HHS contraceptive mandate debate: summarized

I just got asked for a summary of the HHS contraceptive mandate debate.  I've written quite a bit on the topic previously, but since the situation (and my understanding of it) evolved over time, I thought it would be worthwhile to pull together my previous posts and some final commentary.  It's worth noting that while the Obama Administration and USCCB seem committed to their final stances, the rules are open for public comment through June, and will only be finalized in August.

The mandate

As part of the Affordable Care Act, all health insurance plans are required to cover preventative care without co-pay, but the definition of such care was left to the executive branch.  On the recommendation of the National Academy of Sciences, the Obama Administration included birth control--in particular female birth control, like the pill--in preventative care.  This means that all insurers must cover contraceptives without co-pay. The full text of the most up-to-date proposal for the mandate can be found here: https://www.federalregister.gov/articles/2012/03/21/2012-6689/certain-preventive-services-under-the-affordable-care-act

The objection

Catholic institutions objected on the grounds that contraception is against the teachings of the Catholic Church.  They felt it a breach of religious freedom that they were required to pay for products the primary use of which they considered to be immoral.  As the Obama Administration has responded to this objection the complaints have changed.  The most recent statements by the USCCB can be found here: http://www.usccb.org/issues-and-action/religious-liberty/conscience-protection/

The response

The administration, gradually, made the following adjustments/clarifications to address the conscientious objections:

1. The mandate only applies to non-Church organizations, such as Hospitals, Charities, and Schools.  Parishes and other institutions who primarily hire and serve Catholics (or people of other objecting faiths) are exempt.
2. Insurance organizations must not charge the insuring institution for additional contraceptive coverage.
3. For self-insured institutions (most large catholic organizations), the cost of the contraceptive coverage would be born in full by an external entity, rather than by the institution itself.
4. (A clarification) The cost of insurance plans with full contraceptive coverage is actually lower than the cost of insurance plans without full contraceptive coverage.

Some links to articles on the subject

The status of similar mandates already imposed by individual states.

A pretty up-to-date summary of the issues by a news source.

And another article

And some more coverage

Statement by the USCCB (Catholic Bishops)

The most up to date formal proposal (a difficult read)

My thoughts

Since no Catholic institution will have to pay for contraceptive coverage (free from insurers, and free from insurance managers for self-insured institutions), there is no violation of conscience.  Since US law recognizes rights of reproductive freedom and privacy, allowing institutions to inspect employees' sexual practices in the provisioning of healthcare (for instance to cover the pill for ovarian cyst treatment but not contraception) is arguably a violation of employee rights.  And since I conceive religious freedom as essentially individual rather than institutional and no individual is coerced by this law, I can find no valid religious-freedom argument against it.  The case is further undermined by the governments subsidy of health insurance: taking the government's subsidy means taking the strings attached too.  I do think that it might be reasonable to fine non-compliant institutions the exact amount of government subsidy as another means of exemption, but even that butts up against employee rights in an uncomfortable way.

My previous thoughts (in chronological order)

These kind of shift around as the situation and my view of it shifts, but the in series they follow all the important points of argument, and the comments often include useful insights or counter-arguments.

1. My initial take

2. Clarifications and a look at some more nuanced objections

3. Some commentary from a philosophy of government/legal perspective

4. A little summary of how things looked after the Obama administration made response 3 

Why do we disagree?

This question matters.  It determines the scope of debate and helps us understand differing viewpoints.  It is also answered with confusion or misinformation with hilarious frequency.  I'll touch on how to think about these disagreements and briefly highlight some examples of confusion in the tax and voter ID debates.  Anyway, why do we disagree?

In politics, it seems to come down to a few things:

1. Differing, empirically testable, ideas about the world (facts)
2. Differing, empirically testable, ideas about how the world works (models)
3. Differing ideas about the proper values and goals of society 
4. Differing ideas about the proper powers of government

or, if you like:

1. What is the world like?
2. What can we do about it?
3. What should we do about it?
4. How shouldn't we do it?

None of that is terribly controversial, but I think that people often confuse the origins of their disagreement.  

I often, for instance, hear conservatives saying that the government shouldn't raise taxes on the rich, but depending on who you talk to, the answer to why varies a lot.  For some it is "because they are job creators", but for others it is "because it isn't fair".  These world views have the same conclusion, but different implications.  We can, to some extent, test the proposition that raising taxes will mean less job creation.  If a person genuinely believes this to be the primary reason not to raise taxes on the rich, then empirical arguments are the most appropriate forum of discussion.  For the "it isn't fair" person, the proper arguments are philosophical--diminishing marginal utility, &c.  Of course, people often convolve many different types of reasons, or simply hold positions as an aspect of group identity, but the basic point still stands.

