Anthony Esolen, writing for Public Discourse, holds forth on the illegitimate claims that contraception advocates make about the “medical” or “health” reasons that favor contraceptive use, via America’s (and his) favorite pass-time:
But the use of estrogen as contraception is not medical at all. Quite the contrary. A couple who use estrogen to prevent the conception of a child do not ingest the drug to enhance the performance of their reproductive organs, or to heal any debility therein. Their worry is rather that those organs are functioning in a healthy and natural way, and they wish they weren’t. They want to obtain not ability but debility. They want not to repair but to thwart. Here it is usually argued that the drug is medical because it prevents a disease. But that is to invert the meaning of words. When the reproductive organs are used in a reproductive act, the conception of a child is the healthy and natural result. That is a plain biological fact. If John and Mary are using their organs in that way, and they cannot conceive a child, then this calls for a remedy; that is the province of medicine. It is also the province of medicine to shield us against casual exposure to communicable diseases—exposure that we cannot prevent, and that subjects us to debility or death. Childbearing and malaria are not the same sorts of thing.
Read the entire article here
March 8th, 2012 | 10:32 am
As I just noted elsewhere, the cost of prescription contraceptives has long been deductible on federal income tax as a medical expense. I find it odd that people opposed to contraceptives resort to attempting to define medical in such a way as to exclude contraception and sterilization. If prescription drugs and surgery aren’t “medical,” I don’t know what they are. The costs of facelifts or other surgery that is not tax deductible still are referred to as medical expenses. If someone other than a medical professional does a tubal ligation or a facelift, he or she will be charged with practicing medicine without a license. I don’t think a defense would be that performing a tubal ligation isn’t really “medical.”
March 8th, 2012 | 10:49 am
If prescription drugs and surgery aren’t “medical,” I don’t know what they are.
While I agree with you, it’s nevertheless true that many advocate the HHS mandate using logic indistinguishable from a claim that all medical operations should be covered. Yet I doubt most of them would include facelifts and breast implants in that group.
March 8th, 2012 | 11:59 am
@David,
You may be technically correct that contraceptives are a species of medicine, but as Professor Esolen points out, contraceptives (used as such when there is no medical justification to avoid pregnancy) are not used to cure a condition in which an organ of the body is not functioning properly but are, rather, being used to cause an organ of the body to function improperly, specifically, to disable the healthy, normal function of the body’s reproductive organs. I am convinced that this is precisely what Scripture condemns when it condemns pharmakeia, the use of potions, etc. to debilitate normal, healthy, bodily functions, whether in thinking (e.g., the use of mind-altering drugs) or in reproduction (e.g., the use of drugs which debilitate reproductive function). So call it what you will, the distinction remains whatever it is properly called. There is a difference between using medicine to help a body’s organs to perform normally and the use of medicine to cause a body’s organs to perform abnormally, between returning an organ to performing its normal, healthy function and to debilitate it form performing its normal, healthy function. Calling these two very different acts by the same name doesn’t make them the same thing.
March 8th, 2012 | 12:16 pm
I find it odd that people opposed to contraceptives resort to attempting to define medical in such a way as to exclude contraception and sterilization.
I do not find it odd at all. For instance, I find it understandable that people in favor of abortion resort to attempting to define person in such a way as to exclude some human beings from a right to life. One arguing for a proposition will naturally want the terms of the debate defined in a way favorable to one’s agrument.
The fact that the government considers contraceptives a deductible medical expense is irrelevant, unless you are making an appeal to the government’s authority in setting statutory or legal definitions. (I would be curious to see how quickly that appeal would evaporate should the governing authorities choose to amend the law to exclude contraceptives as a deductible medical expense.)
Regardless, I think the larger point of the article is that contraceptives, like breast augmentations, sex reassignment, and performance-enhancing drugs, are not administered to improve the health of the person, but for other reasons.
March 8th, 2012 | 1:40 pm
The fact that the government considers contraceptives a deductible medical expense is irrelevant, unless you are making an appeal to the government’s authority in setting statutory or legal definitions.
Caleb Herod,
I assume the reason we are having this discussion is because many people don’t want insurers to be required by the government to cover contraception. The argument is that contraception isn’t “medical.” I am pointing out that the federal government (in this case the IRS) long ago settled the controversy over whether contraceptives, sterilization, and abortion were deductible as medical expenses. They all are. So those arguing that contraceptives aren’t “medical” and therefore the government should not require them to be covered by medical insurance will have to reopen a debate the government settled long ago. There were early arguments after the pill was introduced that it should be a medical deduction only if prescribed for a woman for whom a pregnancy would be a serious health threat. But that view did not prevail. Now some are resurrecting the old argument in what is certain to be a futile argument against the contraceptive mandate.
