31 Comments

Leroy Huizenga (@LHuizenga)
February 7th, 2013 | 4:55 pm

One thing that’s really interesting in the statement is that Dolan mentions individuals — “we will continue to stand united with brother bishops, religious institutions, and individual citizens who seek redress in the courts for as long as this is necessary.”

There’s been a lot of concern among some of my Catholic business-owning friends that they’d be left in the lurch if the Administration was able to come to accommodation with institutions. Apparently not.

Leroy Huizenga (@LHuizenga)
February 7th, 2013 | 4:56 pm

…and another part, making this clear:

“Cardinal Dolan also said the proposal refuses to acknowledge conscience rights of business owners who operate their businesses according to their faith and moral values.

“‘In obedience to our Judeo-Christian heritage, we have consistently taught our people to live their lives during the week to reflect the same beliefs that they proclaim on the Sabbath,’ Cardinal Dolan said. ‘We cannot now abandon them to be forced to violate their morally well-informed consciences.’”

David Nickol
February 7th, 2013 | 5:56 pm

I can understand the concern about owners of for-profit businesses, although I don’t believe they should be exempt. But I really don’t understand the objection on behalf of religious organizations. Unless I am not understanding something, they are required to do nothing, and they are required to pay for nothing. It is true that if they insure their employees, the employees will get insurance covering contraception from a third party. But they would be providing insurance in any case. It seems to me that if this is analyzed according to the principles regarding “cooperating with evil,” the bishops have an incredibly feeble case. Are they really saying it is necessary to deny all your employees insurance coverage without contraception so that a third party won’t provide employees who want it with coverage of contraception?

Suppose I announce that I will be outside a certain church on Sunday morning to hand out to anyone who has attended services coupons for a free subscription to a pornographic web site. Would the church be morally obligated not to hold services?

Gail White
February 7th, 2013 | 8:45 pm

Living in Louisiana, I have many nonCatholic friends who work for Catholic hospitals and schools. Also, a majority of the Catholics of my acquaintance practice birth control. I am amazed that the Vatican should attempt to deprive these people of access to contraception.
I pray that God will take away the Church’s heart of stone and give it a heart of flesh.

Mick Lee
February 8th, 2013 | 7:13 am

Mr. Nickol: I have worked in the medical insurance field for over twenty years and I can definitively tell you that no insurance program provides any benefit for “free”–nor can they. One way or another, you are paying for it. You may, as a matter of legal fiction, believe you are paying nothing for a particular benefit when in fact your policy compensates for that “zero cost” by giving you a less than favorable benefit somewhere else. In other words, one hand gives while the other takes away.

Overlooked in the current discussion is the fact that most Catholic hospitals and many Catholic owned businesses self-insure. In those cases, even a legal fiction such as “free contraception” cannot provide any cover for what is going on.

Boonton
February 8th, 2013 | 7:50 am

We should be clear about the political games here. The Bishops are not really making a case for religious freedom, they are making a case against it. The principle they are advocating is that employers should be able to use their position to impose their religious (and other views) on their employees. The Bishops are making an assumption that when employers do this, they are more often than not aligned with the Church. But this is clearly a double edged sword. If an employer can deny contraception coverage because of his claimed moral beliefs, an employer can just as easily deny pregnancy coverage because he is oppposed to single motherhood or because he advocates population control.

On the flip side the administration has the odd fact that contraception coverage appears to literally cost nothing. Health plans that offer it seem to either have no increased expenses or even lower expenses than ones that don’t. Since this is the case insurance companies have no qualms about offering it for free and the religious argument against it gets even harder to sustain. Since employers aren’t really paying for it, what exactly is their claim here? If paying for it was really the issue then the Bishops should simply ask insurance companies prepare an estimate of what premiums would be without coverage and then *pay* the insurance companies the savings back, which I’m sure the insurance companies will be happyt o live with.

peg
February 8th, 2013 | 7:51 am

” I am amazed that the Vatican should attempt to deprive these people of access to contraception.”

