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What rides on the rider

In their statement on the revised version of the HHS regulations, the U.S. bishops write that under the new terms, the mandate "would allow non-profit, religious employers to declare that they do not offer such coverage [of sterilization and contraception]. But the employee and insurer may separately agree to add that coverage. The employee would not have to pay any additional amount to obtain this coverage, and the coverage would be provided as a part of the employer's policy, not as a separate rider."This redfaced point, which as far as I know has not been contested in any of the descriptions of the regulations that are out there, seems to me to matter quite a bit. For in order for there to be a meaningful sense in which the HHS mandate doesn't require employers to provide insurance coverage for sterilization and the purchase of contraceptives, there needs to be a meaningful sense in which the insurance policy provided by the employer is different from the one that covers these things. Otherwise, we end up with a situation where, while an employer-sponsored policy may not cover sterilization and contraception at the moment that it is issued by the employer, once the employee requests the insurer to add such coverage that same (employer-sponsored) policy now does cover these things, and such coverage is integrated seamlessly with the rest of what the policy covers. It may be true that the default employer-sponsored policy does not pay for anything that the employer finds morally objectionable, but if the modified policy is also an employer-sponsored one, and coverage for sterilization and contraception is a part of it, then the employer has sponsored a policy that covers sterilization and contraception. And surely it will not matter that the employer did not have to tell the employee that there was an employer-sponsored plan available that covered these things, or that the insurer happens to be making it available to the employer at a reduced rate.By contrast, if coverage for these things is on the books as an additional rider that the employee is offered the opportunity to add for free, then -- so long as it really is free for the employer -- the force of this worry diminishes significantly. For then it strikes me the most accurate way to describe the situation would be as one where it must be in the terms of the employer-sponsored policy that it includes an option to add some separate policy that would bring with it some additional coverage, albeit of a sort the employer would rather not provide. I do not expect that everyone who is worried about the mandate's effects on religious liberty would be persuaded by this, but I think I might (though I would still oppose the mandate on other grounds). In any case it would go some way to addressing the concern about the "seamlessness" of employer-sponsored coverage as described in the paragraph above.I will now be shouted at in the comboxes. Please be charitable, as I am not in anyone's pocket here, and I have been thinking a lot about these questions and working hard to set my thoughts straight.

Comments

Commenting Guidelines

Anitra: I see you're quite anxious for an answer from this Mr. Gallico character. I've finally heard back from him, and, in response to your query, he proposes the following deadline: February 30.

As I suspected.

Unless they have already done all the work on this and have it all stored on a computer ready to print out, I think this is more like a 6 months project to get to a final draft to issue for formal comments. During that time they need to nail down whether the insurance companies will go along with providing free contraception and the mechanics of how to do it - and then have listening sessions with the stakeholders, including USCCB, before issuing a draft for public comments. Public comments requires 2 months and evaluating comments and revising the draft probably another 3 monthsOn that schedule, the draft would go out for public comments in August and comments would end in October, just before the elections. The final rule could be adopted at the beginning of January. If there is a new President, he would probably put a hold on all recently adopted regulations pending review. So, To the extent it affects the way anyone votes, their decision will probably be based on the draft sent out for comments.qGiven the amount of criticism that has been based on lack of detail in he Federal Register, I think hey will want to be sure he comments draft is bulletproof before they release it.

"Jim Pauwels, I suppose because 85% of employees already have contraception included in their health benefit plans."But not, I assume, with no co-pay requirement, at least in the majority of cases.But that 85% of employees already have it covered supports my belief that the new regulation is a solution in search of a problem.

"Right now, it cant do that because the bishop wont allow them to solicit the hospital employees. The new regulations will require them to do it, so the bishop can no longer prevent it."Is this true - that insurance companies will have the right to *actively solicit* employees of Catholic institutions, using the enrollment lists provided by the employer, in order to push contraception, for financial reasons? I had not seen that active solicitation was part of the plan. That seems to me pretty morally objectionable (if you believe that contraception is morally objectionable). That would strengthen the bishops' case considerably.I had assumed that the employee would initiate the request.If contraception is the financial no-brainer for insurers that is being alleged here, then I would expect that insurers would have been flooding young female employees of all their clients, not just the Catholic clients, with contraception solicitations. Granted that I am neither young nor female (although I am married to someone who is younger and female and whose career has mostly been with large corporations with decent benefits plans), I've never heard of this happening.Suppose, for the sake of conversation, an employee receives the insurance company free-contraception email blast, buys a contraceptive product online, takes it, and becomes gravely ill. That sounds like the kind of thing insurance companies, which in my experience don't lack for legal counsel, would wish to avoid.