One might argue, with some justification, that contraception is not a medical expense that should be covered by medical insurance. But The argument that it was not a medical expense was settled long ago. If you want to categorize it as a different kind of medical expense than, say, a vaccination or an appendectomy, it is nevertheless a medical expense.
March 8th, 2012 | 2:23 pm
@David,
So the question is settled forever and can never be reopened or reconsidered. That is a very weak position to take and one which would place you on the wrong side of history on repeated occasions.
The best reasons that insurance shouldn’t be mandated for contraception are (1) absent cases in which pregnancy has been medically diagnosed as an unusual and significant health risk, it is not being used to cure or prevent a disease and (2) absent cases in which pregnancy has been medically diagnosed as an unusual and significant health risk, it is purely elective and (3) in the vast majority of cases, it is a relatively inexpensive, ordinary expense of modern life, not the type of extraordinary expense for which insurance is typically purchased. There are, in fact, less expensive alternatives, such as natural family planning.
March 8th, 2012 | 2:41 pm
Wait, wait, wait… so legal definitions that have been decided for years, perhaps even decades, should be considered settled and beyond reasonable disputation? Could we apply the same reasoning to definitions that have existed for century or even millennia? I’m thinking of a word that starts with “m” and ends with “arriage.” Truly this is a new thing from you, David!
March 8th, 2012 | 3:50 pm
So the question is settled forever and can never be reopened or reconsidered.
Gregory K. Laughlin,
Almost any question can be reopened, but if you really want to reopen this one and be consistent, you have to explain why it just dawned on people that contraception was “not medical,” when the cost of contraception has gone unchallenged as a medical expense for decades. You also have to explain why most employer-provided health care coverage pays for contraception if it is “not medical,” and why 28 states over the past decade or so made coverage of contraception mandatory. I don’t think anyone who argues contraception is “not medical,” or that health insurance should be modeled after care insurance, realistically expects to get anywhere. Also, I don’t think many people would like the “not medical” standard to be consistently applied, because it really would apply to prenatal care and hospital delivery. Pregnancy is not a disease, childbirth is as natural as breathing or sleeping, and having a baby is elective.
March 8th, 2012 | 4:05 pm
or that health insurance should be modeled after care insurance
That should be car insurance, not care insurance.
Let me just add that health insurance is what it is today because people want it that way. There may be better schemes, but is there any realistic chance of radically reshaping health care coverage in America? I certainly don’t think so. Two thirds of Americans under 65 are insured, and they don’t want to give up what they have. There is also a widespread belief that we have “the greatest health care system in the world,” when in reality we pay much more than other countries and the outcomes are inferior. And the insurance industry, not to mention the pharmaceutical industry, has a great deal of political power that they will wield to block any comprehensive changes. I think it is almost certainly true that if there was a move to get insurance not to cover contraception, the insurance industry would fight it.
March 8th, 2012 | 5:42 pm
Where to begin, David?
I never mentioned car insurance, I mentioned the purpose of insurance in general, which is to provide funding for extraordinary expenses for which earnings, savings or income from savings may prove insufficient. Earnings, savings and income generated from savings (e.g., interest, dividends, and capital gains) is how people traditional pay for ordinary expenses. Insurance was not designed for the paying of ongoing, frequent, ordinary expenses of life. That concept doesn’t apply just to car insurance, it has historically applied to all insurance. Even with products such as whole life, what is really involved is a policy that combines insurance with savings in one package. It’s only part insurance.
Second, I’m not really arguing that contraception is not medical. I’m suggesting that it is different in kind from medical care which is designed to cure or prevent disease or to improve or maintain health (setting aside the cases in which it is used to prevent a pregnancy which has been diagnosed as a serious health risk to the would-be mother). It is designed to disable the normal, healthy function of organs, not to restore such function.
Third, prenatal care is designed to prevent diseases or to improve or maintain health, both for the mother and her child. Prenatal care is not used to disable the normal, healthy functions of any organ or other body part, quite the opposite.
