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February 09, 2012

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I am not fine with paying, directly or indirectly, the cost of elective abortion. I can't prevent others from doing what they will with their own money. I do like having a bit of a say-so with how my money is spent.

A question for you, McK:

Why is it your money?

You provide health insurance as part of the compensation that you offer your employees. What they do with that compensation is their business.

If your employee took some of the cash you paid them and procured an elective abortion, would you then argue that you shouldn't be required to pay them in money? Or that you could put some limits or restrictions on what they spent the money on?

Whose health insurance is it?

Why is it that the choices the Church has to make under the mandate are so much more important that the choices everyone else would have to make without it? (Just go work somewhere else, a..hole!)

No, that is not the choice workers are faced with. The choice is: work for a company that declines to offer birth control/abortion coverage and pay for that yourself OR work elsewhere.

IF they wish to provide health insurance as part of their compensation, which they ARE NOT required to do, then the requirement is (soon to be was) is that whatever health insurance plan they offer has to cover birth control expenses.

If they cannot do that in good conscience, their employees can purchase insurance on the private market. PPACA intends to establish exchanges to make that easier. It works not-too-badly here in MA.

Russell, see my comment above. The fix is not complex or onerous. Rather than either provide insurance or not, simply allow insurance less birth control/abortion coverage and the employee can buy that rider separately.

I suppose another issue is whether an insurer can be forced, as a condition of doing business, to offer birth control/abortion coverage.

Is the left so intent on these coverages that they would rather there be no insurance than insurance that didn't reach these two, discrete coverages.

Why is it your money?

You provide health insurance as part of the compensation that you offer your employees. What they do with that compensation is their business.

Here's where the logic breaks down: I require my employees to have health insurance, either on the firm's group policy or under their spouse's policy. I don't want the headache of an uninsured employee getting sick or being in an accident and my paying a lot of doctor and hospital bills (which I have done in the past). Those who are covered on a spouse's plan get a slightly better deal on the salary side than those who are covered on my plan, but much less than the cost of insurance.

When it comes to health insurance, I don't give my employees a choice--particularly at the non-professional level. Call it paternalism, I don't care.

But, what we are talking about here is mandated insurance that would further mandate, eventually, abortion coverage. If I am mandated to buy that insurance, I am buying it with my money. I am not going to pay, directly or through mandated insurance coverage, for an elective abortion.

Employees are free to spend their money pretty much any way they want, including a legal abortion. The only exception that comes to mind is that I have terminated one employee with a drinking problem (at work) and who wouldn't get help. Other than that, I can't think of what else a hypothetical employee might do with their money that both legal and so offensive that I would terminate them.

McKinney: Birth Control is part of women's health. No, it is birth control. In specific instances, where pregnancy poses an elevated risk of harm to a women, it is a health issue.

I'm sorry, but I'm not going to let this go. Pregnancy ALWAYS poses an elevated risk to women's health. Pregnancy is risky. The link I provided includes risks to women with pre-existing health problems, as well as pregnancy issues that come up totally by surprise. Have you ever heard of a nonpregnant woman having gestational diabetes? No, because it's a risk of pregnancy. How about pre-eclampsia? No, it happens because women are pregnant - it's not predictable. How about a torn pelvic floor? Almost everyone has some pelvic floor problems - some temporary, some permanent.

So let's, for now, ignore those and other "serious" possibilities, such as stroke. What about common morning sickness? Do you consider going to the doctor to get medical treatment when you've been throwing up for three months?

Lots of women endure these risks for the sake of bringing a child into the world. But to pretend that they aren't health risks is an appalling lie.

Contraception lowers infant mortality rates: " In countries where fewer than 10% of women use a modern contraceptive method (the pill, the injectable, the implant, the IUD, the condom or sterilization), the average infant mortality rate is 100 deaths per 1,000 live births, compared with 79 per 1,000 in countries where 10-29% of women use a method and 52 per 1,000 in countries where 30% or more do so (Chart A). As would be expected, given the high levels of infant mortality in Sub-Saharan Africa, contraceptive use is much lower there than in other regions; prevalence is below 10% is 16 countries and 5% or less in 10." It also lowers maternal mortality rates. If defining contraception as a health care issue is "leftist," it's yet another instance where the left is reality-based.

McKinney: Birth Control is part of women's health. No, it is birth control. In specific instances, where pregnancy poses an elevated risk of harm to a women, it is a health issue.

I'm sorry, but I'm not going to let this go. Pregnancy ALWAYS poses an elevated risk to women's health. Pregnancy is risky. The link I provided includes risks to women with pre-existing health problems, as well as pregnancy issues that come up totally by surprise. Have you ever heard of a nonpregnant woman having gestational diabetes? No, because it's a risk of pregnancy. How about pre-eclampsia? No, it happens because women are pregnant - it's not predictable. How about a torn pelvic floor? Almost everyone has some pelvic floor problems - some temporary, some permanent.

So let's, for now, ignore those and other "serious" possibilities, such as stroke. What about common morning sickness? Do you consider going to the doctor to get medical treatment when you've been throwing up for three months?

Lots of women endure these risks for the sake of bringing a child into the world. But to pretend that these aren't health risks is an appalling lie.

(cont'd)

Contraception lowers infant mortality rates: " In countries where fewer than 10% of women use a modern contraceptive method (the pill, the injectable, the implant, the IUD, the condom or sterilization), the average infant mortality rate is 100 deaths per 1,000 live births, compared with 79 per 1,000 in countries where 10-29% of women use a method and 52 per 1,000 in countries where 30% or more do so (Chart A). As would be expected, given the high levels of infant mortality in Sub-Saharan Africa, contraceptive use is much lower there than in other regions; prevalence is below 10% is 16 countries and 5% or less in 10." It also lowers maternal mortality rates. If defining contraception as a health care issue is "leftist," it's yet another instance where the left is reality-based.

Rather than either provide insurance or not, simply allow insurance less birth control/abortion coverage and the employee can buy that rider separately.

Something akin to that is where it looks like it is going to land. Apparently, the insurance company will be required to provide the coverage and *not* charge the employer for it if the employer has a scruple about it.

It will be interesting to see how far that flies.

Is the left so intent on these coverages that they would rather there be no insurance than insurance that didn't reach these two, discrete coverages.

I think "the left" is intent on people being able to go to the doctor and get whatever health care they require, without being horsed around by their employers.

I wish we would just get out of the business of having health insurance be provided by employers in the first place. It's not a particularly good approach, for anyone involved. Another topic, no doubt.

I'm sympathetic to folks who find themselves uncomfortable with legal or other policy requirements on grounds of conscience.

What I'm not comfortable with are those folks dictating the terms under which other folks have to live.

The terms "cart" and "horse" come to mind.

And yes, employees of Catholic hospitals can buy the rider for themselves, but they're not the folks who have the issue. They're just the folks who are being asked to pay for it.

Long story short, I imagine this will all get sorted out in some way or other that everyone can find a way to live with. And, if so, that is a pretty good outcome, by my lights.

I just object to the "Obama / lefties / the government is oppressing people of faith" thing. It's ridiculous.

And as a slightly OT editorial aside, if there is one religious community in this country that is by god not being oppressed, it is the Catholic Church.

I intended to provide a link in the 3:08 pm comment above, but it got lost: http://womenshealth.gov/pregnancy/you-are-pregnant/pregnancy-complications.cfm

Is the left so intent on these coverages that they would rather there be no insurance than insurance that didn't reach these two, discrete coverages.

Going at bit past russell's response's including scare quotes, can we discuss what we as individuals think, since we're all participating as individuals in this discussion on this blog, rather than asking people here to figure out what "the left" is intent on?

With that, what I'm intent on is not that there be no insurance. That's not going to happen over this.

(I might as well ask if the right is so intent on Catholic-owned business not having to comply with the law when it causes religious objections, that they are willing generally to give Catholic doctrine priority over statute.)

Is the left so intent on these coverages that they would rather there be no insurance than insurance that didn't reach these two, discrete coverages.

One other thing: The above is not a constitutional question about freedom of religion. It is purely a practical one, correct?

McTx: I suppose another issue is whether an insurer can be forced, as a condition of doing business, to offer birth control/abortion coverage.

Well quite clearly they can be, though perhaps that's not what you meant by "issue."

More generally McKinney, it seems to me that you're arguing that requiring, e.g., a Catholic hospital to provide health insurance that covers contraception (or abortion, for that matter), is unconstitutional. Is that the case or are you arguing some more practical point?

