Religious liberty is critical, President Obama says in an interview, but not as critical as providing contraceptive coverage:
Yeah. Well it’s absolutely true that religious liberty is critical. I mean that’s what our country was founded on. That’s the reason why we exempted churches, we exempted religious institutions, but we did say that big Catholic hospitals or universities who employ a lot of non-Catholics and who receive a lot of federal money, that for them to be in a position to say to a woman who works there you can’t get that from your insurance company even though the institution isn’t paying for it, that that crosses the line where that woman, she suddenly is gonna have to bear the burden and the cost of that. And that’s not fair.
Whatever one’s views on the morality of contraception (this is an issue, it should be said, on which First Things staff and writers have a variety of views) it simply is not a part of medicine as traditionally defined. To include contraception in a health plan on the same level as any other treatment—to assign it such importance that it overrules any claim of religious liberty—is very nearly to make the bizarre suggestion that fertility is a disease.
July 10th, 2012 | 3:50 pm
. . . . is very nearly to make the bizarre suggestion that fertility is a disease.
Only if insurance coverage of prenatal care and hospital delivery suggests that pregnancy and childbirth are diseases.
The argument against the contraceptive mandate based on religious freedom makes sense. The argument that, in the 21st century, contraception is not a medical matter is nonsense. The vast majority of employer-provided insurance plans cover contraception, and 26 states have some kind of contraception mandate. Doctors write prescriptions for contraceptives, and drugstores fill them. The United States has been providing family planning services and contraceptives to Americans through Title X since the Nixon administration, all through the nation’s doctors and medical system. Contraception is an integral part of medical care. That simply does not imply that fertility is a disease.
July 10th, 2012 | 3:53 pm
How about a level playing field – condoms for men?
July 10th, 2012 | 4:09 pm
Matthew,
Who gets to define both “health” and “health care”? For better or worse, our society has empowered [1] medical professional organizations and [2] health insurance companies to make these definitions. The philosophical foundations of their definitions are tenuous as the definitions evolve through the political process as much as through the medical process. Reasoned debate plays little role here.
It’s interesting that female oral contraception is defined as “health care” and thus “covered” (i.e. subsidized through the official institutions of medical payment), but condoms are not. Of course, at one time condoms were defined as medical devices by the US medical profession. I suggest the change was much more about politics than about medicine, as is the current proposal from Obama.
July 10th, 2012 | 4:20 pm
How about a level playing field – condoms for men?
Condoms may be paid for out of your Flexible Spending Account, so they are in that sense considered a medical expense by the federal government.
July 10th, 2012 | 4:39 pm
…I see the Obama “amen” corner has already chimed in….
publius,
If you are referring to me, please note that I buy the argument that the contraceptive mandate is an infringement on religious liberty. I don’t buy the argument that contraception isn’t health care or that the acceptance of contraception as health care implies fertility is a disease. The latter is just nonsense. And, by the way, the Catholic Bishops have made it quite clear (to some people’s consternation) that they are not arguing against coverage of contraception or trying in any way to interfere with people getting contraception. They just want to be exempt from being a party to providing it. The religious liberty argument is made widely and credibly. The argument that if contraception is medical care, then fertility or pregnancy is a disease is generally something you get only on blogs.
July 10th, 2012 | 5:51 pm
“Condoms may be paid for out of your Flexible Spending Account, so they are in that sense considered a medical expense by the federal government.”
So may prescription birth control.
July 10th, 2012 | 8:06 pm
Contraception prevents a healthy functioning part of the body from working. No other medication or surgery does that. To say it is preventative, in the same class as say, vaccines, is to skip over the mechanism of action. Prenatal care and obstetric care doesn’t stop a organ system from functioning when there is nothing wrong with that system, hence the notion that contraception treats fertility as a disease. The organ system to be halted is the female endocrine reproductive axis. This benefits leftist men who want women to be available for their own functioning reproductive endocrine axis which could be halted at the cerebral level with a little prayer and fasting.
Female circumcision halts this axis as well, for the benefit of fundamentalist muslim men. You can have women treated as objects “to be used”, as PJPII would say, from a hedonistic path or from a rigorist (puritanical) path and they often overlap.
July 10th, 2012 | 9:08 pm
David,
I find it interesting that your argument of 3:50pm is not from reason but from tradition. Of course, treatment of contraception as medical care was once not tradition, and in some states even illegal. This traditional understanding of contraception as health care was invented within the lifetimes of most people reading this blog. When Matthew states that contraception is not “a part of medicine as traditionally defined,” I assume he’s speaking of a tradition which reaches back beyond the 1960s. However, I take your point that a new tradition has largely replaced the old. That doesn’t mean the new tradition is better founded than the old, only different.
July 11th, 2012 | 12:45 am
Contraception prevents a healthy functioning part of the body from working. No other medication or surgery does that.
TXW,
Anesthesia does.