JIm Pauwels, I believe all contraceptives require a doctor's prescription. Presumably you take the prescription to a drug store or send it to a mail-order pharmacy and they bill the insurance company. The Federal Register says that the insurance company will "offer contraceptive coverage directly to the employers plan participants (and their beneficiaries) who desire it, with no cost-sharing."THis is a change from the Hawaii plan, which required the employer to notify employees where to go to get contraception. Some people (USCCB ?) objected to requiring the employer to do that. To respond to that, HHS said that the insurance company would offer contraceptives to the employees.

Doerflinger explicitly rejected the Hawaii arrangement because of the referral policy. I also believe CHA let the administration know such a setup was unacceptable.We've been over the actuarial studies several times, Jim. Along with the experience of large group policies that added contraception coverage, they show that insurers incur no additional long-term costs by offering free contraception coverage.

John H - there is a difference between "offer" and "solicit". The former could simply mean, "fulfill any requests that come in from employees". The latter encompasses active promotion. If I were the chief executive of a Catholic institution (and my views on contraception align with the church's), I would have a moral objection to supplying a list of employees to a 3rd party so it could actively solicit to give away contraception. That seems to take the Catholic institution into the realm of immediate cooperation with evil. Conceivably, it could be immediate cooperation under duress, which would mitigate the Catholic institution's culpability. Cf. the description of immediate cooperation at what is quickly becoming one of my favorite little landing pages.http://www.ascensionhealth.org/index.php?option=com_content&view=article...)

If I were the chief executive of a Catholic institution (and my views on contraception align with the churchs), I would have a moral objection to supplying a list of employees to a 3rd party so it could actively solicit to give away contraception.-- Jim PauwelsYou don't have to do that. They already have the list of people you told them to insure under your contract. Those are the people they will notify.

"They already have the list of people you told them to insure under your contract."Certainly - because I gave it to them. That I gave it to them earlier, during the most recent open-enrollment period, doesn't seem to make any moral difference. That I gave it to them for some other reason, knowing that it would also be used for this reason, doesn't seem to make any moral difference.

My recollection has been (at least some) Amish individuals were exempt from Social Security taxes because of their religious objection to any kind of insurance - but that Amish employers were not exempt from paying Social Security taxes on their employees. I hunted this down this morning and found this Supreme Court decision:Congress has accommodated, to the extent compatible with a comprehensive national program, the practices of those who believe it a violation of their faith to participate in the social security system. In 1402(g) Congress granted an exemption, on religious grounds, to self-employed Amish and others.[11] Confining the 1402(g) exemption to the self-employed provided for a narrow category which was readily identifiable. Self-employed persons in a religious community having its own "welfare" system are distinguishable from the generality of wage earners employed by others.Congress and the courts have been sensitive to the needs flowing from the Free Exercise Clause, but every person cannot be shielded from all the burden incident to exercising every aspect of the right to practice religious beliefs. When followers of a particular sect enter into commercial activity as a matter of choice, the limits they accept on their own conduct as a matter of conscience and faith are not to be superimposed on the statutory schemes which are binding on others in that activity. Granting an exemption from social security taxes to an employer operates to impose the employer's religious faith on the employees. Congress drew a line in 1402(g), exempting the self-employed Amish but not all persons working for an Amish employer. The tax imposed on employers to support the social security system must be uniformly applicable to all, except as Congress provides explicitly otherwise.U.S. v. Lee, 102 S. Ct. 1051 (1982)http://www.ssa.gov/OP_Home/rulings/oasi/45/SSR82-44-oasi-45.html

Jim Pauwels, I suppose it depends on how great an evil you believe it is that the insurance company will use the list to notify your employees that, if they wish, it will pay their costs for contraception.You are giving them the list in order to obtain insurance for your employees so there is no formal cooperation. I would think that the good of providing insurance for your employees would outweigh any remote cooperation you might see in it. But that is a decision you would have to make.