Also, you state "I am not going to pay, directly or through mandated insurance coverage, for an elective abortion." So, if the state of Texas required all employers to provide health insurance to employees that covered elective abortions, you'd...consider that unconstitutional as applied to you/your business? Move to another state? Just (genuinely) curious.

Is the left so intent on these coverages that they would rather there be no insurance than insurance that didn't reach these two, discrete coverages.

Is the right so intent on treating contraception as different from all other health issues, including other sexual and reproductive health issues like erectile dysfunction, that this is the hill they want to die on?

I'm pretty sure the Republican party isn't dying on the abortion issue. In fact it looks to me like it is one of the few issues on which it attracts people who might otherwise be much more open to the left. See especially Catholics.

Luckily for all involved, I didn't say "abortion issue," I said "contraception."

But to pretend that these aren't health risks is an appalling lie.

Henceforth, I will try to lie only minimally and in a non-appalling fashion. I don't view a normal pregnancy as any more of a 'health risk' than driving a car, probably less, but I don't have the numbers. If a woman is sufficiently concerned about getting pregnant, for health reasons, she has a number of remedies and options.

That said, a fair reading of my objections to this proposal are: (1) constitutional, (2) my general hostility to gov't mandates (the least of my objections) and (3) abortion, which is the end game to all of this.

It is no secret that I would reverse Roe and return the matter to the states for elective abortion (not for health, rape or incest). I am not going to sit on the sidelines while stage one in making abortion funding a federally-mandated obligation is on the front burner.

I just object to the "Obama / lefties / the government is oppressing people of faith" thing. It's ridiculous.

As, am I fairly sure, those on the RCC side and people like me, object to being as roundly disparaged because we don't meekly bow our heads and submit.

Or, dismissed as opportunistic partisans, for example: "This whole controversy is a pile of partisan crap intended to give Republican candidates something to beat Obama over the head with."

"Motive questioning" is a subset of mind reading. Just as Santorum, as one of many examples, simply cannot comprehend how important the right to contraception is to millions of Americans, too many on the left cannot comprehend (1) how little millions of Americans care to have to gov't dictate to any church and (2) how strongly many Americans feel about elective abortion and how much more strongly they feel about being compelled to be a party, directly or one step removed, from that procedure. Some accommodation on these discrete topics is going to have to be made.

too many on the left right cannot comprehend . . . (2) how strongly many Americans feel about elective abortion capital punishment and how much more strongly they feel about being compelled to be a party, directly or one step removed, from that procedure. Some accommodation on these discrete topics is going to have to be made.

I don't view a normal pregnancy as any more of a 'health risk' than driving a car, probably less, but I don't have the numbers.

I gave you some numbers. And when someone's not pregnant yet, she doesn't know yet whether her pregnancy is "normal". That's why it's a "risk". But even a "normal" (again, ?) pregnancy has health effects, something that I tried to explain with the morning sickness example: not everyone wants to vomit for three months.

If a woman is sufficiently concerned about getting pregnant, for health reasons, she has a number of remedies and options.

Yes, she does! It's called contraception, and under the Affordable Care Act, she can get it covered by insurance. Hooray for modern medicine!

MKTx: "Rather than either provide insurance or not, simply allow insurance less birth control/abortion coverage and the employee can buy that rider separately."

Thus effectively giving their female employees a pay cut. Way to go.

Is that the case or are you arguing some more practical point?

It is both. If my 4:02 didn't clear that up, let me know.

So, if the state of Texas required all employers to provide health insurance to employees that covered elective abortions, you'd...consider that unconstitutional as applied to you/your business? Move to another state? Just (genuinely) curious.

I would consider it unconstitutional, for sure. Move to another state? Probably not. Cut my practice back to just me: quite possibly. Fortunately, your hypo is about as unlikely as Phil supporting Santorum.

Is the right so intent on treating contraception as different from all other health issues, including other sexual and reproductive health issues like erectile dysfunction, that this is the hill they want to die on?

Probably. The right, as I see it (and I am not an authorized spokesperson, given my views on a number of subjects), values gov't leaving churches alone quite highly, even if it is someone else's church (not that this doesn't produce its own set of contradictions). The right, as qualified above, is fine with employer-paid insurance, less so with mandates coming down from on high out of Washington, i.e. the small gov't thing. Elective abortion opponents are adamantly opposed to being made a party to that procedure. I note that you are careful to couch this in terms of contraception. Having seen the Obama administration trick Catholic Dem congressmen into voting for HCR, I don't view your limitation as having any long term meaning or reliability. The end game is abortion and your personal assurances give no comfort, as sincere as I am sure they are. So, is this the hill to die on? Yes, I would say so. Is the left equally willing to die on this hill?

[Me]--Is the left so intent on these coverages that they would rather there be no insurance than insurance that didn't reach these two, discrete coverages.

[HSH]--One other thing: The above is not a constitutional question about freedom of religion. It is purely a practical one, correct?

It is both and it is also simply a matter of principle. Even if we didn't have a 1St Amendment, I would oppose on principle, the feds telling any church that it had to violate a fundamental, long-standing and widely known tenet of its faith.

I believe it was Russell who suggested that the RCC could just not offer insurance. While that seems a pragmatic solution, it has constitutional infirmities and is wrong as a matter of principle. That solution chills the free exercise of religion and, as a matter of principle, imposing one quarter's policy preferences on the entire country, regardless of burden created thereby, is contrary to my concept of freedom. And not just mine, I am fairly confident.

McTx: a fair reading of my objections to this proposal are: (1) constitutional,

But you don't have a leg to stand on w.r.t. this point, at least not in the context of hospitals/charities run by religious organizations, unless you want to object to the SCOTUS jurisprudence (which would be fine, of course).

I mean, suppose a pillar of my religious doctrine mandates that the employees at my religiously run non-profit hospital have to walk a 40 foot high tight rope with no safety belt to go to the bathroom, but the OSHA regs state (effectively) that there must be a safety belt (or, gasp, no tight rope at all!) with no religious exception, is that regulation unconstitutional in your view?

"Motive questioning" is a subset of mind reading.

Fair enough.

For the record, my comment about the political use of this issue was not directed at you. And no worries, there are plenty of other folks who are only to happy to wear that cap.

Also for the record, as mentioned above I am more than sympathetic to folks who find it problematic to live out their personal convictions in a not-always-friendly social context.

At the risk of repeating myself, what I find objectionable is when those folks attempt to square their personal moral circles by making other people change *their* lives to accomodate them.

I can assure you I've been on both sides of that. It's not always an easy tightrope to walk, but as far as I can tell it's not intended to be.

If it was easy, we'd all be saints, wouldn't we?

I would still be interested in your thoughts about why the money you spend to compensate your employees belongs to you, and not to them. I get that you, or anyone really, could have concerns about how that money is ultimately spent, but there's only so far down that rabbit hole that you can go.

We all contribute to stuff that we find objectionable. The alternative is to become a hermit.

"....but I don't have the numbers."

That's pretty damnned feeble coming from an attorney with a long record of scribbling on the internets. Google "health care risks of pregnancy" and dip into any one of over 22 million hits.

JHFC.

too many on the left [right] cannot comprehend . . . (2) how strongly many Americans feel about [elective abortion] capital punishment and how much more strongly they feel about being compelled to be a party, directly or one step removed, from that procedure. Some accommodation on these discrete topics is going to have to be made.

Cool. Let's make a deal. Ohio citizens get to vote on whether there is capital punishment without judicial review by a federal court, and Texas citizens get to do the same on elective abortion. Any takers?

Thus effectively giving their female employees a pay cut. Way to go.

That would be female employees who elect to work for entities that opt out on conscience grounds. Yes. A women has the right to contraception. She does not have the right to compel what amounts to a conscientious objector to pay for it.

Because it is a fundamental tenet of their faith

Right up their with the Immaculate Conception and the Holy Trinity, eh? Somehow I doubt that very much.

McTx: It is both. If my 4:02 didn't clear that up, let me know.

It did, thanks.

I would consider it unconstitutional, for sure. Move to another state? Probably not. Cut my practice back to just me: quite possibly. Fortunately, your hypo is about as unlikely as Phil supporting Santorum.

Unconstitutional applied generally, such as to your law practice or Apple Computer, or as applied to religious institutions (however defined)? If the former, under what theory?

I'm starting to wonder if I was wrong above in my objection to sapient/HSH's distinction between employee compensation paid directly to employees who can do what they want with it, including procuring an "elective abortion" (to use your term), and employee compensation split between the employee and an insurance policy that covers elective abortions. As they note, it's ultimately up to the employee to utilize the policy to procure an elective abortion, just as it is if they were given cash.

