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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, its far less important than the principle, and practice, of religious freedom.

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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 whats 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 its 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 wont. 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.

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 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 sons teeth, paying cash. Why? Because my dental insurance plan does not cover braces, because braces are deemed cosmetic and optional; thats 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.

So the rules in question are about protecting the non-Catholic employees at Catholic institutions from the religious convictions of the Catholic employers.

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, butand I am not the first person to point this outthe 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/voltai...

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.

Stuart Buck: Are you capable of being less obnoxious? You know what's stupid? Saying something is both stupid and asinine.

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.

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.)

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, mandatesare 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 Websters, 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 cant 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 dont have to pay for contraception. And lets 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.

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