Weve been over the actuarial studies several times, Jim. Along with the experience of large group policies that added contraception coverage, they show that insurers incur no additional long-term costs by offering free contraception coverage.You've "been over" them only the sense of quoting a few sentences about them, not in the sense of describing or having any idea what their data and methodology was. In any event, if those studies were well-done and accurate, you just proved that the mandate is completely superfluous, or even that it has no conceivable purpose other than to coerce religious objectors. After all, if what you say is true, everyone (employers, insurance companies) outside of religious objectors would be happy to provide contraceptive coverage without any mandate.

If contraception is the financial no-brainer for insurers that is being alleged here, then I would expect that insurers would have been flooding young female employees of all their clients, not just the Catholic clients, with contraception solicitations. Exactly. And employers would virtually all be doing likewise. No one who is defending the administration has any answer to that point.

Oh, Stuart. You're persistent. I'll give you that. For the moment, let us forget the documented fact that according to experience and actual actuaries, contraception coverage is at least revenue-neutral for insurers. What if the reason insurers didn't offer it for free was that, in concert with drug manufacturers, they knew they could make a little extra money on it? That seems the simplest explanation to your query.For the record, a huge percentage of health-care policies include contraception. Something like 80 or 90 percent. Has either of you ever negotiated a group policy? Perhaps insurers include contraception as a matter of course, and group purchasers must opt out. Maybe brokers are urged by insurers to push contraception coverage. I doubt you know.

Stuart: I have no obligation to verify the methods of the several actuarial firms who have confirmed what I guess you're denying again. They are actuaries. They set the bloody tables. They say it costs insurance companies nothing to offer contraception cover, and in the long run it may save them money. Of course it doesn't take an actuary to understand why such coverage could save employers money (lost productivity). I don't know why this is difficult to accept. The largest group plan in the United States added contraception coverage in the middle of the fiscal year -- after the terms of the policy has been set. The insurers who covered those employers were offered a period of redress during which they could lodge complaints that the added coverage presented a financial burden none did. There is nothing left to complain about except that insurance companies didn't behave how you think they should have given this information. As though the insurance market is just like the produce market. Give it up, Stuart. The data do not support your theory.

Grant, that's all fine, but the more you argue the point that providing contraceptive coverage is at worst cost-neutral, the more you're proving that a mandate is completely pointless except for the purpose of coercing religious objectors.For the record, a huge percentage of health-care policies include contraception. Something like 80 or 90 percent. Well, if that's true, the marketing of contraceptive coverage has already worked remarkably well, and employers have indeed signed up in overwhelming numbers. In fact, pretty much the only holdouts would have to be those employers that have serious moral concerns or religious objections. So you've just basically argued that a mandate can't accomplish anything other than forcing conscientious objectors to go along.I take it then that you would strenuously object to the whole idea of mandating something when the only people whose conduct would be forcibly changed by the mandate are your fellow believers.

What I just said there explains why the Obama administration wouldn't barely allow any exemption for religious objectors. After all, a broader exemption would mean that the mandate wouldn't accomplish anything -- no extra contraception coverage would result if you exempted the only people who weren't already providing it.

would barely . . .

Grant is also helping to illustrate why the mandate will likely not survive legal scrutiny. If 90% of restaurants in America already serve pork with the only exceptions being Jews and Muslims, then if you bring forth a federal mandate to serve pork and refuse to provide a religious exemption beyond the narrowest one possible, it looks all the more like specifically targeting those religions.

Of course it doesnt take an actuary to understand why such coverage could save employers money (lost productivity).Maybe it does save money, but it most certainly does take an actuary to see why. It's far too simplistic to compare the cost of contraception with the cost of pregnancy. You'd also have to know rates of substitution and elasticities of demand absent coverage, takeup rates given coverage, pre-existing rates of pregnancy and how those rates change in the presence of coverage, abortion rates, etc. That's just to start. Then you'd have to balance in how much it would cost if some employees shifted away from condom usage and hence acquired more STDs (which cost something), or how many employees would get breast cancer, stroke, etc., based on increased contraceptive usage (which in turn would be affected by other risk factors that make contraception more dangerous, such as smoking). You may be entirely right that contraception saves money, and that hence the mandate has no purpose beyond violating the conscience of objectors, but to suggest it's a simple question is wrong.

"Weve been over the actuarial studies several times, Jim"I'm not debating the findings of the actuarial studies. It makes intuitive sense (financially) that fewer pregnancies may mean fewer expenses for the insurance company.