What is it about the latter that is so objectionable as compared to the former? Is it the collective aspect of insurance, i.e., it's cheaper for 50 people to collectively purchase health insurance as part of the same plan than to do so separately, and thus through your business it's now cheaper to procure an elective abortion than it otherwise would be?

IOW, I think you seem to be making a distinction based on some sort of "independent actor" between you/your business and the elective abortion, if that's correct, I'm not sure why it's any less applicable in the "health insurance policy that covers elective abortions" case than it is in the "employees use compensation to procure elective abortions" case.

But you don't have a leg to stand on w.r.t. this point, at least not in the context of hospitals/charities run by religious organizations, unless you want to object to the SCOTUS jurisprudence (which would be fine, of course).

I mean, suppose a pillar of my religious doctrine mandates that the employees at my religiously run non-profit hospital have to walk a 40 foot high tight rope with no safety belt to go to the bathroom, but the OSHA regs state (effectively) that there must be a safety belt (or, gasp, no tight rope at all!) with no religious exception, is that regulation unconstitutional in your view?

From a constitutional perspective, you correctly identify the issue, or at least the friction point. If anyone wants to open a hospital, they are subject to the same rules, regulations, standards, etc. as any other hospital. That falls generally within the health/police power of the state. A religious objection, for example, to scrubbing prior to surgery doesn't exempt that religion for standard hospital hygiene.

From my con law class, I vaguely recall a body of 1st amendment jurisprudence that defines in a very general way the indicia of 'faith' that is within the 1st amendment. That is, a person doesn't have to be a member of a recognized church or religion to fall within the limited number of exceptions the SCt has created based on faith, such as conscientious objectors.

Opposition to birth control, and certainly opposition to abortion, fall easily within the broad constitutional definition of 'faith.'

Your seemingly irreconcilable dichotomy, however, misses a key point. In your hypo, the 'faith' wants to compel non-practicioners to violate a value neutral statute by an act of commission for "religious" reasons that are so irrational as to fall outside even the very broad constitutional definition of 'faith'.

Further, your hypo is the opposite of what we have been discussing. The RCC is not trying to compel, other than by doctrine, anyone to do anything. Rather, it is being compelled to perform an act that violates a fundamental tenet of its faith. The RCC is passive, in this sense, and the gov't is active, demanding an act which violates conscience.

Declining to do something for all employees is not the same as requiring all employees to actively do something as a condition of employment. For example, non-religious employees of an RCC run hospital could not be required by their employer to attend mass, foregoe contraception or any number of other things.

I would still be interested in your thoughts about why the money you spend to compensate your employees belongs to you, and not to them. I get that you, or anyone really, could have concerns about how that money is ultimately spent, but there's only so far down that rabbit hole that you can go.

It is my money until it gets to them, and, under current law, I don't have to, in the sense that I am not legally required to, insure my employees. That is a voluntary decision on my part. If HRC in fact compels me to either buy insurance or pay a fine, and if the cost of insurance is less than the fine (I've heard it's otherwise, which would be another really stupid feature of that 2500 page simplification of our overly complicated health care system, but that is for another day), then it is no longer a voluntary act by me, it's a mandate. With my money.

She does not have the right to compel what amounts to a conscientious objector to pay for it.

And the conscientious objector has the prerogative of not providing health insurance as part of compensation.

The RCC IS NOT BEING FORCED BY LAW OR PUBLIC POLICY TO PROVIDE ACCESS TO BIRTH CONTROL.

It's not.

You have a strong conviction about some moral or ethical principle? Live it out. But it's not everybody else's job to make that convenient for you.

But there is a world of difference between not bending the public policy that the other 99% of the world has to live with to suit your preferences, and "compelling" you to abandon your principles.

I'm curious to know how far you would be willing to take this. The number and variety of ways in which religious people are inconvenienced by public policy is pretty broad.

I am not legally required to, insure my employees. That is a voluntary decision on my part.

Thank you.

Unconstitutional applied generally, such as to your law practice or Apple Computer, or as applied to religious institutions (however defined)? If the former, under what theory?

Good question. In fact, so good that I reserve the right to amend,modify or retract some or all of what I'm going to throw out here. Yes, for the RCC, yes for McKinney & Cooper, No for Apple Computer.

Why, he asks.

Neither individuals nor private religious institutions should be compelled to violate their conscience in this instance. In the case of publicly traded entities, the ownership is so attenuated that there isn't enough of an identifiable conscience present to violate.

I realize this is riddled with technical issues and contradictions, but it's just too damn close to the cocktail hour at the end of a long week for me to do better.

IOW, I think you seem to be making a distinction based on some sort of "independent actor" between you/your business and the elective abortion, if that's correct, I'm not sure why it's any less applicable in the "health insurance policy that covers elective abortions" case than it is in the "employees use compensation to procure elective abortions" case.

Like I said, it's getting late and it's been a long week. However, if I understand correctly, you are saying: let McKinney opt out of paying for abortion coverage and give the savings on the reduced premium to his employees who can then buy that coverage if they choose?

I might be ok with that. Would you be ok with me giving all of my employees twice the amount of the savings in exchange for their written agreement not to buy abortion coverage?

Right up their with the Immaculate Conception and the Holy Trinity, eh? Somehow I doubt that very much.

Maybe. I can't order someone else's theological priorities, or second guess why they believe as they do.

That's pretty damnned feeble coming from an attorney with a long record of scribbling on the internets.

I have a long record of scribbling here and nowhere else. I don't have time to research much. I spend far more time here than I should. I try to shoot straight and qualify when I should be citing proof. That's all.

And the conscientious objector has the prerogative of not providing health insurance as part of compensation.

And the flip side, is that you would tie conferring a very valuable benefit on employees to committing an act that violates, in a very significant way, the RCC's faith.

Further, the intent is punish the RCC for its position by making it a less competitive and attractive employer.

Why this is particularly wrong is that it is the individual who decides whether to work at a RCC hospital or charity. Why not let the individual decide whether birth control coverage is such an important aspect of his/her life that he/she will forgo work at an RCC institution rather than do without? Why should the feds make that decision for not only the RCC, but for every citizen in the country?

I'm curious to know how far you would be willing to take this. The number and variety of ways in which religious people are inconvenienced by public policy is pretty broad.

Russell, I think it is just the opposite. Gov't requires citizens to do very little that violates conscience, other than pay taxes. Gov't doesn't tell us where to live, where to work, what to do in our spare time, what to think, what to believe, who we sleep or associate with, and so on and so on.

What do you have in mind when you think of things the gov't makes us do that run counter to our consciences?

Further, the intent is punish the RCC for its position by making it a less competitive and attractive employer.

No, I personally have no such intent, and I doubt anybody making this particular policy has any such intent.

The *intent* is to ensure that contraception is covered by health insurance. The kind of contraception in question is something you can only get from your doctor, which makes it health care. If it's not covered, a lot of people who actually do need it, for any strength of the word "need" that is used in common conversation, will find it difficult to afford.

"Punishing the RCC" has nothing whatsoever to do with it.

The RCC, not the rest of us, have an issue with this. And that's fine, we all have our own beliefs and convictions. But, it's *their* issue, not the rest of ours, so it's *their* hash to settle, not the rest of ours.

Don't like the "don't provide coverage" idea? Then they can get creative and come up with something else.

I personally actually have no problem with them, or anybody else, getting an exemption of some sort. Different constituencies make deals all the time regarding policy and legislation.

But what this is NOT is the government suppressing the free exercise of religion.

Gov't requires citizens to do very little that violates conscience, other than pay taxes.

Actually IMO it's more common than you would think.

A simple example, found after a minute of random googling.

Not a lot of Hasidim in TX? There are lots in NY.

If I can find an hour to go looking around, I'll see if I can find more.

It's not at all uncommon for a religious community to bump up against public laws and policies. We do our best to accommodate them, but sometimes doing so means making life that much more difficult for everybody else, so the burden falls on that community to adjust to the rest of us.

Or, you know, buy a bunch of land in Rockland County, set up their own little village, and tell the rest of the world to go to hell. Their choice.

The RCC is a big enough dog that they generally don't have to go the separatist route. They get their way fairly often.

Lucky them.

Why should the feds make that decision for not only the RCC, but for every citizen in the country?

And seriously, just to ground this in reality:

NOBODY IS MAKING ANYBODY USE CONTRACEPTION.

The one and only requirement under discussion is whether insurance plans should be required to cover it as a medical expense, should any of their insureds decide to avail themselves of it.

