Let me see if I have this straight:

(1) Barack Obama invents a "right" to free birth control.

(2) The Catholic Church considers that acquiescence in that "right" to be a grave sin.

(3) So the Panderer-in-Chief comes up with a compromise whose mendacity is obvious to anyone who's read the Constitution or taken an economics class that makes that "right" into the default position, Catholic moral objections notwithstanding. QED, Catholic ministries like hospitals, even those that self-insure MUST see to it that their employees are provided with birth control pills at no cost to them.

In other words, we do things my way or we need to keep talking until you realize how wrong you are. Good to see that Episcopal "compromise" has become so mainstream. News flash, Andrew. Some things can't be talked through. Ever.

One more thing. Labelling, Andrew? Name-calling? Please. No one on the left side of this debate has been more villified than the Roman Catholic bishops. Probably because the Catholic bishops don't have the mainstream media, public access channels like MSNBC and much of the Episcopal left doing their name-calling for them.

What, I think, is missing from the list of 11 points is clarity on what constitutes blocking access. If I don't provide the service, am I blocking access?

In particular, what does #6 mean?

6. Recognize that the right of conscience includes a right to decline to participate in the delivery of services, but it does not include a right to attempt to block a patient’s access to those services.

For example: A Catholic hospital could choose not to provide abortions, but that does not give it the right to block a patient's access to those services. The question is, how is it blocking access?

As Andrew says, the conflict in the news is over the mandate to provide employees with contraceptive coverage. Although #6 applies to patients, it extends to employees who are not patients.

But, again, where is the violation of #6? The Catholic institutional employer who refuses to include contraceptives in its employee insurance plan is not blocking employees from buying contraceptives. The goods are not competing.

It may well be that there are Catholic bishops who would like to use the power of the state to prevent access to abortion and contraceptives. But that does not mean that they are blocking access.

There are cases where a woman is in need of an emergency abortion. She already be at a Catholic hospital, or the ambulance is taking her to one because it is nearest, or there is no closer hospital. In these cases denial of service is close to blocking.

In the case of contraceptives I do not come to the same conclusion. Individuals do not have to go through their employer provided health plan to obtain contraceptives, you are not compelled to work for a Catholic institution. It's argued that someone women don't buy contraceptives because the price exceeds what they are willing to sacrifice. But this is not a denial of access, it is a choice. If the government wants these women to have contraceptives the solution is to hand them out. (Although you do wonder if in that case the woman wouldn't see them because they value the cash more than the pills.)

John I can see your points but I am older and I lived through health insurance not covering birth control. I was youngish and made little money. The prescription that I had to purchase was thyroid medication. There definitely were months when birth control medication was outside of my budget.

Also, in an employment environment that we currently have, to say that a person does not have to work for a Catholic owned I institution may be ignoring the job search reality for many people.

Additionally, the fact that a bill has already been introduced to allow employers to disallow coverage of anything if they have a "moral" objection to it seems to indicate that the issue of birth control is merely a opening move in this chess game.

And on a merely emotional level - I don't want women to go back to the second class status that they had even when I started in the workforce - making less (lifting laws) and limited reproductive choice (which was better than when my mother started)

The curious thing about this whole controversy is this: health care actuaries (like my husband) will tell you that it is CHEAPER for an insurance company to cover birth control than it is to pay for birthing babies (and all the potential complications thereof). Any insurance company will gladly hand out contraceptives for free, knowing that doing so saves them more money than it costs. This is why the Obama compromise works, economically speaking. The insurance companies are not complaining about handing out free birth control to employees of Catholic institutions because it actually SAVES THEM MONEY.

Therefore the whole argument of the Catholic bishops is at best uninformed. They are not willing to pay for birth control? Fine and even understandable, given their beliefs. Now here's the kicker - are they planning to accept the cost savings inherent in the fact that 98% of their employees will actually use the free contraceptives? Or will they insist on paying the higher health insurance premiums that should result if birth control were not provided? If this is truly a principled stand, they will insist on paying the higher premiums.

Susan Snook

John, you wrote, "It may well be that there are Catholic bishops who would like to use the power of the state to prevent access to abortion and contraceptives. But that does not mean that they are blocking access."

I'm not sure one follows from the other. What, then, is required in your understanding of "blocking?" There certanily are those bishops who would like to use the power of the state to prevent access to abortion or contraception. In this instance, the expression of that is that they want the right of conscientious objection to apply to any employer who happens to be Roman Catholic, whether the business or institution is associated with the Roman Church or not. That is, they want to be sure any holder of a MacDonalds franchise who happens to be Roman Catholic, would be able to exclude contraceptive medications from the pharmacy provisions of any health insurance plan offered to employees (the likelihood that MacDonalds might or might not allow that doesn't change the fact of the bishops' expressed intent.) Are you suggested that because the bishops haven't succeeded so far that we shouldn't be concerned?