No one is attempting to deprive anyone of access to contraception. These people are free to get and use all the contraceptives they want. Aren’t they doing so now without hindrance from “the Vatican”? It’s a free country.

Our objection is making the Catholic employer buy it for them.

You are free to buy a gun, too, but it is unjust to make your Quaker employer buy it for you.

Boonton
February 8th, 2013 | 8:02 am

Mick

I have worked in the medical insurance field for over twenty years and I can definitively tell you that no insurance program provides any benefit for “free”–nor can they.

Clearly you’re leaving a lot out here. There’s multiple ways to offer something for free.

A trivial one is offer something no one will use. “replace your roof if a falling space station lands on your house”

A more sinsiter one is to offer something that alters your risk pool. Imagine a plan that offered reduced gym memberships and armoatherapy. This might be very appealing to a 20-something go getter in excellent health. Not so much for someone whose battled cancer and worried about remission…she would rather see a plan that covers the best oncologists. If the costs avoided by scaring away the sick people meet or exceed the costs of gyms and scented candles, then it is indeed ‘free’ for those in the plan.

Less troubling is offering something that lowers the total payouts. Say an auto ins. company offers to fix cracked windshields for free (cost say $100 per car). If it turns out for every 1000 fixes, it avoids one accident that cost $100,000 the service pays for itself and is indeed ‘free’ to both the company and policy holders.

Boonton
February 8th, 2013 | 8:45 am

peg

Our objection is making the Catholic employer buy it for them.

No one is making anyone buy anything for them. A person chooses to buy contraception with their health coverage, or they don’t. If you’re going to say that is making the employer buy it for them then you might as well claim the Catholic employer who simply pays his contraception using employee in money is also ‘forced to buy it’ for them.

Michael PS
February 8th, 2013 | 10:08 am

David Nickol & Booton

By providing insurance coverage, the employers are facilitating access to contraceptives, sterilisation and abortifacient drugs to their employees.

The policy is, in effect, a voucher for these services. Who pays what is beside the point.

David Nickol
February 8th, 2013 | 11:14 am

By providing insurance coverage, the employers are facilitating access to contraceptives, sterilisation and abortifacient drugs to their employees.

Michael PS,

I don’t see it that way at all. We are in general talking about employers who have previously provided insurance to their employees, and who want to do so in the future. Now the government has come up with a plan that guarantees insurance coverage of contraception to anyone who wants it if their employer declines to provide it. It seems to me that under the newly clarified rules (which continue to be a proposal open to comments and changes) what the bishops want is not to be forced to provide coverage of contraception, but to be given a way so that they can prevent their employees from getting such coverage. The “accommodation” permits nonprofit religious organizations to continue to do exactly what they have been doing up until now—providing insurance coverage for their employees, and not providing or paying for coverage of contraception. To use the language of double-effect reasoning, there will be two effects now when religious employers provide insurance coverage. The intended, beneficial effect will be that their employees have health insurance. The unwilled, unintended effect is that their women employees will receive, from a third party, insurance coverage of contraception. Certainly it will not be the intention of Catholic religious organizations who provide insurance for their employees that the employees then get independent coverage of contraception. Knowing something will happen as a result of your actions is not the same thing as willing it to happen

Artaban
February 8th, 2013 | 11:17 am

“On the flip side the administration has the odd fact that contraception coverage appears to literally cost nothing. Health plans that offer it seem to either have no increased expenses or even lower expenses than ones that don’t. Since this is the case insurance companies have no qualms about offering it for free and the religious argument against it gets even harder to sustain.”

Boonton, you have got to be kidding. Do any sort of summary research on the things they are going to be required to cover. The Plan B pill runs from $20-$120 depending on your state and “insurance coverage”. Sterilizations, such as vasectomies, tubal ligations, and reversals of those procedures run from $1200 to $6000.