These are not the same thing.

And what makes it "health care" as opposed to "a band aid" or "a box of cotton balls" is that, in the cases we're talking about, you can't get it other than through a physician.

Fortunately, your hypo is about as unlikely as Phil supporting Santorum.

Considering that he'd find himself on the losing end of a Reagan '84 style landslide, I'm consdering sending him my next ten paychecks.

A simple example, found after a minute of random googling.

Well, not really. If the RCC was running hospitals that treated women only after all of the men had been treated, you might have a point. Nothing in the RCC's position discriminates: no one gets contraception or sterilization services. The impact might be disparate, but the application is universal. Moreover, women are not treated differently or required to do something differently.

And seriously, just to ground this in reality:

NOBODY IS MAKING ANYBODY USE CONTRACEPTION.

The one and only requirement under discussion is whether insurance plans should be required to cover it as a medical expense, should any of their insureds decide to avail themselves of it.

I wasn't very clear then. You say the RCC must either provide the full ride insurance or it won't be allowed to provide any insurance. This is couched as a 'choice'. Leaving aside the notion that this is in any appreciable way voluntary, what benefit, what good is served by the 'all or none' approach?

Clearly, the intent is to make 'none' such an unpalatable choice as to compel 'all.' If that is not the intent, then what is?

Yet, the ultimate decider could and should be people who work, or chose not to work, for an RCC institution. They can decide whether they want the coverage so badly that they will forgo work at an RCC institution.

I said nothing about making someone use contraception. Here is my question, again: Why not let the individual decide whether birth control coverage is such an important aspect of his/her life that he/she will forgo work at an RCC institution rather than do without? Why should the feds make that decision for not only the RCC, but for every citizen in the country?

And what makes it "health care" as opposed to "a band aid" or "a box of cotton balls" is that, in the cases we're talking about, you can't get it other than through a physician.

Also true for cosmetic surgery and IVF (is this covered? Seriously, my guess is 'no', but . . .). By this test anything a doctor does is covered. We can't afford it, if that is the case.

Considering that he'd find himself on the losing end of a Reagan '84 style landslide, I'm consdering sending him my next ten paychecks.

Fair point. He couldn't win if California and New York seceded.

And what makes it "health care" as opposed to "a band aid" or "a box of cotton balls" is that, in the cases we're talking about, you can't get it other than through a physician.

Thank you, russell.

And I, for one, don't mind that people don't do extensive research to support their positions when they comment here (although it's very welcome when they do). But to make supposedly factual assertions such as "normal pregnancy [is no more] of a 'health risk' than driving a car," assertions that are at odds with common sense, requires a little bit of substantiation. I don't know when "driving a car" had a special medical field devoted to it, whereas pregnancy has a field called "obstetrics." I don't know when car drivers were asked to pay monthly visits to a physician, whereas pregnant women do so, and do so at a more frequent rates during the last trimester, even in a "normal" pregnancy. I don't know why it isn't a given that women often suffer lifelong physical consequences (and sometimes death) from bearing children. The first thing most women do when they discover that they are pregnant is make a doctor's appointment. The fact that pregnancy is a risk to women's health is beyond dispute. Women used to die during childbirth at very high rates, and one of the reasons they don't now is contraception. Contraception for high risk people, contraception to space children, contraception for women who have completed their families, contraception for people who have mental health issues, contraception for women who need to regulate their hormones so that they don't bleed to death ....

I'm sorry to be stuck on this one point, but it seems to be a fundamental disagreement between people who are so worried about [male] Catholics' employment sensibilities, and women who are responsible for their own health. This is truly disturbing. The only reason I'm even considering calming down is that I feel that women's health has not been compromised today.

" If it's not covered, a lot of people who actually do need it, for any strength of the word "need" that is used in common conversation, will find it difficult to afford."

I keep going back to this. Are you actually contending that "a whole lot of people" that are employeed at Catholic hospitals and charities wont be able to afford it?

For patients not covered by health insurance, birth control pills typically cost $20 to $50 a month.

from here.

I figure most people would prefer getting the job with the rest of the health insurance and pay for their birth control.

I figure most people would prefer getting the job with the rest of the health insurance and pay for their birth control.

That might be true for some women, but under the ACA, people will be able to get insurance for themselves for reasonable cost. Some women, on principal, don't want to have to pay extra for their birth control under a discriminatory plan. Even if Jim Crow personally benefitted me, maybe I'd go for Not Jim Crow.

cleek: but i feel compelled to point out that contraception is an important matter to men, as well.

If you say so, but I never hear any pro-lifers demanding that men keep their pants zipped or declaring that a man is headed to eternal damnation.

In fact, when an abortion protestor confronted me, I asked why his sign didn't include the men who impregnated the women, and he said it was because the women let them in (his wording).

The first thing most women do when they discover that they are pregnant is make a doctor's appointment.

Because they are worried about dying? Or because they are interested in prenatal care? I do a lot of personal injury work. Pregnancy is a lot harder on the baby than it is on the mom. Driving cars is a lot more dangerous than a normal pregnancy.

In 2004, there were 4,112,052 live births. Infant mortality was 679 per 100,000 live births or 27,920 stillborn babies. Maternal mortality rate? 12 per 100,000 live births, or 492. Out of a country of 300,000,000.

And you say women are taking the pill because they are afraid of dying in childbirth? Or morning sickness?

They don't want to get pregnant. For plenty of valid reasons. That's why my wife--and I am quite sure my daughter--took the pill.

Sapient, you write as if there is this vast number of women who very much want but cannot afford birth control, and who are suffering accordingly. Seriously? PP is pretty much everywhere, certainly in every large and most small to medium urban areas.

I am sure there are plenty of women who should be on birth control. I am quite confident most of these women fail to take the time to get to a doctor or a free clinic or PP and avail themselves of what is pretty damned available and for a very reasonable price. Probably a lot less than they pay for their cell phone.

I'm glad that you support Planned Parenthood, McKinney. But perhaps the salutary statistics you report about infant and maternal mortality in this country is that people can plan their families with contraception.

And, yes, people get prenatal care for both themselves and their potential babies. Trust me: if they're not well, their babies won't be. It's called medicine.

Driving, on the other hand, is an inherently risky act. It's a different story than a risky medical condition that can prevented with pills.

" If anyone wants to open a hospital, they are subject to the same rules, regulations, standards, etc. as any other hospital."

This really irritates me in the context of this discussion.

The entire reason this is an issue is because Catholic hospitals were serving poor people's health needs *BEFORE THE FREAKING GOVERNMENT BOTHERED TO DO IT*.

The whole reason it remains an issue is *the freaking government doesn't want to pay to open up hospitals to serve those people*.

This isn't a case of Catholics being pushy and forcing their way into a well served area that the government was covering just fine thank you very much.

The reason this is an issue at all is because the governments in question don't want to have to pay to create hospitals to serve poor people. Catholic hospitals filled that need to the best of their ability. The government eventually (and usually MUCH later) decided to help SOME by reimbursing the Catholic hospitals for extending their service to still other poor people.

Yikes, I'm not even Catholic, but the whole frame of this discussion really pisses me off. This is exactly the reason why people think the government is pushy and ridiculous. Trying to do things like this is exactly what makes Democrats look ridiculous to anyone who has reservations about government busybodies. Catholic hospitals are *doing what the government doesn't want to do*. Forcing them to offer contraception when it is pretty clearly against their beliefs while they are still doing you an enormous favor is just ridiculous.

Sebastian: "Catholic hospitals are *doing what the government doesn't want to do*."

No, actually, Sebastian, Catholic hospitals were doing what the government didn't want to do. Catholics in the 1950's and 1960's (when I grew up in the Catholic church) had a very serious charitable mission. Now, not so much. It's pretty much about hating on women and gay people.

I was baptized Catholic. I know about Catholics. There used to be some good in it [not enough to make up for the sexism, child abuse, etc., from a modern day perspective], but it's not really there anymore. Don't kid yourself.

"That might be true for some women, but under the ACA, people will be able to get insurance for themselves for reasonable cost."

Really? You figure that some number beyond negligible will turn down employer paid insurance (at say 80%) and buy it themselves if that is a choice? Even if it doesn't include contraception benefits?

I can see many employers ceasing to provide it, but I don't see many people making that choice when the employer does offer to pay.

I can see many employers ceasing to provide it, but I don't see many people making that choice when the employer does offer to pay.