I think there becomes an unresolved confusion in where the rights lie. To assert a right for institutions of the Roman Catholic Church (or of any other faith community, for that matter) is not the same as asserting a right for every member of the Roman Catholic Church in any economic activity.

Marshall Scott

Y'all are making this too complicated.

If you take tax dollars, you provide ALL legal medical procedures and medications to consumers/patients and employees.

Otherwise, go completely private and serve only those who share your beliefs.

If you are the only game in town (or a reasonable distance--20 miles?), you provide ALL legal medical procedures and medications to consumers/patients and employees.

Otherwise you sell to someone who will or find another profession.

See how easy that is?

I'm sick and tired of religious leaders meddling in my healthcare--and the way this conversation is framed grants that violation of my rights legitimacy it doesn't deserve and should never have had in the first place.

Change the frame. Stop allowing the U.S. Conference of Catholic Bishops--or any other religious group or individual--to impose their dogma on people who don't share their beliefs.

I'm with Paige that if you tax dollars, then live by the rules our democratic system has created. That means get out of the hospital business if you can't in good conscience abide by the rules. Period.

As to blocking, I'll concede the bishops are trying to broaden the contraceptives argument to Catholic business owners. I presume of them are not corporate welfare recipients. Is it so clear they can't have conscience objection? I'd have to see details. But even there, how is not buying contraceptives for employees blocking them from obtaining them?

With Catholic institutions making up so much of the field I concede that can impinge on the alternatives available to some in the healthcare field, especially for whom a move would be a sacrifice. But even in the case where you have little choice but to accept a job with a Catholic institution, none of those institutions to my knowledge are dictating reproductive choices as a condition of employment.

An argument that cost is a barrier, a denial of access has to be backed up with more details: is it so much cheaper for employers to buy, is it true insurance companies will be glad to give it for free because it's a savings, why not government provision, won't the cost of the mandate simply be shifted to the employee through a change in the wage?

you are not compelled to work for a Catholic institution

Seriously, JohnC?

To a (non-Catholic) receptionist at "St Joe's Hospital"---in 2012, in THIS economy, w/ THIS unemployment rate---the best you've got to offer her (and her family) is "There's the Exit"?

If the government wants these women to have contraceptives the solution is to hand them out.

Which I'm sure is Just A-OK w/ the Republicans in the House!

I'm for Single-Payer Health Insurance/"Medicare for All" as much as next bleeding-heart liberal Episcopalian. But let's not make the Perfect the enemy of the Good here, OK?

Birth control is not just another discretionary-spending item, to come from one's paycheck. Birth control is health care, and that's why we have health insurance. The important thing is that it BE COVERED, not who pays. Obama's compromise is a perfectly reasonable approach, w/ the health insurance system we have NOW (not the Single-Payer Future Perfect!).

JC Fisher

@ ChristopherJ

Let me see if I have this straight: (1) Barack Obama invents a "right" to free birth control.

No, that would have been one . . . Yahweh!

So God created humankind in his image, in the image of God he created them; male and female he created them. [Gen 1:27]

HTH! :-)

JC Fisher

The thing that I find strange is that in the years I worked as a Chaplain in a Catholic institution (even before it partnered with a for-profit--and even then we functioned according to Catholic ethical and religious directives) the hospital offered birth control through it's health insurance plan to their employees.

It is well documented that several Catholic Universities and at least one large Catholic hospital system does right now. If these institutions can do it on their own and still be abiding by the ethical and religious directives for Catholic healthcare, I don't know what the problem is if the government mandates the exact same practice.

Maybe these institutions provide these because they choose to or because their states mandate the coverage. In either case, they either chose to provide the coverage or chose not to complain about their state's mandate.

Why scream now?

Let's look at this situation from the standpoint of how to balance two competing goods: providing full and free access to quality healthcare that the patient is in charge of versus the need of a religious hospital not to undertake procedures or provide services they find objectionable.

My example comes from real life, the Catholic hospital where I worked. Here is how they handled it.

This hospital did not provide certain services, full disclosure was made and arrangements were made for patients to go to a neighboring facility for the procedure. This was normal practice.

Our hospital covered medications and procedures that our hospital did not--and would not--provide.