According to the studies of real-life actuaries, I am right that contraception coverage is for insurers at least cost-neutral. I didn't say that one need not be an actuary to do actuarial work. I meant that it takes little more than common human reason to understand that workers who get pregnant eventually become less productive as a result of the pregnancy and then maternity leave. Just as one can understand why insurers would prefer to cover women who don't get pregnant over those who do because having babies ends up being more expensive than not having babies.

" I suppose it depends on how great an evil you believe it is that the insurance company will use the list to notify your employees that, if they wish, it will pay their costs for contraception... I would think that the good of providing insurance for your employees would outweigh any remote cooperation you might see in it. But that is a decision you would have to make."John H, I agree. Note that the substantial degree of judgment you're describing here: "depends on how great an evil you believe it is ... I would think the good outweighs ... a decision you would have to make." These are judgments that the Catholic employer (or any employer) is able to make under the status quo, in which the employer and the insurer enter into a private contract that includes the terms and conditions of contraceptive coverage. If the employer has a moral objection to contraception, she can negotiate to exclude it. If she has an objection to her employees being solicited for it, she can negotiate a non-solicitation policy.That arrangement seems appropriate to me, because it allocates the moral agency where it belongs. If the employee wants to use contraception, she's morally responsible for that decision. If the employer wants to cooperate in it, then under the status quo, she's freely chosen to cooperate, and bears whatever moral responsibility that entails. If the insurer, for some financial reason or some other reason, wants to actively solicit the employer's employees to utilize contraception, then the appropriate measure of moral responsibility accrues to the insurer.Under the President's proposal, the employee's responsibility remains, but the moral freedom of the employer is taken away. If the insurer is required to actively solicit, then its freedom is also taken away. I can see that the President's accommodation would put an employer who strongly opposes contraception in a moral bind.I believe that the bishops, in their Taco Bell franchisee scenario, have a point.

I can see that the Presidents accommodation would put an employer who strongly opposes contraception in a moral bindSticking to non-profits for now (hospitals, universities, charities):If the government announced that it would set up a program that would pay the cost of contraception for anyone who has a job but doesn't get free contraception from their employer's insurance, would that mean that I shouldn't hire anyone because giving them a job would qualify them to receive free contraception? Should I fire all my existing employees?I don't think so. Essentially, that is what the government is doing when it uses insurance companies to pay the cost of contraception for those employees. You, as the employer, have no control over that and, I would say, no moral responsibility for it.

Just as one can understand why insurers would prefer to cover women who dont get pregnant over those who do because having babies ends up being more expensive than not having babies.Right, but that's still a simplistic and naive way to view the issue. Covering contraception doesn't necessarily mean all that much reduction in the number of women who get pregnant in the first place. To understand this requires one to know that 1) many women of childbearing age want to get pregnant; 2) many women of childbearing age are going to use contraception whether it's covered or not (one study suggests that subsidizing contraception increases the usage rate by a mere 1% to 1.8%); 3) many women of childbearing age are just going to switch from using condoms to using the subsidized contraception, which means greater expense without much (if any) reduction in risk of pregnancy; 4) some women for whatever reason don't particularly want to get pregnant but aren't going to use contraception even if it's covered; and 5) even if there's a tiny increase in pregnancy from not covering contraception, some of those women will abort, which doesn't cost the insurance company anything. Anyway, let's grant that the actuaries are right in all of their estimations here. Now you've just proved that the mandate is completely unnecessary except for the purpose of violating objectors' conscience. After all, you still can't come up with any theory as to what else a mandate could possibly accomplish if contraceptive coverage saves money and nearly everyone is already doing it. The only thing left for a mandate to do is force your co-religionists to violate their conscience. Why wouldn't you be a bit more upset about that? Why be a pawn for the administration on this issue?

