In comments, Sebastian writes:
You’d have to squint pretty hard to get the idea that freedom from state coercion is a general organizing principle of progressivism […]
See for example recent progressive discussions about the state forcing employers to provide birth control access (the original Obama proposal especially). Religious exemptions? Not interested. The need to have employers provide birth control? Obvious, because employer-employee relationships ummm clearly implicate birth control?
Health insurance is not something employers buy as a gift to employees. It’s compensation. It’s part of our pay.
(In comments at Bleeding Heart Libertarians, SavannahRob asks “If similar unfortunate accidents of history had given us employer-funded mortgages, would we be arguing about whether the employer could dictate living arrangements to the employee based on religious sentiments?”)
Sebastian could with equal sense — which is to say, no real sense at all — argue that employers should be able to put restrictions on what we do with our paycheck. Should a Jewish employer be allowed to forbid his employees from using their paychecks to buy pork products? After all, it’s the employer’s money; why shouldn’t the employer be able to control how it’s spent?
But it’s not the employer’s money; it’s our money. And, in the same way, it’s not the employer’s health insurance; it’s our health insurance.
Sebastian’s heart is breaking at the thought of a poor, poor boss being coerced by the government — but the idea of that same boss using compensation to shove his religious beliefs down his employees’ throats doesn’t appear to give him a moment’s pause.
That’s a perfect illustration of the different ways libertarians and progressives view freedom. For a libertarian, the only freedom that counts is freedom from the government. For a progressive, freedom from government isn’t enough freedom; Someone who is “free” to live in poverty under a bridge, or “free” to have their life controlled by their boss, isn’t really free. What we should be working for is the most substantive freedom possible. That includes (or should include) trying to fight the government’s abusive behaviors; but it also includes using the government to secure ordinary people greater freedom from coercive employment practices, and more generally with freedom from economic coercion.
It’s part of your compensation.
Well, no. Health insurance != money. Your employer can only offer you one kind of dollar. But it can (and often does) offer you various kinds of health insurance, covering different kinds of ailments to different levels of coverage and deductibles. You don’t get to define what kinds of health insurance your employer offers you, what kinds of coverages they offer. It’s their choice, not yours. And, in fact, they can choose not to offer it to their employees at all.
And guess what? You can even choose to not buy health insurance at all. Maybe your spouse has insurance and you don’t need to get it yourself. Maybe you have it through a second job, or you buy it privately. Or maybe you just don’t choose to do so. The employer is under no obligation to offer you the cash they would have spent on subsidizing your health insurance.
Here’s where the analogy falls apart completely. The employer is not trying to tell you how to spend your money. The employer is telling you how it’s going to spend it’s money when it subsidizes the choices of health insurance it offers to you. That subsidy is part of your compensation, but the company, not you, gets to choose what it will subsidize. However, if you want to purchase additional coverage – say for contraception expenses – you are entirely free to contact insurers directly to do so and there is nothing your employer can do about it. Or – you can just go out and buy your own contraception out of your own paycheck.
Let’s say it’s customary that you get a meat benefit. Employers in general across the country offer you the chance to buy 50 pounds of meat a week at a discounted rate, with the employer paying the difference to the butcher. Many employers offer you the opportunity to get any kind of meat you want. But Jewish or Muslim employers don’t. They generally don’t offer you the option to buy pork chops or ribs at a discounted rate as part of your compensation. But they cannot stop you from buying your own pork chops. They are not telling you how to spend your money. They’re telling you how they’re going to spend theirs.
“Sebastian could with equal sense — which is to say, no real sense at all — argue that employers should be able to put restrictions on what we do with our paycheck.” Actually, the employer providing insurance at all instead of cash is them putting restrictions on what you do with your compensation. So is paid sick leave and vacation time. You have already conceded the ability to them to structure compensation. You just don’t like the particular way some businesses do so.
Freedom from state coercion is not compatible with progressive definitions of freedom. Progressives explicitly support reducing one person’s freedom in one way to support other people’s freedoms in another way, using state coercion to do so. To justify that trade off, they have to assign some sort of value to the loss and gain. I don’t think there is any objective way to do that. Your discussion of “substantive freedom” is dependent of some sort of subjective value of “substantive”.
Coercion is inherently incompatible with equal rights*. Which is why I support libertarian definitions of freedom.
*=Except for the null version of rights, where no one has any sort of rights at all. If you want to use that as a starting point for a discussion about the illusory nature of rights, go right ahead. But I’m happy to grant you the right not to be killed as long as you grant me the same thing in exchange.
If it was up to progressives, this would be a non-issue, because we’d have single-payer health care and employers would not pay workers with health insurance.
However, since it’s not up to progressives, we have to make the best of the reality we have. Employers do pay workers in health insurance, whether I like it or not; but since we’re stuck with that, we should at least prevent them from using health insurance as a way to force their religious beliefs onto unwilling workers. ETA: The all-or-nothing approach you advocate — “employers are already involved with health insurance, so we should let them use that to force their religion on their employees” — is great for religious fundamentalists who own businesses, but reduces freedom for their employees, who are a far larger group.
It’s true, there is no objective way of deciding the precise best mix of government power protecting us from coercion, and government power becoming too coercive. However, it’s also not objective to decide, as you do, that state coercion is the only important coercion to worry about. That’s just your subjective preference.
