A phony solution to a phony problem: don’t require employers to pay for reproductive health services; instead, require insurers to provide them “free.” Of course it all has to get figured into the price.

As far as I can tell, the Obama Administration is offering the perfect phony solution to the phony problem of employers whose “consciences” require them to deprive their female employees of health care that might allow them to enjoy having sex. Instead of requiring employers to pay insurance companies to provide basic reproductive health services the new rules will simply require insurers to provide the services. Of course, the cost will have to be figured into the price somehow: just as the (much higher) cost of maternity services already is.

Which raises an interesting question: Should an employer who has a religious belief that population growth is a problem be allowed to deny employees maternity care after the second delivery?

Footnote Astoundingly, this seems to be pleasing both the Catholic Health Association (though maybe not the bishops) and Planned Parenthood.

Author: Mark Kleiman

Professor of Public Policy at the NYU Marron Institute for Urban Management and editor of the Journal of Drug Policy Analysis. Teaches about the methods of policy analysis about drug abuse control and crime control policy, working out the implications of two principles: that swift and certain sanctions don't have to be severe to be effective, and that well-designed threats usually don't have to be carried out. Books: Drugs and Drug Policy: What Everyone Needs to Know (with Jonathan Caulkins and Angela Hawken) When Brute Force Fails: How to Have Less Crime and Less Punishment (Princeton, 2009; named one of the "books of the year" by The Economist Against Excess: Drug Policy for Results (Basic, 1993) Marijuana: Costs of Abuse, Costs of Control (Greenwood, 1989) UCLA Homepage Curriculum Vitae Contact:

23 thoughts on “Compromise”

  1. OFMG. I am home sick today, watching MSNBC. They have just informed us that “Obama has reversed his position on birth control”. They have a panel who says things like “Obama fumbled big time on this”, and Luke Russert who, I guess, understands women or something, its talking about Middle Class Suburban Women, the Ultimate Swing Group, they might be all “hey, for me, I am all about contraception, but Obama, he is telling My Church what to believe”. It’s like these guys see as their responsibility to magnify and validate the completely ridiculous position of the Catholic Church! Finally someone (Presidnet of NOW, I think), points out that the polling is behind Obama, especially independents, and that there already was an exemption in the original policy. And then we go to commercial, where some Alex someone or other reminds us that “Obama has reversed his position on birth control”.

    I weep for the republic.

    1. Rachel Maddow is probably sleeping or prepping, I guess, so she couldn’t come in, slap them all silly, and explain what’s really happening.

  2. Mark is amazed at the acceptance of this solution by the Catholic Health Association. He is only amazed because he is a thoroughgoing consequentialist, and thinks that a deontological solution is inherently a phony one. Well, religion is generally deontological. Much of the law is also deontological (especially criminal and corporate), although most clients are very consequentialistic. As Leo Katz pointed out, a good lawyer is therefore a skilled deontological engineer. (Often enough, the same is true for holy folk.) This looks like good lawyering from the Obama Administration; better than its macroeconomics.

  3. Ebenezer:

    I don’t toss around economic and statistical jargon willy-nilly, certainly not without trying to explain the terms to the laity, or at least providing suitable links.

    WTF is “doentological” (i think I know WTF “consequentialist” means).

    1. Sorry ’bout that. The difference between deontological reasoning and consequentialist reasoning is the difference between “right” and “good.” Deontological types care much more about means than consequentialists, who mostly care about ends. Deontologists tend toward conservatism; consequentialists tend to be centrists or lefties.

      Nobody is a thoroughgoing deontologist or consequentialist. Your bog-standard liberal consequentialist is opposed to torture because it is flat-out wrong. Most deontologists think that a starving person has some greater right to steal food than a well-fed person.

      But in issues like abortion, one’s tendency can make an enormous difference in one’s position. Pretend that you think abortion is morally problematic. A thoroughgoing deontologist might think that this settles the abortion issue: morally problematic behavior is wrong, and should be banned. (Not all deontologists would think that all immoral behavior should be criminalized–the Roman Catholics take a nuanced policy position toward greed, although they’re pretty sure about its moral dimension.) A consequentialist would want to go further. What would a ban do to abortion rates? What would be the morbidity and mortality of back-alley abortions to women? What are the costs of enforcement: social and pecuniary? What would it do to the medical profession? What are the alternatives to banning it? Etc.

      Charles Fried, a smart-honest conservative law professor at Harvard, wrote a nice book in defense of deontological reasoning. I’m basically a consequentialist myself, but I am opposed to torture and capital punishment because they are flat-out wrong IMO. To prove that I’m deontological here, I’m delighted when the cops shoot a dangerous criminal. The end is the same, but the means (self-defense or defense of others) make all the difference. On the other hand, I’m relatively relaxed about Singapore, even though it is an autocracy, which I don’t like. Consequentialist reasoning here; Singapore is well-run, and gives many people a chance at a reasonable life.

      1. I agree with all of this except the statement that “deontologists tend toward conservatism.” I suppose that may be true of most deontologists in the real world (who get their deontology from an uncompromising interpretation of the Christian religion.) But in secular academe, deontology of a Kantian stripe is by far the most popular version of ethics–in fact, many philosophy professors don’t even think consequentialism is capable of a serious defense–and the number of ethics professors who vote Republican asymptotically approaches zero. In fact, many are very radical egalitarians.

        It’s partly a question of what one regards as a serious ethical question to begin with. Tim Scanlon once commented in conversation that to ordinary people a “morals” problem means sex, while an “ethics” problem means money—whereas for (secular) ethicists morality and ethics have nothing to do with sex and only accidentally to do with money.

        1. I’m just a lawyer. When I hear the word “ethics”, I reach for my revolver. It’s usually an attempt to make the seamy seem seemly. But I suppose the word has different valence elsewhere.