I can't see many employers ceasing to provide it when it costs $2000 per employee to opt out. I'm quite happy with the situation in that people who are truly conscientious objectors have some skin in the game and can object. Then, people who are employees can decide. A good balance.

Sapient I'm not sure what you're trying to say about Catholics in general, but I'm making a very specific point--governments don't want to have to pay to replace the Catholic hospitals that governments have been leaning on for fifty or more years.

Hypothetical: Christian Scientist employer decides to provide health insurance but refuses to cover treatments, paying only for checkups. Should that employer be allowed to do so? Discuss.

"governments don't want to have to pay to replace the Catholic hospitals that governments have been leaning on for fifty or more years"

If "governments have been leaning on" Catholic hospitals, it's time that people came clean. This is part of health care reform. Health care isn't a charitable enterprise. In a developed, wealthy nation, it's a proper role for government to insure that people obtain health care. The fact that government has "leaned on" Catholic hospitals, means that government hasn't been carrying its share of the burden. More taxes; more government subsidized healthcare.

Yet, the ultimate decider could and should be people who work, or chose not to work, for an RCC institution. They can decide whether they want the coverage so badly that they will forgo work at an RCC institution.

I figure most people would prefer getting the job with the rest of the health insurance and pay for their birth control.

Fine with me. That's their choice.

To reiterate yet again, here's my point:

As a matter of public policy, the government of the United States would like to require that employers who provide health insurance to their employees ensure that those plans cover birth control.

Because birth control is a useful element of health care.

And I'm sure it's not that hard for any of us here to make meaningful distinctions between birth control and cosmetic surgery. Can't we? I thought so.

The RCC objects to this, because they don't want to be in the position of funding something that includes something they don't agree with. Which, as an aside, basically puts them in the same position as 99.999% of the people in the world. But I digress.

So, they would like that requirement removed.

Personally, I am not RCC, have nothing whatsoever to do with the RCC, do not receive any aspect of my health care from an RCC sponsored hospital, and in general am completely unaffected by anything the RCC says.

Gladly so.

So, I have no dog in this fight.

My *observation* is that their demand that the requirement be removed from the law amounts to a demand that EVERYBODY ELSE IN THE FREAKING WORLD assume the burden associated with them not wanting to fund, however indirectly, birth control.

To me, that's more than a little f***ed up.

Every day, people with non-mainstream religious beliefs bump up against the law in some fashion or another.

In general, if that can be accommodated, that's what we do. But if accommodating somebody's odd religious quirk means that lots and lots of other people end up holding the bag, then maybe we don't.

None of this amounts to religious bigotry. It amounts to getting along in a pluralistic society.

Which is what we happen to live in.

And for the record, if you're a surgeon at an RCC hospital, $50 a month is noise. If you're sweeping floors, not so much.

Sebastian: if you're operating a hospital, even from the most laudable of motives, you are no longer operating purely in the world of religious faith and worship. You are engaging in the secular world.

All of which is fine, but if you are going to engage in the secular world, even from the most selfless and beneficient of motives, you still have to deal with that world on its own terms. You can't demand that it bend to your preferences.

Or, you can, but the answer might be "no".

As a practical matter, I don't really give a crap either way if RCC hospitals offer insurance that covers birth control or not. There are, frankly, much bigger fish to fry here in the good old USA at the moment.

But what pisses *me* off is framing this as a matter of government oppression of religious faith and practice.

If a religious order wants to build houses and give them away, they still have to comply with building code. Even if they have some weird scruple about studs being 16" on center.

If they want to cook food and give it away, the kitchen still has to comply with public health codes. Trust me on this.

And if they want to hire people to operate a hospital, they will still have to comply with all of the various rules and regulations that apply in that case.

Sunday's a day of rest, but they don't make all of the patients pack up and go home and Saturday night. Right?

So it's time to give the religious self-pity thing a rest.

Trying to do things like this is exactly what makes Democrats look ridiculous to anyone who has reservations about government busybodies.

See, I'd think that would come more from, say, requiring women to get a transvaginal ultrasound and listen to a lecture on fetal development and be forced to listen to a heartbeat before getting an abortion, but then I am not possessed of the deep moral insights that conservatives and religious people are. Apparently.

Now matter how far I walk, that same damned mulberry bush is just to my right. (I just read through a good number of comments after being away for a while. It's like being Bill Murray in a certain small town in Pennsylvania on a certain day in early February.)

/meta

"This is part of health care reform. Health care isn't a charitable enterprise. In a developed, wealthy nation, it's a proper role for government to insure that people obtain health care. The fact that government has "leaned on" Catholic hospitals, means that government hasn't been carrying its share of the burden."

So then just make your hospitals, don't do some round about game to piss off the people currently running the hospitals your government won't pay for.

"All of which is fine, but if you are going to engage in the secular world, even from the most selfless and beneficient of motives, you still have to deal with that world on its own terms. You can't demand that it bend to your preferences.

Or, you can, but the answer might be "no"."

Or maybe the answer is yes if enough people think that the government demand isn't particularly necessary. Which apparently seems to be the case at the moment.

Btw, if it is so gosh darned important that 'we' provide contraception, why in the world don't we just raise taxes and have the government provide the contraception? Isn't forcing employers to do it kind of silly if we really deeply believe that it is some sort of public good? Why are we making *any* employer pay for it? And what about unemployed people? Aren't they important enough to get it? Hell, maybe it is even MORE important that they get it. Right?

So darned important? No one would be talking about it at all without those funny-hatted bishops whining about it. It shouldn't be a big deal.

May I just say:

Until "reasonable" people, "moderate" people, "polite" people -- in short "nice" people --stop humoring the demented and respecting the ridiculous, this Groundhog Day will not end.

Religion is not the problem. Respect for religion is the problem. What a bunch of elderly gentlemen in cassocks (or saffron robes, or magic underwear) have to say about ANYTHING would become irrelevant if most people gave up their well-meaning tolerance for "faith."

The professional religionists have a constitutional right to preach, and their flocks have every right to follow their preachments. But sensible people have an equal right to point at them and snicker. What sensible people lack is the GUMPTION to do that.

If you're the sort of person who considers it unseemly to mock and ridicule the religious, you have only yourself to blame when the religious get uppity. If you're the sort of person who can't quite let go of a lingering faith in the supernatural, you have only yourself to blame when the politicians you elect defer to the purveyors of piety who you don't. In short, if you're either afraid or embarassed to be an open atheist, enjoy your Groundhog Day for a few more centuries.

Oh, and if you're a divorced Catholic, or a contraceptive-using Catholic, or a gay Catholic, why in the name of the Flying Spaghetti Monster are you still a Catholic?

--TP

"No one would be talking about it at all without those funny-hatted bishops whining about it. It shouldn't be a big deal."

Really? Then why isn't the government just providing contraception?

Because they came up with a perfectly reasonable solution within a larger framework that shouldn't have been a big deal and wasn't one until the electoral spoon of the race for the Republican nomination stirred the pot?

Not that I'm opposed to the govt providing contraception...

So then just make your hospitals, don't do some round about game to piss off the people currently running the hospitals your government won't pay for.

if it is so gosh darned important that 'we' provide contraception, why in the world don't we just raise taxes and have the government provide the contraception? Isn't forcing employers to do it kind of silly if we really deeply believe that it is some sort of public good? Why are we making *any* employer pay for it? And what about unemployed people? Aren't they important enough to get it?

All good with me. More than all good with, maybe.

Then why isn't the government just providing contraception?

Or, more realistically, why doesn't the government simply provide a basic level of health insurance?

I think we all know the answer to that one.

maybe the answer is yes if enough people think that the government demand isn't particularly necessary.

Also all good as far as I'm concerned. "Enough people think" ought to be how we make decisions about public policy.

What I don't buy, in this particular case, is that the issue is a matter of religious liberty.

You don't have to go too far down that rabbit hole before it becomes absurd.

Let's stay close to topic with a real life example: THIS IS NOT A HYPOTHETICAL.
During my lifetime (at least some) catholic hospitals in the US had signs at their entrance informing pregnant women coming there to give birth that in case of birth complications the hospitals #1 priority would be the baptism (if need be inside the uterus) of the child EVEN IF THAT MEANT THAT THE WOMAN WOULD DIE. In other words, if given the unpleasant choice between saving the life of the mother and letting the child die unbaptized or to baptize the child (even if it dies seconds later) while letting the mother die, it would be the latter option without exception. If it was up to me anyone involved in such practices would be stripped of the right to practice medicine and get sued into the poorhouse and to the hot place below with their religion or conscience. And the 'you have been warned' signs would make no difference.
I do not know, whether this practice is still legal in the US. The Vatican changed its position in (iirc) 1982 making this optional instead of mandatory (while still considering it the better choice).
And just preempting an expected objection: There might not have been a choice to go to another hospital since the catholic one could well have been the only one within reach.