It’s simplistic to believe that the best solution is always the most “objective” solution — (ETA:) that is, the solution that requires the least subjective consideration. The kind of objective solutions you favor lack nuance and demonstratively leads to bad results.
I sense that Sebastian (and others) understands the context of this discussion differently than I do. Here’s a brief synopsis of my understanding:
Due to problems with adverse selection, among other things, health insurance has economies of scale — that is, the cost of insuring an entire population is less than the cost of purchasing an individual policy for each member of the population. Thus we confront a market failure in which government can potentially achieve a benefit for a population more efficiently than private actors can.
One means to achieve this benefit is via government-provided insurance. But there are other means to approximate this outcome that might prove to be less disruptive to the status quo. As I understand it, the Affordable Care Act (“ObamaCare”) basically imposes a tax (called a “fee” or “penalty”) on people (or their employers) and provides health insurance – but the law also permits people to opt out by demonstrating that they have secured their own insurance that is at least as good as the government-provided insurance.
What should the government insurance cover? Well, pregnancy and child birth are expensive, so arguably we’ll want to cover that. And if we’re going to cover that, then arguably we’ll want to cover cheaper substitutes as well. Assuming that birth control is a cheap substitute for pregnancy and child birth, we’d want the government policy to cover birth control.
Ergo, private insurers that want to offer a policy that qualifies as a substitute for the government-provided policy would need to also cover birth control.
That said: as far as I know, the Affordable Care Act does not require any private party to provide any insurance as all. Any party has the option to simply pay the tax/fee/whatever and wash their hands of the whole affair.
Different people have different understandings of liberty. For some people, liberty means the right to smoke; for others, liberty means the right to breathe air free from smoke – a right that can be difficult to secure in the absence of laws restricting the behavior of smokers.
Some people think liberty can best be secured by limiting the power of government. Some people think liberty can best be secured through maximizing the choices available to the greatest number. Often this is achieved through “unbundling” – that is, ensuring that a person’s circumstances with respect to Issue A are unconstrained (or are minimally constrained) by their circumstances with respect to Issue B. Thus, we pass laws trying to limit the extent to which a person’s speech subjects them to criminal sanction; or a person’s race limits their access to housing; or a person’s physical disabilities limits their access to employment; or a person’s religion limit their access to a public education; or a person’s gender limits their access to marriage.
Unbundling makes the most sense in monopoly/cartel-type circumstances – that is, where a common policy is enforced on a large portion of the market. Laws impose a common policy, and are therefore a frequent target of unbundling. (“Why must I attend this school simply because I live in this neighborhood?”) But racism can be understood as a common policy enforced on a large population, too, making it an appropriate target of unbundling.
But in competitive markets, we generally don’t worry about unbundling. Don’t like the way Apple compels you to buy their software as a condition of buying their hardware? The remedy is not to buy an Apple product. The law has not forced Apple to unbundle this choice because, up until the present, Apple has represented a pretty small portion of the market. In contrast, antitrust laws did compel Microsoft to unbundle its Explorer Browser from its Windows Operating System. Why? Microsoft Windows occupies a much larger portion of the market.
Amp suggest that it would be wrongful for an employer to seek to control how employees spent their paychecks. And yes, it would be – assuming this were not part of an employment contract. But should there be a prohibition on making this part of an employment contract? That is, is there a public policy need to compel unbundling with respect to this issue? That’s unclear to me.
On conscientious objection:
I share Sebastian’s view that the Administration’s policy on contraception burdens liberty. Indeed, there’s a name for this type of burden on liberty. It’s called taxation.
I don’t begrudge anyone their religious views. I don’t begrudge Catholics saying that they object to paying money that will be used to finance contraceptives. And I don’t begrudge libertarians saying that they object to government, period. Indeed, if I ever encountered a person that had NO qualms about government, I’d suspect I’d encountered someone who wasn’t paying attention.
What do I object to? I object to government discrimination on the basis of religion. I object to government privileging one person’s religion over another. Whatever policy we adopt for the Catholics we should also adopt for the libertarians.
My deepest liberty concerns go to acts of physical coercion and compulsory personal services: War, arrest/detention, drafts/slavery, truancy, compulsory child birth. Duties that can be reduced to simply paying cash – rendering unto Caesar – occupy a lower position in my hierarchy of concerns.
Again, as far as I can tell, ObamaCare does not compel any private party to do anything other than pay money to government. Yes, a private party has the option to buy certain types of insurance in lieu of paying money, but that’s an option, not an obligation.
I find this current furor over birth control easy to understand from a partisan perspective, but hard to understand from a liberty perspective. I understand the Catholic Church, and others, may have doctrinal objections to a variety of things – birth control, capital punishment, war, etc. And I understand that the money I pay to government finances all of these things. Thus, I have difficulty taking Catholics seriously when they argue passionately about the harm of paying for birth control, yet placidly pay their taxes financing war and capital punishment.
Hard-core libertarians argue that no one should have to pay anything to government if he doesn’t feel like it. Wise or not, that’s a consistent view. A contrary, and consistent, view is to conclude that we make many decisions collectively, and the duty to pay for the collective does not depend upon your approval of every aspect of the collective. But people advocating some middle ground – objecting to paying for this one aspect of public policy, but not all the other (more egregious) ones — leave me puzzled.