Finally, we are not discussing health insurance in general, we are discussing a mandate that health insurance cover contraceptives. No such mandate has existed at the federal level ever. It is not the status quo; it is an innovation. It is true that many, perhaps most, private insurers cover contraception. It likely saves them money. Well and good. It’s the mandate and only the mandate that is at issue. And this is precisely why it is important to compare the nature and cost of contraceptives to other health care costs which insurance covers. When that is done, I fail to see why contraceptive coverage should be mandated. It is different in kind (not curing or preventing disease, nor maintaining or improving health) from the health care for which people need to have coverage, it is relatively inexpensive, it is not an extraordinary expense of such magnitude that it cannot be paid for from earnings or savings if one budgets, it is elective (again, setting aside the cases in which pregnancy is a significant health risk), and there are alternatives to avoid pregnancy without the expense of medicine and without disabling the normal and healthy function of organs (i.e., total or periodic abstinence). If an employer nonetheless chooses to insure contraception, I don’t have problem with it. My employer does so. It is the mandate and only the mandate which requires employers with religious objections (religious objections which are as old as the Christian faith and, in fact, predate it) to which I have an objection. Maybe the reason its definition as medical care has not been challenged before is that there was no mandate that people who object to its use on religious grounds be compelled to pay for it. It is one thing to give a tax deduction for it (a tax deduction which only applies when medical expenses are significant, I might add), it is another to mandate that a private, religious based institution pay for something to which they object on religious grounds.
March 8th, 2012 | 6:08 pm
Their worry is rather that those [reproductive] organs are functioning in a healthy and natural way, and they wish they weren’t.
If I understand correctly, women are generally born that way – fertile. It seems to me to be absurdly amusing that progressive voices suggest, perhaps demand, that women change who they are; I thought the message was to embrace your biology and inclination as well as act upon those aspects thus becoming a joyful person.
How can the State countenance such bigoted behavior? Should not corporations, rather than chipping in for sterility, be promoting and advertising Fertility Pride Parades?
March 8th, 2012 | 6:45 pm
@ Gregory:
“Maybe the reason its definition as medical care has not been challenged before is that there was no mandate that people who object to its use on religious grounds be compelled to pay for it.”
You make it sound as though employers are purchasing contraception as a gift for their employees, which is far from the case. Employees are compensated for their work with both a salary and participation in a health insurance pool. Employers, in my view, should have no more right to object to the provision of certain services from that pool than they have a right to step in and prevent employees from spending money from their paychecks on contraception. The notion that employers have a “religious conscience” basis to refuse to compensate employees in certain ways is nonsense.
March 8th, 2012 | 7:09 pm
SteveP,
No one, including the Catholic Church, advocates that women let their fertility take control of them instead of taking control of their fertility. Responsibly spacing and limiting children for married couples are seen as good. The only arguments are over methods.
March 8th, 2012 | 9:30 pm
As I just noted elsewhere, the cost of prescription contraceptives has long been deductible on federal income tax as a medical expense. I find it odd that people opposed to contraceptives resort to attempting to define medical in such a way as to exclude contraception and sterilization.
I think it’s wonderful that we’re finally at a point where formal categorization is both possible and necessary.
There’s a book you might like to read, called “Sorting Things Out: Classifications And Its Consequences” by Geoffrey C. Bowker and Susan Leigh Star. Several of the examples it uses involve the evolution of medical terminology – reading this book, you can almost see how categories change, grow, and sometimes have to be revised, as we grow and prosper, because categorization itself is part of progress.
Which I find an exciting prospect. I am firmly convinced that what is most needed right now is some serious ethical progress to catch up with the breathtaking “leaping forward” quality of technological process we’ve seen for the past century or two.
March 8th, 2012 | 9:36 pm
How can the State countenance such bigoted behavior? Should not corporations, rather than chipping in for sterility, be promoting and advertising Fertility Pride Parades?
This made me laugh out loud, and my first thought was what fun that would be – then I realized, I would love the idea of Fertility Pride Parades, but only if there were some way to keep the entire process from being a show of domination that not only celebrates one set of values, but intimidates and behaves aggressively (overtly or covertly) toward rival values.
Unfortunately, I do not think it is possible to have the one aspect of a “pride parade” without the other. Controversy over a “hot button” is exactly what makes a fun St. Patrick’s parade in New York City different from a “blood and thunder” parade in Belfast.
March 8th, 2012 | 9:40 pm
David Nickol: If I understand correctly, a woman’s body cycles through a period of fertility and infertility – she was born that way. What, precisely, are you trying to control?