"Because they came up with a perfectly reasonable solution within a larger framework that shouldn't have been a big deal and wasn't one until the electoral spoon of the race for the Republican nomination stirred the pot?"

Of course, in the best groundhog day tradition this sentence uses "perfectly reasonable". "they", and "larger framework" to, probably unconsciously, avoid saying that the problem here is that the PPACA gave the director of HHS, one person, the right to change this law that is in place, for or against, in all fifty states by declaring an executive policy.

I can't think of anything less reasonable, a worse definition of "they" or a "larger framework" more unconstitutional.

Really? Then why isn't the government just providing contraception?

With the announcement of the "compromise" it appears we now have that policy. My thanks to the Roman Catholic Bishops for bringing this about.

I could have sworn the PPACA was passed by our elected representatives and signed into law by our elected president. It sounds like there was a "they" in there, and that "they" followed the process by which we make laws in this country, according to our constitution.

(You really can't think of anything less reasonable? What about guys in funny hats protecting serial molesters?)

Ok, I don't think it is reasonable. With little effort, covering all things I can think about, I do come up with a list of more unreasonable things pretty easily.

But this is on the list.

I guess I'm a little unclear on why folks think the (now defunct) ruling is bad.

Birth control shouldn't be on the list of things that are required to be covered, because it's not a significant part of health care, and it's not terribly expensive to just buy it yourself?

Birth control shouldn't be on the list because not everyone agrees that it should be available at all and they therefore shouldn't be forced to pay for it?

Birth control shouldn't be on the list because the RCC funds health insurance as part of operating hospitals and other non-church institutions and requiring them to fund birth control, however indirectly, transgresses their right to religious freedom?

The process by which birth control came to be on the list is inherently autocratic and unconstitutional?

Any federal regulation that requires people to fund or otherwise participate in things they don't agree with, or find morally or ethically wrong, is illegitimate?

All of the above?

The arguments both pro and con are varied, that's fine. I'm just trying to get a handle on what the actual problem is.

Russell,

You remember all the heated arguments about the Fugitive Slave Act, right? Good times. In my admittedly imperfect recollection, the basic issue was about the morality of slavery and those who believed slavery to be a moral abomination being "forced" by the federal government to return slaves to their masters arose from that basic disagreement.

Apparently, the morality of The Pill is still in doubt.

"Birth control shouldn't be on the list because the RCC funds health insurance as part of operating hospitals and other non-church institutions and requiring them to fund birth control, however indirectly, transgresses their right to religious freedom?

The process by which birth control came to be on the list is inherently autocratic and unconstitutional?"

My take is that the redefinition of Catholic Hospitals as non-church institutions thus not eligible for the exemption from this requirement was autocratic and unconstitutional. Simple enough.

And as much as you hate this being described as a religious freedom issue, I hate, a word I don't use much, this issue being compared to Jim Crow laws and The Fugitive Slave Act.

I also found your Sunday day of rest comparison a little out there. Have you been in a hospital over the weekend? Skeleton staff and you don't get anything done except a few meals unless you are coding. That's all hospitals, not just RCC.


My take is that the redefinition of Catholic Hospitals as non-church institutions thus not eligible for the exemption from this requirement was autocratic and unconstitutional. Simple enough.

There is a standard for defining institutions as religious or not. As there ought to be.

I'm sure the degree to which any given Catholic hospital is a church institution, or not, varies quite widely. We have to draw the line somewhere.

And yes, by 'we', I mean the bureaucrats in government whose job it is to implement the laws that Congress makes.

I have a longer post floating around in the ether, maybe it will show up, maybe it won't.

Hospitals and churches are two different things, and lots of other things are not churches. I think that's all that "non-church institutions" is meant to convey. Those things might be run by the Catholic Church (two capital C's), but their churches are churches (small c's), and their other stuff is other stuff.

While I'm at it, I'm putting this out there once again, and I might several more times so no one forgets: They can teach their adherents whatever they like regarding birth control, and their adherents can follow those teachings if they so choose. AFAIAC, that's freedom of religion, in whole.

This whole thing is so far out of context from a religious-freedom standpoint that it makes my head spin. Catholics are free to be Catholics. And no one has to use birth control if they don't want to.

FWIW, I can take some of what Sebastian wrote without too much trouble. The government is (or was) making an institution that is doing good work in an area where it's needed and requiring (sort of) that institution to do something it doesn't like (being anthropomorphic about it) on moral grounds, and the government is essentially doing so because of the good work that institution is doing.

Maybe that's a bad idea. Maybe it's bad politics. What it isn't is unconstitutional as a violation of freedom of religion.

FWIW, I can take some of what Sebastian wrote without too much trouble.

Likewise. As well as what lots of others have written on this thread.

For the record, in case it's of interest or use, here is the IRS regs on what can be considered religious or charitable organization for tax purposes.

What I note is that, while both religious and charitable orgs receive tax exemptions, the two categories are distinct. That is, religious organizations are not the same as charitable organizations. Even if the charitable organization is operated for religious reasons, and/or by a religious organization.

Charitable != religious. For purposes of law.

And yes I know that we're talking about HHS, not the IRS. It's an example. Humor me.

I don't know where all of this is going to land, but it seems to me that operating a hospital can very arguably be a charitable activity, but is much less arguably a religious one.

YMMV.

If you say so,

yes, i do. and i'll say it again, loudly: MEN CARE ABOUT REPRODUCTION TOO. THEY WANT TO HAVE A SAY IN SUCH THINGS. A CHILD CHANGES THEIR LIVES, TOO. THAT'S WHY CONTRACEPTION IS NOT A WOMEN-ONLY ISSUE.

"Birth control shouldn't be on the list of things that are required to be covered, because it's not a significant part of health care, and it's not terribly expensive to just buy it yourself?"

I'd say that birth control doesn't make sense from a health insurance perspective because it is a regular cost not an insurable cost (you can't save money by insuring against a regular cost because it just jacks up the premiums by the amount of the cost since you are regularly using it). If the government wants to cover regular recurring cost items it should just pay for them. Laundering it through 'insurance' is a silly way to do it because it doesn't really make sense through the insurance lens. (I.e. you shouldn't buy 'insurance' for automobile oil changes because if you're doing them right the 'insurance' ends up being exactly the same amount of money as the oil changes).

And the idea of having mandated employer 'paid-for' birth control is just silly anyway. What does employment have to do with birth control? Shouldn't we have birth control for the unemployed too? It is just silly. The history of health care in the US is admittedly stupid, but do we really have to go out of our way to compound it? If Congress wants to pay for national birth control availability it should do so. It isn't saving any money in the grand scheme of things by forcing insurance companies to do so, the only thing it saves is the *appearance* of having to pay for it. It is still paid for in a collective enough way that it might as well be 'taxes'.

And it is the beginning of another rant, but it *feels* to me like more and more really important political decisions are being hidden behind bureaucratic 'clarifications'. I hate hate hate when bureaucrats take the normal way of doing things, 'clarify' it away, and say "what? it has always been that way". It is a deeply dishonest way of doing politics. If you want to make a big change, go through the political process. Don't have a pet bureaucrat just pretend that you're 'clarifying' an already existing rule.

I'd say that birth control doesn't make sense from a health insurance perspective because it is a regular cost not an insurable cost (you can't save money by insuring against a regular cost because it just jacks up the premiums by the amount of the cost since you are regularly using it).

Birth control is cheaper when purchased in bulk. Are you arguing that I would pay the say for viagra without insurance as the insurance company does?

Plus it spreads the cost to the other half of the population that can't get pregnant, but generally causes it.

How is birth control different from immunizations or checkups where you know the wchedule and can plan for the cost?

There's a lot more than half of the population that can't get pregnant, but significantly less than half that can cause it. In any case, most women of child-bearing age don't stay on birth control constantly, and it's not always planned when they go on or off it.

I'd say this particular argument is a pretty bad one, even if I'm not opposed to government-provided contraception as an alternative.

So, RCC-affiliated organizations that employ people of diverse backgrounds and beliefs and that, as employers, provide health insurance plans that include prescription coverage must now include birth control pills under that coverage. This in compliance with an 11-year-old EEOC ruling. And now these employers no longer have to pay for this specific coverage - insurance carriers will pay the cost.