"If the government announced that it would set up a program that would pay the cost of contraception for anyone who has a job but doesnt get free contraception from their employers insurance, would that mean that I shouldnt hire anyone because giving them a job would qualify them to receive free contraception? Should I fire all my existing employees?"Nobody's talking about firing or not hiring anyone. There are two ways I can think of to keep the employers well out of it. One is to set up a new government entitlement - free contraception for all. Employment status doesn't matter. It wouldn't depend on employer cooperation: the employer doesn't provide any lists or help with enrollment in any way. Women would get their free contraceptives some other other way - through public health clinics, or through gynecological practices (although that would set up a new set of problems for Catholic practicioners), or Social Security offices, or some other way. Maybe they would just show up at the pharmacy with the prescription; the pharmacy rings it up at no charge; and the pharmacy bills HHS. Sounds simple enough.The other way is to maintain the status quo, in which the employer freely negotiates with the insurer, and no special classes are defined for religious institutions. Under the status quo, the employer is still saddled with trying to discern how proximate or remote the cooperation with evil is in providing contraceptive subsidies to his employees, but at least he's free to make that discernment as best as he can. There's a lot to be said for freedom. The putative disadvantage to maintaining the status quo is that there would not be a no-charge contraception benefit for all women. But I've made no secret of the fact that I'm absolutely fine with that state of affairs. (In fact, I'd be inclined to go in the other direction and invent a new "sin tax" - let the state tack on a 200% surcharge on every pill sold. I'd bet the states' fiscal houses would be in order in no time.)

You're Freudian slip is showing if you're equating contraception with sin.

Jeanne - there is nothing Freudian about it, and it's not a slip. Of *course* contraception is a sin.

Yes, let us grant that actuaries know more about this than we do. But you misunderstand my position. I don't have a settled opinion of the mandate. I don't think it's irrational, given the policy goal as supported by the advice of independent medical experts. I found its original iteration objectionable for reasons I've already repeated dozens of times. I believe this one to be imperfect, but an improvement in that it addresses two of the bishops' and other Catholic groups' major complaints: that religious groups would have to contract and "pay for" services contrary to Catholic teaching; and that any compromise could not involve the employers in a referral scheme. The revised proposal satisfies those objections. If the rumors are true and HHS is going to exempt self-funded health programs, it will be much improved. But I don't see Obama, given his policy commitments, letting any Catholic group that mostly employs and serves non-Catholics off the hook. Incidentally, this is not about conscience, not at the institutional level. Institutions don't have consciences. People do. And if a Catholic group is forced by law not to contract and pay for contraception services, and they do not have to refer for such services, then the cooperation is quite remote, and therefore licit, when weighed against the greater good of providing health coverage to workers.

I dont think its irrational, given the policy goal as supported by the advice of independent medical experts. The question isn't whether it's "irrational" from a secular perspective, but whether a Catholic should be in any way supporting a policy that pretty much everyone already follows -- except for religious objectors, who are the only ones left whose behavior could be affected by the mandate. religious groups would have to contract and pay for services contrary to Catholic teachingIf that was your ground of objection, how does it not equally apply to the suggested revision? Under either proposal, 1) employers buy a health insurance policy, and 2) insurance companies provide an employee with contraceptive coverage. No one has explained how it makes any moral difference whether the insurance company goes through the transparent charade of doing (2) as a "free supplement" or "rider" or whatever you want to call it. (2) still ineluctably goes with (1), neither one ever appearing without the other.

Whites and blacks in the United States already have a collective birthrate that is less than replacement. All the talk of contraception is at least partly motivated out of an unspoken (of course) desire that fertile Hispanics start having fewer babies. Maybe that's the reason for not exempting Catholic agencies/organizations -- lots of Hispanic Catholic employees.

I'll leave the genocidal theories to you.But as to the moral-theological one: I've explained this several times. That you disagree or refuse to accept the distinctions as developed by the Catholic moral tradition does not mean "no one has explained how it makes any moral difference." If the bishops are after a situation in which Catholic institutions that employ and serve the public are able to avoid all entanglements with evil, they will be disappointed in the end. So the question is: At what point is the cooperation with evil remote enough to be licit? There is a moral difference between agreeing to a contract that includes payment for a benefit that is contrary to the institutions religious beliefs and agreeing to a contract that excludes that benefit. Just as there is a moral difference between directly referring for contraception services and not having to refer at all. Every degree of separation between moral agent and evil outcome matters. One does not have to favor the mandate to see that when weighed against the proportionate good of providing health care to employees, the very remote material cooperation required by the mandate is not much different from the remote material cooperation hundreds of Catholic organizations have accepted voluntarily by paying insurance companies at all.