In this way the employee's conscience was not penalized if she wanted birth control pills even if the sponsors--the Catholic Church--was opposed to it. The employee and the insurance company worked out where she got her pills, if that was her conscience and her choice.

At the same the hospitals "conscience" was not violated because we were not forced by the state nor the insurer to directly provide medications or procedures the hospital would find objectionable.

In other words, we as both employer and as health care provider pretty much followed what Galston and Rogers write above as a matter of course. Both goods were balanced.

Now, I've been away from the place for ten years so who knows what they do now, but based on both my experience and my reading of Catholic moral theology, I am having a hard time seeing how this policy actually, functionally impinges on any religious hospital's right to do or be anything.

I disagree with John Chilton that the conscience of a Catholic institution is being impinged upon by this mandate.

I do think the Catholic employer who refuses the mandated coverage--who wants a "bye" from the accepted standard of care-- is inappropriatly impinging on the good-faith conscience of another free moral agent, namely the employee.

The objecting employer is also making a false case that any money he spends should only be used for service he approves of.

To me, that is like saying that since public roads are being used by SUV's, and I think Hummers are bad for the environment, I want the gas station to not charge me the portion of my gas tax that pays for the wear and tear caused by SUVs.

What if I told my grocery store to discount the part of my purchases that goes to pay for the stocking, sale and marketing of white bread and cigarettes?

The whole point of insurance, like taxes, is that it creates a pool of money that pays for the care for all the insured.

As David Brooks points out in todays NYTimes, we in the USA use tax breaks to employers to promote public policy in all kinds of ways. That means that if insurance companies want to be in the health insurance business they should do certain things for everyone regardless. In this case, preventative care and, yes, the pill.

Christopher Johnson is wrong that this is somehow a new, oppressive invention. This "right" was not invented out of thin air. Government, insurance companies and the public health system have been using insurance regulation and tax law to promote public health for decades.

The Affordable Health Care Act standardizes what is a now a crazy quilt of mandates across the fifty states. The attempt is make preventative care on a whole host of issues consistently accessible. It's the pill that's getting all the attention. In any case, these issues are not new. Hospitals, insurers and employers have been dealing with these questions on a state by state basis for years.

Back to the question at hand.

The truth is that once we let go of our money either for taxes or insurance (or for that matter buying any good or service) it might be used for something we don't like.

Should I object and demand a refund from my insurance plan that pays for the services of a Christian Science practitioner for an employee of that faith even though I disagree with their theology and medical practice? In many states insurance plans have to pay for that service.

In many states, insurance companies have to pay for the pre-packing of a patients blood if their religion prohibits transfusion from another donor. It's expensive, but they do it. Should I object and demand a discount because I'm not a Jehovah's Witness?

What if I found out that my insurance pool includes people who use in-vitro fertilization or use morphine for palliative care that may also hasten death and what I diapprove of these procedures? Should I insist that I be discounted from paying for these, too?

Where will this logic end?

For one thing, insurance would stop being insurance because you could no longer underwrite groups of people on the off change that some member of the group might object to one part or another of someone else's coverage.

A few points.

1) This is not a new mandate from Obama. As has been pointed out numerous times, the mandate dates from the Bush administration, and Catholic institutions have complied with it under state law in 28 states. What's different now? Politics.

2) The Bishops indeed want every employer, not just Roman Catholic affiliates, to have the right to choose what medical coverage their employee receives.

Really? If you are a Jehovah's witness, you can block transfusions? If you are Muslim, you can forbid your employee to take the money you pay him, and buy a ham sandwich? A fundamentalist can refuse to promote a woman over a man? What about benefits for the legal spouses of previously divorced people (marriages the RC consider sacramentally invalid). Do they get coverage? Should they be able to "opt out"? Why not? If religious belief gets a "bye" from adhering to employment laws....

Of course not. If you choose to participate in the public sphere you have to adhere to public mores.

3) No one is being forced to use contraception; that is a matter of personal conscience. It makes good medical sense to prevent unwanted pregnancies (let alone having medical uses outside of pregnancy prevention). Indeed, one might easily argue that the knowledge of what health care benefit is used by an individual should be under the privacy laws and no business of their employer.

4) Finally, as to "the women can buy it themselves": a claim that is generally spoken by men. First, contraception is expensive. Second, not all formulations are the same or have the same side effects. Some women can't tolerate certain pill formulations, for example-- but may not be able to afford the newer, non-generic drugs that suit them better. So what? say the men. Tough luck. Get a new job for someone with a different religion.

Seriously? That's a solution?