Why should the health insurance industry agree to do this? Because it, unlike some people, understands that birth control pills are cheaper and safer than prenatal care, obstetric and hospital services, and pregnancy-related health concerns (ectopic pregnancy, diabetes, pre-eclampsia, acute hemorrhage from spontaneous abortions and placental abruptions, etc.). And that birth control pills are prescribed to treat other medical conditions. It's not as though health insurance plans haven't already included birth control pills for the last decade or so, although often at a steeper co-pay or deductible than, let's say, Viagra.

How expensive or not are birth control pills? This article provides some answers.

Since RCC-affiliated employers will no longer be required to act against their religious beliefs, now that birth control is strictly in the hands of the employee, her doctors, and the insurance carrier, the debate between religious freedom and a woman's right to equally appropriate health care will go away, right? We all know the answer to that. Because it is and always has been more a matter of controlling women's sexual and reproductive processes than one of a religious organization's apparent freedom to tell other people what to do.

As a woman, I know that I am not an equal citizen under the law as long as my vagina, uterus, and Fallopian tubes are subject to other people's religious beliefs and political ideology. Yeah, freedom!

One of my closest friends nearly died - and her baby did die - due to pre-eclampsia. The birth of a healthy daughter two years later could never remove her husband's fear of losing his wife, and her own grief at losing her child. Two women of my acquaintance, from my childbirth class, died within a week after I gave birth to my second child. One died because of cerebral hemorrhage, the other from acute hemorrhaging with placental abruption. There are other possible costs, personal and financial. My firstborn died when four days old after a surgery to repair a serious heart defect. My third pregnancy ended when my four-month fetus died in utero, and I had to spend 24 hours in the hospital before and after "giving birth" to my son.

So I say to all those who assert that pregnancy is no big deal, or that birth control is not a "significant part of health care" that you should, please, Just. Shut. Up.

Because it is and always has been more a matter of controlling women's sexual and reproductive processes than one of a religious organization's apparent freedom to tell other people what to do.

While I'd say this always plays a big role, in the current situation it looks to me more like another excuse to attack Obama and the Dems. The purpose is to paint Obama as a tyrant, archenemy of religion (unless it is radical atheist Islam*), immoral, out-of-touch-with-the-American-people etc.
This is the crowd that claimed that universal healthcare was invented by Hitler in preparation for the Holocaust (and that Obama has the same intention), that Christians in the US are persecuted worse than under Stalin in the Soviet Union, that Obama is building a secret army of brainwashed youngsters...
These days the GOPsters attack the Dems for proposing stuff that in some cases they themselves proposed less than a month earlier. They don't take yes for an answer. If suddenly Obama would propose making contraception illegal and abortion a capital offense, at least parts of the Right would do a 180° turn within 24 hours and accuse him of taking away inalienable rights. These guys want to abolish social security, medicare, medicaid etc. while at the same time claiming that Obama wants to take away the same programs from needy Americans. And they are successful, which does not increase my respect for the average US citizen. Oh yes, and Obama was also actually against getting Osama bin Laden with all credit belonging to Chain-Eye/Shrub and the waterboard (cf. Faux News this week).
Sorry for the rant (no actually not and I'd go further, if that would not violate the rules)

*no, that is not a mistake. It has become a meme in parts of the Right that Islam is not a religion (and thus not protected by the 1st amendment) and that radical secularists (=atheists) and radical Islamists have identical goals (and may actually be the same). Just as the Newt.

I don'think that leaving churches alone is a rightwing value. It's an American value.
However what's happened since Lee Atwood's day is, in an attempt to broaden the Republican base, the R leadership decided to use controversial relgious issues as wedges in close elections. Often this fanning of flames was done cynically with no desire to actually accomplish anything. Remember family values, code for hating the gays? What R politicians ever tried to do anything real for families? And Terri Schiavo was really really important to Bush and the R's in congress--until opinion polls showed that their grandstanding wasn't working. Then suddenly she didn't matter any more.

I think this flap about birth control is just another cynical dodge by the godbotherers. The effect of it might be to give to force non-Catholic women to either abide by Catholic standards or accept a de facto pay cut, which is hardly "leaving churches alone". It's more like expanding the power of one church.

I don't really think the R politicians who are milking this controversy care if wha tthe result is since the only result they ever care about on any issue is how it effects the next election.

birth control doesn't make sense from a health insurance perspective because it is a regular cost not an insurable cost

If I understand your point correctly, the same would be true of any prescription med that is taken on a regular basis. Which covers a lot of ground.

Perhaps I've misunderstood your point.

What does employment have to do with birth control? Shouldn't we have birth control for the unemployed too?

Employment has the same relationship to prescription birth control meds as it does to every other form of medical product or service.

Which is to say, none inherently, but lots because of the way in which we deliver health services in this country.

Health insurance is available to unemployed people generally through one of COBRA, Medicaid, or Medicare.

If COBRA, coverage basically follows whatever plan you are continuing from your former employer.

If Medicaid, prescription birth control is covered.

If Medicare, it depends, it may or may not be covered under Part D. Medicare is primarily intended for folks over 65, so it's a less relevant part of the package.

Look, here are the high points as to why prescription birth control is viewed as a part of health care, and why an insurer might cover it.

Prescription health care - birth control pills, etc. - are only available through a doctor. You can't just go buy them at the pharmacy. So, they are basically like any other prescription med as far as that goes. And there is good reason for them to only be available by prescription, because there are potential health issues involved with taking them, so a doctor's involvement is appropriate.

Being able to manage whether and when you have children has a strong correlation to the health and general medical outcomes for women and children. And, as cleek has repeatedly noted, this has implications for men as well. So from a basic preventative health / health management point of view, it is sensible to cover prescription birth control.

Not everyone approves of it, and nobody is required to use it. If an individual has no moral objection to it, and chooses to use it, then covering it makes it that much more likely that they will do so. Actuarily, it makes sense.

I get why the RCC is upset, and I'm not hostile to groups or individuals wanting to honor their private conscience. But laudable as it is for the RCC to sponsor or operate hospitals, employing medical staff is not exactly the same thing as practicing the Catholic religion.

What I see at the moment is that the RCC has been relieved of the burden of contributing in any way to birth control costs, and they still object. So, I am even less convinced that the issue is one of safeguarding their religious liberty.

IMVHO, they are simply against artificial birth control, and don't want anyone, Catholic or not, to have access to it.

It's not their privilege to make that decision.

Thank you, Dawn.

" think this flap about birth control is just another cynical dodge by the godbotherers. The effect of it might be to give to force non-Catholic women to either abide by Catholic standards or accept a de facto pay cut,"

Two points here.

First, this wasn't a flap until the administration changed the rules. The R's didn't suddenly come out against something that had been in place. So, I don't think it is a cynical attempt by either side, but if it was it would be the D's creating an issue that didn't exist.

And, second, because the rule would change what exists today, no one would be taking a pay cut by NOT changing it. Also, since,( I admit to assuming), many unmarried men and women past needing birth control are insured by the RCC, they would be taking a pay cut if their insurance went up due to the increased coverage.

So, in the overall discussion, I don't see either of those as a particularly strong argument, either way.

First, this wasn't a flap until the administration changed the rules. The R's didn't suddenly come out against something that had been in place. So, I don't think it is a cynical attempt by either side, but if it was it would be the D's creating an issue that didn't exist.

I guess you haven't been paying attention. Contraception coverage has been available from insurance companies that have offered prescription drug benefits under the law of most states. Plenty of other plans have provided it as well. The main significant change is that it's part of ACA, which Republicans hate (although some of it was their idea) because a Democratic president and Congress passed it.

many unmarried men and women past needing birth control are insured by the RCC, they would be taking a pay cut if their insurance went up due to the increased coverage.

Again, not paying attention? Contraceptive coverage ends up reducing insurance costs because the costs of unintended pregnancies are much higher than the costs of providing contraception. Reducing costs for everyone, including people past fertility age.

It would be nice if people who "don't have the facts" would at least read the facts presented in the comments.


Reply to 2 points:

1. This only became a flap when the bishop's made it one. The administration's policy flows logically from the thrust of the AHCA's emphasis on preventative health care, cost control, and non-discrimination. There have been successive policies adopted since the Act's passage that have led more or less inevitably to this policy. It was not simply made up from thin air.
2. Yes. Far better to preserve gender based pay discrimination? And really, we could reduce health insurance costs dramatically by simply excluding old people. After all, growing old and getting ill are just a part of life and are obviously not "an insurable cost". Nobody forces you to grow old.