Oh, there's no genocidal intent whatsoever, and a careful or even not-so-careful reader would have noticed that I didn't say that. People on your side certainly think of themselves as purely altruistic and benevolent in helping Hispanics hold down the number of children. But that's who the policy has to be aimed at -- no one could possibly be worried that whites, for example, are the ones who need more contraception. As for the moral-theological distinction you're trying to draw, it still isn't convincing. You say, "There is a moral difference between agreeing to a contract that includes payment for a benefit that is contrary to the institutions religious beliefs and agreeing to a contract that excludes that benefit." But this supposed difference is utterly semantic. The second contract "excludes that benefit" ONLY by pretending to be unaware of what's going on. In both contracts, the employer agrees to a contract that involves payment, and the insurance company ultimately provides the same package of benefits. If one objects to providing any of those benefits, it is no consolation that the objectionable benefit is going to be provided under the complete fiction of a separate and "free" arrangement.

You have a habit of staking out a position and then defending it by saying no one can disagree with it -- not honestly, not intelligently. It's unfortunate and unnecessary, because you alienate interlocutors who might otherwise be disposed to engage you. And "people on your side"? Stop making assertions about the minds of people you don't know. It's presumptuous.Here is one reason whites might favor the mandate: most prescription contraception is not all that cheap. A white friend of mine was telling me that her insurance provider classifies her prescription contraception drug as Tier 3, and it costs her $50 a month. Now, that isn't impossible for a lot of people to cover. But for a lot of people it's not easy. So for her it's not just a question of "needing" more contraception, but of being able to access it for free.It is not a complete fiction according to Catholic moral theology because intent means something to Catholics -- as does the level of duress. The awareness of the arrangement finally supports the view that this is licit remote material cooperation with evil -- because no one involved is under the impression that the Catholic Church is contracting for benefits it deems immoral. The bishop of Madison decided that it was more important to provide health coverage including contraception than to take the morally pure route by self-funding the diocesan employee health plan, which would have been quite costly. He weighed the goods. That's how Catholics do moral theology.

There are lots of things that I'd like to get for free. A smart-phone, for example, which I don't have because of the expense. Why don't I get a federal mandate? The bishop of Madison decided that it was more important to provide health coverage including contraception than to take the morally pure route by self-funding the diocesan employee health plan, which would have been quite costly.The fact that he made this tradeoff isn't relevant when the question is whether to require such a tradeoff in the first instance, or whether your efforts would be better spent lobbying against the mandate instead of defending it as kind-of OK after all.

And look, if someone decides that they have to have the most expensive contraceptive pill that is still patented, rather than settling for the $9-a-month pills at Walmart or Target, that's just one of the choices that we have to make in life, just as we might have to choose between the $50 designer shampoo at the salon vs. the $3 bottle of generic shampoo at Walmart. Life is tough.

"There is a moral difference between agreeing to a contract that includes payment for a benefit that is contrary to the institutions religious beliefs and agreeing to a contract that excludes that benefit. Just as there is a moral difference between directly referring for contraception services and not having to refer at all. Every degree of separation between moral agent and evil outcome matters."FWIW, I agree with this.Stuart, you and I agree about many things, but my own opinion is that the argument that there is essentially no moral difference the original mandate and the proposed accommodation, is not a winning one. There is a real moral difference between the original plan and the revised plan as Grant has outlined here. To that extent, the accommodation is more beneficial to Catholic institutional employers.Also FWIW, I think the bishops and others are correct when they point out that the accommodation creates new problems of its own. But the term "shell game" has been thrown around a lot by detractors, even in some cases by bishops, and I really don't see that it is a shell game. I've tried to explain in some of my comments why that is so. There are still many things to dislike about the mandate and the accommodation. Even if you grant that the accommodation solves one narrow issue to some extent, it still poses fundamental religious liberty problems; religious liberty belongs, not just to institutions, but to individuals, including the proprietors of businesses and other organizations that employ others. Also, alleviating the concerns of Catholic hospitals and universities by shifting it to Catholic insurers and institutions that self-insure is the equivalent of treating one patient of smallpox by transferring the virus to another patient and then taking credit for the brilliant cure of the first patient. And beyond the religious-liberty issues: that the government can mandate what two other parties must privately agree to do is offensive to me. That the government can order a third party to give away a good or service for free is offensive to me. That the government is trying to solve exigent social problems by promoting immorality rather than virtuous behavior is profoundly offensive; that it is attempting to entangle third parties in its official program of immorality is even more offensive; and that it wants to include Christian organizations in its webs of immorality is most offensive. And referring to contraception as "women's health" rather than what everyone knows what it really is - contraception - is an exercise in Newspeak. I thought we took sledgehammers to the Berlin Wall so that we wouldn't have to be subject to that kind of thing.