For what it’s worth, the Framers did not discuss conscientious objection much when working on the First Amendment’s Free Exercise and Anti-Establishment clauses. But they did when discussing the Second Amendment – you know, “A well regulated militia being necessary to the security of a free state, the right of the people to keep and bear arms shall not be infringed.” Oddly, the Framers seemed to imagine that this amendment pertained to well-regulated militias. Consequently they discussed at length whether to adopt the policies found in other states’ constitutions pertaining to conscientious objectors to war. Specifically, these provisions declared that contentious objectors could not be drafted into the military – provided that the objectors recruited a replacement, or paid money sufficient to hire a replacement. While contentious objectors could be freed from providing personal services that offended them, there was never any idea that they could be freed from PAYING for policies that offended them.
(Ultimately the Framers couldn’t agree whether contentious objector status should be a matter of individual right or executive discretion, so the subject was eventually excluded from the amendment.)
Of course, others HAVE objected to paying money to a government that does things they find offensive: famously, Henry David Thoreau refused to pay his taxes due to his opposition to slavery and the Mexican-American War. And he went to jail until the taxes were paid. For better or worse, not even the Obama Administration can deprive contentious objectors of this option.
You have a very… interesting definition of coercion. It seems almost like you’re equating “coercion” with “pressure.” As such the argument really doesn’t work well.
In the context of most discussion of coercion, there’s an implication that EITHER the demand or the consequences is illegal/entirely unrealistic/horrific/etc.
So, for example, “sleep with me or you’re fired” is coercion: the demand meets the criteria. “do the job just like I want you to, or I will personally see to it that you are deported in the morning” is coercion: the consequences meet the criteria.
But “work harder or you’re fired” isn’t coercion. “Work harder” is an objectively acceptable demand, and “you’re fired” is an objectively acceptable consequence. That is true even though the demand may impose incredible pressures on the employee, and even if the employee isn’t able to meet the demand.
How do you distinguish between “coercion” and “not coercion?” I have a feeling you’re using a very different definition.
This isn’t just a semantic argument. “Coercion” is a word that carries only negative implications, unlike, say “incentive” or “disincentive.” Coercion is improper or extreme incentives. When you talk about economic coercion (as opposed to talking about economic incentives) you’re expressing an innate value judgment that the incentives aren’t OK.
Oh, this is the thread I need. Good bye productive life.
Briefly: I think everyone misses the point at least in part.
Employers have EVERY RIGHT to “force” their religious, spiritual, political, economic, cultural, sports team, fanfiction, and other preferences, beliefs, fundamental axioms, or passing whims, on their employees.
Employees have EVERY RIGHT to tell their Christian Scientist, table-rapping, socialist, free-market-fetishiving, Angel-Is-Better-Than-Buffy, Go BRONCOS!!!, Picard/Kirk slash forbidden & Archer/T’Pau slash mandatory-foisting employers to go fuck themselves.
The remedy for someone who’s employer does not cover their birth control preference, or their gall-bladder cancer treatment needs, or their desire to see a psychologist every fifteen minutes for feefee adjustment, or their absolute empirical need to be in psychotherapy to prevent DEATH, is stark and simple and absolute: Quit. Threaten to quit if you don’t get what you want, and then do quit if your ultimatum fails. (It may not.)
In the vast majority of cases, and I mean vast, the benefits to the employer of being tolerant and pluralistic and accepting of all (roughly mainstream) preferences of life are so great that they swamp the much smaller benefits derived from sticking it to those Angel-haters. Bring BOTH DVDs to the company vampire show party. Very, very, very few employers are going to waste priceless human capital (acquired either through painful searching or even more painful training) simply to gratify petty personal prejudices.
When it IS worth sacrificing capital on the altar of preference, then you know that at least the preference really does mean something to the boys upstairs or the ladies in the boardroom or whomever is making the call. “Wow, I guess they REALLY are opposed to birth control – they’ve lost half the IT department and they aren’t changing it back.” Good!
People SHOULD sort and SHOULD associate themselves with others who feel and think in compatible ways. The true Buffyphobes should make their own little enclaves and the diehard Angel-haters should do the same, and the vast majority in the middle can just agree to disagree, or not give a damn. (Heretics.) We have to let the market work, and in this case that means letting people sort themselves out instead of spending the finite and dwindling resources of the state on trying to prevent people from thinking the way they think.
Me, personally? I’m on Team Guy Who Tried To Run Over Bella With A Car. And if you want to work for me, you’ll be on the same team or face my endless mockery. But not firing, or a revocation of any time off used to see a Twilight movie, because I like capital more than I like most of my likes.
They are not. You can buy your own contraception (either directly or through buying private insurance coverage) and there’s nothing the Catholic Church can do. Now, if they were, say, making you piss in a cup and then testing it for contraceptive hormones and then firing you if they caught you using them (as they can for, say, smoking marijuana), then you’d have a point, one that I would agree with. But until that line is crossed then no one is forcing their religious viewpoints on anyone.
You have no right to have your health insurance cover anything you want and then force your employer to pay for part of it. There’s nothing special about birth control that privileges it over actual diseases, never mind discretionary expenditures.
And, as far as individual liberty is concerned, I agree. But what about the rights of the public to efficient public policy?
When the guy who just quit his job then collapses in the street for lack of health care, who picks up the tab? For better or worse, WE DO; those costs get socialized throughout the system. So if there’s a more efficient way to deal this this problem, we’re justified in adopting those more efficient measures. And if I stand up and say, “WAIT! Your provision of efficient government services offends my world view!” I expect people to respond with a chorus of tough titties. I do not have a liberty right to demand that government operate inefficiently.
