Monday, January 30, 2012

Injecting principled Reasoning into the Contraceptive Mandate Shouting Match

Recently, there has been a bunch of noise about Catholic Institutions being required to provide deductible-free access to contraceptives in the health insurance plans they provide their employees.  Angry diatribes and weirdly neutral negative opinion pieces have been written on the subject.  They are angry (or bizarrely bland), so it's understandable that they don't clearly understand what they're talking about.  Let me clear things up for everyone involved (that means you Catholic Bishops).

See the difference? Me neither.

The objections in this debate are essentially of the form "We object to you forcing us to recognize that the people we employ use the money we give them to buy contraceptives."  That is dumb.

Kinds of thing that would infringe on religious freedom:

  1. Requiring Catholic hospitals to provide abortions
  2. Requiring Catholic doctors to prescribe the pill
  3. Requiring Catholic pharmacies (do these exist?) to sell the pill or condoms or what-have-you.

Kinds of thing that would NOT infringe on religious freedom:

  1. Requiring that health insurance benefits provided by Catholic institutions include deductible-free access to contraceptives
  2. Requiring that Catholic institutions pay their full-time employees (Note: 2 is equivalent to 1)

Reasoning in word form below the fold:

Employer compensation ALREADY provide morally identical access to contraceptives through the mechanism of "purchasing".  It turns out that the money an employer pays to an employee is usable for the purchase of any good or service legally available in the U.S., including contraception.  Unless an entity is legally allowed to fire its employees for using contraceptives, covering contraceptives makes zero impact on the amount of compensation package available for the purchase of contraceptives.  Since only churches are allowed to make firing decisions like the one I described, it is entirely consistent that churches be the only institutions exempt from the coverage rules (which they are).


  1. Here's the difference. In the before, the employer is paying for a health plan that does not include contraception, sterilization, etc. Thus the entirety of the cost of those falls on the employee.
    In the after, the employer is paying for a health plan that does include contraception. The cost of the health plan is now theoretically higher, due to increased coverage. The employer and employee both pay a portion of the increased rate. The Catholic institution is now subsidizing activities it finds morally objectionable.

    Said another way, in the before, I would have $2 a month or whatever more in my pocket than in the after. In the after, that money is instead being used, in large part, to cover contraceptives, etc.

  2. Okay, if you believe that total compensation remains unchanged (in other words the $2 either goes to your salary or to the increased cost of health insurance to cover contraception), then there is no difference in the total level of employer provided support for contraceptives. Every employee has the ability to use their compensation on birth control, and the total amount of money available for them to use on birth control remains unchanged.

    Subsidize has no real meaning within the context of your employer. Your employer subsidizes all of your activities equally, by paying you. Unless they have the right to stop paying you for a thing, they are subsidizing it. Catholic institutions do not posses that right in general, and so are already subsidizing it just as much as their employees use it.

    Incidentally, the cost to the insurance company and therefore (indirectly) to the institution is exactly the cost of all the contraceptives purchased by the employees. So, the institution is paying for exactly as much stuff it objects to regardless of the means of purchase. Insurance is just "healthbucks". It is a type of compensation available for medical uses. People not using contraceptives directly reduces the cost of providing the plan year to year, people using other services increases the cost. Furthermore, your resources aren't kept in a special bucket by the insurance company, it goes in with all the other people insured by that company, so just by using an insurance company that provides objectionable coverage you are "subsidizing" that behavior, regardless of the content of their plans. But since by subsidizing we mean giving people flexibly usable compensation that can be applied to a variety of goods and services, we're really not doing anything different from what we've already done. We're just admitting it. I still don't see how this isn't a distinction without difference.

    1. You're not the only one who can make crappy pictures
      The Before
      The After

      The arrows, as in your graph above, represent the flow of money.
      In the before, notice that the only lines going to contraceptives come from the employees. Meaning, the employees don't have to spend that money if they don't want to. They have the choice as to whether or not they will adhere to Catholic teachings. The insurer may spend money on contraceptives as its covered by other plans, but that money shouldn't be coming from plans that don't include contraceptives.
      In the after, we've taken that choice away from the individual employee. We're saying that money is going to go to the insurer. The insurer will spend a portion of that money on contraceptives as it's included in the plan.
      So the problem is that for those employees who weren't buying contraceptives, they're now part of a plan that covers it. Out of the money paid into that plan by the employee and employer, a portion of it will go towards paying for contraceptives. This is a violation of the Catholic conscience, the only solution to which is not paying any money towards a health plan. This, in turn, is a violation of Catholic social teaching. Thus, Cardinal-Designate Dolan's comment, "In effect, the president is saying we have a year to figure out how to violate our consciences."

      Summary: Catholics are being forced to pay for plans that include contraceptives. This makes Catholics pay for contraceptives, violating their consciences.

    2. I think your diagrams make my point excellently. In both cases all the money is flowing exclusively from the employer. In both cases, the purchase of contraceptives is at the behest of an employee and through a party one degree removed from the employer.

      I think you very naively assume that insurance companies have any interest whatsoever in keeping money pools separated by plan. If you believe that, why not choose to believe that they only pay for contraceptives out of the contributions of those people purchasing them? Mark me in the "highly skeptical" column on that one. Money is money; it is just numbers in their books, and it is certainly pooled in their profit coffers at the end of the year.

      For that matter, if your "some of my money goes toward buying contraceptives through the purchase of this third party healthcare purchasing service called health insurance" argument is valid, then Catholics would be morally obliged to boycott all institutions providing healthcare coverage of contraceptives to their employees, as some portion of that Catholic's money would go to the purchase of contraceptives (one aspect of the expenses of that business).

      In no instance here is a Catholic required to purchase a contraceptive, nor are they required to sell a contraceptive. Any law violating either principle could be reasonably framed as impinging on freedom of religion. Though it is worth mentioning that neither of those actions is innately sinful. The sin is in using the contraceptive for its intended purpose. Some contraceptives have valid alternative uses (makeshift balloons, acne control), and their use is only sinful within the context of use as contraceptive.

  3. Also, by your argument Catholics can only validly work at institutions that don't already have health plans that cover contraceptives, as their money is currently being used to purchase contraception EVEN AS WE SPEAK. Consider your circumstances. Are you buying contraception and sterilization services right now? Without even knowing it?