An analogy: Republicans come up with a plan to mandate that all insurance policies must cover a particular drug (call it X) that is made solely from organs harvested from political prisoners in China, and that is used to remove wrinkles from one's forehead. Some people object, including on religious grounds (we shouldn't be subsidizing drugs made in that way).So Republicans offer a compromise position: Insurance plans don't have to literally include Drug X. Instead, anytime an employer buys an insurance plan, the plan must merely be accompanied by an offer of "free" Drug X to any insured person who asks. Who would be happy with that compromise solution? Who would think that it insulated oneself (as an employer) from being involved with an insurance plan that provided such drugs to one's employees?

Stuart: Problem solved: You can get a free smartphone from any U.S. mobile carrier. Enjoy.I wouldn't want to curtail your lobbying efforts, but I do think the bishops conference will have to start availing itself of the moral-theological resources provided by the Catholic tradition.The $9/month pills available at Target, etc., are not the same as the more expensive ones. They are older models. They work differently because they contain much higher doses of hormones, and therefore have stronger side effects, and greater potential to cause cancer. The difference between the cheap high-dose pills and the more expensive low-dose pills is nothing like the difference between generic and name-brand shampoo.

Stuart: you seem to believe that there is a universe in which moral agents may easily engage in morally pure acts. The Catholic tradition developed categories of cooperation precisely because that universe is a fantasy, and to help us figure out when and how it's permissible to cooperate with evil.

I rather doubt that Stuart thinks that. I think he thinks only that the federal government was not created to force us to cooperate with evil in ways we'd rather not.

The difference between the cheap high-dose pills and the more expensive low-dose pills is nothing like the difference between generic and name-brand shampoo.OK. But I have a novel idea: how about using condoms, which don't involve any dangerous hormones at all, and which are very cheap, and which have the added bonus of protecting against STDs? (Yes, there are a few women who take artificial contraception for real medical reasons, but no one objects to that, and Humanae Vitae expressly approved such medical treatments.)

It's not a few, Stuart. It's something like 40 percent of women who use prescription contraceptives. And the failure rate of condoms is about 15 percent.

Then what is the burden of the word "insulate," John? If one doesn't like being forced to cooperate with evil (by the government or by free-market capitalism), there's always the monastery.

Yes, there is that option. Too, there is the option of hoping (and working) for a government that is less prone to force such things on us. (And of course there are many such things, including lots that are much more serious than cooperation in the provision of contraceptives, that our government has a way of forcing.)

Its not a few, Stuart. Its something like 40 percent of women who use prescription contraceptives. And the failure rate of condoms is about 15 percent.40%? The overwhelming majority of those are for situations like, "I'll take birth control pills to prevent pregnancy, and oh isn't it nice that the menstrual cycle is a bit more regular or less crampy." Its not a few, Stuart. Its something like 40 percent of women who use prescription contraceptives. And the failure rate of condoms is about 15 percent.The failure rate of anything not used properly (or at all) is going to be high. That's not the condoms' fault.

Evidence for the usage claim: http://www.guttmacher.org/pubs/Beyond-Birth-Control.pdf That report is pretty comical for how it presents information like the following:

Reliance on birth control pills for noncontraceptive reasons is highest among pill users who are teenagers. In fact, teens are more likely to report using the pill for noncontraceptive purposes than for birth control: Some 82% of 1519-year-olds who use OCPs say they do so for noncontraceptive reasons.

This is all written with a straight face, as if there's no possible reason that 15 year olds might not tell the full truth about why they were really using contraceptives. In other news, the research arm of a condom company might issue a report about the marvelous benefits of condoms, in which it might say 82% of teenage boys who carry a condom in their pockets are overwhelmingly doing so to 1) use as a water balloon for practical jokes, or 2) use as a glove when handling raw meat. Hmm, why would we ever think that something was being oversold there?

And yet, Stuart, that is their failure rate. The pill has a failure rate too. It's just a lot lower.Your knowledge of the female mind is impressive in its range. I hope you'll forgive me if I remain unpersuaded by it.

Well, you could look at what the survey actually says (86% report using contraception for -- surprise -- contraceptive purposes), while some of those claim that there's a supplemental benefit as well (mostly the reasons I stated).And as for the women (often teenagers) who claim that there's no contraceptive purpose at all, you could exercise some critical thinking, as journalists sometimes do, and ponder whether teenagers always tell the full truth about their sexual activity.

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