One really has to chuck any common/fiscal sense out the door to think that offering those services could somehow be done, “for free”.

Artaban
February 8th, 2013 | 11:39 am

Boonton,

Let’s also look at the fundamental logical contradictions in your statement:

1. If “insurance companies have no qualms about offering it for free”, then why is the government forcing employers to pay for it?

2. If “contraception coverage appears to literally cost nothing” why are those who aren’t PAYING for it being fined up to $500,000 per year? (Makes the government seem awfully discriminatory and unjust, if what you’re saying is true.)

Mick Lee
February 8th, 2013 | 11:42 am

Dear Boonton: Well, one would think so, wouldn’t one? Take your example of gym memberships and aromatherapy, the most direct answer is that most people (including 20-somethings) won’t use them regardless of personal out of pocket expense. The other answer is that lifting dumb bells, running, and doing setups have never been demonstrated to have any impact on the acquisition of cancer.
The major problem with your claim is that it rests on a series of “ifs”—one of the largest “ifs” being the demonstration of cause and effect or even a correlation. The largest “if” is whether overall costs are in fact reduced. The raw fact is that no contraception benefit has ever been demonstrated to reduce overall costs. Why? One important reason seems to be that what we “contain” now has a habit of ballooning out somewhere/sometime else. In other words, by and large, the children a woman avoids having now are conceived and born later—and being later often meaning more expensive with the complications of age. Another important factor is that members who are covered by a plan which does not have a contraceptive benefit are highly likely to purchase some form of contraception for themselves out of their own pocket. (If nothing else, they go to Planned Parenthood) Throw in the unwanted pregnancies from those who did not use contraception along with unwanted pregnancies resulting from the statistically predictable failure rate of the contraceptives themselves and the whole cup of tea gets rather cloudy. The best thing that can be said for contraceptive coverage and its effect on total costs is an unsubstantiated “it-could-have-been worse”.
This not to say that a contraceptive benefit MAY not reduce overall costs. It simply has not been demonstrated—and if it is ever demonstrated under what circumstances does it work and not work. The difficulty right now is that there…

Boonton
February 8th, 2013 | 11:46 am

Michael PS

By that reasoning money is the ‘ultimate voucher’ since once you give someone cash there’s really no way to have any control over what he spends it on. Consider a ‘factory town’ that pays its employees in ‘script’ that can only be used at the company store or for company housing where management controls what is stocked. By this reasoning a law that said employers must pay their employees in wages would run afoul of ‘religious freedom’ since some factory owner could claim his religious scruples do not allow him to hand his cash over to his immoral employees who, left to their own devices, will spend it on vice!

Richard M
February 8th, 2013 | 11:48 am

Hello Gail,

Also, a majority of the Catholics of my acquaintance practice birth control.

And they are imperiling their souls by doing so.

If the Church has a heart of stone, it’s because it has failed to pronounce this teaching with sufficient vigor over the last 45 years.

I am amazed that the Vatican should attempt to deprive these people of access to contraception.

Last I checked, contraception is still legal and available for purchase with relative ease – and even can be insured. The Catholic Church is advocating nothing to change these facts. It simply does not want to have to pay for them, and by paying for them, tacitly endorse such evils.

Richard M
February 8th, 2013 | 11:57 am

Hello Boonton,

Less troubling is offering something that lowers the total payouts. Say an auto ins. company offers to fix cracked windshields for free (cost say $100 per car).

You might as well spell it out: You think this is cost free, or even a money saver, for insurance companies because it will mean that they have fewer (unintended) pregnancies to cover down the road.

But there’s been no evidence to support such a proposition. The HHS, in its original statement for the mandate, writes that insurers will be glad to offer free birth control without raising premiums on employers because the suddenly-free access to birth control will lower the costs of medical care. That only works if all of these employed women never had access to birth control in the first place — which we know is absurd, as the CDC’s 20-year study on unplanned pregnancies demonstrated. If these women have been accessing birth control already as the study demonstrates, then there are no cost savings and insurers will have to pay more.

