Doctor Cleveland's picture

    Birth Control Makes Catholicism Work

    The brilliant Ramona and Destor have been especially brilliant this week on the Catholic bishops' outrage at having to pay for full employee health insurance. Destor is so smart about the church and state principles involved, and Ramona so good on the women's-health issues, that I have nothing left to add but my own personal experience. I am a former employee of the Catholic Church. I used to have a health-insurance card with the Archdiocese of Boston's seal printed on it. That wasn't an experience of religious liberty. That was an employer exercising its muscle to impose on employees' religious consciences. And it involved the hypocritical pretense that the Archdiocese and its good works did not fundamentally depend on careful family planning by its employees, as every American diocese did and does.


    I was in no personal need of the contraceptive pills that my health card wouldn't get me, because I was a dude and because I had a romantic life which rendered family planning moot. But one of my co-workers explained what our health-insurance card meant for her. Prescriptions for contraceptives weren't covered, and had to be paid for out-of-pocket at the exorbitant rate reserved for the uninsured. And any doctor's appointment where contraceptives were discussed or prescribed was also not covered, even if the appointment was primarily to treat something else. (And obviously, it didn't matter why contraceptives were being prescribed. If, like many women, my co-worker needed the pill for medical reasons unrelated to family planning, then she would simply have an uninsured medical problem.) That isn't just refusing to be "forced to buy contraceptives." That is an employer using its muscle to put obstacles in its employees' way, to press its own agenda upon employees no matter their own religious beliefs. In this case, my Jewish co-worker had her employer's religious convictions forced upon her. That is not freedom of conscience.


    This is what "freedom of religion" has come to mean to today's religious right: the privilege to push your religion on others, and to play the victim when your bullying is interrupted. The official leadership of the Catholic Church has utterly failed to convince even its own followers of its position on contraception: 

    in recent polls, about 95 percent of Catholics have said they use contraceptives, and 89 percent say the decision to use them should be theirs, not the church’s,

    and another recent poll shows Catholics favoring the Obama administration's ruling by a 58-37 margin. So the "religious principle" being discussed here is a recent teaching embraced mainly by the Church's hierarchy, but not actually part of most believers' practice of the faith. But having failed to persuade rank-and-file Catholics of the Church's novel and ill-thought-out position, the leader of my Archdiocese, Bernard Cardinal Law, resorted to bullying employees with his economic power, interfering with their medical decisions because he was The Boss.


    The claim that Cardinal Law's conscience would have been violated if the organization he led had been "forced to buy contraceptives" is nonsense. The Church does not buy contraceptives, penicillin, X-rays, or any other medical good. It buys a premium for a health plan for its employees, and that plan pays for medical goods and services. But isn't that just buying contraceptives with the Cardinal's money? No. Because the premium on my health plan was not the Cardinal's money, even if his little stamp was on the card. It was my money. It was part of my pay. I had earned it, through the work specified in my contract, and what I did with the benefits I was owed was no more the Cardinal's business than what I did with my paycheck. Employees' medical decisions and religious beliefs are their own. (If I bought a hamburger on Good Friday, I wasn't forcing the Cardinal to "buy meat" against his religious beliefs. Once someone pays you, the money is yours.)  Even if the employer pays the insurer directly, that doesn't entitle it to dictate the way medical insurance was used. If it did, the Christian Science Monitor couldn't be required to provide health insurance at all.


    And let me be very blunt here. Almost all of the employees covered by the new ruling are working in the non-profit sector at non-profit salaries. They are teachers, doctors, nurses, and social workers in the Catholic Church's schools, hospitals, charities, and colleges. They are not paid unfairly, but the Church does not pay them, and could not afford to pay them, well enough that they don't need to worry about when and how they start their families. The first year I worked for the Boston Church, I was paid the princely sum of fifteen thousand dollars plus health insurance. My co-workers who had more experience and credentials than I did were paid better than that, at least, but they were still paid much less than people in similar jobs outside the Church. I didn't think my salary was unfair, considering the original skill level I brought with me, and I was happy to have the opportunity to do the work I was doing and to get better at it. But that decision was only possible for me because I was not going to be starting a family. I could not have taken that job if I were responsible for a child. If I'd had a child on the way, I would have had to look for other work. And the idea that I would "let God decide" when children would come, and in what numbers, while I was working for a salary that wouldn't cover day care, is the height of irresponsibility. Catholic schools and Catholic charities and Catholic hospitals are only economically possible because of contraception. Without family planning, they would have to close.


