Saturday, February 11, 2012
Confused policy on contraceptives
The current political debate on whether Government health insurance should cover purchase of contraceptives by employees of Catholic institutions is a confused mess. Relying on first principles provides the answer. The purpose of insurance is to cover the risks of intentional, deliberate acts, not the acts themselves. We buy car insurance to cover the risks of accident, not to reimburse us for buying the car. Medical insurance generally covers the costs of pregnancy due to the risk of contraceptive failure, but there's no reason for it to cover the cost of buying the contraceptives themselves. Why should other people pay for one family's contraceptives?
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Let’s see if I have this straight. The compromise is that the Church does not have to cover contraceptive and abortion-related services for its employees but that the insurance companies have to offer the services to all comers at no extra cost. Does this not mean that the Church is, in fact, paying for them. Am I missing something?
Yes. You and I and others will pay for it including of course the Catholic church. If the services were cost effective the coverage would not have had to be mandated.
Wouldn't all the insurance company's policy holders pay, not just the Catholic policy holders? But the Church might therefore have to increase wages.
No. I thought that the company would raise the premium on the Church’s policy to handle the costs even though the services were not covered unless explicitly requested by employees.
It seems to me that the issue is that in the name of "efficiency" in the health care system, the government is mandating insurance coverage. That's what Obamacare is about. But in the actual implementation of Obamacare, it becomes necessary to specify in detail what people must do. By it's nature, mandating what people must do is intrusive and it generates hostile reaction from those who aren't inclined to do what the mandate requires. It is unfortunate that this has come up only in the context of contraception and the Catholic church because the issue should generate much broader reaction. There must be lots of other groups that will find themselves subjected to mandates of different kinds. If they don't see that the conflict between the church and the state has broader implications, that is, if the church is mollified and the issue blows over, it will constitute a major step down the road to government control of everyday activity and we will be the worse for it.
I can see the logic of requiring people to be insured against catastrophic occurrences, but health insurance covering toothpaste (which my policy covers, if the toothpaste is obtained by prescription) seems about as clever as requiring automobile insurance to pay for tire inflation.
Why does the government require that all insurance policies provide free contraceptives? No one prevents individuals, including employees of Catholic University, from buying contraceptives. Nothing that I know of denies insurance companies the ability to cover contraceptives. This whole controversy has to do with mandated coverage in general, and the Catholic church's objection to being forced to act against church doctrine simply points out how onerous the mandate will turn out to be.
An important point against the contraception and like mandates (that I have not heard others make) is that they freeze in place a government-prescribed package of benefits that may correspond with current health care patterns and social preferences but will soon be out of date, increasingly inefficient, and virtually impossible to change as interest groups coalesce around the status quo. And where's the fairness? Why should gals get the stuff free and not guys?
All, the debate is more confused than that, and is not limited to contraception. Employees of certain Catholic affiliated institutions are being given special attention because the institutions concerns are being voiced in an organized way. But what about individual Catholics and others who (1)work for secular institutions and receive health insurance as part of their pay, with the money pay reduced to compensate for the insurance, and (2)have moral and/or religious objections to contraception or abortion. Aren't they subsidizing the insurance, too. If they do not get a pass just like the employees of Catholic Hospitals, doesn't this amount to a federal subsidy of religion in possible contravention of the 1st Amendment? Do you have to belong to an organized religion to have your scruples matter to the government? Do Christian Scientists, Seventh Day Adventists and others have a dog in the fight?
By chance I watched one of the "discussion" programs this morning and heard E. J. Dionne, Peggy Noonan, and a couple of others discussing the church/contraception/mandate issue. It became clear that the President would like to make the issue one of contraceptives while the Republicans want to make it about religious freedom. It seems to me that the point is neither religion nor contraceptives but freedom itself. No one seemed to recognize that the main issue is the mandate. The original battle-ground of the health care bill was the mandate and this is simply a manifestation of what it means for the government to tell you what you have to do. The Constitution generally focusses on what government cannot do. It would be hard to extend the "don't do" to cover "must do." If the administration gets away with it by letting the church off the hook, the country will be in for a long painful time.
So here's what a friend of mine who's sort of in the political center had to say. He favors subsidization of contraceptives because they are intended to prevent unwanted births, and the more of those that occur, the more he and others likely will have to pay to support them. He doesn't deny the freedom issue, just feels that on practical grounds it's a good idea to provide contraceptives as widely as possible, and he's OK with the state requiring them within insurance schemes. It seems to me that in a comprehensive welfare state, these kinds of arguments can be made for a very large number of government interventions, they're justified because the alternative is taxpayers paying out even more. (The Road to Serfdom," by Hayek.)
To the political friend, I'd say this:
There used to be a time when mothers told their daughters, one way or another, "you lay, you pay"—a simple message of individual responsibility, after all. Hopefully, they told their sons the same thing. Sure, it didn't always work, but there was a greater purpose there.
The Obama policy turns this around: "I gotta lay, and you gotta pay!" The implicit assumption is that women are not able or willing to pay for their own contraception or otherwise control their sexual behavior. So much for the liberal vision of women, and we discern here a level of hypocrisy so deep it would be laughable if it weren't so often repeated as a central political mantra. Thus, women are encouraged to become wards of the State, rather than independent human beings. Yes, there's a road to somewhere there. I'd think it's in the name of raw majoritarianism, pure and simple. Power is so seductive to people who are deeply convinced of their own moral superiority.
Judging from other things this particular friend has said to me, I'd say his working political principle is a common one; he's for more benefits for himself, at minimum cost to himself. He admits he could be wrong on the calculus of the contraception issue, but thinks it likely that over the longer term it will save him money, so go for it. No more complicated than that. And to his credit, he openly admits that that's the way he thinks about politics, believing that just about everybody else does too.
And that is a key aspect of what the Constitution is about, protecting us from the majoritarian logic of I want to use the system to get the most for me I can at the least expense to me. The logic still pertains, but we have put more constraints on its exercise than most other polities.
I was actually embarrassed for Jack Lew on Fox news this morning; he's the new White House chief of staff and former OMB director. He was dead wrong about the cost-effectiveness of requiring female contraceptive insurance, said it's costless! If that were the case insurance companies would have been providing it on their own.
There are tons of reasons both economic and constitutional for opposing mandates. But unfortunately many voters don't mind government paternalism and I'm afraid the majority of voters do not understand insurance.
Well, it seems we are in for a lot of embarassment. Time and again, I read that the proposed new CAFE requirements are going to save far more in gas money than the incremental cost to vehicles. I also read that DOE's appliance efficiency standards are cost effective. I haven't looked, but I'll bet the same is argued for green building standards. The not-so-subtle undertone in all of these is that companies need to be helped to make the right choices, consumers will benefit and we will all be better off. The only question in my mind is whether those who proclaim these fine things actually believe what they are saying.
CAFE standards are not cost-effective nor, obviously, are green energy standards. This administration has found ways to tote up costs as if they are benefits, e.g. so-called job creation. If there are negative externalities in consuming fossil fuels they are best addressed by Pigovian taxes. It doesn't matter much if those who proclaim falsehoods believe them, but it is embarrassing to watch.
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