Now, I don't think it is impossible to convince people to change their positions in 3 & 4 type disagreements, but it's substantially harder.  It is, however, possible to give people better access to facts, and in many cases that changes the nature of the discussion for the better.

Presenting evidence of the extremely low incidence of voter ID fraud, for instance, seems to have shifted the debate from "we need to curb rampant voter ID fraud" to "it is right and proper for voters to show ID in order to vote".  In other words, the debate has shifted from an empirical one to an ideological one.  From my perspective, that is good, because ideological questions are the only valid questions to ask voters in my idealized constitutional anarchy model of government.   Voters are, in fact, quite bad at discerning which facts and models best reflect the real world.  But, they are excellent at determining what they think are good goals to focus on as a society, and what they think are categorically unacceptable ways of achieving those goals.

I'll have more on practical applications of this idea, and ways in which it might help move the debate forward in a later post.

Not sold on the Local Food movement: take two

My college roommate--an ecologist--just took a swing at my local food skepticism post.  I think he missed in all the same ways that my other ecophile buddies do, but his comment gave me a great sampling of the typical arguments I hear.  I'm going to address each of them in the hopes that future ecophiles might be able to help me understand their position better, or come to the realization that their position is untenable and surrender to my superior arguments.  You can read his original comments here; I'm just going to summarize what I see as the key claims and arguments and then address them systematically.

My Claims	Common Ecophile claims
Sustainability should be about efficiency	Sustainability isn't just about efficiency
Even if externalities were priced in and subsidies were eliminated, industrial agriculture would benefit from economies of scale and be cheaper than "local" food.	Industrial agriculture is cheaper because its real costs are hidden (subsides and externalities)
Sustainability is only a real concern for resources that we must use continuously, but that we use faster than we make.  Creating a viable alternative, finding a way to slow consumption, and/or finding a way to speed production are the only ways to address real sustainability problems.	We should stop using X now so we don't catastrophically run out of X later.
Organic food has not been shown to be any healthier or more nutritious than regular food.	Organic is healthier and more nutritious
I see no reason to believe that waste per unit product is higher for industrial agriculture, nor have I seen any numbers to show it.  Please educate me if such arguments/numbers exist.	Industrial agriculture produces more waste than local agriculture.

My Conclusions:
Sustainability efforts should be focused on pricing in externalities and improving resource usage efficiency.  The health/nutrition stuff doesn't really have science on its side.  I also think that we benefit enormously from global food markets, since regional disease and bad weather events would be catastrophic if there weren't willing food exporters distributed around the world.  It's one of the best tools we have for avoiding global food shortages.  Increased diversity would be another good defense from this, but we don't need to go local to do it, and I'm not sure going local would help.

My Arguments:
Piles of arguments below the fold.  Before you read them you should know that I approach ecological issues in an entirely human-centric manner.  I don't think we should destroy pretty places or be mean to animals just because we can.  But, I don't care about pretty places or rare animal species or being nice to caged chickens or anything like that except in so far as it benefits human beings to do so.  I think saving the algae is way more important than saving the whales and I'd flatten every mountain in Africa if it meant we could feed all the Africans.  I am glad we forced smallpox into extinction and would happily support mass extinctions of many other organisms that are inconvenient to human beings (eg. malaria, HIV).

A Key Question

I used to think that the important thing to ask someone whose views you wanted to understand is "why do you believe this?"  It seems like a good start for a discussion, and a way of figuring out whether you're on the same page as someone, what they value, and how they came to their decision.  But, after spending the better part of this year embroiled in near-constant virtually-zero-progress political debates, I can't help but think that I had this one wrong.  I think I figured out a better one.  "What hypothetical evidence would it take to change your mind on this issue?" Try it out on some people.

I like this question because it separates core value issues from higher order policy ideas.  If you can't give a real answer to this question (I can't think of any possible evidence that could convince me that slavery should be legal... for instance), then your policy goal is simply to enact your favored policy (in this case abolition).  However, I can think of lots of ways that, say, my belief in the fiscal stimulus's effectiveness could be overturned.  For example, if someone showed me that job losses or GDP losses had accelerated or stayed the same after its implementation, I would be forced to abandon my belief that the stimulus improved the economy.

If you manage to have a conversation with someone entirely about the ways in which each of your views could (hypothetically of course) be overturned, then you are a lot closer to understanding where they come from, and how you can fix them ;-).

Here's my economic issue list.  Please feel free to comment in your own convinceables.

Looking for Good Conservative Blogs

So, internet, I ask you for help.  I want blogs of well spoken, evidence driven conservatives.  My recent movement into the blogosphere has been through Paul Krugman and his commonly linked blogs, which naturally puts a rather liberal slant on my reading.  I'd rather like to see legitimate disagreements to what these people are saying as I find myself wanting to hear counterarguments on subjects that are outside of my expertise.  Please suggest anyone worth reading.