Again, as far as I know, nobody is requiring any private party to do JACK SHIT other than pay money to government. So feel free to remonstrate about ObamaCare as you would remonstrate against any other use of taxpayer dollars you don’t care for. But that’s the full extent of the liberty concern.
See, this goes right back to definitions of freedom. Sure, you can quit. If you work at the only Catholic hospital in town, you’re perfectly free to try to change career paths in a crappy economy. But the point that a lot of us are making is that you shouldn’t have to, and that it’s wrong for the Church to put you in that situation in the first place. (And only if you’re female. I don’t see any religious people trying to limit men’s basic healthcare.)
Your argument also implies that it’s totally cool to fire people based on race, sexual orientation, or religion. Maybe not *wise* but not something that should be illegal. Is that an accurate assessment of your position?
Well, you’re ignoring the fact that birth control treats “actual diseases,” but okay. There’s still the glaring issue of providing men and women different compensation for the same work. Don’t want to cover contraception? Fine, then don’t cover prescriptions at all. But don’t provide a benefit that women pay the same for but get less benefit from.
“Men’s” birth control isn’t paid for now. (Taking the somewhat risible stance that the Pill is “for” women while condoms are “for” men…when clearly all forms of birth control benefit all partners in a heterosexual coupling.)
But if we accept that stance (which seems fair, at least argumentatively, even though it’s ridiculous, since the ‘they’re-taking-away-my-birth-control’ folks seem very focused that this is WOMEN’S health care in particular, then you’ve got a bad fact environment to make your argument in. Because the status quo ante is that most insurers pay for “women’s” birth control and decline to pay for “men’s”. You’re asking for a legal enshrinement of a female-superior status quo.
But in reality both men and women benefit from birth control regardless of who is taking it, so – while women have more physically on the line in terms of the direct consequences of pregnancy – it is not really accurate to talk about the birth control pill as being for women. My college girlfriend was on the Pill, and I got a lot more out of it than she did.
The drugs that are used for hormonal birth control also have medical benefit against a variety of non-pregnancy-oriented conditions and diseases, but it isn’t “birth control” if it’s being prescribed for those conditions. So I’m not leaving it out; it’s a different question altogether.
Theoretically, yes, I think it would be OK to allow discrimination against races or genders or other protected categories. In practice…no. The harms are so large and the history so egregious that the theoretical right must yield a little bit, and a few types of categorization and sorting must be ruled out of bounds. I think of this exception as being like radiation therapy for cancer. Could you use nuclear medicine to fight acne? Probably you could, but I’m pretty sure it would be a *terrible idea*. It’s for cancer. “No black people need apply”, “women’s resumes go to the special pink HR section in the annex”, etc., those are cancer. They justify the use of the heavy gun.
“the point that a lot of us are making is that you shouldn’t have to, and that it’s wrong for the Church to put you in that situation in the first place.”
You shouldn’t have to pay for your own volitional choices? The Church is making you have PIV sex, the Church is making you not want to have a kid right at the moment, the Church is making you choose one particular form of birth control among several?
When I worked for Microsoft, one of the great benefits of the company was that you could buy software in the company store. Most of it was Microsoft titles, which you got at incredible discounts (like, Word Professional for $20), some of it was other companies’ stuff in areas where MS didn’t have an offering but the employees really needed it, and that stuff was sold at cost.
If Bill Gates had decided that non-relational databases were EVIL and that the company store would no longer stock any products that used non-relational database technology, what rights of the employees would have been violated? From what I can see, none. MS wasn’t forcing anyone to use flat-file database applications before, they aren’t forcing anyone to use them now – they’re simply saying that, due to a belief held by the boss, we’re no longer going to pay for this one category of software. What “position” is Microsoft forcing its employees to take in this scenario?
Now, if you believe that there is a “right to health care” (and oh dear Lord let us please not rehash that argument again) then this analogy will seem stilted – but for those of us who don’t believe in that right (and it certainly isn’t a right we find enshrined in any of our canonical documents or Democracy FAQs) it’s dead on. You want something. Your employer may or may not decide to offer it to you as part of your compensation package. If you really want it, and they don’t care all THAT much, it would be smart of them to provide it – but there doesn’t seem to be any compelling reason to REQUIRE them to do it by state action.
“Again, as far as I know, nobody is requiring any private party to do JACK SHIT other than pay money to government.”
The rules under discussion (which have been implemented to some extent, from what I gather, though it is a rather hopeless muddle) require companies to offer insurance which covers certain specified things but not others. The revised rules following the original flap backed off on making the companies pay for it, and instead made the insurers pay for it, on the theory that indirectly paying for something I find a grievous moral wrong is better than directly paying for it. Either way, we are not talking about “give the government some money and it will buy birth control for everyone” – note that the Medicaid system pays for birth control and is supported in that by both parties.
“But what about the rights of the public to efficient public policy?”
There clearly is no such right. There is a *desire* for efficient public policy, and within the bounds of its framework of enumerated powers the government should certainly toil ceaselessly towards increasing the efficiency of its policy. But the good being sought, of an efficient political economy, is subordinate to the intrinsic rights of the citizenry and the articulated limits on government action. It would be “efficient public policy” if, following every incident of gunplay in a city, every citizen within shooting distance of the shot being fired was paralyzed in place, brain-scanned, and then held in stasis while police investigators conducted their investigation at leisure. (Or in today’s technology, if there were minirecorders on every square foot of the planet and on every person, and all those devices were tapped by the police without any regard for privacy rights).