If, in fact, insurance companies were in possession of such evidence, they would have been offering contraceptive coverage at no charge long, long, long before now. But they haven’t. They only have begun doing so because Obamacare is forcing them to do so.

This coverage *will* cost money, because these contraceptives cost money. They simply do. Contraceptive manufacturers are not in the business of giving away Yasmin or Ella for free. If they say they aren’t costing anything, they’re lying. And if they’re costing money, someone is paying for them. In this case, Catholic hospitals, charities, and schools.

David Nickol
February 8th, 2013 | 1:41 pm

The Plan B pill runs from $20-$120 depending on your state and “insurance coverage”. Sterilizations, such as vasectomies, tubal ligations, and reversals of those procedures run from $1200 to $6000.

Artaban,

Let’s say an uncomplicated pregnancy and simple hospital delivery (i.e., no c-section, normal birth weight) cost $8000. Assuming an average price of $50 for Plan B, an insurance company can pay for 160 uses of Plan B, and if only one pregnancy is prevented, the insurance company will “break even.”

“The average cost of medical care for a premature or low birth-weight baby for its first year of life is about $49,000, according to a new report from the March of Dimes Foundation.” In extreme cases, costs can run over $1 million.

Four in ten pregnancies are unplanned or unwanted. Good medical coverage that prevents unwanted pregnancies saves huge amounts of money. People sometimes claimed to be shocked at the idea of saving money by contraception. But even those who use NFP (natural family planning) are attempting to prevent the conception of unintended children. The Catholic Church does not insist that people have as many children as possible. It is perfectly legitimate to limit the number of children conceived to the number of children wanted.

David Nickol
February 8th, 2013 | 1:44 pm

It simply does not want to have to pay for them, and by paying for them, tacitly endorse such evils.

Richard M,

Under the current proposals, the Catholic Church and other religious organizations will not pay for contraceptives or the cost of insurance coverage of contraceptives.

Boonton
February 8th, 2013 | 2:58 pm

Artaban,

I’m not seeing any contradictions. Gov’t isn’t forcing employers to pay for contraception. Employers either pay for health coverage or they pay to subsidize individuals buying health coverage directly through exchanges. As for your $500K a year fine, that has nothing to do with what employers are funding but what insurance companies are selling as ‘full coverage plans’.

JDD
February 8th, 2013 | 3:36 pm

Mr. Nickol, you have proven yourself through previous conversations to be very aware that the issue is *how* – not whether – the number of children conceived – and I’m glad you worded it that way – is limited.

Catechism of the Catholic Church paragraphs 2366-2368 in particular:

http://www.scborromeo.org/ccc/p3s2c2a6.htm#2366

Richard M
February 8th, 2013 | 3:38 pm

Hello David,

Under the current proposals, the Catholic Church and other religious organizations will not pay for contraceptives or the cost of insurance coverage of contraceptives.

I disagree, David. Respectfully.

I think Matthew Franck has addressed this point on FT today, even if you didn’t find it persuasive.

Artaban
February 8th, 2013 | 4:07 pm

David,

In Missouri at least, the cost of a pregnancy sans complications–from prenatal to birth is only $4000 without insurance. I know, because my wife and I researched it when choosing medical coverage for her. That’s half your “assumed” number.

The rest of your Plan B analogy is extremely weak, for several reasons:
1) The U.S. birthrate is 64 per 1000 women.
Around 12% of U.S. births are premature. That’s 7.68 babies for every 1000 women. Not all of those 7.68 actually survive a year and incur the $49,000 (March of Dimes reports survivability no higher than 90% at 37 weeks). So for 1000 women of childbearing years, less than 1% face the situation you describe.