      2. He is only amazed because he is a thoroughgoing consequentialist…
        Nobody is a thoroughgoing deontologist or consequentialist.

        So… Mark is the exception that proves the rule?

        Jabbing aside, thanks for the explanation. I hadn’t heard the term “deontologist” before (nor, apparently, my spell-checker).

  4. I suppose if Planned Parenthood is okay with the phony compromise, I should be; but it seems to me the lesson of l’affaire Komen is that when women speak up we win the argument. I’m not sure why the Administration couldn’t wait until we mobilized before offering a “compromise” which means that women whose health plans require them to use Catholic hospitals will have to go to two different locations to get comprehensive health care. (And how will that work, exactly? Will I walk to the Blue Cross Blue Shield headquarters to get my prescription? Will the insurers have doctors on staff? In other words, WTF?) Sticking insurers with the cost directly (as if they hadn’t been stuck with the cost before) will provide a perfect excuse for them to raise rates.

    The whole birth control issue has only come up because the economy is improving while the Republicans cannibalize themselves. After the election we should pressure the Administration to reverse its reversal and allow women to get contraceptives where we get the rest of our health care.

    1. The “compromise” has nothing to do with hospital patients. It’s about hospital employees. An orderly or a nurse at a Catholic hospital will now be able go to her GYN, as usual, get her pap smears and breast exam, and at the same time get her birth control prescription. Then she can go to the drugstore and get her pills for free. So for the employee, this “compromise” is no compromise at all; she gets her birth control for free, the same way her kids get their vaccinations for free.

    2. Uhm, what Cardinal Fang said. I am usually a lot more impressed with your arguments. In this case, you don’t even seem to understand what the controversy is about, let alone what the “compromise” actually entails.

  5. Not being a lawyer or ethicist, I had to look deontological up, but once I did, I fully agree with Ebenezer Scrooge. The administration played the deontological rule-based ethics game perfectly. If you meet the rule, the challenge is rendered null, whatever the consequences.

    Having satisfied the religious groups’ rule, the issue will (or should, except for the blockheaded tenacity of Sean Hannity and his ilk) now quickly subside.

  6. So just hypothetically, suppose the employees of the Christian Science Monitor are told that because of the owners’ deeply held religious principles, their health care will provide only access to Christian Science reading rooms, and no access to hospitals or doctors. Can we possibly accommodate every religion’s exceptions to health care?

    At what point to we acknowledge that we have a conflict of rights, and if an institution hires many non-coreligionists, it must leave the moral choices to them.

    1. The parallel would be that the Monitor would buy their employees health insurance that on paper only covered reading rooms, but the insurance companies would then tell the employees that real medicine is also covered, just like regular health insurance.

  7. This seems fair enough. The issue of an expanded exemption for religious organizations (remember, there was already exemptions for actual worship organizations, this is about religious hospitals, schools and other organizations) is really about making it so religious organizations themselves will not have to condone or spend directly (yes, yes, both health care and social services non-profits are heavily subsidized by the government) on the controversial health services. The subsidization of these services is a secondary issue, and the availability of the services is a tertiary issue. I mean the Catholic bishops don’t like them either, but those are different issues even if only in a very subtle way.

  8. This “compromise” is a total win for Obama and–more importantly–for women. And by getting the endorsement of the CHA, Obama has skillfully isolated the Bishops, a group of aging, celibate misogynists with a long history of catastrophic pastoral failure to live down

  9. The real confusion with this issue seems to be the notion that employers are “giving” their employees health insurance, when in fact, the health insurance is part of compensation paid to employees for their work.

    Employees are the ones who are actually paying for the insurance, through their labor, and the employer is just the one negotiating with the insurers for this benefit. If insurance is to be part of compensation, employees have the right to expect full medical coverage that meets the prevailing standard of care. Otherwise, should employers who are Jehovah Witnesses be able to deny transfusion coverage, or Jewish employers be able to deny coverage for heart valve replacement using porcine valves?

    Furthermore, the provision of contraception will actually reduce the employer’s cost of providing health insurance, because pregnancy itself is expensive and so is the provision of dependent health insurance coverage. This would raise the cost of health insurance for all employees, Catholic and non-Catholic alike, which would necessitate reducing the salary portion of their compensation, while for the employer it’s all revenue-neutral. This cost increase would cause actual monetary harm to the employees, forcing them to financially support the employer’s religious beliefs regardless of their preference.

    1. kathleen: “The real confusion with this issue seems to be the notion that employers are “giving” their employees health insurance, when in fact, the health insurance is part of compensation paid to employees for their work.”

      It’s even worse. Employer-paid healthcare actually functions as a substantial tax shelter for employers. To the tune of a few hundred billion dollars a year.

      Right now, employees do have a significant benefit because group policies are much more competitively priced; however, the regulation is not meant for now, but to define essential health benefits when the exchanges will go live in 2014, at which point you will presumably be able to get comparatively priced health insurance without having your employer involved. At that point (i.e., when the regulation actually comes into force), religious employers will get a nice tax break and for the privilege of paying less taxes get to have a say in your health plan choice, too.

  10. Mark Kleiman seems to have missed the logic of the compromise, which is that under the compromise employers aren’t paying the cost of covering contraception because there is no net cost. According to the Obama administration:

    “Covering contraception is cost neutral since it saves money by keeping women healthy and preventing spending on other health services. For example, there was no increase in premiums when contraception was added to the Federal Employees Health Benefit System and required of non-religious employers in Hawaii. One study found that covering contraception saved employees $97 per year, per employee.”

  11. “…contraception was …. required of non-religious employers in Hawaii.”
    So they can screw their workers as long as they don’t fertilise them?

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