March 8th, 2012 | 10:44 pm
Finally, we are not discussing health insurance in general, we are discussing a mandate that health insurance cover contraceptives
It is important to recognize that the appeal to universal health coverage was specifically based on the argument that a society owes it to its members to not let them die of treatable diseases, or suffer when it’s not necessary.
The government’s requirement should be limited only to covering that which is medically necessary. To do anything else is to use the sickness and suffering of the uninsured as an opening – a wedge – with which to sneak a political agenda past the democratic processes that rightfully should rule political agendas and/or to sneak “pork” into the budget.
If anything and everything that has ever been called “medical” – for any reason – is now equally urgent, then “universal health care” is going to increase, not relieve, suffering, and we are going to be redistributing resources away from the old and the sick, toward the young and the healthy.
Fortunately there is no reason why even every “medical” expense needs to be equally covered – let alone expenses that are only arguably “medical” in nature.
As we make decisions about how to allocate health care resources, we have an obligation to consider need or importance as one of the factors, urgency (that is, how time-sensitive it is) as another, and various other factors.
Birth control is not a high priority by any standard. It is readily available, cheap, etc. – and quite frankly it’s about time we start expecting that our citizens take responsibility for themselves: anyone old enough to be having sex is old enough to be taking responsibility for their own contraceptive needs.
March 9th, 2012 | 9:59 am
“Employers, in my view, should have no more right to object to the provision of certain services from that pool than they have a right to step in and prevent employees from spending money from their paychecks on contraception.”
But an employee cannot reasonably say that a health insurance mandate is nobody else’s concern in the same sense he could say that how he spends his money is nobody else’s concern. It would be one thing if he were freely negotiating with his employer for the benefits he wants; however, in this case a third party (the government) is dictating the terms of the package. The mandate is a public policy and therefore affects everybody. Even from a purely economic perspective, forcing an employer to spend more on benefits will at best cut into everyone else’s salary. It may also force the employer to cut positions or prevent the employer from hiring new people. Have you ever had to lay someone off so that you could afford to keep paying expensive benefits to the remaining people? It’s not pretty and I predict it will happen more often as the mandates keep piling up.
March 9th, 2012 | 10:22 am
Even from a purely economic perspective, forcing an employer to spend more on benefits will at best cut into everyone else’s salary.
Paul,
It is very much a matter of dispute whether the contraceptive mandate will increase the employer’s cost of providing insurance. It is the Obama administration’s contention that it will not, and stipulation is that insurance companies must provide it free. If indeed the insurance companies raise premiums to provide contraceptive coverage to religious organization under the new “accommodation,” the terms of the accommodation will not have been met.
The whole topic of what insurance costs and what makes premiums rise is a very complex one, and I don’t want to get into it here. But very good arguments have been made that adding contraceptive coverage will not increase costs and could possibly lower them.
March 9th, 2012 | 12:40 pm
It is very much a matter of dispute whether the contraceptive mandate will increase the employer’s cost of providing insurance. It is the Obama administration’s contention that it will not, and stipulation is that insurance companies must provide it free.
While it is sort of true that contraceptives could be viewed as “free” if you count the savings from unwanted pregnancies, it isn’t really honest to make this argument because it relies on a “false dilemma” fallacy – it posits two options as if those two options were the only two options, when in fact there are other options: the real alternative to no contraceptive coverage is not unwanted pregnancy, but individuals getting their contraceptives from one of the many other readily available sources.
March 9th, 2012 | 4:53 pm
@Rhm,
Paul pretty much posted what I would have to say. As a preface, I haven’t the slightest idea how you came to conclude that I believe contraceptive coverage would be a gift from employers to employees. Nothing I posted provides the slightest evidence for such a conclusion. Compensation is what employers offer as consideration for the value of the employee’s labor. The employee can accept or reject such offers and can make counteroffers. I certainly don’t object to an employer agreeing to include contraceptive coverage as part of the compensation package. That’s not the issue. I don’t even have a problem with a union negotiating for such coverage as part of the hard nosed business of reaching labor agreements in which an employer may reluctantly, but voluntarily, agree to such coverage. The issue for me, again, is only whether an employer should be mandated to do so by the government. It’s not about an employer telling an employee how he or she may spend their earnings nor about an employer dictating to an employee whether he or she may use contraceptives. Employees are free to spend their earnings however they wish, including purchasing contraceptives. That has been the way most employees obtained contraceptives for decades, through their own expenditures out of their earnings, not by employer provision. The mandate is an attempt to change the status quo. Let’s stop pretending it is otherwise.
