Contraception mandate and liberalism (a.k.a Beating a dead horse) (updated 19/3/2012, 8:40am GMT+8)

Kevin Vallier over at Bleeding Heart Libertarians argues that liberals must oppose the contraception mandate.

In order to determine whether a law or policy is illiberal, we must describe the various forms of coercion it involves. For the mandate, this is easy: the Obama administration will force religious organizations to use their financial resources to support a practice they find sinful. (Under the new policy, they will coerce health insurance companies associated with religious organizations to do the same.) No other coercion is involved.

Defenders of the mandate insist that a woman’s reproductive liberty is significantly restricted if her employer refuses to pay for contraception. This is false. To see why, abstract. Is A’s liberty to X restricted if A’s boss refuses to pay for X? Especially when X is cheap and readily available? And when A can choose another employer? And when A’s government could provide X directly without using force against a voluntary association? No, no, no, and no.

I can see no way to generalize the moral relationship between women who wish to use contraception and their Roman Catholic employers into a plausible moral principle that demonstrates that the RCC is coercively blocking their employees from acquiring and using contraception.

(Emphasis added)

I am inclined to agree even though I wouldn’t state it exactly the same way. Note especially the last part of the second paragraph. Given that there are other ways to ensure that everyone had some minimum of health insurance, the insurance mandate is odious because such things could be provided without coercion. Is there a rationale with going with the mandate rather than with an alternative which would do the same thing without such coercion?

To find out, we need to explore the alternative. In my alternative, there will be a public option that covers whatever employers fail to cover. People will purchase the public option as and add-on to their normal employer-provided insurance. Presumably, we could also build in an exception such that people need not purchase what they conscientiously object to. So, this way, people who object to using contraception need not buy any and those who don’t object are covered regardless of whether their employers happen to be catholic.

What are the problems with this option? It is possibly more inefficient, might exacerbate some adverse selection problems etc. Is that a sufficient reason? If people are in grinding poverty and the marginal inefficiency is going to make them even worse off, then yes, the relative inefficiency could be sufficient reason for this kind of coercion. Whether it all things considered is depends on, to a certain extent, how much the Catholic institutions involved are being coerced. (There is a difference between threatening you with a $100 fine and the death penalty)

There is of course the meta-issue about whether it is within the bounds of acceptable discourse to say that liberals must oppose something that most actual liberals fail to oppose. I of course do think so. Political philosophers do this all the time. There are many philosophers who do ask and attempt to answer the question of what should liberals/libertarians/egalitarians want?So, here’s a question for the league: Is there anything problematic about saying that liberals should endorse something that most real life liberals don’t actually endorse?

[Update: 19/3/2012, 8:40am GMT+8]

Nob Akimoto gives us an idea of what the mandate really requires.

1. “Large” employers (more than 50 full time employees) are asked to provide health insurance to their employees under ACA’s employer mandate.

2. Employers who do not provide health insurance, have over 50 full time employees, and those employees make up to 200% of federal poverty limit are assessed a fee roughly equal to the premium support employees get on the health care exchange.

3. In effect this works as a tax. Baseline is that employers are taxed if they don’t provide health insurance. (the assessment) Small employers (less than 50 full time employees), employers who provide health insurance or employers who have employee compensation levels that keep them from getting a premium support in the exchanges are exempt.

4. The mandate on contraceptive coverage was originally intended to quantify what health insurance would be considered adequate to meet this employer mandate. This has since been changed that all health insurance plans sold in the United States (and thus eligible for participation in the Exchanges) must cover contraception if requested by the covered party.

Presumably, the tax goes to defraying the cost of insurance purchased on the exchange. If I’m reading this right, the employee will only have to pay for insurance that is more expensive than the fee. i.e. the fee actually is a kind of voucher which subsidises to a certain level, the insurance the employee wants to buy. This of course doesn’t make the PPACA unproblematic. I can still foresee some unintended consequences that follow from this system. It is also somewhat irksome on general grounds to be forced to provide a particular kind of benefit or not at all. It does however diffuse the religious freedom objection. This is because presumably, the catholic church does not object to people using their own money to buy whatever insurance they want. Also, the RCC linked organisations need not cover contraception if the employee doesn’t want them covered. And if the employee wants one covered the RCC need not subscribe to the insurance directly, but can leave it to the employee’s discretion.

If on the other hand, the employee has to pay the full cost of the insurance purchased on the exchange, then while it may qualify as a tax on a technicality, it looks an awful lot like a fine. i.e.  employers are punished for failing to provide a particular kind of benefit in a particular way. i.e. it really is a mandate. But from what Nob says, that doesn’t look to be the case.

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317 thoughts on “Contraception mandate and liberalism (a.k.a Beating a dead horse) (updated 19/3/2012, 8:40am GMT+8)

  1. Murali-

    Good post, butyou ignore the corner that many conservatives have attempted to paint this issue in to, namely with their preemptive response to the very alternative you propose. As evidenced by the “Fluke wants government-subsidized condoms” meme that floated around the airwaves and the “Fluke wants the goverment to pay for her pill” argument pressed by some here*, your proposal is unlikely to garner the neccessary support to come to pass. The lack of a viable alternative proposed by the biggest opponents of the mandate indicates they either don’t think access to contraception is an issue or, if they do, they aren’t too interested in solving it. And while there might be legitimate merit in either or both of those positions, I haven’t them particularly well-articulated.

    * While I personally don’t find either position a particularly honest assessment of the situation, the folks here generally put forth a more cogent, accurate response than talk radio. Unfortunately, the reach and influence of the latter is much great in shaping the discourse.

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  2. It’s like the whole fight about public option during the battle for PPACA never happened at all. Yup, that was all a smokescreen by liberals because what we really want is to force regulation down the Church’s throat.

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    • As someone who actually hated on the public option while the bill was being discussed, the reason I preferred the mandate then was because I didnt foresee that religious liberty could be implicated. (although to be fair, I would have preferred mandatory HSAs to mandatory insurance)

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      • I like HSA’s myself. I think that program needs expanded.
        I feel that expanding that program is what the R’s should have been doing rather than holding hearings for religious leaders to voice objection.

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        • Conceptually, HSA are great.

          As implemented, they suck.

          I’d be on board with HSA being the bedrock cornerstone of health coverage in the U.S. if we made them more like conceptually awesome and less like the mind-numbingly brainkilling red tape hideousity they are.

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          • I have never worked anywhere with HSA rollover.

            This means at the beginning of the year, I have to have some reasonable estimate of my uncovered expenses in the upcoming year in order to come within any sort of non-prohibitive delta from my actual costs, at the end of the year.  I’m also not allowed to cover health-related expense that don’t take place in this particular year, which is an absurdity: first aid kits are not allowable expenses, for example.  I can’t buy a bottle of aspirin unless I have a heart condition that requires me to take a daily aspirin; virtually no OTC drugs or equipment (bandages, etc.) are covered.

            If you have routine medically-related expenses that are significant, like insulin supplies, and you have no children, then these can work well for you.

            If your medical expenses are bursty (like most people), you can’t put enough money in your account to cover what you’ll actually need without taking a huge risk that at the end of the year the money vanishes in a puff of smoke, and you can’t even spend your end-of-the-year surplus on medical foresight options.

            I’m not a marginal income person, I don’t live from paycheck to paycheck.  However, I know lots of people who are, and HSA are basically useless for them not only for all of the above reasons, but because they can’t afford to pay out the $150 for the copay, drugs, and treatment costs of a doctor’s visit and then wait three weeks to get their actual payback, either.

            Allow rollover, some reasonable OTC amount, and give people a frickin’ payment card, HSA would be a hunner’d-twenny times more awesome than they are now, and they’d be easier to administer.

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            • HSA’s roll over.(*)

              FSA’s don’t.

              I admit that there is some confusion between the two, and that the former is definitely preferable to the latter.  Indeed, maybe it’s something the government <i>should</i> do, given that it’s an entity without a profit motive (so there’s no incentive to cut costs by denying coverage) and it avoids the complication of tying a rolling account fund to a term of employment.

              (*) yes, I know.  But “HSAs” looks like an acronym, rather than a pluralization of “HSA”.

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              • I’m pretty sure all rules for FSA’s are laws made by the federal government, NOT policies made by insurance companies.  The health reform bill actually took out a lot of things that you could previously use your FSA for.  As frustrating as it was to see the things I could no longer buy, it sort of made sense.  Clearasil?  Even things like band-aids, which you could reasonably make a case the government has an interesting in subsidizing (and let’s not kid ourselves and pretend that the tax break offered through the FSA for such things is anything other than their subsidization)… if you are going to subsidize them, do so for everyone.  It didn’t seem right that I, a gainfully employed person in a two-income household, paid less for band-aids than folks with less money but no access to an FSA.

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                • I would agree on the Clearisil if FSA’s had rollover. Without the rollover, giving people some way to spend their money strikes me as a good idea. Maybe limit Clearisil purchases to November and December or something :).

                  More seriously, my understanding is that they cut out OTC entirely, meaning things like Sudafed for Naproxen and the like are no longer covered. That sucks.

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                  • A few OTC things still qualify, like contact lens solution.

                    Personally, I don’t understand why they don’t just let you have the money back.  Not doing so seems unnecessarily punitive and ultimately discouraging.  I realize there would be some complications because the money would need to be taxed after the fact, but maybe just tax everyone at whatever the top tax rate is on the remaining money or charge an administrative fee to recoup the costs of figuring out who is owed what.

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            • I was on an HSA briefly but never went to the doctor in that time.  But I have a unique benefits package from my employer that made it worthwhile.

              Basically what they do is calculate the cost of covering the employee only in the most basic HMO plan they offer.  Last year, that was $5400.  As an employee, I can A) put the full $5400 towards paying insurance (which will cover me in my entirety but I have to make up the difference if I want to cover wife/kids), B) opt for the HSA which is LESS than $5400 a month and put the difference into my HSA, or C) take the money as taxed income, presuming I can demonstrate coverage elsewhere.  We did have roll-over with the HSAs which meant that once we hit the point where we would be able to cover all of our expenses (capped at $2500 per person per year, I believe), we could then take the difference between the $5400 and the premium as extra income.  Theoretically, you could keep pumping up the amount in your HSA, but you earned no interest on this money and couldn’t take it out for anything other than health expenses until you retired.

              It worked well for me.  I went from earning my base salary only to making my base salary plus a small difference between what it cost for my premiums/out-of-pocket expenses and the $5400.  Considering I never went to the doctor, I’ve got $2500 sitting in an HSA right now (I’m on my wife’s plan now, meaning I get the full $5400 minus taxes).

              So, I suppose it depends on how the HSA is setup.  Obviously, my employer’s approach was much more desirable than most and is really a better approach overall.  My last two employer’s took this route, which might mean it is becoming a more popular route or might just reflect the weird ways in which independent schools work.

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              • At the last company I worked for, the high-deductible plan inexplicably had a deductible just below the minimum which would have made it eligible for an HSA. Instead we got something they called a medical savings account. The company would deposit something like $500 per year, and this would not roll over. I tried to get them to offer a plan with a slightly higher deductible to qualify for an HSA (which I had been using at my previous company to get an extra few thousand dollars of tax-deferred savings), but they didn’t seem to have any idea what I was talking about.

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  3. Is there anything problematic about saying that liberals should endorse something that most real life liberals don’t actually endorse?

    No, no more than there’s anything wrong with people saying conservatives should hold a position that most conservatives don’t actually hold (e.g.: opposing foreign interventionism on the grounds of Burkean caution; supporting same-sex marriage on the basis that serving as arbiter of morality isn’t a proper role for limited government).

    In this case – I prefer the public option to mandates.  So do a lot of liberals.  It’s extremely pertinent to remember that the reason we don’t have a public option is that Republicans and conservative Democrats shot it down.  (I’m more than a little suspicious the Republicans rejected it because they knew a mandate would be easier to rally sustained public opposition against.)

    My understanding of the differences between good (streamlined) and bad (convoluted) policy suggests that when the government is having to dictate the precise contents of insurance plans offered by businesses, something’s gone wrong.  I can’t see any reason why it shouldn’t be just as legal for one company to offer $40/hr wages and no benefits as it is for another to offer $6/hr wages and some health insurance.  And if that’s legal, then why shouldn’t it be legal for the company to select which benefits it offers?

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  4. So, here’s a question for the league: Is there anything problematic about saying that liberals should endorse something that most real life liberals don’t actually endorse?

    Yikes, no. I assume being a liberal is not merely a collection of unprincipled opinions that are picked at random for each issue. There are supposed to be a few overarching principles from which the applications are derived. If the majority of liberals are applying their principles incorrectly to an issue, then a majority of liberals are not taing the liberal position. Also, I consider it almost an obligation to let people know when their beliefs are based on inconsistent reasons (like a vegetarian who opposes killing animals because they are sentient but is just fine with late term abortion).

    I think the terms left wing and right wing cover the concept of whatever the majority of people who call themselves that actually believe, without references to principles. So, in other words, it makes sense to me to say that even though most liberals believe X, X is not really liberal. It does not make sense to me to say that even though most left wingers believe X, X is not really left wing.