That efficiency would be monstrous to any number of due-process rights which we afford to the guilty and the innocent alike, and so *no matter how great the efficiency gain would be*, certain actions are, or ought to be, prohibited from governmental exercise. They’re not allowed to administer scopolamine to everyone in a ten-block radius and force them to spill everything they saw. They’re not allowed to indefinitely detain people the cops are pretty sure know something until they choose to talk. And so forth.
Now, as it happens, I agree that there are and were structural ways of increasing government involvement with and control over healthcare, which would not violate any of these fundamental rights. I don’t give a fig for my church’s prohibition of birth control, but if I did, I am not harmed in any impermissible way by my Medicaid tax dollars going to provide OrthoCyclen to the impoverished lady across the street. I have to suck it up, just like she has to suck up her sales tax money going to the cops who she views as oppressive and barbaric but who I view as the thin blue line saving us from the savages.
The method chosen, however, is impermissible in my view. (And I should say that it seemed impermissible, or at least, very ill-advised, in previous iterations where private insurance was mandated to cover certain things, usually diseases with a lobby attached, overriding the decisions of the insurers and the purchasers of insurance alike in favor of the government’s preferred vision.) That method has come into starker relief in the birth control arena because, though the numbers are relatively small, there really are people with profoundly strong religious conscience against certain kinds of birth control. Nobody who accepts modern medicine in general was hetted up over “you must cover diabetes screening” because nobody sees paying for diabetes screening as a big moral issue.
That isn’t the case with birth control.
I think, as a question of fact, there are employers who provide employees with accomodation as part of their compensation and they do get to dictate living arrangements in that case.
Again, as a question of fact, compensation with insurance is very common even in countries with government provided health care. (Though typically doesn’t include birth control, is that a massive oversight and scandal – people don’t generally see it as that in those countries?)
Are they? I can see why you might want to insure people against say cancer, that’s to some degree unpredictable and you’re buying protection against the risk of getting cancer. But how do you insure against realising you want to have sex. You can’t. It’s a classically uninsurable discretionary current expenditure.
So it’s not really insurance you’re buying there, you’re basically obtaining a routine healthcare cost reductions through economies of scale and cross-subsidising birth control users by anyone who wants to buy proper protection-against-risk style insurance. I can’t see why people who just want to stick to buying or providing insurance (which let us not forget a really good thing), shouldn’t be allowed to.
Why focus on the expanding the health, and not the insurance? Why not force employers who provide health insurance to provide life insurance, or home insurance or car insurance. If you’re going to abitrarily expand the package there are things you can throw in there with much more in common with insurance than the provision of birth control.
No, you shouldn’t have to quit your job (and hope to God you can get another one with insurance) because your employer doesn’t want you to have birth control directly through your insurance company.
Hey, I would have no problem with adding “a pack of condoms every month” to the preventative things that insurance needs to cover without a copay. Also, vasectomies generally are covered. Condoms are also much cheaper than hormonal birth control (unless maybe you’re having sex twice a day all month long), and they don’t require a prescription or a doctor’s visit to get, so the condoms to hormonal BC comparison is not exactly apples to apples.
But the point is that women already pay more out of pocket for prescriptions than men, in large part due to birth control. It’s not appropriate for a man and a woman to both pay the same for prescription coverage when they aren’t actually receiving the same coverage.
Also, contraception is a woman’s health issue specifically because 1) women get pregnant and men don’t and 2) being able to control your own fertility is part of health. Condoms don’t allow a woman to control her fertility, any more than the pill allows a man to control his. Yeah, in a perfect world couples will make mutually good decisions, but it doesn’t always work that way.
Sure it is. It’s *her* body. The fact that it benefits her partner is nice for him, but it doesn’t affect him to nearly the same extent it does her, except as much as he chooses for it to. (Whether he’s getting her pickles and ice cream, rubbing her feet, holding her hair while she pukes, driving her to the hospital, and then raising a kid with her for eighteen years, or whether he gives her the finger and leaves the state (and maybe pays child support) is totally up to him.) Having kids screws up women’s career and earning power in ways that it usually doesn’t for men. Socially, the responsibility for the outcome of the pregnancy (and everything about the kid’s life) is placed on her shoulders. Hell, if she miscarries, she may even get arrested for murder.
It’s interrelated, though. If a woman has a condition that’s treated with the Pill, a Catholic employer isn’t necessarily going to cover it just because it’s not birth control ( http://www.rhrealitycheck.org/article/2012/02/10/why-contraception-mandate-matters). A huge part of the need for affordable BC pills is the fact that a lot of women need them even if they’re not (or not just) trying to avoid pregnancy.
Why would you have to quit your job? Birth control is not leukemia treatment; it is generally within the fiscal reach of employed people. The basic high-dose pill is $9 a month at WalMart. There are pricier blends; one nice woman that now hates me on Facebook (same discussion) pays $30 a month for hers. I’ve seen other people saying $20 or $50.
It’s not something that there are plausible scenarios of “I had to quit my job and move back to Birmingham” spinnable from.
You don’t get to define what kinds of health insurance your employer offers you, what kinds of coverages they offer. It’s their choice, not yours. And, in fact, they can choose not to offer it to their employees at all.