    The sisters and brothers who once staffed those institutions no longer exist in anything close to the numbers needed to keep them open. You cannot run a school or hospital with American nuns any more, because there aren't any. They have been replaced by lay employees who have not taken vows of poverty, and so need to be paid. The schools and hospitals stay open because those lay workers are willing to work for below-market wages. But since those educated below-market-wage professionals have also not taken vows of chastity, they have to make decisions about starting families, and about the size of their families. They cannot afford to let children come on their own schedule, in whatever numbers. They have to make the same decisions that most middle-class families make about when they can afford to have a baby, except they have to make them even more carefully. If everyone who worked for the Catholic Church in this country had the large, unplanned families the Church recommends, then the schools and hospitals and charities would not be able to pay the parents well enough to support their children. Those schools and hospitals would either go broke or lose most of their workers to more profitable jobs. This is the reality underlying the Church's good works.


    It isn't wrong; those schools and charities and hospitals need to be low-cost to serve the Church's mission. I've never been sorry I worked for them, or served the people I served while I was on the Church's payroll. But to pay people a wage which will not allow them to start a family and then make them go into their underpaid pockets for the birth-control pills that allow them to keep working for you is wrong. It is unworthy of any of the values the Church stands for. And making a grand pious show of it only makes the bishops' behavior more sinful.


    We all have choices. Where to work. What to believe. Who to follow. Why work for an institution you fundamentally disagree with?  I don't see anyone forcing anything in the diocese. If I disagree with football, I don't work for the NFL, don't buy tickets and don't put my sons in the game. Choose another path. Find another team. 

    If no one who disobeyed the "no contraceptives rule" worked for the Church, every Catholic school in this country would have to close. Go to a Catholic school, a Catholic hospital, a Catholic non-profit, and look around at the staff. Almost all of them are using family planning. How many of those people have four or more children? How many don't? Why do you think they don't? No one's rhythm is that good.

    As for fundamental disagreements, who says my disagreement is fundamental? The Church is two thousand years old. The bishops are hung up on a fifty-year-old rule that is far from the core teachings, or the traditional philosophical logic of the Church. The bishops are choosing to prioritize marginal concerns over central ones. And worse, they're deliberately turning a blind eye to the ways they have come to depend on that rule being disobeyed.

    Nancy, are you in fundamental agreemt with the church on every single issue? For example, if you were to discover that your sons had been abused by a priest who was then transferred out of the diocese (a long-standing practice) in order to cover up the problem, would you stick with the team, or follow your own advice and simply find a new team?

    Some of the congressional women have started a site. "A million for women." Sen. Barbara Boxer hopes to be able to harness women to put political pressure and support for women issues. GOP thinks they can make some political hay from this trying to turn this into a first amendment religion right. I think is time women threaten to vote as a block.

    Well there aint many nuns left in this country.

    71,000 according to NBC


    Average age? 70 years plus.

    These are 2004 figures.

    Not a lot of Nuns' daughters become nuns!

    I remember back in 72 or 73; there were very few jobs available to college graduates and a couple of my friends graduated with teaching certificates and the best they could do was to move to the boondocks or teach at a Catholic School.

    $7,000 in 1973 still was not a lot of money.

    Nancy has good points. We make our choices.

    MSNBC was clear about this. In no other country does the government have to run into this issue because there is a one payer system that has nothing to do with employment.