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    • That is very well-reasoned. And that’s the trouble with it. It doesn’t match up historically.
      A few years back, I became interested in the progressive movement; particularly why it is that the “progressives” we see these days are so much different than the early progressives.
      There were actually two movements, and the one co-opted the name of the other– not right away, but over a period of time.
      Progressivism I has played itself out by the 50’s. FDR actually had a lot to do with that.
      Progressivism II effectively started with the Port Huron Statement; long-winded and whiny, a portent of things to come. It is notable for its opposition to nuclear power.
      The student protest movements of the 60’s grew into institutions in the 70’s. Those institutions became more radicalized and gained political power. These were not diaspora populations, but integrated ones.
      The traditional base of the Democratic Party– minorities and blue-collar workers– have since been overrun by this white-collar college-educated ‘Progressive’ wing of the party.
      These are people with a group of positions looking for something to tie them together.

      I’m no dittohead over here. I know that I’m one of a handful of conservatives at this site, but I’m really a displaced blue dog. I’m a journeyman who was a consistent D voter, right up until 2008 when I drove the 9 hours from Milwaukee to Kansas City so that I could cast my ballot for McCain.

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      • So you only find the Democratic positions unaccptable in 2008? Why? Why not before? I’m sure the take-over by the “elites” that you talked about happened before that. Why were you able to stand it until then?

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        • I guess my point is I don’t see Obama’s position as being that substantially different than previous Democratic presidential nominees of the recent past. If it wasn’t a deal-breaker before, why was it a deal-breaker in 2008?

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        • I didn’t pay that much attention until then.

          2008 wasn’t at issue. I thought we had two good candidates. I happen to like Obama.
          That doesn’t mean I like everything he does.

          On the 16th of January, I sent out this text to about 40 other members:
          I’m starting a petition, and I want every one of you to sign. The AFL-CIO hasn’t represented the interests of the trades for a very long time.We need a new inter-fraternal organization.

          I got a lot of positive responses. Not one negative response.
          My union has something like 350,000 active members.
          Were 12 trade unions to walk out of the AFL-CIO to form their own organization, I don’t think they would stand.

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            • “Don’t unions elect their leaders? If workers don’t feel the AFL-CIO leadership is representing them, they can elect leaders who do.”

              It would seem that way, unless you’ve worked in a union and understand how they operate.

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              • … you’ve worked in a union?  sorry, I still think that you lack standing. I know a guy who’s rigged union elections (running a surprise word-of-mouth campaign, overturning the expected outcome, you dig?). Workers elect their leaders, but the workers that go into unions are just like PA voters — they vote “name first, competency second”

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            • Every union follows their own constitution and by-laws.
              We elect our local leaders. Our local leaders elect leaders at the state level. After that, I don’t know.
              From talking with millwrights, I know that they no longer elect their business agents. Their BA’s are appointed by the national.

              There was a time when the trades had more of an influence over the AFL. The shop unions were barred, and they formed the CIO. Since that merger, the crafts have been second fiddle.
              I would love to wake up tomorrow to find that 40 – 45% of the AFL-CIO membership has voted to walk out.
              In fact, the idea of it makes me very happy.

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  5.  Is there anything problematic about saying that liberals should endorse something that most real life liberals don’t actually endorse?

    Of course, as noted by other commenters, most real-life liberals do endorse a public option; many go so far as to endorse single-payer healthcare. The question is whether there’s anything problematic about saying that liberals should OPPOSE something that most real-life liberals don’t OPPOSE, when the reason they don’t oppose it is that their first- and second-best alternative options have already been foreclosed by the political opposition.

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  6. That’s kind of what I was thinking, that there is no reason we shouldn’t be able to make both sides happy. Where employer-based coverage doesn’t look viable on the long-term, there has been substantial effort to tie our horse to that wagon.
    I think the matter could have been dealt with better through incentives and offsets.
    But the idea that, “My pharmacist will not accept legal tender from persons other than my employer,” was out on a strong roll.
    We never even got to COBRA.

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      • That only applies to circumstances where tender is due.  The shop can just refuse to sell you the thing at all, which means no tender is due.  However, if you bought something on credit then tender is owned–at that point the shop is required to take your legal tender.

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  7. Why should Liberals, that is to say, people who are motivated by the needs of the poor, find any common ground with corporations?     Is a hospital a church?   No it isn’t, any more than my home is a church.   These hospitals are not incorporated as non-profits.   At best, they are incorporated as not-for-profit, which is a very different animal, legally.

    Do these hospitals charge for their services?   Of course they do.

    This is all so much maundering-on about nothing.

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    • If that’s your viewpoint then you should be arguing for these hospitals to be shut down entirely as Establishment Clause violations.  After all, the government permitting them to exist is de facto government support of religious practice, right?

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  8. Such a bunch of nonsense.  The state already mandates minimum wage and safety standards for the workplace and it doesn’t matter if these standards conflict with the employers religious beliefs; a minimum standard of healthcare coverage is no different.

    Now, the to answer to your question is “no.”  (Note, however, that when such exhortations run counter to popular sentiment they are generally just plain wrong.)

     

     

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    • The state already mandates minimum wage and safety standards for the workplace and it doesn’t matter if these standards conflict with the employers religious beliefs; a minimum standard of healthcare coverage is no different

      It does matter if these standards conflict with religious beliefs. The only difference between minimum wage and this is that in the latter, no one has objected to paying the minimum wage on religious grounds so far.

      Also, you do realise that the minimum wage hurts the worst off right?

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      • No, I don’t.  I’ve read arguments to that effect and their rebuttals — the rebuttals made more sense.

        “no one has objected to paying the minimum wage on religious grounds so far”

        Give it time, someone will.

         

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      • But the point is that the response to the mandate opens up the possibility of such requirements being resisted on religious liberty grounds. Church of BSK fervently opposed minimum wage laws. If and when we open a hospital, we intend to pay below minimum wage.

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          • And we are back to nobody having to do anything they don’t wantto, regardless of the obligations they’ve agred to by undertaking voluntary actions.

            Look… You don’t get to pick and choose what consequences and obligations you have just because you don’t like them. Don’t want to cover contraception? Fine… Don’t offer insurance. Or don’t run a hospital.

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            • “Look… You don’t get to pick and choose what consequences and obligations you have just because you don’t like them. Don’t want to cover contraception? Fine… Don’t offer insurance. Or don’t run a hospital.”

              In other words, if you don’t want to be controlled by government, don’t start a business. This is a message that will inspire economic growth in the 21st like we’ve never witnessed…wait, what am I saying?

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              • That is the system we have. Don’t like it? Participate in the system to effect the change you believe in, adhere to the laws, or go somewhere with a system you prefer. It’s not rocket science.

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                • I hesitate to join in because I have decided not to participate in further contraception discussions, but this is tangential enough that I will make an exception:

                  Arguing in favor of conscientious objection seems to me to fall in favor of “participate in the system to effect the change you believe in.”

                  I don’t think there is anything problematic in saying, for example, that we should give the Amish a pass on various laws and regulations we pass among ourselves. This point of view may not be the best one, but arguing for exceptions to the system we have is in effect arguing to add  modifications to the system we have and, if enacted, part of the system we have.

                   

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                  • we should give the Amish a pass

                    The question becomes then, how much of a pass? In the specific case of the Amish, they get less of a pass than one would presume.

                    The Amish are not really a good analogy here. Their CO status allows them to avoid military service, which in an all-volunteer military, is not hard to avoid without CO status. If we’re to be fair to the analogy, we’d have to concede this is more like the Amish demanding to be in the special forces without ever brandishing a weapon.

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                    • The line between religious liberty and public requirements is a very long and complex one.

                      At varying times, Jehova’s Witnesses, Quakers, Amish, and others have come into conflict with laws, and the results are mixed.

                      This is not one of those cases. The RCC is not being forced to do anything. It wants to enter the business world and compete with secular businesses yet not comply with the same regulations.

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                  • But the Amish have sacrificed. The RCC has not. It wants all of the benefits of being involved in public sphere but none of the costs. And instead of participating in the political process to mitigate costs, it simpy wants a pass.

                    Cake…eating… All that jazz.

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                    • BSK and L60,

                      This isn’t a defense of the RCC in particular (I’m on the record as supporting the mandate’s application to them), but the distinction between participation and non-participation is not so clear cut (a pacifist arguably benefits from the existence of a military willing to do precisely what he is not, but I still think we should try to allow them to avoid confrontational military service if we can).

                      On the other hand, I actually agree (and almost put this in my original comment) that a sacrifice or a willingness to sacrifice in lieu of what they object to doing is not unreasonable. Requiring a pacifist to serve in a way that is not confrontational, for example. In the paragraph I almost put in my previous comment, some sort of fine or alternative requirement of voluntary service for those who don’t want to vaccinate*.

                      That strikes me as reasonable. But also different from the original suggestion, that conscientious objection should only be met by trying to change the thing being objected to and, failure of that, compliance or exile.

                      * – I am pretty steadfastly pro-vaccination. The goal, when carving out exceptions, ought to be to keep the number of exceptions low enough so as not to cause undue influence on everybody else. If too many people opt out of vaccinations, for example, then you would need to either up the sacrifice or find a way to cut down on the number of exemptions. I believe that there is a give and take and flow to these things. I think that some hardfast Right of Conscience, which TVD advocates, runs contrary to this. But so, too, does “we can’t make exceptions to people who want to participate in society.” Where the RCC falls in all of this is only one dot on the graph.

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                    • Riffing off Will’s idea of letting them do something else, given that we are in the business of telling people how to provide compensation for their employees, we can tell employers that they are to provide some cash equivalent to the premium of the thing not covered

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                    • BSK,

                      You may recall, that was one of the things that I put in the “arguments that I found compelling” on my post. There does seem to be a reasonable alternative here. Or, if it’s not reasonable, the other side has yet to make the case that it’s not.

                      But dammit, I’m not talking about contraception anymore!

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                    • Quite alright. I just wanted to make sure nobody thought I was evading the point (but wanted to do so in a way that wasn’t me, talking about contraception, right now).

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                    • Murali’s idea is the one I’ve always thought seemed like the best solution to this.  If a religious organization (or any business, really) wants to not include a certain form of health care in its health insurance, then require them to provide a cash equivalent in the form of higher wages.  Workers get more money, companies get less regulation, everyone’s happy.

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                    • WillT, I don’t think the government should force a church to do what it thinks is immoral.  It’s bad governance, contrary to the American ideal of pluralism, and probably unconstitutional.

                      I don’t know what “some hardfast Right of Conscience” would look like, as I’ve never employed the term or concept.

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                    • TVD, my bad on that. I switched around some terms from something you used to something more general, but forgot to take your name/initials off. Mea Culpa.

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                    • WillT, I don’t think the government should force a church to do what it thinks is immoral. It’s bad governance, contrary to the American ideal of pluralism, and probably unconstitutional.

                      TVD, I’m sympathetic to this assertion. But as people have been arguing (not just asserting): the mandate doesn’t apply to churches, but to corporate entities owned by churches that operate in the secular world; the mandate doesn’t violate ‘the free exercise of religious beliefs’ since it doesn’t compel any church member to (God forbid!) take oral contraception; it doesn’t prohibit the Church from not offering insurance in their secular pursuits and paying the fine; and finally, it presupposes that the secular activities of the church are insulated from the otherwise applicable laws simply because those businesses are governed by a 501-c3.

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    • “Such a bunch of nonsense. The state already mandates minimum wage and safety standards for the workplace and it doesn’t matter if these standards conflict with the employers religious beliefs; a minimum standard of healthcare coverage is no different.”

      The Right misses the fundamental issue — economic mandates in general. I’m worried more about separation of State and Economy than I am State and Religion. We’re not in danger of the State assigning a State religion or preventing the free expression of religious beliefs, but the economy is being murdered by government interventions. When people embrace mandates in one area of the economy, but then righteously reject mandates in areas that affect their precious prinicples, they have no ground to stand on.

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  9. No-one at all is coercing religious institutions to have employees, to enter the public sphere or have any involvement with “the outside world” whatever. We don’t even ask them to pay taxes. They have insinuated themselves into the marketplace. Requiring a “level playing field” is a reasonable position. Making sure that their employees have the same protections and access to benefits that are universally known to be beneficial on the whole, is also reasonable.

    They can’t hire children to melt down obsolete electronics or demand that workers siphon gasoline orally, either. Are they exempt from OHSA because it is not mentioned at all in scripture?

    I scanned the old and new testaments, and there are (surprise) no injunctions against contraception or recreational sex, so such strictures are dogma not doctrine.

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      • Ok, this is what I see here:
        1). The churches perform a public good. Anyone that wants to perform a public good, we should encourage them to do so.
        I’m not concerned about it being a core tenet of their faith. We can leave it to the church in question to decide for itself how to best express its own faith.

        2). I sometimes wonder if there are any social institutions other than government that the Left would like to see strengthened in our society.
        Whenever the solution is, “More Government!” I try to look for some other mechanism that can fill that function.
        Government does have a function, yes; and that function is not “Everything under the sun.”

        3). I already know that all of the membership from my union has health insurance coverage. In fact, I remember voting to ensure that all members would pay the same, regardless of whether they have families, or the number of dependents.
        If you could briefly outline your reasoning behind this notion that non-union employees should enjoy the benefits of collective bargaining, I …. might not find it plausible.