This statement seems to me to be the canonical argument in favor of universal health insurance and removing this ridiculous historical accident linking employment and insurance.
Also note that Ron points out-perhaps without even realizing it-that implementation of universal health insurance via a central mechanism would actually increase one’s options. Especially if we went with something along the German model. In Germany you can get the basic public health insurance, AOK, which is something like Kaiser Permanente. Or you can get one of a number of public insurance plans that are specialized in one way or another, usually along the lines of type of employment. Or you can go with private insurance. Far more choices than which crappy lowest bidder private insurer your employer deigns to offer you.
Dianne, it is wonderful to see liberals beginning to come around to the view that everything FDR did, aside from winning World War II, was a terrible mistake. ;)
I could live with certain forms of single payer (as could many people on my side of the aisle). I think the problem is that the kinds of single payer we could tolerate are kinds that people on the other side of the aisle are just not excited about, so there isn’t much political capital hanging low on the tree.
May I humbly suggest that you don’t know what you’re talking about?
Does the Patient Protection and Affordable Oh Screw It ObamaCare “require companies to offer insurance blah blah blah”? NO. The law requires firms with 50+ employees to make a “Shared Responsibility Payment” of up to $3000/yr/employee, and individuals to pay the lesser of 2.5% of adjusted gross income or the cost of a qualifying policy available on the insurance exchange (with various exceptions). In short, it’s a tax. Heck, this part of the law is even codified in the tax code at 26 U.S.C. § 5000A(b)-(c).
Now, again, firms and individuals have the option to provide insurance that meets certain minimum standards in lieu of paying the tax. But that’s merely an option; there is no obligation to do it. I find no mandate to do anything other than pay a tax. I don’t know how many other ways I can say this. I’m depleting this website’s supply of italics.
I’m baffled that you have such a keen grasp of this issue in the context of Medicaid, but not in the context of ObamaCare. It’s the exact same issue.
Oh crap, that’s the last of the italics. Happy now?
The birth control flap involved people grumbling that, in order to avoid paying the shared responsibility payment, they’d have to provide insurance that covered birth control. But the problem provides its own solution: Don’t want to provide that kind of insurance? Then don’t; make the shared responsibility payment instead. But because some people wanted to whip up some kind of contrived ideological problem, Obama offered a contrived ideological remedy to them. I surmise the purpose of the remedy was to force people to admit that birth control was merely a fig leaf designed to conceal a generalized hostility to the law.
Do I object to “indirectly paying for something I find a grievous moral wrong”? Sure. And I discuss that at some length above. But here’s the short version: tough titties; I pay my taxes anyway.
Fortunately, you don’t. I find it rather difficult to believe that the choice between buying birth control pills out of your own paycheck or having their cost covered through your health insurance would force you to quit your job.
Not by the Catholic Church, I bet.
The men are paying the same amount for the prescriptions covered by their health plan as the women are, and they are paying the same rates. Ulcer medication, heart pills, thyroid supplements, insulin, etc. are all paid for at the same rate by the insurance company for both men and women. They get the same coverage at the same rates. What you want to do is to add to the list an additional medication for women while the women get to pay the same amount as men. AND, force the Catholic Church to subsidize it.
A prescription plan does not pay for all of your prescriptions no matter what they are. It pays for certain drugs only, and may well even limit you to specific forms of a given drug (the most common example of the latter is requiring you to buy generic drugs if they are available). So the assertion that women spend more money on prescriptions overall, if true, is moot. They both pay the same amount for what’s covered. Insurance companies are under no obligation to cover whatever prescriptions you get for any reason you want, or to even out overall medical expenditures among different kinds of groups.
You’re being obtuse, Nobody. Fine, there are “options” other than providing the insurance in the form that the government wants it. Hey, there are “options” to paying your taxes! I hear some of the federal prisons back east are still very nice.
But in common sense terms, “do it our way, or pay us a bunch of money; doing it the way you were perfectly happy doing it before is no longer allowed, so if you continue to do it that way you’ll have to pay a bunch of money in addition to the cost of doing it the old way” is pretty darn mandatey when the guy meaningfully smacking the truncheon into his meaty palm is Uncle Sam.
Yes, it’s mandatey — in precisely the same way that any other TAX is mandatey. And it impinges on liberty — in precisely the same way that any TAX impinges on liberty. But not in any other sense.
Ultimately it’s just a tax. People whining about the Act are simply whining about paying taxes. And they deserve the same consideration as anyone else who doesn’t like paying taxes. But no more consideration.
How is birth control a medication for women? Last I checked, it’s pretty much completely unnecessary as birth control – unless men are involved, too. Or was there some biological breakthrough I missed?
Birth control is not a medication for women. It’s a medication for society, administered by women. What does society get by subsidizing birth control? Among other things, it gets to avoid the cost of (many) unwanted pregnancies and births. (Or perhaps you’re arguing that pregnancy and childbirth should not be covered by insurance either?) Unless you can demonstrate that the aggregate cost of subsidizing birth control is more than the aggregate cost of the additional pregnancies and births that would result in the absence of the subsidized birth control, I’m skeptical that any “subsidy” is occurring at all.
You could say that I pay taxes for firefighters. Or you could say I pay taxes for a social goal of suppressing fires – a goal that is administered by firefighters. Either way, I think it’s poor public policy to expect firefighters to bear the cost of their services all by themselves.
Right – insurance companies pay for the least expensive alternative. So, which is least expensive: pregnancy and child birth, or birth control?