March 9th, 2012 | 4:58 pm
The whole topic of what insurance costs and what makes premiums rise is a very complex one, and I don’t want to get into it here. But very good arguments have been made that adding contraceptive coverage will not increase costs and could possibly lower them.
And, if that is so, then employers who refuse to provide contraceptive coverage may have to actually pay more for health insurance for their workers than those who do provide such coverage. That is, Catholic institutions may pay an economic price for their decision not to provide such coverage. If so, well and good, let them pay the price of their convictions. And they may lose some very good employees as a result of such refusal. Again, well and good, let them pay the of their convictions. If such institutions suffer in the marketplace, then so be it. I’m not weeping for the employers who must make the choice between lower costs and better employees versus their conviction. I’m simply advocating that they be permitted to make that decision and, if it costs them, suffer the consequences of that decision.
March 9th, 2012 | 5:23 pm
That has been the way most employees obtained contraceptives for decades, through their own expenditures out of their earnings, not by employer provision. The mandate is an attempt to change the status quo.
Gregory K. Laughlin,
Actually, most employer-provided insurance already covers contraceptives.
March 10th, 2012 | 6:23 am
I’ll take your word for it, though my employer only added the coverage in the last two or three years. Do you have evidence that most employees have had such coverage for decades? But let’s assume that they have, what percentage of Americans would lack such coverage if Catholic institutions were allowed the full opt out several bishops have asked for? And how much does the average American using contraceptives without coverage spend each year for whatever product the use?
March 10th, 2012 | 3:07 pm
Here’s a site that gives cost estimates: http://money.usnews.com/money/blogs/alpha-consumer/2010/08/27/the-real-cost-of-birth-control-
March 10th, 2012 | 6:35 pm
Gregory K. Laughlin,
I am not sure how the cost information is relevant. If it’s a matter of religious liberty, as the Catholic bishops insist, then what has cost got to do with it? Would you be persuaded that women who truly can’t afford contraceptives should get them without co-pay as part of insurance? Is it a violation of religious liberty to require religious employers to provide insurance that covers contraception if contraception is cheap, but not a violation of religious liberty to require religious employers to provide insurance that covers contraception if contraception is expensive?
March 11th, 2012 | 7:14 am
No. But it’s relative inexpensiveness reveals the motives of its proponents is other than pretended.
March 11th, 2012 | 12:55 pm
No. But it’s relative inexpensiveness reveals the motives of its proponents is other than pretended.
Gregory K. Laughlin,
I assume the proponents you are talking about are the proponents of the “contraceptive mandate,” not the proponents of contraception itself. I think it’s important to note that the “contraceptive mandate” originates not in the Obama administration but in the recommendations in the report Clinical Preventive Services for Women: Closing the Gapsissued by the Institute of Medicine:
March 12th, 2012 | 8:28 am
@David,
The point, David, is that the relative benefit of the mandate as applied to religious objectors is small, while the cost to religious freedom is high. Giving the Institute of Medicine (IOM) the benefit of the doubt, it might not have considered the full implications of the latter. In its “unbiased” assessment (I don’t believe anyone is unbiased about anything; we all bring our biases to the table, including a bias as to which factors we believe matter and which do not), it may well not have consider factors other than purely “medical” ones. In any event, if contraceptive coverage is the cost saver which you assert (and from what I’ve read, it is difficult to say whether that is the case or not, but I’ll accept the conclusion for argument sake), then it is hard to imagine why an employer without religious objection wouldn’t cover it. We are, therefore, almost certainly talking about a relatively small number of employees who would lack coverage for what is a relatively small, ordinary expense of everyday life, the type of expense which is not normally the subject of insurance coverage in the first place. Providing the exemption, therefore, is a very small price to pay to preserve religious liberty. Given that, again, I believe motives other than those propounded by the advocates of no religious exemption (upon which I presume the IOM is silent being outside its area of expertise if, indeed, it is unbiased) are at work in those who refuse to grant such an exemption. Indeed, it would seem that the private generosity of contraceptive proponents should be sufficient to provide access to any who would lack sufficient funds to pay for such products and services without mandated coverage for religious institutions.
It is now time for me to move on to other things. This thread has been quite enlightening.
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