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        • Because the Republican party has made it its mission to destroy unions, so that the majority of people don’t have the PRIVILEGE of collective bargaining. Come on, Will, don’t be so selfish, do you think you and your union buddies are the only ones who matters? Doesn’t matter anyway, keep voting for Republicans, and pretty soon, no one will have collective bargaining privileges. That will show the elite, progressives Democratic party, right?

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          • If unions are to survive, they are going to have to argue that or argue for mandatory union membership. Or else, there is a massive free-rider problem. If joining a union is optional and people get the benefits regardless of whetherr they pay their dues, the there is no incentive to join the union and membership in the union will dwindle with time. Or to put it from another angle, what is the point of being a scab if you cannot ask for fewer benefits?

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          • No, I’m not saying screw the non-union workers.
            I was one myself for many years.
            I’m saying that we’re dealing with an employee/employer type of relationship here.
            I don’t consider the employee to be the property of the employer.
            We have a way to negotiate those terms.

            The way our contract works is that it’s negotiated every three years. When we get a raise, we vote as to how much of it goes to wages and how much goes to health & welfare, which then leads to another vote where we decide how much is going into pension, annuity, insurance, apprenticeship training, target fund, political fund, etc.
            Exactly what the insurance covers or doesn’t is determined by the underwriters. When we change insurance companies (and we have), the prospective underwriter gets to review our records for something like three years. Then they present us a few different options. It’s the Secretary of Finance that gives the report at the meeting. We vote on it after the report. We either take it, or we tell him to keep shopping.
            I’ve never heard anyone ask about contraception coverage.
            Our benefits are now administered by National Employee Benefits Association (NEBA) in Jacksonville. They do a lot of the benefit coordination for various locals.

            From that view, basically we have the gov’t involved in contract negotiations. It’s not even really the contract; it’s part of the Secretary of Finance’s duties.

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        •  I sometimes wonder if there are any social institutions other than government that the Left would like to see strengthened in our society.

          Yes, there are. Liberals love the insitutions of labor unions and want them strengthened;

          Liberals want to expand marriage and  family creation to all people, not just “opposite marriage” genders.

          Liberals are famous for organizing community groups of citizens devoted to improving their lives.

          We even elected a President who was such an organizer.

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        • 1). The churches perform a public good. Anyone that wants to perform a public good, we should encourage them to do so.
          I’m not concerned about it being a core tenet of their faith. We can leave it to the church in question to decide for itself how to best express its own faith.

          I’m with you on that.

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  10. This is nonsensical.

    The mandate isn’t mandatory, in the sense that these organizations will magically stop existing if they don’t give employer based insurance coverage.

    It’s a chosen tax exemption. Organizations are perfectly welcome to not do anything that’s “morally objectionable” by simply putting their employees on the exchange, rather than providing the insurance themselves.

    The end.

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      • I dont get the vitriol. What is wrong with saying the following:

        P, Q, R and S are things that seem non-negotiable to liberalism (because many liberals have belived them and most if not all liberals continue to believe them and non-liberals dont believe all of them). Here are the principles A, B and C which do a good job of explaining P, Q, R and S as well as a whole bunch of other stuff that liberals actually believe. But, if you believe A, B and C, you should endorse X and oppose Y. But many self identified liberals oppose X and endorse Y. The fact that they do so means either that they dont really endorse A, B and C or that they haven’t thought through the implications of believing A, B and C. If they want to reject any of A, B and C, then they are going to have a problem justifying P, Q, R and S. If they drop one of P,Q, R and S, how is it that they count as liberals?

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          • I’m willing to do that. But responses of the type “I’m sick of being told what liberals ought to believe” are not about the particular contents or assumptions that go into the variables, but about the form of the argument in and of itself.

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        • I never see you doing this philosophical exercise for conservatives or libertarians. Why is that? Don’t tell me, I know, because despite what Nob said, you consider yourself a liberal, and therefore is just being tough on your own team. But do this often enough, some people might think you’re just concern-trolling.

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          • I have done it for conservatives and libertarians.

            Against conservatives I have argues that if they really cared about Burkean caution, they should not only oppose the french revolution, but the american revolution, the american civil war, and every kind of foreign intervention.

            On libertarianism, I have argued that the libertarian preference for gridlock is inconsistent as gridlock also prevents libertarian reforms.

            I have also argued that libertarians should be more sceptical of democracy since libertarian economic policies are not only not popular, but never will be.

            On libertarianism, I have also argued for why a Rawlsian justificatory apparatus does a better job of defending libertarianism than the Nozick/Locke paradigm.

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        • If they drop one of P,Q, R and S, how is it that they count as liberals?

          I think you’re confusing people who fall under the contemporary, politically-determined name ‘liberal’ with a an a priori philosophical theory of political economy akin to ‘classical liberalism’. liberals /= classical liberals.

          You’re criticizing liberals for not being libertarians.

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          • Maybe we should just give him the word, and assume any  time Murali writes “liberal”, he’s not really talking about the left side of the political aisle as it currently exists in the US.

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              • Not to speak for Murali here, but I think that’s closer to his view. He was pretty clear about it, actually: liberalism is defined by a set of a priori and antecedent commitments, so liberal policy follows trivially from them. And anyone who holds a view which doesn’t follow from those first principles isn’t really a liberal.

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                  • I get that Murali. There’s nothing wrong with that part of the argument. But I don’t think that the premise – contraception coverage could be included in a non-coercive way – makes any sense. And for a bunch of reasons. One is that I don’t think the inclusion of contraception coverage within the existing insurance mandate constitutes an illegitimate use of government’s coercive power. As Mike Farmer wrote upthread, at that point, the justification for coercion has already been conceded. I also don’t think contributing to a general pool which provides contraception coverage violates a ‘the free exercise of religious beliefs’ since no one is mandated/compelled to actually make a claim for contraception nor take it.

                    On the other side of it, the supplemental plan you propose (limited public option) would presumably be funded by general tax revenues or by imposing limited ones. If general, then it kicks the can around a bit but doesn’t resolve any of the underlying issues. So that leaves funding it with a limited tax – one which those who find the tax morally offensive could reject. But what would that tax be, and how would it  function? I’ve already had this discussions with people, and I haven’t yet heard details about how this otherwise ‘simple’ solution would work consistently with it’s objective.

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                    • If general, then it kicks the can around a bit but doesn’t resolve any of the underlying issues

                      Actually, kicking the can to the state solves a number of problems. I haven’t fully worked out my views on the authority of the state yet, but as a first stab, I would say that it is plauible that the state has the authority to tax people and spend it in ways that they might find morally offensive but not have the authority to make people do things that they find morally offensive.

                      Not having fully worked things out yet, I fully concede that I might be wrong on this.

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                    • So taxing a Catholic to raise additional funds to pay for contraception is cool…
                      -BUT-
                      Using fees collected from patients of all faiths, often collected from insurance companies employing people of all faiths, themselves funded through premiums generally paid by secular employers, to pay the premiums for insurance coverage which goes into a general fund of monies collected from various employers, primarily secularly run, which might then be used to offer the employees of Catholic-run business is an issue? You do realize that because of pooled funds that some of the Catholic-run businesses’ money does pay for contraceptin, just not for their own employees?

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                    • So taxing a Catholic to raise additional funds to pay for contraception is cool… -BUT- Using fees collected from patients of all faiths, often collected from insurance companies employing people of all faiths, themselves funded through premiums generally paid by secular employers, to pay the premiums for insurance coverage which goes into a general fund of monies collected from various employers, primarily secularly run, which might then be used to offer the employees of Catholic-run business is an issue? 

                      For now, I will say yes to this, but I may walk this back later in the morning tomorrow/today (its 1.52 am in Singapore and I’m off to bed)

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      • Is this some manner of liberal bias?

        Propaganda not working?

        Do you have a liberal basis for being so “fucking sick of people”?
        I think I would like to hear that out of liberals more often.

        If liberals believe that conservatives will only believe those things that Rush Limbaugh (solely on the basis of 1). being able to score the good dope, 2). knowing a good divorce attorney that can get you off the hook, 3). didn’t really look that plastered at CPAC, etc.) tells them to believe, why is it that liberals would believe that they should not believe those things some conservative who is not Rush Limbaugh tells them they should believe, if only for the good of their own belief system?

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        • Now, now.   We Liberals have been told about The Way Things Ought to Be for a very long time now by Conservatives.

          But the way things work out in the real world always seems to go the Liberal’s way.   Race relations, LGBT issues, health care and the like…. first the Conservatives fart indignantly about how Society’s Going to Hell in a Little Red Wagon, laws get passed, much ranting and frothing thereafter — until the dust settles down —

          And then, mira-fucking-bile dictu, when confronted on these issues, especially their opposition to segregation over the years, the Conservatives will tell us to our faces they were never opposed to integration or equal rights for women. Watch and see, even now they’re backing away from their homophobia, knowing it’s so much ignorant bullshit.

          There is a practical difference between honest Conservatism, which attempts to preserve much that is good in society, knowing it is good and attempting to slowly improve upon that good — and the Reactionary Bumpkins now attempting to pass themselves off as Conservatives.

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      • To clarify.

        I’m tired of this whole fucking contraception discussion in general, because the whole debate is being done mostly by men, who have no fucking clue what they’re talking about, going on about first principles based bullshit that didn’t apply when the first tracts were written, much less today. I applaud Sonmi and Katherine and Kimmi’s patience on this subject and their tolerance.

        My own tolerance for this sort of debate only goes so far, and I reached it long past since, especially when it became clear that no one arguing against the contraception mandate had 1. any inkling what the actual employer mandate in ACA actually requires, and 2. any interest in portraying the issue as anything other than the big bad government bullying the victimized Roman Catholic Church.

        Nevermind my general problems with the RCC. If it were up to me, that entire morally bankrupt institution would be hauled up before an international tribunal, its records seized and its leaders placed under arrest for aiding and abetting in the criminal sexual assault of minors. No, my loathing of popery and the damned institution aside, this debate itself is sickeningly abstract.

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          • Yes, because “hailing” from a country means supporting every policy in that country, and being responsible for anything that happens in that country, and having no right to criticize the policies of the country one lives in now.  BTW, has Nob specifically said that he was born in Japan? Second generation and further Italian-Americans for example don’t “hail” from Italy, surely?

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            • Yeah, I was born in Japan. I’m a Japanese citizen, I speak Japanese, I prefer natto to hamburgers (yes, really) and the only thing that comes to mind when I think about the need for there to be a black/grey market in birth control in my home country is disgust.

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            • sonmi,

              whoa there, girl. still on your side here. And Nob’s, who is perfectly free to articulate whatever views of his native country that he wishes. I ask him, specifically, because I’ve never been there!

              and as for Italian Americans — depends on how long they’ve lived in Italy. My dad carries on quite brisk Italian conversations with our formerly-Russian relatives.

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    • I agree Nob. The whole discussion has spiraled into the stratosphere of speculation and straw grasping. But I wanted to point out one thing here, which is a theme I’ve seen repeated by many who oppose the contraception mandate:

      the Obama administration will force religious organizations to use their financial resources to support a practice they find sinful.

      The argument Vallier appears to be making here, and the one Murali piggybacks off of, seems to assume that an employer has the right (or liberty) to restrict the uses of employee compensation. This came up in another thread where the lever in the argument against the contraception mandate was that it goes against the moral beliefs of ‘the business owner writing the checks’. One criticism I have here is against this view as a libertarian position: why think that the employer has any prior right to determine how employees use their wages in any event? The second is why think that the employer’s ‘right’ supercedes the rights and liberties of the employees?

      Now, of course, in this particular case, the idea is that the owner (or ownership) holds certain relgious/moral beliefs as a part of the institutional framework under which employees are hired, so the moral beliefs are in some sense constitutive of the institution doing the hiring and providing the health insurance. But the argument at that point is confused, no? Either employers have a right to determine where employee compensation goes full stop, or they don’t. So the issue has nothing to do with an employers rights here. It has to do with whether or not the institutional beliefs of a church pass into the institutional structure of a hospital (say) owned by a church. And on that score, it seems to me there are too many ways to defeat the claim that they do, or should, to justify providing those institutions an exemption from the coverage mandate.

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      • Arizona is apparently pushing a bill that will allow employers to request medical justification for women taking advantage of existing contraception coverage and, absent that, give employers the power to fire them. Now, the bill has little to no chance passing but the mindset amongst some is increasingly clear: the lower on the totem pole you are, the less power and rights you deserve.

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        • I made this argument earlier to Rufus and Tod, and I’ll repeat it here: the GOP actively opposes women’s access to abortion services, contraception, plan B, birth control coverage, funding of PP, and actively supports transgavinal ultrasounds, employer rights to restrict contraception, firing of employees who violate ownerships ‘religious beliefs’, abstinence as birth control, etc etc. Not to mention the language used when proposing or discussing these policy positions (!).

          So, to say, as some people do, that this is just all politics or rhetoric, and that the GOP and conservatives aren’t actively trying to restrict and otherwise roll back the right’s of women is either a deliberate confusion or a distinction without a difference.

