not indigent. While I’m sure the Bishops believe the entire mandate should be removed, their letters only deal with the narrow religious restriction.
David,
The Bishops arent objecting to women going to their gynecologist. And the bishops arent privy to whats discussed there so I’m not sure what you find objectionable.
As for the ‘abstinence if it worked argument’, my guess would be that the statistics of unwanted pregnancies and abortions were much better in times past. The sex ed contraception era is a failure by the statistics you provided.
Its true that shotgun marriages and public shaming may not have produced optimal outcomes nor reduced unplanned pregnancies or abortions to zero, but I’d be surprised if the numbers were not alot lower in that era. And we are dealing with humans who as we all know from our own personal experience make mistakes, so no regime will produce zero bad outcomes.
. . . my guess would be that the statistics of unwanted pregnancies and abortions were much better in times past.
——
No need to guess. Read a little history or visit a few graveyards.
After the fifth or sixth pregnancy killed a woman, the father of the children married a second wife. After she died, a third could step in and take care of the children.
(Why do you think there were so many “evil stepmothers” in fairy tales?)
Someone correctly made the point that contraception is not something that should be covered by insurance. BC pills for example, are consumables designed to disable a part of the body so as to prevent conception; designed to interrupts the natural cycle.
Sterilization for the purpose of contraception is a one-time affair, but it designed to interrupt the body’s natural process.
As such, unless they are part of a medical treatment separate from preventing child birth, why would any of this be covered by health insurance in the first place?
Sounds like a dream cooked up in a big-Pharma marketing laboratory.
Get the government to mandate that employers buy insurance that provides the pills you make, free of charge to women who would need to take one each day.
Sounds profitable to me – force someone to pay for the pills you make and hand them out to folks whom you, via decades of advertising and propaganda, have convinced they desparately want/need your pills.
$$
The Bishops arent objecting to women going to their gynecologist. And the bishops arent privy to whats discussed there so I’m not sure what you find objectionable.
Bruce,
I can only imagine that if a woman goes to her gynecologist to discuss what the best method of contraception is for her, and they both conclude oral contraceptives would be best, whereupon the doctor writes a prescription, the bishops would not want to pay for that visit.
Unless you believe “error has no rights” I don’t see the reason for the anger in many of the discussions I follow.
It is certainly true that many of our fellow citizens believe in good faith that:
1. Using contraceptives to have the pleasure of sex wihout the danger of pregnancy is perfectly moral, regardless of whether you are married or not. In fact, it may be praiseworthy for several reasons.
2. Life does not begin prior to implantation.
The Catholic church teaches that both of those beliefs are wrong.
But what is the civil government to do when it must decide whether “preventative health care” for women required by law to be provided in insurance policies should include contraception, including some contraceptives that may prevent implantation of an embryo?
And what is the civil government to do when it must decide whether some employers should be exempted because of their religious beliefs from providing insurance covering those contraceptives.
Those are both enormously difficult issues to decide in our society. Any one of us may disagree with the decision that was made, but the assumption that it must reflect bad will on the part of the people who made it – or that “Satan is living in the White House” as I read on one blog – ignores the difference between a democratic republic and a theocracy and assumes that the government should always act in accordance with our religious beliefs – and if it doesn’t, it must be because it hates us and our religion.
A bill has been introduced in the Senate to grant a full exemption to every individual who has a religious objection to including contraception in insurance she/he must provide.
A new lawsuit will most likely be brought to settle the constitutionality of the HHS requirement.
Those are the ways that issues are resolved in this society that we share. Not by claiming that people who don’t share our beliefs are evil – or that their beliefs are simply excuses for immorality.
Here is a medical discussion regarding whether some hormonal emergency contraceptives can have an abortifacient effect.
“We acknowledge the concerns expressed by Drs Larimore, Stanford, and Kahlenborn regard- ing the definition of abortifacient and the mechanism of action of emergency contraception (EC). The American College of Obstetrics and Gynecology states that implantation is a necessary step in the establishment of a pregnancy and that abortifacient refers to the disruption of an implanted pregnancy. According to this definition, which is shared by the Food and Drug Administration, the National Institutes of Health, and the majority of the gynecologic literature, EC is not an abortifacient.”
The bishop’s reply indicates that they believe that some emergency contraceptives may be abortifacients. This is probably based on the Church’s teaching that abortion includes preventing implantation of a fertilized egg – which is different from the FDA, NIM and other groups.
However, Bishop Lori and the other Connecticut bishops agreed that Cathoic hospitals in Connecticut would provide emergency contraceptives in their emergency rooms as required by State law.
David Nickol:
Actually, what is funny is that 28 states have some form of a contraceptive mandate, and yet mandating contraceptive coverage is just now becoming a hot-button issue.
Why would you say something like this, just because you personally haven’t noticed the issue before now? Yes, contraceptive mandates are more of a hot-button issue now, given that national issues are more prominent than state-level issues. Another factor is that many states included broad conscience protections, and hence muted much of the opposition.
But when states failed to include enough conscience protection, it has most certainly been a hot-button issue. There was the famous 2004 California Supreme Court case of Catholic Charities of Sacramento, for example. And in New York, there was the 2006 case Catholic Charities of the Diocese of Albany v. Serio.
The bishops are not paying one red cent for anything.