Perhaps true of insurance companies in general. But the context of this discussion is ObamaCare – and specifically, what minimum coverage should we want a firm to provide in lieu of making a “Shared Responsibility Payment”? Thus, it is unclear to me that we need to – or would want to – emulate the practices of private insurers. After all, part of the rationale for ObamaCare is the fact that private insurers behave in ways that are optimal for their firms but suboptimal for society.
Instead, we need to consider what policies should guide our choices of what to include in the insurance package. I have proposed one such policy: If we cover something, let’s also cover cheaper substitutes for that something. Here’s another proposal: let’s defray as many risks as we can cost-effectively, provided that doing so creates few moral hazards. If black people in the US are predisposed to hypertension, let’s socialize the costs of hypertension. Why not? Yes, this may represent a subsidy to black people – but honestly, I don’t think it will alter many people’s choice to be black. Similarly, if women bear disproportionate costs, why not socialize those incremental costs? I doubt it will provoke a flood of people getting gender-reassignment surgeries.
I’m sure that’s difficult for you to believe, being someone who can’t get pregnant. But if you’re working a low-paying job for a Catholic school or hospital, say, food service, and your birth control costs more than you spend on groceries in a month, it’s a problem. It’s also a problem if you have health issues that make sterilization a really good idea, but your insurance won’t cover that, so you get to pay out of pocket for hormonal birth control until menopause.
It’s BS to whine about being “forced” to cover contraception (when you wouldn’t have to cover it, you could just pay the tax), but not give a fig about people who are “forced” to go without medical care (who, also, could pay it out of pocket, maybe, if they have the cash).
Okay, first of all, *male* health issues are covered, while a large swath of female ones are not. Need Viagra? It’s covered. Prostate health? Covered. Need pills so you don’t bleed 10 days out of a month and pass out from blood loss? Well, you’ll have to give personal embarrassing health info to your HR person, and we’ll think about covering it. Doctor said you’ll die if you get pregnant again? Well, sucks to be you.
Also, not providing contraception coverage is actually more expensive than just covering it. Pregnancies are expensive, particularly if there are complications. So the Church isn’t subsidizing anything; they’re arguing that they should get to pay more so that their female employees can have less coverage, while still counting that coverage as “good enough” to avoid the tax.
A huge part of the reason why birth control should be covered without copay is that it’s cheaper for the insurance company to do it that way. If anything, the Catholic church’s employees would be subsidizing the Church’s decision not to offer birth control, as the cost to insure that population would be higher.
Yes, it is, generally. But if you’re living paycheck to paycheck, even that $9 might end up being out of reach some months. It’s also worth pointing out that not all BC pills are the same. When I was on the pill, I went through about six different types trying to find one that would a) actually regulate my cycle and b) not produce awful side effects. In college, I think I spent 30-50 a month on birth control (in 2000-2003 dollars, whatever that translates to in 2011).
It’s also worth pointing out that hormonal BC is not appropriate for every woman. A woman with high blood pressure who shouldn’t get pregnant might need a copper IUD instead. And those are anything but cheap. And yet, still cheaper to the insurance company than pregnancy, particularly a high-risk pregnancy.
So, when an employee of a Catholic hospital who shouldn’t get pregnant gets to choose between screwing up her blood pressure more and taking a 1 in 4 chance of getting pregnant (the failure rate of natural family planning), and yet she’s paying for health insurance, yeah, this is a problem.
OK, let’s pass the Robert Hayes Owns Everyone Sexually Act of 2012. Effective now, Robert Hayes has ownership in a sexual sense of every American citizen over the age of consent. Now, you can avoid becoming my bruised, battered, but bedazzled love slave simply by paying a $1,000,000 tax to the Treasury (which grants you a 24-hour window in which to escape, convince me of your horrible STD status, or otherwise sidestep my attentions).
So this is just a tax, and anybody who whines about not WANTING to be my love slave or that they don’t have a million dollars, deserves the same level of consideration as anyone else bitching about their taxes. I’m not taking away anyone’s rights of conscience or bodily autonomy – it’s just a tax. Right?
What policy are you talking about, that covers Viagra and male sexual health, but not female sexual health? Or are you just pulling a policy out of thin air which rhetorically-conveniently sounds terribly iniquitous?
I think that the remedy for someone with expensive or unusual reproductive health needs, whether they are male or female, is to avoid employment with the handful of places in this country that are going to be problematic about paying for it. I would not expect Focus on the Family to offer me a compensation package that covers Viagra, abortions for my girlfriends, and sexual augmentation surgery to give me a robo-penis so that I can fulfill my duties under the RHOESA.
Also, you’re again conflating things. The employee of the Catholic Hospital ISN’T paying for her health insurance (that won’t give her a copper IUD or the expensive low-dose birth control formulation or whatever, that she needs). Her employer is paying for it. You won’t get any argument from me over that system being broken, and it being irrational for her employer to be the one picking up the tab. Get your representatives in the political system to draw up an honest public-funded plan that respects individual rights, and you’ll find me in agreement that the plan needs to cover all reasonably mainstream medical procedures and treatments. But instead they drew up a do-what-we-say-private-actors plan, and such a plan runs up against the rights of conscience of the actors in question. If my weird religious group thinks that elbows must never be tampered with because they’re God’s favorite organ, then people with tennis elbow shouldn’t come work for us, because we aren’t paying for their surgery.