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          • I wouldn’t say it’s all politics, but I don’t think it’s nearly the united front that the Republicans have on, say, global warming. It seems to me there’s at least some division between the Republican political organization and the Republican religious organization. So, saying that some religious fanatics getting a wacko bill voted on in, say, Kansas is equivalent to the “GOP position” seems overstated. Let me put it this way- I think this is one of those issues like gay marriage where you can gradually peel individual Republicans away from the more extreme positions and, in the future, more and more of them will move away from those positions. Or you can equate them all with Rush Limbaugh and the blue noses of Kansas and get the rest of them to circle the wagons around the most extreme positions. I’d rather go with the first tactic because I just don’t see the US becoming a one-party state in ten years due to “demographic forces”, like some others do.

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        • Okay, that is incredibly creepy.  You can cover contraception or you can not cover it, but when employers start trying to dictate what employees can and can’t do with their own bodies in their private lives, that’s a severe violation of liberty.

          * Illegal activity (e.g., illegal drug use) is clearly an exception.

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          • * Illegal activity (e.g., illegal drug use) is clearly an exception.

            In the present circumstances, yes.  I think it is a horrible exception, myself.  The state has boundaries on its police power (whether they’re correct or not is subject to debate, of course), but the private sector has been granted a huge pass in the name of this one particular illegal activity and unjustly so.

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            • No, this is definitely a thing. I had one employer that barely even offered health insurance that banned smoking, on your own time, because the owner’s sister died of lung cancer. The notion of employers dictating what you can and cannot do on your own time is not new or limited to this subject. That being said, there is a difference between banning smoking and banning contraception. Among other things, banning the latter would make it nearly impossible to find employees, and there are gender discrimination issues with contraception* that don’t exist with cigarettes. Applying the same to male employees’ wives and daughters might mitigate the degree of discrimination, but I don’t think it gets rid of it. The discrimination argument here is actually stronger than the discrimination argument about withholding contraception on insurance.

              * – Not that I’m talking about contraception!**

              ** – Crap.

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            • There’s a story here about it.

              It’s interesting because the worker pulled the whole “right to privacy” thing and the judge said that that wasn’t a good defense because the worker didn’t try to hide the fact that he smoked. There’s also an interesting line in there about how the test generally isn’t used to fire folks, just to not hire them in the first place.

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              • This situation brings up a whole other sort of line drawing…

                Would it be wrong for an employer to fire someone who attended and participated in Klan rallies on the weekend (the employee neither broke laws nor was party to the breaking of laws?  What if customers knew and complained?

                Would it be wrong for an employer to fire someone who attended and participated in a radical Islamic mosque on the weekend (again, no laws broken or being a party to law breaking)?  What if customers knew and complained?  What if it was a regular mosque but customers still complained or went elsewhere?

                There was a case a while back where a police officer and two firefighters participated in a parade float that mocked the racially motivated dragging death of James Byrd, Jr.  Their firing was eventually ruled wrong by the courts, with part of the argument being that they were not in uniform, on duty, or otherwise representing their organizations at the time.  Of course, they also weren’t engaged in a “private” act as they participated in a public parade.  The judge’s ruling was at least in part based on the fact that the actions were taken by the government and thus constituted a 1st Amendment free speech violation.  I remember at the time being torn, because it did seem like they had a legitimate right to free speech.  But, for the cop specifically, the express of such believes could certainly have an impact on his job performance, which does seem reasonable to fire someone over.

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                • It’s worth noting that public employees (such as police and fire) generally have more protections than private ones, from a legal and I believe Constitutional standpoint. The problem with “could have an impact on job performance” is that it would apply not just to the officers in question, but also to officers who support (for instance) drug decriminalization through LEAP or general activism. You could say, I suppose, that an officer who expresses racism will have job performance problems due to the reactions of those around him, while a LEAP officer might not, but that’s a thin line, but that could apply to any number of things since we’d be specifically looking at how people react to something, rather than the something itself. On the other hand, how people respond does matter. It’s dicey terrain.

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                  • When I referred to job performance implications, I was thinking more about the confidence (or lack thereof) of the officer in question being able to put aside his racist feelings to work appropriately with the black members of his community.  Now, theoretically, this question could be asked of any cop for every time of bias and doing so would not be productive.  But if you are going to put on a public display of racism, I think the burden fairly shifts to the employee to demonstrate how he will avoid that believe he is apparently so proud of from clouding his judgement.

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                    • When I referred to job performance implications, I was thinking more about the confidence (or lack thereof) of the officer in question being able to put aside his racist feelings to work appropriately with the black members of his community.

                      See, I think this *does* apply to LEAP officers as well. How can we expect them to enforce laws they are activisting against? That sort of thing. I’m not sure how you could apply it in one instance, but not the other. Your thoughts?

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                    • A few thoughts which, when cobbled together, may or may not provide a comprehensive or consistent response:

                      1.)  Racism is often visceral in nature.  Opposition to drug laws is generally not so.  I would venture to guess it would be easier for a LEAP officer to say, “I believe that prosecuting drug use is wrong but I have a duty to uphold and will arrest drug users until such a time that I am not duty bound to” than for a racist officer to put aside his racism when confronting individuals in potentially hostile situations.

                      2.)  Furthermore, one predisposition risks over action and the other under action.  If a LEAP officer lets a pot smoker go, that kid can get picked up by the next officer.  If a racist cop shoots an unarmed black kid, he can’t be unshod by the next cop he interacts with.

                      3.)  It might still be prudent to put the burden of proof on a LEAP officer to demonstrate that his believes will not interfere with his work.  I would venture to guess he would have an easier time doing so (for some of the reasons stated above), though that might be my own personal bias creeping in.

                      4.)  Racism is a response to individuals; I presume that LEAP advocacy is a response to actions.  Cops interact with many, many people who are neither criminals nor suspects of crime.  Witnesses, community members, victims… if the racist cop cannot set aside his racism, his interactions with all of these people risk being tainted.  A LEAP officer would have no reason to even inquire about these people’s drug use, unless it was germane to their interaction (and my hunch would be a LEAP officer would be less likely to presume it is).

                      Ultimately, I guess I take a both/and approach.  LEAP officers might also be required to prove their beliefs won’t impact their work.  It is just a lower hurdle to clear.  Thinking more about it, we pretty much all have to prove that we are capable of performing our jobs.  If I was assessing an employee’s ability to do so and his job involved making split-second decisions, interacting with members of the community, and acting as an unbiased arbiter and assessor of situations, racism would be a much bigger X in the “no” column than LEAP advocacy (which would probably still be in the “no” column for a cop, but not necessarily in other professions).

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                • A couple things.

                  1. At-will employment laws basically mean there’s no protection for employees at all. You could for example be fired for all wearing orange (see: http://lifeinc.today.msnbc.msn.com/_news/2012/03/19/10759617-matching-orange-shirts-get-workers-fired ) and it wouldn’t mean a damned thing.

                  2. Federal employees generally have greater limitations on their freedom of speech. In particular Article 88 of the UCMJ basically forbids serving personnel from offering “demeaning” statements in public about the president of the United States.

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                  • I know that’s true of the military, but is that true of non-uniformed, civilian employees? When I was young, my father was prohibited from so much as putting a yardsign up for his preferred candidate. That changed at some point, though, and the impression I got was that there were little or no restrictions so long as he was not doing it in his capacity as, and did not make mention of, his position as a muckity-muck with the Department of Muck.

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    • Oh.

      OH.

      If that’s how it works, I’ve been completely misunderstanding this debate.  I though this was about making it mandatory for employers to provide a certain health insurance package.

      If it’s just “if you provide employee health insurance covering u, v, w, x, y, and z, you get a tax deduction for it; if you don’t include x in your employee health insurance, it’s not tax-deductible” – that’s perfectly fine.  That doesn’t have anything whatsoever to do with religious freedom.

      Is that what’s going on here?  I’m amazed I haven’t run into the clarification before.

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      • So it’s slightly more convoluted than that but it essentially goes as follows:

        1. “Large” employers (more than 50 full time employees) are asked to provide health insurance to their employees under ACA’s employer mandate.

        2. Employers who do not provide health insurance, have over 50 full time employees, and those employees make up to 200% of federal poverty limit are assessed a fee roughly equal to the premium support employees get on the health care exchange.

        3. In effect this works as a tax. Baseline is that employers are taxed if they don’t provide health insurance. (the assessment) Small employers (less than 50 full time employees), employers who provide health insurance or employers who have employee compensation levels that keep them from getting a premium support in the exchanges are exempt.

        4. The mandate on contraceptive coverage was originally intended to quantify what health insurance would be considered adequate to meet this employer mandate. This has since been changed that all health insurance plans sold in the United States (and thus eligible for participation in the Exchanges) must cover contraception if requested by the covered party.

        This is the long and short of it.

        In essence it’s a taxation issue. Employers do have options outside of just providing health insurance coverage. They don’t get an exemption to the assessment (which is in essence a tax exemption) and would otherwise be forced to treat their employee compensation as cash compensation rather than insurance compensation (which has different taxation rules).

        One may argue that this is unfair. But it’s scarcely an issue of religious freedom. It’s a preferred taxation issue. Just like the marriage deduction, or the child credit, or even the mortgage deduction.

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  11. I don’t know how many times we have to keep going over this, but as Blaise says above, a hospital isn’t a church. There isn’t anything left to talk about, so I’m not sure why we keep trying.

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      • Or, could we say lots of people opposed to contraception seem to think they have found a good excuse for opposing something they can’t otherwise defend – or are loathe to admit – opposing?

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    • This never was about “religious freedom”.  I don’t hear any clamor about Hindus having to pay for meat in public school lunches, which there would be if this was truly about “religious freedom”.  Like every other time we’ve heard that phrase, it’s about a particular group of Christians wanting to force their beliefs onto others.

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  12. “Is A’s liberty to X restricted if A’s boss refuses to pay for X? Especially when X is cheap and readily available? And when A can choose another employer? And when A’s government could provide X directly without using force against a voluntary association? No, no, no, and no.”
    How many assumptions are being made here? Let’s work backwards.

    As noted, the GOP and conservatives and actively resisted the government offering contraception. The “If you don’t like it, don’t work there” argument presumes everyone lives in an area with multiple employmentmoptions. Contraception is not cheap and readiy available for all women. Not everyone lives in an urban environment with public transport to PP and other sources that offer contraceptive cheaply. Which takes us to the first question, which s much harder to answer with a flat-out “No.”

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    • Good points all, but I’d also add that it’s a big assumption that contraception would be readily available by other sources if we start interpreting the first amendment as reading “Well, maybe we should enshrine the preferences of religious institutions into law.”

      The church doesn’t want you to have birth control pills.  They’re not burning down labs and destroying stockpiles, as they might have in centuries past, but they are actively working to restrict the distribution of contraceptives. The current mandate takes away their main weapon in that battle.  If they cannot actively deny people contraceptives, then they’ll be left trying to convince people not to take them.

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      • There’s an interesting followup story about the Komen/PP fallout. It appears that the Catholic church in Ohio actively rejected its association with Komen because Komen funded PP, which directly led to the Komen severing ties to PP.

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      • The church doesn’t want you to have birth control pills.

        Needs to be restated loudly and often.

        Also-

        The Conservative movement wants your availability to have birth control to be entirely at the whim and discretion of your employer. Thus the avalanche of bills at the national, state and local level dutting off funds for public clinics, removing coverage of birth control (not abortion) for millions of middle class women.

        There is an agenda here, and it has not one thing to do with protecting “religious liberty”.

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          • That’s the thing that sucks about religious liberty.  Sometimes you have to tell religious institutions, “No.”  It’s not that we want to take away their liberties.  It’s that we don’t want them to take liberties.  Crucial difference.

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  13. I’m with the Economist on this one:

    “Michael McConnell, a professor of law at Stanford University, calls this a self-inflicted wound, “a typical culture-war issue” in which one tribe uses governmental power to damage the other.

    Whatever happened to the art of the possible?

    He is surely right. America is lucky to possess alongside its public institutions a rich ecosystem of hospitals, universities and schools that are largely secular in function and serve all faiths, but are animated by a religious vocation. Why punish them? It cannot be beyond the wit of man to give their employees access to contraception without making the employers trample deeply held beliefs by paying directly. 

    I can’t believe they couldn’t find a way to avoid at least some of this furor. I realize that, yes, the GOP is going to attack Obama regardless of what happens or what day it is. But, surely, were they smarter, they could have avoided stepping in this particular pile of controversy. As for the GOP, holy Christ, I can’t believe they cocked this one up for themselves. All they had to do was stick to “religious freedom’ and not get into the supposed immorality of women who use birth control, which nearly all adult women do at some point. So what do they do? Bigmouths strike again.

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    • Here is my uestion: the mandate was in the original bill, signed 2 years ago. Why did GOP wait until now to object? Either they didn’t read the bill -or- they waited until 6 months before enforcement and 9 months before the general (aka the heart of primary season) to culture war the crap out of the issue. Why would Obama expect opposition now after the bill passed 2 years ago. The problem is… I’m not sure which of tose is more damning to the GOP.