July 11th, 2012 | 10:03 am
Also, immunosuppressant drugs inhibit an extremely vital bodily system when its healthy functioning would have adverse effects—for example, after an organ transplant. When the immune system rejects something foreign to the body, like a transplanted organ, it is functioning exactly as nature intended it to.
Proton pump inhibitors and antihistamines also are often used to suppress perfectly natural physiological functions when their healthy functioning is unwanted.
The drops that your eye doctor uses to dilate your pupils when you have an eye exam block receptors in the muscles of the eye that constrict pupil size. Perfectly healthy eyes are temporarily altered just so your doctor can get a better look inside.
Anybody who used an antiperspirant this morning is preventing healthy sweat glands from functioning normally.
There are no doubt numerous other medical interventions that, for one reason or another, interfere with the normal functioning of bodily organs or systems more or less temporarily when that normal functioning is unwanted.
July 11th, 2012 | 10:36 am
“Medicine” obviously comes from Latin “medeor” meaning to restore, via “ars medicina” the physician’s art.
Since ancient times, medicine was distinguished from surgery and, to this day, in UK hospitals, one commonly finds “Medical Wards,” presided over by a Consultant Physician (known as “Dr X”) and “Surgical Wards,” presided over by a Consultant Surgeon (known as “Mr X”)
The distinctive characteristic of medicine would appear to be treatment by means of pharmaceuticals. Now, φάρμακον [pharmakon]can mean (amongst other things) a medicine, a poison, a cosmetic, or a magic potion or philtre. It would certainly have applied to a medicinal (as opposed to a mechanical) contraceptive.
July 11th, 2012 | 11:17 am
This traditional understanding of contraception as health care was invented within the lifetimes of most people reading this blog.
Darel,
If that were true, it would be because there was no effective contraceptive drug prior to the 1950s. But it is not true. Browse through Contraception and Abortion from the Ancient World to the Renaissance, for example, on Google Books, and you will find that such people as Galen (the famous Roman physician of the second century) prescribed contraceptives and abortifacients. Medicine has concerned itself with controlling fertility from the beginnings of its origins.
July 11th, 2012 | 11:42 am
Obamacare already carves out major secular excptions to the contraceptive mandate, the most prominent being “grandfathered” health care plans. As Ed Whalen has observed:
“In July 2010, in the very order in which HHS first set forth its interim final rules for coverage of preventive services under Obamacare (as well as in this contemporaneous HHS publication), HHS projected (as its “mid-range estimate”) that 55% of large-employer plans would remain grandfathered in 2013 and that 34% of small-employer plans would remain grandfathered of that year. Large-employer plans accounted for 133 million enrollees, and small-employer plans accounted for 43 million enrollees, so HHS’s “mid-range” projections anticipated that roughly 88 million Americans would not be subject to Obamacare’s “minimal essential coverage” provisions in 2013.
http://www.eppc.org/publications/pubid.4654/pub_detail.asp ”
The obvious purpose of excluding the “grandfathered” plans is to provide cover for Obama’s promise that people will not have to give up their existing coverage if they like it.
Obama is thus in the position of arguing that while fairness requires religious employers to act against their conscience, fairness does not require other employers with “grandfathered” plans to provide contraceptive coverage to allow Obama to keep a political promise.
July 11th, 2012 | 11:48 am
In order:
Anesthesia and immunosuppressants are not ends in themselves. They are used so that other bodily functions can, or can be made to, function better (or at all.)
Antihistamines and other inhibitors are used so that the body *as a whole* can function better. You suppress one working function so that another does not function harmfully or even lethally.
Dilating eyedrops are like anesthesia — a temporary disabling of one function so that other will function better long-term.
Antiperspirant is getting into trivia — you may as well say that eating bland food prevents your taste buds from functioning normally, or that sunscreen prevents your melanin production from functioning normally. And I don’t recall the last time anyone tried to get anyone else to pay for their anti-perspirant on grounds of justice and equity.
Contraceptives are not like any of these things except in the atypical case where pregnancy itself is a life-threatening condition. It merely suppresses one function so that function does not function for reasons not connected to bodily health, not for the benefit of the rest of the body. It is, in the typical case, a disabling of bodily function to obtain a non-medical end.
July 11th, 2012 | 12:40 pm
Anesthesia and immunosuppressants are not ends in themselves.
pentamom,
Contraceptives are not ends in themselves, either. All of your explanations for why the things I mentioned are justifiable as medical interventions do not get around the fact that the following statement is false:
Anyone who has ever had surgery under general anesthesia (for anything other than an operation on the central nervous system itself) is very glad their healthy, functioning central nervous system was largely prevented from functioning.
Contraceptives are not like any of these things except in the atypical case where pregnancy itself is a life-threatening condition.
If you read the IOM report from which the recommendations for contraceptive coverage were taken, there are significant health issues for both women and their babies in unplanned pregnancies and in pregnancies too closely spaced. I understand the religious objections to contraception, but setting those aside, I do not see any reason why a woman who does not want to get pregnant for a specific period, whether it be to space the children she has or whether it be never to have children, should not get the help of a doctor and whatever drugs she and the doctor think will best help her avoid pregnancy. Whether insurance should pay for it is not my concern here. I am simply arguing that a doctor writing a prescription for oral contraceptives and a woman using them is most reasonably thought of as a medical matter.