Oh please — I won’t dignify this absurdity with a response. Who wouldn’t want to be Robert’s love slave? You’re going to have to do better than that.
Who wouldn’t want to be Robert’s love slave?
Lesbians. The asexual. Straight men. Straight women with strong dispositions against blondes, conservative/libertarians, or the incredibly handsome. People who wish to be monogamous with someone else. People who find coerced sex inherently unappealing regardless of attraction. (Hell, I think I’m awesome and would totally do me, but if I’m told that I have to do me, screw that. Fight the power!) Anyone who doesn’t like it rough. (TMI, sorry.)
So, lots of people. I think you should answer my question. Either this is “just a tax” or it’s an infringement on people’s rights with a bogus “tax” argument attached to it in a transparent attempt to get around rights questions. Which do you think?
Seriously? Very well.
No, the hypothetical Robert describes is not just a tax. As described, paying money would not relieve people of the threat of Robert’s predations; there’s also a variety of other steps required.
Yes, taxation imposes burdens, and the burdens are arguably in proportion to the magnitude of the tax and the payer’s ability to pay.
That said, taxes – and the ObamaCare “Shared Responsibility Payment” in particular — are not the only burdens people bear. People bear the burden of securing potable water. Note that government did not create this burden, but government may be able to help reduce it. Thus, some people spend hours every day walking to rivers with jugs on their heads, and even more hours walking back, to acquire a supply of water of doubtful quality. Other people simply turn on their taps – and then pay the pittance charged by their local government. Guess which group the libertarians believe are oppressed?
Similarly, people bear the burden of securing health care. Again, government does not create that burden, but government may be able to make that burden lighter. Thus, in some places people may faint and no one would take the initiative to extend care. In other places people may be surrounded by people who have a commercial interest in extending care because a system of taxation is created to compensate them for taking initiative to extend care. Again, you can guess which group the libertarians regard as oppressed.
Does ObamaCare represent a burden on liberty? Relative to what?
Relative to the libertarian fantasy world in which all manner of public services are presumed to be provided by magic pixies? Yes.
Relative to the status quo? Don’t know. To make such a case, you’d need to demonstrate that the status quo is both sustainable, prone to distribute costs more efficiently than ObamaCare will, and prone to fewer impingement on freedom. Note that under the status quo, 1) much of the cost of pregnancy/child birth is already socialized through health insurance, 2) contraceptives are arguably a cheaper substitute to pregnancy/child birth, and 3) the practice of socializing the cost of birth control has been long established via Medicaid.
Thus, I struggle to understand what new grounds people have for umbrage. Perhaps all this umbrage is sincere – that the socialization of birth control is some monumentally greater affront to liberty than, say, black prisons, torture memos, Guantanamo Bay, capital punishment, etc. Or perhaps some people are simply pre-umbraged for my convenience, and happy to find any excuse to give vent to it. I guess we’ll each have to review the evidence and draw our own conclusions.
“See, this goes right back to definitions of freedom. Sure, you can quit. If you work at the only Catholic hospital in town, you’re perfectly free to try to change career paths in a crappy economy. But the point that a lot of us are making is that you shouldn’t have to, and that it’s wrong for the Church to put you in that situation in the first place.”
Hmmmm, yet so far as I can tell the only reason to force the Catholic Church to provide health care with contraception which is against their religion is because “they employ people”. Allegedly that is an excellent argument. It seems strangely similar, especially since the Government doesn’t have to put employers in that situation in the first place.
Amp, I’m not sure if you only wanted to focus on the birth control issue, but the thrust of my comment was that it is pretty ridiculous to act as if progressives have some sort of general anti-coercion organizing principle.
As I said in that same comment:
Progressives and Libertarians are pretty much orthogonal to each other on state power. Progressives want to use it, a lot, for good things. Yay, good things! They don’t want it to be used for bad things. Boo, bad things. Libertarians tend to believe that government power often gets used for bad things, sometimes REALLY bad things. They tend to believe that corporations gain more power than they ever could possibly get without government by co-opting government.
I tend to believe that government can do some good things, but I see a lot of force to the libertarian critique that empowering governments is like gambling, and the historical odds of it not being used in really atrocious ways seem low.
Progressives seem extremely willing to take that gamble. Casting “freedom from government coercion” as an organizing principle doesn’t seem accurate to me.
Are you agreeing with that in general, but disagreeing in the particular case I offered? Or are you making the (I’d say much more challenging) case that progressives really have some sort of general anti-coercion thing as a basic organizing principle in the same way (or even more) than libertarians?
For what it’s worth, since the argument “oh, birth control is cheap, why are you making such a big deal about getting it covered?” always comes up, my birth control costs me $76 out of pocket per month. It is the Nuvaring so there’s not a generic version yet, so this is more than average, but it’s not unusual. In my current financial situation, I’ve decided it’s worth it compared to the various pills I’ve tried that are cheaper but always caused me unpredictable bleeding. However, if I were still on a student budget, this would be a tougher choice and I would be even more eager for my insurance to fully cover birth control without a copay.
@ Jessica – I just got a refill on mine and glanced at the receipt- it’s $10 a month with insurance and would be $135 a month without. That’s not cheap, and it’s the only formulation out there that doesn’t make me sick (i.e. constant nausea and occasional vomiting along with some other things that I won’t get into here). Interesting that in different markets, it has a different base cost for us.
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