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          • I’m not really sure how my comment came across that way at all. For the motivations, I think there are hard line religious people who really do have a problem with birth control, although I really don’t think they’re the majority of the party loyal, and there are a lot of others in the party who are willing to pimp out the religious hardliners to stir up anger against Obama because they’re looking for whatever comes in handy. It seems pretty clear that a lot of the people claiming to be so terribly outraged by this are really just delighted at the idea that this one might be the wedge issue that turns people against him. Hell, they’ve said as much here. As for the idiocy part, when a vast majority of American adult females have used birth control at some point, making this an issue about how they’re all taking slut pills and health insurance that pays for slut pills is tantamount to prostitution was, in my opinion, a really fishing stupid thing to do. But I thought I said that above.

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            • Seriously, I see sending those employees down to the high school to pick up some free condoms from the high school nurse as being less odious than sticking to employer-based coverage no matter what.

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  14. First:

    The medications prescribed as birth control have MANY other uses such as allowing some women to actually function two days of the month when without those hormones they can do no more than sit in a dark room with a wet cloth on their forehead.  The entire argument related to this issue is tossed out the airlock when the emphasis is on “sinful and distasteful.”

    My wife needs those pills to function.  It is ~not~ about family planning.  We can and have used other contraceptives when we’ve needed/ wanted to.  But she still wants to be on the pill to regulate all the OTHER things that the pill regulates.  And no employer has the right to second guess what medical professionals have deemed necessary medical treatments.  You’d never consent to an employer telling you that you had to pay out of pocket for heart surgery because “well if you just relaxed more you wouldn’t have had that heart attack”.  Why in the name of all that Firefly is this even still being discussed?

    Second:

    Do you have any concept of how insurance works?  All of this “opting out of what you don’t like” waters down the pool of cash required to keep everything expensive affordable.  The more you add exceptions the only real result is that the costs of already insanely high insurance continues to rise.  There is a fine line between incentives to keep long term costs down (such as breaks in rates for improving health/ quitting smoking), and simply creating insurance that is so A La Carte that it ceases to function as any form of insurance at all.

    Insurance works the best with the most affordable rates when doctors are trusted to prescribe what is necessary, and everyone pays in for everything so that the largest pool is used and then subdivided down among the insured.

    This is Pre-Economics 101….

     

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    • Doctors in the US have a tendency to overprescribe and over test. They can do so because the patient  has no incentive to give objections because he has already paid his premium and american doctors are paid on a fee for service. Trusting american Doctors (with all respect to Dr Saunders) to control costs is like trusting the fox with the henhouse.

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      • My experience is at odds with this, Murali. Insurance companies still have the final say on whether a test or procedure will be covered by patient’s plan. Doctors don’t have as much latitude as we’re inclined to believe. Insurance companies, on the other hand, reflexively reject tests and procedures which fall outside their company determined protocols.

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        • As an anecdotal experience: My father was denied a CAT scan for almost 18 months. Insurance – a rather big name company I’m sure you’d recognize (it rhymes with “igna”) wouldn’t cover it unless he completed a course of physical therapy first.

          His doctor wanted him to have it — he suspected the pain and movement issues were the result of a bone spur on a cervical verterbae. The insurance company, however, decided my father should undergo a lengthy period of physical therapy first — one aimed at ergonomic issues, judging by the exercises he mentioned.

          So why did they deny him the CAT scan? It was never made fully clear, despite appeals from his doctor. I suspect it had something to do with the issue at hand — a CAT scan is expensive, and the operation to handle a bone spur is quite pricey. (They replace the actual vertebrae with a cadaver’s. Fun for the whole family). Not quite up there with joint replacement, but still an awful lot of money.

          Looking at from the insurance company’s perspective — they had all the incentive in the world to deny him treatment. The situation was not life threatening (merely excruiciatinly painful). It was entirely possible it was a repititive stress issue (possible, but unlikely) so they could claim good faith. And by the time they’d wasted a year or so, my father’s annual benefits choices would be up and either he or the company might choose another provider.

          In short, they  have every incentive to push that CAT scan and the likely surgery off into the future. There wasn’t anything they could be really sued for, and if they  just kept saying “No” long enough, someone ELSE would pay for it.

          Which is, in fact, exactly what happened.

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      • The analogy would be:
        He gets a particular form of compensation that can be used to get food.

        However, due to “religious beliefs”, said compensation can’t be used to purchase pork. But his wife needs pork to function. There would be an objection there, right?

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        • But only for people who can’t afford it. The vast majority of people pay for it out of pocket. Why no mandate that every employer’s compensation package must include food vouchers?

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          • We do. The vouchers are called “money” and employers are forced by law to give it to anyone who works for them.

            Which is yet another way of saying what we have been saying all along- the contraceptive coverage is not a freebie benefit given as charity- it is a form of compensation no different than cash, except the employee gets the group rate benefit.

            Or to put it still another way- We could grant the RCC’s wish and not have the insurance be provided- but we could just as easily mandate that the employer provide the employee with a cash equivalent which the employee would use to buy it themselves, thus allowing the RCC not to have to touch the filthy lucre of contraceptive covereage.

            Which I suspect would be equally objectionable- since the real goal is not to absolve the RCC of providning morally objectionable coverage, but to allow employers to shut off access to contraception.

            Unlike the Amish, who simply insist that their members not do certain things- the RCC finds contraceptive use by ANYONE to be morally objectionable, and is seeking ways to enforce that.

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            • We could grant the RCC’s wish and not have the insurance be provided- but we could just as easily mandate that the employer provide the employee with a cash equivalent which the employee would use to buy it themselves, thus allowing the RCC not to have to touch the filthy lucre of contraceptive covereage.

              Which I suspect would be equally objectionable

              No they wouldn’t. They may still complain, but their complaint would lack adequate grounds to be taken seriously. As it stands, if Stillwater’s description is right, they have a valid complaint. If the situation is more that the fee merely picks up the slack and is not punitive as I gleaned from Nob, it is smilar enough to the cash compensation that they dont have much of a case there either.

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            • We do. The vouchers are called “money” and employers are forced by law to give it to anyone who works for them.

              If cash counts as food vouchers, then it also counts as contraception coverage. So there’s no problem here, right? Employers are already providing contraception coverage in the form of cash wages.

              Unlike the Amish, who simply insist that their members not do certain things- the RCC finds contraceptive use by ANYONE to be morally objectionable, and is seeking ways to enforce that.

              Really? I must have missed the part where they’re lobbying to ban contraception altogether.

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      • Because there isn’t someone sitting in judgement of her as a human being for needing food to function.

        And because they’re not using their religious beliefs as an excuse to deny her specific kinds of food she needs.

        And lastly because someone with experience in making sure my wife stays healthy isn’t having their opinion over-written by some religious nutter.

         

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        • No one is using religious beliefs to deny anyone anything (That’s an odd phrasing. It makes it sound like religious beliefs are superpowers). A woman goes to the doctor, the doctor prescribes oral contraceptives, and then she goes to the pharmacy and pays for them. She’s not being denied contraceptives any more than she’s being denied food.

          I’m going to need you to stay after class and write “The absence of subsidy does not constitute prohibition” on the blackboard fifty times.

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          • I’m going to need you to stay after class and write ”The absence of subsidy does not constitute prohibition” on the blackboard fifty times.

            Wow, condescending much? How about this?

            INSURANCE IS NOT A SUBSIDY

            HEALTH INSURANCE IS NOT A FAVOR GRANTED BY YOUR EMPLOYERS, IT’S EMPLOYEES’ COMPENSATION

            And one more time,

            INSURANCE IS NOT A SUBSIDY

            So, do I get a passing grade, oh wise one?

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            • No, you don’t, because:

              1. Contraception coverage isn’t insurance. It’s a prepayment plan. Regular, predictable expenses are not insurable events.

              2. When employers choose not to compensate you in the form of health insurance that covers contraceptives, and the government forces them to, that’s not market compensation. It’s a forced subsidy.

              And you’re just quibbling over semantics, anyway. The point is that the claim by “A Teacher” that anyone is being denied birth control is straight up bullshit. Those who want it can buy it.

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              • 1. Not ALL women take birth control for their WHOLE life, from birth to death. And even if they do, how is it any different from a man born with a congenital disease, requiring medication for his whole life?

                2. Maybe employers should have lobbied for single-payer, then. Problem solved, no obligation on their part anymore.

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                • 1. Not all, but the probability is high enough and the cost is low enough that it really doesn’t make sense to insure. If there were a disease that most men had that could be treated by an inexpensive drug, I would similarly argue that it’s not a good candidate for insurance. Really, I think all health insurance plans should have high deductibles, rendering the question more or less moot.

                  2. What are you, five? “If you don’t want to buy me a pony, then you have to buy me a bicycle!”

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                  • Brandon thinks he lives in a world where $1000 is something that most Americans have in their bank accounts.

                    Or Brandon wishes he lives in that world…

                    Brandon, do you think that insurance companies have the right to maximize profit, even if that means that they cease to be insurance companies?

                    Brandon, What are your feelings about MetLife not passing the governments stress test — for banks? what if GM or GE failed that test?

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                    • Brandon thinks he lives in a world where $1000 is something that most Americans have in their bank accounts.

                      First of all, unless one is close to abject poverty (or a severely imprudent spender), $1000 shouldnt be too difficult for most people to have in their bank accounts.

                      Secondly, you dont need $1000 of spending money at any one time. Given that the higher end contraception is going to cost $1000 a year, that should amount to about $2.60 a day or $84 a month. I think $84/month is manageable by al but the very poorest.

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                    • Murali,

                      thanks for answering this.

                      Brandon and I were talking about more than birth control pills, however.

                      And it is apparent that 66% of Americans are either severely imprudent spenders or close to abject poverty.

                      It’s a chilling thought, isn’t it?

                      I think that is one of the better “rock a person back on their heels” charges against libertarians in general, actually.

                      Not having $1000 in the bank account is indicative of people who cannot afford $84 extra dollars a month — all their money is currently being spent. if you want, i can find more sources.

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                • Annual exams are precisely the kinds of things which are not insurable events. Insulin, high blood pressure and cholesterol are insurable if you insure before you get diabetes or heart disease, but become uninsurable once you already get the conditions. i.e. it is developing heart disease or diabtes itself which is the insurable event.

                  Getting health insurance for annual checkups is a lot like using car insurance for regular servicing.

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                  • That’s not entirely accurate to actual health insurance markets because the reason they pay for them is not because they’re insurable events. It’s because they’re obligated to insure the customers and obligated to pay for their major medical expenses. There’s an actuarial decision to be made on how badly you can get hurt when the folks that elect not to do their maintenance end up needing much costlier covered expenses later – so you’re better off encouraging maintenance.

                    Now, for autos since everyone is on a state-mandated but individual market, insurance companies probably just refuse to cover any damage to your car if you destroy your engine by never getting the oil changed. Health insurance is pretty different – insurance companies can’t deny your claim for coverage because you didn’t get a checkup – they’re paying no matter what short of fraud. That changes the incentives pretty dramatically regarding routine and maintenance care.

                     

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                    • Ok, where I live auto insurance is different. It’s not mandated and your premium goes up whenever you have an accident and even more when you are found to be at fault. Health insurance only covers catastrophic care.

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                  • Brandon, do you think that insurance companies have the right to maximize profit, even if that means that they cease to be insurance companies?

                    Brandon, What are your feelings about MetLife not passing the governments stress test — for banks? what if GM or GE failed that test?

                    you on his side, you get de same questions.

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                    • Brandon, do you think that insurance companies have the right to maximize profit, even if that means that they cease to be insurance companies?

                      How would that even happen? What do you mean that they cease to be insurance companies?

                      What are your feelings about MetLife not passing the governments stress test — for banks? what if GM or GE failed that test?

                      Can you elaborate? Some insurance comppany did not pass the government’s stress test for banks? What was this stress test and why is this even relevant to the discussion?

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                    • They would cease to be insurance companies by using other methods to create money other than providing insurance. Say, whatever you want to call “bundling together health care” or “providing a stock account with guaranteed income.” [both real life american examples]

                      MetLife is so much out of the insurance industry (term life insurance) and into things like “whole life insurance” (stock account! guaranteed income!) that the Feds feel they need to treat it like a bank.

                      I’m merely noting that many corporations, despite what they claim to be, actually make their money off other lines of business. GM made all its money off of being a lender for car loans (GMAC). It got froze when the government froze all shorting on financial corporations. GM (general motors) is supposed to make cars, ya know?

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                    • The mere fact that many corporations make their money in avenues that lie outside the purvew of their stated purpose is troubling in the sense that it might be symptomatic of something more deeplly wrong with the system. I’m not sure that there is anything wrong with it in and of itself. Of course, there could also be more benign explanations for the phenomena.

                      However, normally, I would expect each branch of a company to be profitable in its own right. Using the profits of one division to cover the losses of another doesnt seem like a sound business practice to me. And there is nothing wrong per se with diversification.

                      But do they have the right? Yeah sure they do. (at least with respect to the kinds of examples you brought up)

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              • It’s a forced subsidy.

                It’s a (forced) socialization of cost. Which is the whole point of insurance, even private insurance free from government regulation. Your argument here doesn’t appear to be that costs of specific benefits are socialized (and therefore subsidized by others in the pool), it’s that oral contraception is elective. Is that right?

