Tuesday, February 07, 2012

Irony, Public Health Policy, and Contraceptives

In a sarcastic way, I find it amusing to consider the recent debate about providing free contraceptives as part of health insurance, and combine that with the issue back from 2010, whether there should be a public option.  Were there such an option and if each employee or student covered by an institution provided health care plan might select the public option instead, then the current debate would be a non-issue.  Church sanctioned institutions would be allowed to provide insurance that didn't included coverage for contraceptives, because individuals would have a reasonable alternative that did include such coverage.  In the current circumstance there is no alternative.

The NewsHour had what I thought was a balanced segment on the issue last night.   Among the points made is that most Catholic women will use contraception sometime during their lifetimes.   A second point is that for low income Catholic women, the example was a Masters student at Catholic University who did not have a full time job, the out of pocket expense for contraceptives would impose a hardship.

Nobody is taking on the public health issue directly where the evidence seems overwhelming and in support of the regulation.  Children born out of wedlock are less healthy and get worse care.  More ubiquitous contraception would provide a partial remedy to this situation.

While it is easy to understand the Catholic Church's position on this matter, it is clear that the Catholic Church is not concerned with protecting a woman's right to choose.  So they can argue that the matter isn't about that at all, but rather about their right to adhere to the practices they teach.

What is more disturbing is how thoughtful Conservative pundits have reacted to this issue.  David Brooks had a column today that is totally over the top.  Judging by the few comments of readers that I read, they felt the same way.  His argument is essentially that the charitable organizations provide essential services to the poor.  These good works need to continue.  The government regulation will cause them to cease, so they should be exempted from the the regulation.  He also argues that there needs to be a medley of different approaches to this service provision, because the cycle of poverty is a complex beast.

These arguments are nonsense.  If the cost of health insurance went up for reasons entirely unrelated to contraceptives - the population got less healthy or certain treatments became more expensive, that might impose some hardship on the charitable organizations who'd have to pay higher health insurance premiums for employees, but they wouldn't shut down.  Quite the contrary, they'd intensify their efforts at seeking donations.  So on the business case for this argument, there really isn't one.  There is then the ethical tradeoff that must be made - indirectly support contraception through the health care plans for employees or cease doing the good works.  Brooks argues that if faced with that tradeoff many institutions would opt for the latter.  Sounds fishy to me.  It certainly sounds like a weak commitment to the good works, and yet we're told   And on the medley of offerings argument - it sure would be a lot more convincing if there were decent public schools in the community.  As it is now the charitable organizations seem to be something of an excuse for not providing decent public schools.   So I'd argue for less of a medley until that situation gets remedied.

Michael Gerson makes much the same argument as David Brooks, though he couches it in political terms.  All of this is about the election next November, according to Gerson.  Saying that, with one stroke Gerson frees himself from talking about the public health issue or about a woman's right to choose.

This is one issue I'd like to see go to the Supreme Court soon.  At present, six of the Justices are Catholic.  If they all recused themselves on the matter, there wouldn't be a quorum.   How's that for irony?

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