2) On the other hand, of the 993-995 other women, how many are using Plan B? I tried finding out how many pills are sold annually, but ended up on a site where one person admitted to using 3 in 3 weeks.. http://answers.yahoo.com/question/index?qid=20080515202239AAApApc

Granted, that’s anecdotal, but I think we can all make a pretty educated guess that over 1000 Plan B pills are being used yearly by 993 women. Hence, according to your math, it’s more expensive than preventing premature pregnancies.

David Nickol
February 8th, 2013 | 5:06 pm

Artaban,

According to one source I checked—and it is not out of line with many others—the national average for hospital delivery (vaginal birth, no complications) was $10,166 in 2010. The average cost for a caesarian (without complications) was $17,052. About 33% of births are c-sections. According to WebMD, “The costs of childbirth can be steep. The charge for an uncomplicated cesarean section was about $15,800 in 2008, while an uncomplicated vaginal birth cost about $9,600, government data show.” That is roughly the same as the chart I linked to.

I really don’t understand the rest of your calculations. But pregnancy and childbirth are much more expensive than your figure, and also we’re talking about risk, not overall national figures.

Tim
February 8th, 2013 | 8:56 pm

And to follow up on Richard M. once more.

Where is the evidence that women have unplanned pregnancies because they cannot access contraception? The CDC’s 2009 report blew that out of the water. It found that 99% of sexually active women had used at least one form of contraception during the period in which they were surveyed. A report highlighted by the Alan Guttmacher institute led Will Saletan to conclude that a “lack of access” to contraception had little, if anything, to do with the abortion rate in this country.

Nancy Pelosi tells us that 98% of Catholic women have used contraception. If that number is even remotely accurate, then obviously access to contraception is a non-issue. That is, unless you’re the Obama administration looking to gin up support among unmarried women in an election year.

Boonton
February 9th, 2013 | 7:00 am

The first reason contraception coverage appears free that comes to mind is the fact that the cost of the most expensive birth control pills is cheaper than the most economical hospital birth. But the observation has only been that spending per covered patient has not risen when contraception coverage is added. The why though has not been examined in detail.

Lowering unwanted pregnancies might be one answer. Another might simply be added prevention by inducing otherwise healthy people to do a doctor visit once or twice a year. Another possibility might be the ‘risk pool’…people who worry about pregnancies tend to be younger and healthier so bringing them into a health insurance pool will tend to lower the average cost per patient….sort of like going to lunch with a bunch of lite salad eaters will make your share of the bill go down when the check is split more or less evenly.

That is, unless you’re the Obama administration looking to gin up support among unmarried women in an election year.

I think the issue is more about religious freedom. Namely what I discuss and do with my doctor is my business, not my employer’s. If the arguments against the coverage are accepted you accept a ‘camel’s nose in the tent’ for right wing social engineers.

David Nickol
February 9th, 2013 | 3:49 pm

Where is the evidence that women have unplanned pregnancies because they cannot access contraception?

Tim,

Of course, no matter how readily available contraception is, it cannot work unless it is used. Limiting caloric intake to lose weight is an approach available to all, and yet many people who wish to lose weight find it difficult or impossible to do so. Perhaps we should look at over-the-counter contraceptive devices and inexpensive generic birth control pills as the equivalent of weight loss by limiting calories. Even responsible, well motivated people may need more. The recent St. Louis study on providing free contraception seems to me a good indicator of what is possible through Obamacare. There are more reliable, more effective contraceptives than the birth control pill, such as hormonal implants, and it seems a good bed that if the “contraceptive mandate” survives, many women will choose them.

Tim
February 10th, 2013 | 6:29 am

Boonton,

First of all, I find your attempt to explain how forcing insurers to provide “free” contraception actually reduces costs unpersuasive, to put it mildly. And given that for years liberals have demonized insurance companies as Evil Inc. I find their newfound concern for helping these insurance companies reduce costs just a tad disingenuous.