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                • I wasn’t aware that you were any kind of woman.

                  That’s the problem with the “The misogyny! It’s everywhere!” school of feminism. It’s self-confirming, even in the absence of any actual evidence.

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                  • except that it’s not, in this case. It’s not like she’s accusing you of waving a cigar in her face being a form of imposing your male sexuality on her (because penis == cigar).

                    There’s a very real sense of “women being more emotional” and men being allowed to be angry where women are not.

                    If you were using the same terminology on a gay male, it would also be fair game to play the mysogyny card, to the extent that we associate gay men with femininity (which, as a culture, we somewhat do. other cultures play with homosexuality differently.)

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                • Style Points: all caps is considered shouting (but you knew that). as such, it creates emphasis. An entire post that is nearly all shouting is bad form, as you are diluting the emphasis.

                  I use all caps all the time, but for single words, or a part of a post.

                  He’s well within standard etiquette to read your overemphasis as you being slightly too irate.

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    • I understand your point, but I am not sure why this matters.

      If an employer’s sincerely-held religious beliefs are that suffering during menstruation is God’s punishment on women for Eve’s sins, so that using the Pill to reduce that suffering is wrong, why should the employer be required to pay for it, any more than the Catholic Church should be required to pay for contraceptives?

      This is still being discussed because many people think contraceptives are for slutty sluts who slut and therefore we mustn’t violate religious freedom. Period.

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  15. Forgot to add my point: Most health insurance providers aren’t in the business of providing health care, anymore than coal mine operators are in the business of providing a safe and comfortable working environment.

    They’re in the business of making money. And like coal mine operators can make far more money if they cut things like “Safety”, health insurance companies can make far more if they reflexively tell you “no” whenever you actually try to, you know, get them to pony up.

    They want your premiums, not your claims.

    Hence…regulation. Health care is notoriously ineleastic, impossible to predict individual costs, and relies heavily on expert advice. It’s not exactly the sort of situation in which the inivislble hand works wonders. Quite the opposite, in fact.

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    • They want your premiums, not your claims.

      Exactly right. And well said.  My wife has an almost infinite list of experiences like what your dad went thru. My favorite, tho, is a call where she finally got a manager at a company who repeatedly denied payment for an otherwise uncontroversial procedure to own up to the shenanigans. After taking some abuse his response was that the company’s internal protocols required his staff to reject the claim three times – independently of a review of necessity – before agreeing to it. Which they were now – fourth time’s the charm! – happy to do!

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    • Forgot to add my point: Most health insurance providers aren’t in the business of providing health care, anymore than coal mine operators are in the business of providing a safe and comfortable working environment.

      That’s a cute trick, but you can play this game with anything. Governments aren’t in the business of providing good government–they’re in the business of getting reelected. Teachers aren’t in the business of providing education–they’re in the business of cashing paychecks. Husbands aren’t in the business of By this logic, nothing ever works.

      And there are all kinds of horror stories of people waiting months or years for CAT scans or elective procedures in countries with socialized health care. It’s unlikely that getting your father the treatment he wanted would have been a particulaly high priority for a government-run health care system.

      By the way, why didn’t you just name the insurance company? Reputational deterrents don’t work if people don’t talk.

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  16. Late to the party, Nob and Ryan have expressed my thoughts exactly.

    My question for you, Murali, is if pragmatic approaches are acceptable in a case like this? Assuming that a real public health option is clearly the optimal policy, what are liberals to endorse once they find themselves dealing with a political reality where the optimal policy is not possible? For better or for worse, the American political consensus is to give health care transactions significant tax and policy preferences when related to a certain type of employment arrangement – to the point that it is very expensive and/or difficult to enter the market without being tied to such arrangements. Is it only acceptable for liberals to forsake improving the status quo only? Is it always wrong to seek accommodation that ameliorates some negative aspects of the sub-optimal consensus?

    How does your preference for granting not-for-profits with church funding exemptions improve the lot of the worst off?

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  17. So, following Nob’s post, if someone could clarify: Is this whole debate about requiring businesses to provide health insurance that covers a basket of specific goods (contraception included), or is it about only treating business health-care plans as tax-deductible if they include said basket of goods?

    Because those are two VERY different things.

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    • It’s not about tax deductibility  (after all, the businesses in question are tax-exempt not-for-profit).  Businesses who don’t provide insurance have to pay a fee (unless they meet certain other requirements).  Businesses who don’t provide full coverage for preventative medicine don’t qualify as insurance under the law–and perscription birth control counts as preventative medicine.

      I understand it’s gotten messier with the new “churches won’t pay, insurance companies will” compromise–just as the whole mess was caused by a “government won’t provide insurance, employers will” compromise.

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        • Good Point.  Presumably the non-covering insurance plans would count as taxable income for the purposes of social security witholding.  But the bulk of the cost would be related to the fees, yeah?

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            • I think the tax is imposed to make it prohibitive to deny coverage, and that’s all. If there was no penalty in denying coverage and it was cost effective to do so, an employer (rationally) would. That is, if the employer could do all of the following: a) not provide coverage, b) not make up the difference in wage increases, and c) not have to pay a fine for doing so, they would. Or if they could deny continuance of existing coverage, not return that compensation to employees as a wage increase, and not pay a fine, they would do so. So the tax acts as an incentive to play the game, not necessarily to pick up the financial slack of those on the exchanges.

              Of course, I could be entirely wrong about all this.

               

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              • The fine will eventually be $2000 per year per employee. At my job, I receive the monies that would have gone towards my insurance if I am insured elsewhere. Since I am coverd through my wife, I gross an extra $6000/year. My employer would save money if they offered no insurance and just paid the fines. Of course, they’d be at a competitive disadvantage when it came to hiring folks, especially those who do need coverage.

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                • My employer would save money if they offered no insurance and just paid the fines.

                  Yes, but could they do that? I mean, people would want the compensation from healthcare returned in wages, no? And that would be total cost if employer contribution plus fine. So there’s an incentive for businesses to maintain the employer-provided-insurance structure. Or is that wrong?

                  Like I said, I could be wrong about what I wrote, but it seems to me that the penalty is designed to entrench the existing structures and compel employers to provide insurance, rather than supplement those on the exchanges.

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                  • Well, it depends. They would have no obligation to pay that money in salary. They might raise wages… They might not. Depends on what the employment market looks like, among other factors. As a teacher, my being healthy is of great import to the school. Every day I’m sick costs at least $100 out-of-pocket for them for a sub.

                    But I am sure there are industries where supply/demand of labor favor an employer enough that they could easily get away with cutting coverage, paying a fine, pocketing the difference, and staying fully staffed.

                    Part of me wonders if that was a but of subterfuge… Enough businesses stop offering coverage that they do not suffer a competitive hiring disadvantage and single payer or public option become absolutely necessary. Hmmmmm… Maybe that Obama guy does know what he’s doing…

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                    • One seeds don’t get to feel too good about going to the Sweet Sixteen, Still.  Hell, four seeds like Bucky barely do (though Vandy is pretty darn tough out at a five, so I actually do feel pretty good about yesterday).

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                    • …If Purdue can get this done against KU (up 4 with 4:00 left), that would be something for us B1G folks to feel good about.  Five out of a record seven teams in the field to the Sweet Sixteen?  Awesome!  Let’s go Boilermakers?  (Is there a catchier nickname for their nickname?)

                      (Update: KU takes the lead by 1 at 3:02…)

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                    • That was a pathetic last four possessions by Purdue, yikes.  One basket or foul, and it’s probably game.  But they didn’t seem to be able to run a basic offensive set all of a sudden.  I pin that on Matt Painter.  Couldn’t get them to calm down and execute the fundamentals.

                      It’s going to be awesome to hear the national morons talking about KU’s great comeback, and how of course they won – it’s Kansas, fergodssake.  They did everything they needed to do to lose that game and Purdue did everything they needed to do to win it, except simple execution in the last 90 seconds.

                      Nevertheless: great first two rounds, Big Ten!  Let’s annoy everyone in New York and get a couple schools in the F4!  Hell, let’s make it three!

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            • After having done some pretty inconclusive research into the issue, I agree with Nob’s take on the purpose of the fine. It may have some utility in compelling employers to continue offering insurance (as I said earlier), but from what I can gather the primary purpose of the fine is to offset the government subsidy in situations where an employer doesn’t offer newly issued insurance to employees who’s income is low enough to qualify for subsidies. The two things may be working in tandem, but the more explicit purpose of the fine is to offset the government subsidy.

               

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              • To be fair there’s an element to the assessment that’s made to discourage dropping people, in that companies that already offer health insurance are given a harsher assessment of $3000/person rather than $2000 for those that don’t offer it at all. (There’s a couple things working in tandem here, by the by…but on the whole it actually looks like the long-term goal is to get companies to stop offering health insurance, and instead just get people onto the exchanges.)

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      • The point, for me, is that there’s an obvious “out” for employers who don’t want to provide contraception coverage for religious reasons.  It’s not an absolute requirement, they just have to pay more if they don’t do it.  Which changes my views on the situation a lot and seems to invalidate the religious freedom argument, since the government is not forcing religious hospitals etc. to do anything contrary to their religion.

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  18. I genuinely wish I had more time to invest on this thread and its comments. It is unquestionably to my own detriment that I don’t.

    But if I may be so bold as to speak for those who, like me, don’t have a lot of spare time to parse through all the substantive arguments much less all the navel-gazing that surrounds this issue. I’ll simply offer this:

    When men have a biological and physiological role to play in conception, gestation, and birth beyond ejaculation, then I’ll be happy to entertain their everso laboriously deep waxings on birth control, womens health and any legislation thereof.

    Meantime, I have a daughter. In college. Who, just like her mom, suffers from a debilitating menstrual cycle and …  [gasp!] engages in sex with her longtime boyfriend. Because I care about the healthcare options that are available to her, I not only prefer but insist that she be able to conveniently and affordably access cutting-edge, hormonal birth control. Through her Dr. or her local PP, I don’t really care. I just want it to be there for her. Available and affordable. Free is super good. Frankly, I’ve yet to see a compelling, substantive argument against Free,

    Republicans–at least those in/running for office who affect public policy–seem to largely disagree with me.

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    • I would assume your daughter’s health would also be adversely effected without regular access to food.  Which I also like to see available and affordable, but not convinced it needs to be free.

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      • Copied from above since you opted not to respond to it there…

        “You know we DO pay for food for people who can’t afford it, right? And subsidize much food production to ensure it is affordable?”

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        • Because ‘Government Cheese’ is virtually a synonym for ‘quality’*.  And there’s no downside to ag subsidies.   And it doesn’t seem to me that Ms. Ward nor her daughter would actually have a problem affording the medications they need, both based on her post and that I stipulated that I would like to see it available and affordable.

          *given what one often sees when the government provides ‘free’ food, housing, medical care, etc, I would be leery of taking ‘Public Birth Control Pills’** myself if I were to need them.

          **which to be clear, in the main, is not what most of this last month’s debate is about, but both you and Ms. Ward*** are arguing about this facet

          ***though it’s not clear in Ms. Ward’s case.  And likely, if it’s always been a aspect of Student Health Services to offer Free whatevers, it does seem like there’s no compelling substantive argument for arguing against it.  It certainly not going to save any more money than deferring the  remodeling of the Dean’s residence, or whatever particular boondoggle is ongoing at her daughter’s school.

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          • I’ve no idea what you guys are arguing about, and I’m juggling too many balls at the moment to scroll through 133 (and counting) comments to try and figure it out.

            There is no hormonal, Rx contraception offered free through my daughter’s State school. (ISU, if it matters to your argument.) Typically, an Rx for BC pills (or NuvaRing or any other hormone-based contraception) requires a bi-annual visit to the OB/GYN for all manner of good reason.

            Kolohe, last I checked there was no necessity for a Dr.’s visit to EAT, so please stop with this silly comparison of BC and food.

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            • Dr. Saunders good arguments nothwithstanding, I’m still an orthodox enough of a libertarian to believe that you shouldn’t need to get a doctor’s permission to get birth control either.  And enough of an empiricist to believe everyone and anyone should see some kind of trained medical practitioner at least once a year to make sure all the pieces and parts are working.  (but not to make it mandatory like is required for cars in many states).

              I’m just curious where do we draw the lines when creating the basket of free stuff for middle class and up people?  Though the advantage of keeping something free for everyone is that one eliminates the perverse incentives when one means tests on the basis of income and/or assets. (and less demagoguery and more political support, as any advocate against means testing SS and Medicare will tell you)

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              • While at the doctor’s on Friday, the television in the waiting room was set to some Daytime Television channel. The commercial that I couldn’t help but notice was a commercial for people who wanted to sue the company that made (maybe still makes?) Yaz and Yasmin.

                I wonder what future birth control pills might have similarly awful side effects and what it might mean if provision of these pills are mandated.

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                  • Allow me to rephrase.

                    I’m doing research into how many birth control products have been recalled and, of course, I’m not finding out any hard and fast information.

                    I *DO* know, however, that certain IUDs have been taken off of the market, Norplant has been taken off of the market, and any number of pills have been taken off of the market and all of these have been due to major flaws/side effects.

                    If we were in 1995 and I asked you if you thought that Norplant ought to be covered by insurance, what would you have answered? If we were in 2007 and I asked about Yaz, what would you have answered?