"It would be nice if people who "don't have the facts" would at least read the facts presented in the comments."

Neither of your points addressed what I said. The fact is that almost everywhere the Catholic hospitals DON'T include contraception coverage. If you add it, it costs more. The current uproar was caused by the Democrats trying to change it.

Your "facts" don't address either of the very specific points I made.

Back to my youtube video.

"I guess you haven't been paying attention. Contraception coverage has been available from insurance companies that have offered prescription drug benefits under the law of most states."

And Catholic charity organizations have almost always been exempt because of the religious ramifications.

The Obama administration wanted to change that, and if we're speculating on political motivations why not assume that they did so to give the Planned Parenthood lobby a win against the Catholic Church that they've been looking for for quite some time. When the Obama administration was discussing the national rule, Catholic organizations thought they had been told by the administration that the exemptions would continue.

From the NYT Religion Correspondent here

Well, I think part of the reason the bishops are so outraged is that they feel that they were given a signal by the administration and directly by President Obama. Archbishop Dolan met with President Obama. They talked about the work that the Catholic Church does, that the Catholic Church is not just parishes, but is also hospitals, is universities, charities and that all these institutions have a right to express their religious freedom and religious conscience.

So, Archbishop Dolan thought that he had gotten through to President Obama and thought he had a signal that this decision would go their way. So, when it didn't, they felt greatly betrayed by the president.

Now I'll admit that Goodstein's credibility may be low on this issue since she repeats the discredited "28 states" thing, but presuming that she actually talked to Dolan, she seems to be acting as a reporter.

So the evidence appears to show that the person who chose to make this a political issue was Obama, that he was specifically asked to continue the exemptions for the Catholic church, that he signaled Dolan that he was going to continue the exemptions, and then chose not to.

That looks like evidence of Obama choosing to make this a political issue, not 'Republicans'.

And since when do we assume that Catholics are 'Republicans' anyway? That is very much inaccurate political line drawing. The Republican evangelical base is very mixed on contraception and Catholics have always been very strongly Democratic *except on the issue of abortion and contraception*.

2. Yes. Far better to preserve gender based pay discrimination? And really, we could reduce health insurance costs dramatically by simply excluding old people. After all, growing old and getting ill are just a part of life and are obviously not "an insurable cost". Nobody forces you to grow old.

Ah, yes, the too-often ignored social costs of tolerating the
elderly">http://www.thepoorman.net/2005/08/23/institutionalized/">elderly lifestyle...

And Catholic charity organizations have almost always been exempt because of the religious ramifications.

And apparently they will be again. It appears the policy will be changed so that the RCC will not have to contribute a dime to birth control coverage.

But the bishops are still not happy. They want the requirement removed, no matter who is funding it.

Can I get my personal religious and moral convictions enshrined in public policy, too? Everybody will have to play by my rules.

Trust me, some serious changes will be msde.

Sound good to you?

The RCC is entitled to practice their faith, and to promote it if they wish to. They are not entitled to require everyone else to conform to their beliefs.

Actually, so far as I can tell, they are still paying it for it under the new 'compromise'. They will be paying the insurance premium, the insurance carrier will be forced to provide birth control, and in no world I'm aware of will services provided by the insurer not be reflected in the premium.

"The RCC is entitled to practice their faith, and to promote it if they wish to. They are not entitled to require everyone else to conform to their beliefs."

This is a valid general principle, that has no obvious application to this discussion.

In fact it is especially strange that you put it that way.

So far as I can tell, the only people attempting to require *everyone else* to conform to their beliefs are those who want *all* employers *without exception* to fund personal birth control.

It is a reversal of the facts to spin resisting that as an attempt to require everyone else to conform the the RCC beliefs.

It is a reversal of the facts to spin resisting that as an attempt to require everyone else to conform the the RCC beliefs.

And it is little more than clever but deceptive re-framing to put it as you do here. The RCC may not be attempting to force everyone to conform to their beliefs, but they are trying to make their beliefs the basis of public policy; they are attempting to make the law (to which everyone must conform) conform to their beliefs. They are stating that if they object to a law, the law needs to be revised; i.e., compatibility with RCC beliefs is a standard to which all laws must be held.

The whole shebang has been worth it to the adminstration, so that tehy could jump around and shout "IN YOUR FACE, BART STUPAK !!!" Hah! Here's ur unitory president executive order now!!!

The RCC would like the requirement for health insurance to cover prescription birth control to be removed entirely. Because they think it is morally wrong.

So, to the degree that their position wins the day, the public policy that all of us live with will be changed to accommodate their convictions, regardless of whether the RCC is a party to the transaction in any way, shape, or form, or not.

Hence, my comment.

There is no scenario in which all employers without exception will be required to fund personal birth control. Exemptions for religious groups existed prior to the controversy, and would have persisted under the originally planned policy.

The only thing at issue is the scope of the exception, i.e., whether non-church institutions sponsored or operated by churches are considered 'religious organizations' for purposes of the law.

If you want to press the bishops' argument - that no person anywhere should be required to contribute in any way to anything they have a religious objection to, or for that matter comply with any law or public policy they have a religious objection to, based on 1st Amendment protections of freedom of religion - feel free to do so, but that is going to lead us into some strange places. But if we're going to go down that path, we all will need to get to play, not just the bishops.

If you want to sign up for that, I'm all for it.

From here:

The bishops will also renew their call for lawmakers to pass the “Respect for Rights of Conscience Act,” which would exempt both insurance providers and purchasers — and not just those who are religiously affiliated — from any mandate to cover items of services that is contrary to either’s “religious beliefs or moral convictions.”

Splendid. I say, let's have it. Except I want it to apply to everything - every federal law, mandate, and policy - not just health insurance requirements.

If my conscience tells me that any law or policy is morally askew, I claim an exemption. Not a civil disobedience, I am willing to go to jail if need be exemption, I mean a total carve out.

That law or policy, whatever it is, will simply not apply to me, because in my heart of hearts, I find it morally wrong. My conscience and my god tell me it's wrong.

I am exempt.

Let's go there.

Sebastian, as I pointed out, the "28 states thing" wasn't discredited. Your source for the "discrediting" was discredited. And as to whether some conservative Republican disguised as a theologian or "archbishop" is "disappointed" or "feels betrayed:" meet House Speaker Boehner and Whip Eric Cantor or, perhaps, Mitch McConnell. They, I'm sure, will tell you the same thing, that they thought they explained just everything to President Obama, but still he came out with something that they didn't like which, of course, turned everything into a betrayal, and thus a political issue.

Yeah, right. What a joke.

I'll bet Catholic women aren't going to buy it.

"The RCC would like the requirement for health insurance to cover prescription birth control to be removed entirely. Because they think it is morally wrong."

And you would like it to cover everyone because you think it is morally right.

"The RCC may not be attempting to force everyone to conform to their beliefs, but they are trying to make their beliefs the basis of public policy"

Yes, and you are trying to make YOUR beliefs the basis of public policy.

I get that.

I just don't understand how you don't understand that.

The 28 states thing is at best a misunderstanding and at worst a ouright lie. There are no more than 8 states that don't have explicit religious exemptions. And two of the jurisdictions specifically called out in the 28 states report (New York and DC) definitely exempted hospitals. So the talking point that Catholics are making a stink out something that they've been living with in 28 states is incorrect. It may not have been an intentional falsehood when originally stated, but it is clearly not true and should not be repeated as fact if you want to use actual facts instead of made up ones.

So far as I can tell, the only people attempting to require *everyone else* to conform to their beliefs are those who want *all* employers *without exception* to fund personal birth control.

Is a RC woman covered under such circumstances forced to use contraception?

Is the RC Church, as an institution, forced to provide health insurance as part of a wage package?

Is the RC Church forced to enter the secular business realm?

As they say, both the rich and the poor are free to sleep under bridges. I would ask the Catholic hierarchy to live their conscience....asking for the exemption tells me they are unwilling to do so.

"Is the RC Church forced to enter the secular business realm?"

No, they could close all their non-profit hospitals and the state could either spend hundreds of billions of dollars rebuilding them, or let the poor people they have been serving for longer than you've been alive go unserved. WTF

Sebastian, maybe you could tell us which institutions in which states have had insurance companies that have supplied contraceptive coverage?

No, they could close all their non-profit hospitals and the state could either spend hundreds of billions of dollars rebuilding them, or let the poor people they have been serving for longer than you've been alive go unserved. WTF

Or, they could do what most businesses do, and sell their assets, whereby the doctors, nurses, and administrative staff could work for a new employer.

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Whatnot


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