Furthermore, I think you have it backwards about who is forcing employers to enter into the doctor-patient relationship with respect to contraception. No employer stops an employee from going to the local drug store and purchasing contraception out of pocket. How could they keep track of what you do with your money? But by forcing employers to cover it, you are making those with a moral objection complicit in what you buy. Given that, per the CDC, no one seems to have a problem accessing contraception, forcing employers to be complicit in what people have no problem getting on their own makes no sense at all.

Tim
February 10th, 2013 | 6:59 am

David,

That’s a fair point, although I very much doubt you would see a statistically significant number of people who would avoid pregnancy because their insurance covered more expensive birth control. The CDC’s report on why women had not used contraception when they conceived is illuminating. It can be found here:

http://www.cdc.gov/nchs/data/series/sr_23/sr23_029.pdf

See the top of page 14.

Notice that the responses had little to do with using contraception in a responsible manner. The most common response was that these women did not think they would get pregnant! The second most common was they did not actually mind if they got pregnant. The third most common response was a worry about side effects of birth control. The only response that might speak to that St. Louis study was those who were not expecting to have sex, but I don’t see how “lack of access” could be much of a factor here given that, again, access is not much of an issue.

By the way, I think that St. Louis study shows some methodology flaws, particularly the lack of an effective control group, as Dr. Michael New points out here:

http://www.lifenews.com/2012/10/10/misleading-study-claims-obamacare-birth-control-cuts-abortions/

The people in that study were volunteers, and highly motivated to avoid an unwanted pregnancy, which as the CDC study shows, does not seem to capture the reasoning behind why so many women do not use contraception at the time they conceive.

Subsidizing more expensive contraception is unlikely to make a statistically significant dent in this situation.

Boonton
February 10th, 2013 | 8:23 pm

Tim

And given that for years liberals have demonized insurance companies as Evil Inc.

Are you actually responding to my arguments or are you responding to arguments from imaginary liberals who live inside your head? I think for good and bad insurance companies are profit making institutions, period. In fact, if you read what I wrote carefully, some of the ways insurance companies can lower cost are not all great. (example, making the benefits appeal to healthy people (free gym membership) in the hopes that sicker people will look elsewhere)

No employer stops an employee from going to the local drug store and purchasing contraception out of pocket. How could they keep track of what you do with your money?

I already demonstrated this. Issue pay in the form of ‘factory script’ that can only be used at the company store or company housing in ‘factory towns’. (Variations on this did exist in the 20th century). No doubt in this digital age someone may come up with a prepaid visa that lets the person who buys it customize it so it can only be used for certain types of purchases. Why does your ‘morally complicit’ racket work only for health benefits and not for money? At what point can we say wages belong to the employee who put in his 40 hours and not the employer anymore?

But by forcing employers to cover it, you are making those with a moral objection complicit in what you buy

Again if you find it immorally complicit to have to pay your employees then I don’t think society should take your concerns seriously. At some point a sensible line has to be drawn between what belongs to the employee and what belongs to the employer. If you are paid in health benefits, then the way you use your health benefits are your business, not your employers.

Artaban
February 13th, 2013 | 1:41 pm

David,

Even if one takes all the expenses you cite (and I’m not objecting to several of them), the “expense” of having a baby is nothing compared to the impending cost of not having enough of them.

Medicare and Social Security insolvency are largely due to the diminishing pool of workers contributing to them. Many are beginning to realize the high cost of contraception and abortion that are looming.

Russian, Japanese, and Chinese populations are going to decline so precipitously in the next 60 years it will be roughly equivalent to the depopulation caused by the Black Death.

http://www.slate.com/articles/technology/future_tense/2013/01/world_population_may_actually_start_declining_not_exploding.html

George Friedman (The Next 100 Years) contends that nations will be so economically devastated by lack of babies (and the workers they’d grow up to be) nations will be fighting over immigrants.

Fundamentally, do you believe most human beings are good, their contributions potentially incalculable, and to be cherished and loved, or do you believe they are parasites and to be prevented or destroyed?

I, for one, believe they are created good…