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              • I’m still an orthodox enough of a libertarian to believe that you shouldn’t need to get a doctor’s permission to get birth control either.

                Even after it’s been explained, over and over, that there is no such thing as “birth control”? That there are several options, each with its own pros and cons, that might need explaining or other help in deciding which one works best for a particular patient?

                That seems a bit odd to me.

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        • Because, like I said, there are plenty of other human necessities, like food and water, that even if they are offered via vigorous government supports, even they are offered as a public (and publicly owned) utility, are not, in the main, offered ‘free’ to end users.

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          • So, you’d be OK with socializing the costs of contraception in the form of general funds that go towards overall human health, like insurance premiums or a government imposed tax?

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              • That is eccentric. Tho maybe not – I think JB is also an advocate of single payer over the PPACA.

                But the reason I asked is because I’m sorta-maybe-probably inclined to think that free contraception is actually a pretty good policy, given the cost/benefit wrt liberty issues. Of course, a strictly libertarian position might say that there are no free lunches, but I think the increase in individual liberties flowing from open access to contraception is a pretty compelling argument.

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                    • Does it? More importantly, does it for an acceptable price?

                      I mean, I’d pay 75 cents for a candy bar. I would not pay five bucks for a candy bar. If someone gave me a candy bar and told me that it was five bucks, having it pointed out to me that I was more than happy to pay 75 cents for one would be beside the point, wouldn’t it? Or worse, being told beforehand that the candy bar would be 75 cents, but after the fact that it’d be five bucks.

                      And if there was a history of, for lack of a better term, price-gouging on the part of my candy bar distribution associate, does that change the dynamic?

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                    • I’m not sure this is a good analogy. Where’s the price gouging by government in this case? Government, if anything, is working against the price gougers. I think it’s important to remember that this government has a vested interest in seeing Medicare and Medicaid sustained as general policies.

                       

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                    • I’m just remembering how the CBO scored it to get it to pass… and what the CBO *NOW* says that it will cost.

                      When it passed, it had *THIS* price tag. Now we find that it has *THAT* one.

                      Would “bait and switch” be a more appropriate phrasing?

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                    • “The CBO, in an update to its budget outlook, now estimates that the overall coverage cost of Obama’s Affordable Care Act will drop slightly, to $1.083 trillion over the next decade. Last year, the CBO estimated the price tag to be $1.131 trillion over the same period of time.”
                      http://www.huffingtonpost.com/2012/03/15/health-care-reform_n_1347327.html

                      The initial report that costs would be roughly double what they were initially projected to be was wrong.

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                    • Christ, that Sparty juice is making me see things all kinda strange. I thought the initial CBO siad it’d reduce the deficit.

                      But at least that’s confirmation in the direction I was hoping for. Now, if Creighton can just start drinkin and Believe…

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                    • Radio personalities claim the total costs doubled… Which was a brief but popular meme for a few hours until the fuller picture came out.

                      Reading the actual report, it seems that expenses were up slightly, but so was incoming money, so the net effect was positive (good). I am not savy enough to know the deficit impact.

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                    • I thought the CBO scored it as a deficit reducing bill since it lowered total Medicare costs. That the total cost is more that we currently expend isn’t a surprise. So the devil is in determining how much costs would have gone up under that status quo vs. the ACA.

                      I think on that score, the CBO determined that the ACA reduces government commitments over the timeline. And now it appears it’s even more than was initially proposed.

                      Of course the Sparty-aid might be affecting my judgment.

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                    • Did those estimates include 2009-2014?

                      Because if we’re just talking about the cost over a decade of the program from 2009-2018, I’d like to say that that people who say that we should measure from, oh, 2014-2023 may have a point if they started talking about how much the PPACA would “really” cost. Compared to 2009-2018, that is.

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                    • JB-

                      I don’t know how to answer that question. The first link has a link to the report itself. From a few analyses I read, the meme being pushed by both members of Congress and media members that the costs doubled was either ignorant at best or deceptive at worst. I’m willing to give media folks a bit of a pass, but Congressmen and women ought know how to read a CBO report.

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                    • I’d like to say that that people who say that we should measure from, oh, 2014-2023 may have a point if they started talking about how much the PPACA would “really” cost. Compared to 2009-2018, that is.

                      JB, you’re going to have to do some work to flesh this out, it seems to me, since you’re very intelligent and I can’t understand what you mean here.

                      The fact is the ACA reduces costs over the timeline. If you want to say ‘what timeline is that?’ then you have to show how there’s hidden, temporary savings included in the scoring/data which otherwise won’t persist past a certain point.

                      But you have to be cognizant of one thing here, which is hard for both conservatives as well as non-partisan libertarians to remember: that Obama and the Dems are very interested  in seeing Medicare sustained as a governmental policy, and the ACA was leg. was shaped in part (and a not insubstantial part!) to preserve Medicare. And the goal was to reduce the exponential year-over-year increase provider costs. The ACA actually acts as a restraint on this.

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                    • From what I recall, the PPACA was originally sold as “only costing X dollars over the next 10 years”. This is why it was okay to pass it for the fiscal conservative types in the audience. From what I recall, “over the next 10 years” included a handful of years where nothing happened yet. As such, counting those years gave a mistaken estimate of the actual, eventual, cost of the PPACA.

                      If it turns out the actual, eventual, cost of the PPACA is lower than the CBO originally estimated, that’s awesome. Good for all of us.

                      It still feels baity/switchy.

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                    • What I read addresses that directly, with the CBO saying later periods will see higher costs because they will include fewer or none of the phase in years. This was known, since the incremental phase in was a known part of the bill from the get go.

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                    • “Once everything is factored in, CBO has estimated that the law would reduce the federal deficit by $210 billion over the 2012-2021 period (see Table 1, page 2). CBO did not update that overall figure in its latest report.”
                      From the FactCheck link. They note that GOP criticisms of earlier time frame quotes were legitimate for the reasons cited, but there was nothing misleading about offering different estimates for different periods based on implementation. And they still maintain reduced deficit. Win-win-win.

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                    • And now the costs have been re-projected and they’re lower than originally projected (but, granted, higher than some, mistaken, interpretations of the CBO score… mistaken interpretations that were usefully mistaken, I might add) and in addition to the price tag which has surprised some, we’re now discussing a contraception mandate that, some say, violates some freedom of conscience issues.

                      Surely none of us should be surprised by those either.

                      I’m wondering what we shouldn’t be surprised by next time.

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                    • But now you’re just falling back on the ‘some people will complain’ stance. Initially, you said that the CBO scoring was a bait and switch. Then you said that it still increased total government costs. Now your reduced to saying that some people in the electorate disagree with it anyway and we shouldn’t be surprised by that.

                      What’s the argument here?

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                    • My argument here is pretty much that the misunderstanding of the pricing very much helped to pass the bill (they wanted a number under 1 trillion, if I recall correctly) and the bill passed.

                      Now this misunderstanding being pointed out is… what? Dishonest on the part of the people who remember the “under 1 trillion” argument?

                      I’m one of the folks who noticed that there were a handful of years not being scored at the time… it was one of the arguments against the plan that I thought should have been paid more attention to at the time. Now we’ve got people comparing the future projection to the original project made to help pass the bill at the time… which is… what? Dishonest on their part?

                      It is nice that the future projection is better than the previous future projection, though.

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      • Excellent rebuttal, Aaron.  And I’m pleased to see that the majority of American women respect the religious freedom argument, contrary to the first blush of widely-reported polling.  [A plurality even in favor of a religious exemption for ALL employers!]  All is not yet lost.

        Gerson in the WaPo:

        “In coverage of its own recent poll, the New York Times conceded that the views of women on this topic are “split.” By a plurality of 46 percent to 44 percent, women believe that employers should be able to “opt out” of providing birth-control coverage for religious reasons. But opinion is not really “split” on the question of whether “religiously affiliated employers, such as a hospital and university” should be able to opt out of offering coverage. Women support this proposition by 53 percent to 38 percent.”

        How is this possible? Americans overwhelmingly endorse contraception and regularly practice what they preach. Most believe — myself included — that child spacing and preventing the spread of sexually transmitted diseases are public goods. Why not impose this social consensus on all private institutions?

        The answer depends on your view, not of contraception, but of pluralism and religious freedom.

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        • Tom-

          Your (over?)reliance on polls is curious.

          First, as I’m sure you know, popular support days little about the appropriateness or morality of most legislation.
          Second, you often draw conclusions that cannot be substantiated base on the data provided. As I have pointed out several times before, a slight majority in favor of institutions affiliated with the most popular faith in our nation in opposition to a wildly divisive piece of legislation that has been turned into another battle in the ongoing “culture wars” hardly demonstrates conclusively “that the majority of American women respect the religious freedom argument”. Simply put, we need a hell of a lot more data before such proclimations can be seriously considered. I hope you are able to better substantiate them.

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          • Tell Gerson and the New York Times to go stuff their poll then, BSK, and leave me out of it.  I’ve had enough of your harassment, thank you.  If you reject the poll as inconclusive, that’s fine.  That’s your lookout and has nothing to do with me.  I’m encouraged by what appears to be support for the religious liberty component of this controversy being the primary issue.

             

            I certainly believe it is; whether the cost of contraception should be “socialized” by Obaman mandate, I leave up to our resident libertarians, what few remain.  I think it’s ridiculous because it’s elective, and the mandate is outside of the enumerated constitutional powers, to determine the content of contracts between individual parties.  On the other hand, we “socialize” so many other costs that this barely moves my meter.

             

             

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        • By a plurality of 46 percent to 44 percent, women believe that employers should be able to “opt out” of providing birth-control coverage for religious reasons. But opinion is not really “split” on the question of whether “religiously affiliated employers, such as a hospital and university” should be able to opt out of offering coverage. Women support this proposition by 53 percent to 38 percent.”

          But, as Nob noted above, religiously-affiliated employers (or any employers) CAN “opt out”.  It will just cost them more money.  That’s an actual business decision they’re free to make.  Given that I didn’t understand that fact until today, I expect that most of the people polled also didn’t.

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          • Perhaps, Katherine, but the “fine” will put them into civil disobedience territory, because they’re not going to pay any fine, not 5 bucks.  Will they arrest the bishops?  Seize church property?

            I suppose we can wave away this poll, it’s only one poll.  But this thing isn’t going away.  Me, I think most people don’t realize just what a serious breach of the Constitution and American pluralism this really is, and will get more outraged, not less, the more they learn about it.

            This  will not stand.

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            • Why shouldn’t they pay it?  They have two options – they can offer their employees a full package of health-care coverage (including contraception), or they can choose not to and pay the ‘fine’ to the government to compensate for the resulting need for the government to cover their employees.  The latter option doesn’t violate their religious beliefs, any more than paying taxes to the government does.

              As they’re not being forced to violate their beliefs, this isn’t a religious liberty issue.

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              • I’ll grant that. Nob’s explanation sort of shifted things around in my mind a bit as well.
                Depending on how these taxes or fines are assessed, it might be better for the churches to drop insurance coverage altogether and raise wages to compensate.
                I really think the unions are going to have to drastically reduce their coverage.
                The odd thing is that this sort of thing was to target Wal-Mart’s de facto wage subsidies.
                Always unintended consequences.

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                • It’s $2000 per employee past the first 30 IF any of them are eligible for premium supports on the exchange. (Which I’m sorry, I was mistaken, is actually 138% – 400% of federal poverty level. Note that medicaid recipients do NOT count towards this)

                  So an institution with 400 employees would be assessed: $2000 x 370 per year for not offering health care coverage. Assuming of course that any of its employees are actually on the exchange. If they are NOT eligible for premium supports (e.g. a law firm where everyone makes 400%+ of the poverty line) then they don’t have to pay an assessment.

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    • I not only prefer but insist that she be able to conveniently and affordably access cutting-edge, hormonal birth control

      The thing is insisting that everyone get the cutting edge stuff just drives up premiums. I would make this objection regardless of whether the medication was for heart disease or birth control pills. How would a compromise where the safety net provided access to something less than the cutting edge stuff at affordable rates look to you?

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      • I’m one of those that support capping payouts for prescription coverage. I think it’s necessary to get entitlement spending under control. I think $2000/yr is a reasonable amount.
        I wrote a post about the Rush/Fluke thing on my own blog, not so much to address the underlying issues, but to note the ready-made manufactured offense/outrage media machine. (Note that when it’s the church at issue, “contraceptive care” becomes a matter of rights; when it is private employers who may or may not offer that same care, no on gets excited about it.) Most of my readership is international; Australia, Canada, Netherlands, etc.
        One Australian fellow left a comment stating that:

        In December 1972 the government removed the sales tax impost on all contraceptives, (which was then 27.5%) and added the pill to the Pharmaceutical Benefits Schedule, which meant the cost was heavily subsidized and easily affordable.

        But today most pay the full amount from their own pocket since the Pharmaceutical Benefits Scheme has failed to keep up with the increased cost of the new age contraceptives. These enhanced brands cost about A$300 a year which have less side effects such as fluid retention. But if its covered under the Pharmaceutical Benefits Scheme you wont pay much at all. Not so much of an issue these days.