    I am more worried about these bible thumping universities and think tanks and textbook publishers and....all claiming religious exemption from everything.

    We let this birth control issue slide for Catholics and I predict much harder fights to come from little empires within this country.

    It bothers me.

    Well done. Employees who are practicing effective and supervised family planning would also cost less to cover than those who don't, unplanned pregnancies in many cases result in very expensive medical treatment. Multiple pregnancies where a woman is constantly pregnant may, at some point, be a threat to the life of the mother.

    So the Bishops want to increase costs to bar good medical policy and health maintenance practices related to a woman's fertility. All because a gang of corrupt holy imposters who run an organization permeated with child molesters believe they can tell everyone else how to live.

    Excellent post, Doc.  The Bishop's arguments are dead in the water, as you said so well:

    The claim that Cardinal Law's conscience would have been violated if the organization he led had been "forced to buy contraceptives" is nonsense. The Church does not buy contraceptives, penicillin, X-rays, or any other medical good. It buys a premium for a health plan for its employees, and that plan pays for medical goods and services. But isn't that just buying contraceptives with the Cardinal's money? No. Because the premium on my health plan was not the Cardinal's money, even if his little stamp was on the card. It was my money. It was part of my pay. I had earned it, through the work specified in my contract, and what I did with the benefits I was owed was no more the Cardinal's business than what I did with my paycheck.

    While I disagree with the church's position and I think it's wrong, I have to respect their ability to set limitations on what types of compensation it offers employees.

    If the church offers employees a health plan with restrictions, then it's up to you to take the job at the compensation offered or not. Yes, those restrictions are forcing their beliefs on employees, but only on those that applied for a job that offered compensation with those restrictions, won the job, and accepted the job knowing those restrictions.

    It's not your money. You were paid with a limited plan so you get a limited plan. If you wanted a non-restricted plan, negotiate it up front.

    To use your meat-on-Friday analogy, it's as if the church offered you a meal plan at church cafeterias and you're now demanding to order a burger on Friday because they can't impose beliefs on you. Go to Wendy's and buy it yourself, and they can't stop you, but they don't have to give it to you.

    When you work for an organization based on a cause or belief, don't expect the employer to offer you things that run counter to the belief.

    Welcome back, Patrick.

    One thing the Bishops might not have considered is the competitive hiring environment. If I were a head doctor and found that recruiting had become impossible, I might leave and go elsewhere. But that's their, Bishops, problem.

    I wonder, though, where one draws the line on religious beliefs. I could say as a hospital CEO that giving people workers comp. insurance, which I think is now universally required, is wrong based upon my religious belief that people should know how to prevent injuring themselves---sort of a spare the rod, spoil the child concept so prevalent among the religious folks. 

    Patrick: The thing is in 28 states this rule is already in existence and has been since December 2000.

    In December 2000, the U.S. Equal Employment Opportunity Commission made it clear that an employer’s failure to provide coverage of contraception, when it covers other prescription drugs and preventive care, is a violation of protections against sex discrimination under Title VII of the Civil Rights Act; those protections for employees’ benefits include no exemption for religious employers. 

    This particular issue has been distorted and exploited by a media all too willing to continue on with demonizing women's reproductive health. They are also completely unwilling to do research to fairly present this issue. The media prefers to do whatever it takes to get ratings and reproductive health serves their purpose of replacing facts and reason with spin. For 12 years there has been no uproar over this ruling by the EEOC, only now, when it is an election year and that HHS will require every state to comply with the 2000 ruling.