July 12th, 2012 | 12:31 am
I thought someone could come up with better counter examples than above. My jaw dropped, DROPPED, when I was educated on anesthesia and deodorant!
The key word is “healthy”, perhaps not the best choice. William May or Janet Smith could think of a better word. They key is to look for pathology.
1. Anesthesia: Gallbladder needs out. Pain and sensory nervous system need to be shut off because they become pathological during surgery.
2. Immunosuppressants/anithistamines: similar to vaccine usage, the immune system is pathological in reference to the disease. Like many organ systems this can go both ways depending on the circumstance. Histamine, for example, is useful in some circumstances, pathological in others.
3. PPI’s: Acid reflux is the pathology. Proton pumps are lessened to treat the pathology, yet one can still eat. The whole organ system is not shut down.
4. Mydriatics: Similar to anesthesia, the doctor is looking for pathology, sometimes treating or preventing pathology. I guess any primer on Ends and Means, distal or proximate would elucidate this in more detail. Double effect and all that.
5. Hyperhydrosis: Similar to above, but overlaps with cosmetic and cultural medicine, i.e., smelling bad is pathology, if one wants to medicalize everything.
A hysterectomy for excess bleeding is not contraception. Exogenous hormones for menometrorrhagia is not contraception. Anesthesia in a male prevents the function of the genitals,yet, this is not contraception.
The intent of contraception is to stop a non pathological organ system from working to prevent pregnancy. This is not in the same category as anything listed above, unless fertility/pregnancy is considered pathological. In other words, what is the disease being treated with contraception? NFP is not contraception because the state of fertility is still allowed to exist.
Nobody denies the IOM list of problems with short inter-pregnancy intervals and all that. Yes, contraception prevents pregnancy which prevents gestational diabetes. The disagreement lies in the method. Interesting that the IOM makes sure it is not men who have to take the hormones or the responsibility. Ol’ Galen, famous Galen, would perhaps be proud. Too bad the Empire in which he was a citizen had issues with outlasting those religious fanatics in the catacombs.
July 12th, 2012 | 9:13 am
Physiologically, contraceptives are ends in themselves. They do not function in order to correct or enable something to be done that enables or enhances other aspects of bodily function.
In the typical case of contraception for the woman in normal physical health, she uses the contraception, and does no more to improve or correct her bodily function. She does not use the contraception in order to be able to undergo surgery or to support the functioning of other bodily systems. The contraception is a medical end in itself, though it has non-medical, lifestyle ends.
“I do not see any reason why a woman who does not want to get pregnant for a specific period, whether it be to space the children she has or whether it be never to have children, should not get the help of a doctor and whatever drugs she and the doctor think will best help her avoid pregnancy.”
Nor do I. And there is not a law, policy, or regulation in this country that prevents her from doing so.
July 12th, 2012 | 9:16 am
Clarification: not “whatever drugs will best help her avoid pregnancy.” There are all kinds of drugs, abortifacients included, that might most effectively help someone avoid pregnancy, but that are toxic to mother or unintendedly conceived child, that an unscrupulous doctor or foolish mother want want. I oppose their use.
But many of them are not illegal and no one is interfering with your stated principle above. This is has never been and never will be about “should not get.” It’s about “some other private entity should not be required to act in order to directly provide for her.”
July 12th, 2012 | 9:56 am
The argument that, in the 21st century, contraception is not a medical matter is nonsense.
True, the medical profession has embraced contraception, but then it has also embraced abortion, and, to a large extent, euthanasia. The fact that doctors say it’s “health care” doesn’t make it so.
July 13th, 2012 | 12:01 am
Well, as long as you understand that humanists are the only ones with rights worth worrying about, then it’s obviously not fair.
In fact, you should pay for all their protective gear, for whatever high-risk recreational activity they feel like engaging in. Otherwise, the poor little dears might hurt themselves.
July 13th, 2012 | 12:28 am
True, the medical profession has embraced contraception, but then it has also embraced abortion, and, to a large extent, euthanasia. The fact that doctors say it’s “health care” doesn’t make it so.
Both types of care are things that require people trained in medical knowledge.
But there is a crucial distinction – one that is just beginning to be made – between procedures that have as their purpose the restoration or maintenance of healthy bodily integrity, vs. procedures that are primarily about subverting or interrupting the body’s normal processes for reasons that are about lifestyle and choice, not about maintaining bodily health/integrity.
We must learn to distinguish these two very different types of procedures. We must recognize that the latter are different in kind from the former. There are going to be many, many more such “lifestyle procedures”, and if we don’t learn how to tell the difference honestly, our health care dollars will end up diverted away from the genuinely sick so that the politically well-connected can have their child’s custom eye, hair, and skin colors paid for by the taxpayer.
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