        Which got me to wondering…
        If the Australians are able to deliver this medication to their people for roughly $275/yr USD, why is it costing people $1000/yr here?

        There are a lot of things that would qualify as premium care that Medicare & Medicaid cover that we’re going to need to do away with. It’s not that those people don’t need that medication, but they can get by with something less.
        If you want to see what medical care is required under law, take a look at prisoners. That’s the basic level of medical care that people have a right to.

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        • If the Australians are able to deliver this medication to their people for roughly $275/yr USD, why is it costing people $1000/yr here?

          Because it’s not costing $1000/yr in the US: that was the exaggeration from Sandra Fluke that started this whole bloody mess. And which once again proves our problems remain epistemological: we can’t even find clarity on something that happened last week, on full public record.  [And after sorting it out a half-dozen times hereabouts, damned if I’ll even try again.]

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          • As has been pointed out repeatedly $1000 is not a wild exaggeration at all. Your facts are off Tom. There are numerous places that have cited $75-90 per month as a cost for BC. Even if we used a lower figure of $50 p/m that would $600 per year. Does that somehow make the issues she raised less pertinent: No. Your trying to avoid the issues.

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              • Here are two quick links. It can cost that much. Does it in every case, no of course not. I don’t believe Fluke said it costs a grand in every case. In any case if the cost is only $800 per year that doesn’t actually address any of the issues she raised. Tom’s poking at the alleged exaggeration is just him being slippery it seems.

                http://yourlife.usatoday.com/health/story/2012-03-09/Birth-control-prices-range-widley-from-100-to-1000/53434126/1

                http://theweek.com/article/index/225451/the-cost-of-birth-control-by-the-numbers

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                • Thanks for the link, Greg. It seems to me that Fluke’s estimate wasn’t wrong insofar as it can cost that much, though to suggest that such is typical seems to be a stretch. Even $800 is going to be infrequent and is typically not required if someone can take the pill. Of course, some people can’t take the pill. And people who are prone to error shouldn’t be.

                  The question is, to what extent should be consider the non-cheap versions to be a luxury? On the one hand, generic pills are going to cause problems for some people. And the NuvaRing is more reliable and an IUD more reliable still. This does cause a distortion, though, because who in their right mind would take the cheaper option when the more expensive option is just as free? My wife and I had to make a decision to use a more expensive form of birth control and we had to pay significantly for it. But for reliability we needed to (residency is not conducive to fastidious pill-taking). With this, you simply go with the expensive option just because you can and it’s easier. But it does drive up costs (at least initial ones).

                  On the other hand, of course, society has an interest in helping people who want to prevent pregnancy do so. Further, something like an IUD is expensive up-front but a money-saver in the long run (the price tag from the first article involves the upfront costs of an IUD. Spread out over ten years, it’s actually one of the cheapest options available. Helping women get that would definitely be worth our while. Higher rates of compliance with vaginal rings or patches could also be worth our while, but it doesn’t represent the cost savings because it’s as monthly as a prescription for the pill is.

                  So at least a part of the question of “How much does birth control cost?” depends on how we define birth control, what we believe women are entitled to have paid for, and the financial calculations on whether increased costs for something like a vaginal ring stack up against lower compliance rates with the pill.

                  (So much for my trying not to talk about contraception. Sigh.)

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                  • That is all fair enough Will. It does seem odd we don’t have these kind of discussions about the costs of heart meds or diabetes meds. Yeah costs are discussed in general but nobody is getting into the weeds of how much different kids of diabetes treatments costs. Or maybe its not odd at all.

                     

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                    • Would you say that the silence is deafening?

                      (For the record, I have mentioned coverage Avastin before. Also that little blue pill whose name I don’t want to put into a comment. (This is where someone with more wit than I would put a comment questioning whether you specifically didn’t mention this because you didn’t remember or because you were trying to cover it up.))

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                    • Insurance companies do charge more for generics vs non-generics when it comes to drugs. Concern about this is instigated not by the fact that birth control is finally being treated like any other drug, but because the new law says that it is not to be treated like any other drug. It is to be free, regardless of what prescription-solution is used (OTC solutions still cost). When it comes to things other than drugs, different forms of treatment are very much treated differently.

                      By way of example, my wife has a condition that means that there is only one prescription nose spray that she can safely use. Insurance doesn’t want to kick in, because there are these other nose sprays that are a lot cheaper (I’m not sure what the non-insurance cost is, but with insurance it’s $115 for 30 shots). So then my wife had to turn around and get her doctor to say “No, she has to take this one.” We had to go ahead and pay the $115 because we couldn’t wait, however. We’re hoping they get it sorted out before she needs it again, if she does.

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                    • Will-
                      To clarify my position, I don’t think that all BC should be free, only that it be treated in the same way that other medically nevessary drugs are. If there are medically necessary drugs that insurance will not cover, that is a problem.

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                    • BSK, in our case, they’re supposed to cover it when it’s demonstrated that the cheaper alternatives are not right for the patient. I use the example mostly to illustrate that insurance companies very much do discriminate on the basis of cost and necessity. They didn’t want that particular treatment because they thought that there were less expensive alternatives available. They were wrong about that, but unless that more expensive one is needed, I think that they are right to direct us to the thing that will save money.

                      Another example is a medication I took several years back. Option 1 was generic but had to be taken twice a day. Option 2 was brand and needed to only be taken once. Because of the differential between generics and brand-name, I went with Option 1.

                      I can actually go either way with whether birth control should be free. I’m just demonstrating the potential hazard of offering something for the same price (in this case $0) that costs very different amounts of money to provide for. It may be worth it to do it anyway, but we should recognize that this would make BC comparatively unusual, as far as drugs and treatments go, and that I am not selectively expressing concern in this instance due to it involving women, reproduction, and sex.

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                  • Why don’t we trust doctors to prescribe the right BC for each woman*? Then those who need the more expensive ones get it and those who don’t won’t. And it is wrong to equate more expensive with better. They are simply different. For some women, a cheap generic is a better option than an expensive namebrand. The idea that a woman will insist on the pricey one because, well, gosh, honey, live it up… It’s not YOUR money… That isn’t how it works. Not with BC and, as gregniak pointed out, not with mst other drugs.

                    * I realize there are some perverse incentives in the game that make it harder to trust doctors en masse, but surely there are better ways to correct for those then limiting patient options. Maybe the good doctor Russ can weigh in…

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                    • BSK, because often, there is more than one that will work just fine if taken as directed. I don’t think that women will take NuvaRing just because it’s more expensive. I think they’ll take it because it’s far more convenient. The only reason not to take NuvaRing is because it costs substantially more. Except if it doesn’t because it’s all free (to them).

                      I’m not treating women as some alien species here. This is exactly what I would do in their shoes. These are discussions my wife and I have actually had: “What does Option A cost? What does Option B cost?”

                      And, as I say, maybe we want to pay more when the result is higher compliance rates. But that’s different than suggesting that it won’t affect the decision-making process in a way that will encourage women to go with the more expensive option.

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                    • As I said above, I don’t think it should necessarily free… Just treat BC like all other medically necessary drugs.

                      The real problem is coupling insurance with employment. If we could shop fpr insurance, you could pick the one that covered your wife’s nasal spray and a woman could pay a hither premium and/or copay to have the convenience of Nuva or less and stay on a pill regiment.

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              • Birth control costs $90 a month the same way that an SUV costs $100,000.

                “But that’s the price for a Mercedes-Benz G-class SUV.”

                Why are you denying my access to SUV’s?  You just hate travel and hate people who drive!  This is part of the American War On Drivers!

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  19. I should also say that I see the Church losing this argument for the most part. They *MIGHT* be able to get an exemption for people who work for a church… but not for the church-owned hospitals or universities. I really don’t see there being a grandfather clause or an exemption or anything, at the end of the day.

    The only thing that I could see, in theory, happening to change that is a Santorum election (and picking up a handful of Senate seats and a handful of House seats… essentially returning to 2002 or 2004 numbers)… and I do *NOT* see that happening.

    As such, I see Obama winning in 2012, the Republicans picking up 2, maybe 3, senate seats, losing 2, maybe 3, House seats… and the PPACA continuing unabated. Maybe the Supreme Court will say that this or that part is unconstitutional but, despite the lack of a severability clause, the law as a whole will stand.

    That’s what I see happening.

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    • Wrt the update and nob’s comments:

      Tod, I’m not sure I understand your comments around it, but Nob’s comment is a description of the situation from an accounting pov. And I think it’s a correct description. But the Religious Liberty/anti-contraception crowd is arguing from a different angle here, one that dismisses the accounting aspects of the whole thing.

      The argument seems to be this: government is intruding on existing structures (aka the status quo) by imposing a morally contentious mandate on people of faith to provide services which alter the way they’ve been doing business and in a morally contentious way. So, I agree with Nob that 501-c3 businesses run by the Church of Rome could refrain from providing contraception-covered healthcare and pay the resulting fine, but from the religious liberty advocate’s pov this alone constitutes an undue burden. Of course, this claim requires an argument – eg, that the fine (minus healthcare provision costs, of course) constitutes a restriction on free exericse of religious beliefs. Or that religious-based employers have the right to determine how employees use compensation in lieu of wages. Or something else (there always seems to be another argument for these folks.) But the point I’m making (I guess) is that these arguments exist independently of the accounting argument.

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    • I should also say that I see the Church losing this argument for the most part. They *MIGHT* be able to get an exemption for people who work for a church… but not for the church-owned hospitals or universities. I really don’t see there being a grandfather clause or an exemption or anything, at the end of the day.

      Isn’t there already a different exemption for places of worship? No one is asking the Church to pay for birth control for nuns.

      The Departments of Health and Human Services (HHS), Labor, and the Treasury(the Departments) published interim final regulations implementing section 2713 of thePHS Act on July 19, 2010 (75 FR 41726). In response to comments, the Departmentsamended the interim final regulations on August 1, 2011.4 The amendment providedHRSA with discretion to establish an exemption for group health plans established ormaintained by certain religious employers (and any group health insurance coverageprovided in connection with such plans) with respect to any contraceptive services thatthey would otherwise be required to cover consistent with the HRSA Guidelines. Theamended interim final regulations further specified that, for purposes of this exemptiononly, a religious employer is one that– (1) has the inculcation of religious values as itspurpose; (2) primarily employs persons who share its religious tenets; (3) primarilyserves persons who share its religious tenets; and (4) is a non-profit organizationdescribed in section 6033(a)(1) and section 6033(a)(3)(A)(i) or (iii) of the Code. Section6033(a)(3)(A)(i) and (iii) of the Code refers to churches, their integrated auxiliaries, and conventions or associations of churches, as well as to the exclusively religious activitiesof any religious order. This religious exemption is consistent with the policies in someStates that currently both require contraceptive coverage and provide for some type ofreligious exemption from their contraceptive coverage requirement.

      https://s3.amazonaws.com/public-inspection.federalregister.gov/2012-06689.pdf

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  20. This isn’t a religious liberty issue in the slightest. The central problem is that churches own businesses which pay their employees in part with health insurance. They would only have the right to restrict contraception in insurance if it was agreed they had the right restrict it out of salary. We’re only having this discussion because it was politically useful to brand the issue this way.

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    • That’s what I keep thinking.  I understand that having the government mandate you provide insurance that covers contraception might be problematic to one’s religious liberty, which is why I would think these institutions might be allowed to cherry pick insurance coverage (as loathe as I am to think they’d go throguh the hassle just to keep contraception from being included).  Assuming the employment market ever springs back, I’d be interested to see if there was any effect of being able to offer partial insurance coverage in their ability to attract top level employees.  Or whether they’d end up offering higher wages to make up for the lack of coverage. 

      At the same time, I’m trying to figure out exactly when another benefit, like wages, might be supervised as well to make sure that employees aren’t doing anything morally objectionable with the company dollars.  Maybe we could just go back to the days of the company store where your wages gave you credit in the comapny store to buy only things they deemed worthy of purchase.

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      • “At the same time, I’m trying to figure out exactly when another benefit, like wages, might be supervised as well to make sure that employees aren’t doing anything morally objectionable with the company dollars. Maybe we could just go back to the days of the company store where your wages gave you credit in the comapny store to buy only things they deemed worthy of purchase.”

        Tongue firmly planted in cheek, I presume?

        If the issue is that facilitation of sin through money  is also a sin in the Church’s eyes, surely paying salaries to sluts who buy their own birth control is also a sin.

        Hey, what happened to the blockquote thingy? Why doesn’t it work anymore?

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        • Yes, it was.  And I do appreciate the idea that mandating that these institutions provide insurance that includes contraception is problematic from a religious liberty issue, although I don’t think it’s quite the armageddon scenario of Obama trying to end religious freedoms, specifically against the RCC as Mr. Van Dyke seems to think.  And it does open up a bit of a Pandora’s Box to say that companies can just start opting out of whatever they want based on religious or moral objections, especially when we aren’t talking about the actual church but their public entities.

           

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    • “This isn’t a religious liberty issue in the slightest. The central problem is that churches own businesses which pay their employees in part with health insurance.”

      I just had an amusing notion of arguing that since a church pays the priest, and he hands out wine and communion wafers, that the church should be treated as a restaurant…

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