    According to the Guttmacher Institute:

    28 states require insurers that cover prescription drugs to provide coverage of the full range of FDA-
    approved contraceptive drugs and devices; 17 of these states also require coverage of related outpatient
     2 states exclude emergency contraception from the required coverage.
     1 state excludes minor dependents from coverage.
     20 states allow certain employers and insurers to refuse to comply with the mandate. 8 states have no such
    provision that permits refusal by some employers or insurers.  
     4 states include a “limited” refusal clause that allows only churches and church associations to refuse to
    provide coverage, and does not permit hospitals or other entities to do so.  
     7 states include a “broader” refusal clause that allows churches, associations of churches, religiously
    affiliated elementary and secondary schools, and, potentially, some religious charities and universities to
    refuse, but not hospitals.  
     8 states include an “expansive” refusal clause that allows religious organizations, including at least
    some hospitals, to refuse to provide coverage; 2 of these states also exempt secular organizations with
    moral or religious objections. (An additional state, Nevada, does not exempt any employers but allows
    religious insurers to refuse to provide coverage; 2 other states exempt insurers in addition to employers.)
     14 of the 20 states with exemptions require employees to be notified when their health plan does not
    cover contraceptives.
     4 states attempt to provide access for employees when their employer refuses to offer contraceptive
    coverage, generally by allowing employees to purchase the coverage on their own, but at the group rate.


    Actually, I do not respect any employer's "right" to limit compensation below a reasonable minimum, which is not an absolute right. I do not believe that there is a right to pay someone below minimum wage, for example. And the Constitution will back me up on this; it is illegal, for example, to make someone work for nothing. The law, in this case, sets a minimum for what constitutes health insurance. A prescription for a drug that has to be taken every day in order to regulate menstrual cramps and manage problems such as ovarian cysts is a very reasonable part of minimum coverage.

    In fact, as large employers, Church-related institutions are not forced to provide health insurance at all. They are free to opt out and pay a cash alternative that funds the employees' (more expensive) private insurance. They can take the deal or not. They shouldn't, to use your analogy, take the deal and whine. (Unless of course, you believe that only employers have rights, and only employers can be wronged. I would suggest that any such belief is strictly, ah, faith-based.)

    And the bishops are, in fact, taking the deal offered to them, which is employees who take less salary by delaying childbirth and limiting the numbers of children. If the bishops wish to employ only those who have large, unplanned families, they are free to do so. But they don't. I taught at an institution where my co-workers were predominantly young and married. All of my colleagues together had exactly zero (0) minor children. How did this miracle take place? The Cardinal never asked himself.

    The cafeteria analogy is of course childish nonsense, because the health care is not offered in-house, but through a vendor. The better analogy would be if part of my weekly pay was X dollars of store credit at the local supermarket, but the bishops decided that they had say over how I spent the store account.

    Once you give up the idea that compensation belongs to the worker, you've left free-market capitalism behind. If you sincerely believe that the compensation given to a worker belongs to the employer, and that the employer has a right to dictate its use, you are in fact a feudalist. Have fun storming the castle.

    "(Unless of course, you believe that only employers have rights, and only employers can be wronged. I would suggest that any such belief is strictly, ah, faith-based.)"

    Unless of course I said, and meant, no such thing.

    If we're going to throw around terms like "childish nonsense," the real "childish nonsense" (which is overstated hot air in each case) is treating cash compensation and a benefits package as equivalent - as equally under control of the recipient/employee. Compensation belongs to the employee in the manner and form that is agreed upon.

    No employer has control over what happens with cash payments, but they do set the terms of service on plans they offer. A typical insurance plan has many limitations that are not at the employee's discretion, like what health care providers they can use, what co-pays are required for which services and what items are covered at what rate. 

    Your example of "X dollars of store credit" misses the point. It's NOT dollars you can use however you want. A health pan is a pre-selected group of services you can use, not a wild card you can apply however you see fit.

    If you're hung up on whether it's from a vendor on in-house, then fine, consider it coupons to a restaurant chain. "Not good for alcohol. Please tip based on the stated price. On Fridays, this coupon only good for Fish & Chips."




    * Barring rare exceptions like non-compete agreements in which a departing employee receives a lump sum, but can't use it to start a competitor

    One part of the discussion that seems to be overlooked is that if the government is going to take steps to mandate free birth control coverage  to every American woman, it has to be available to every American woman who wants it and needs it--and that includes Catholic women.

    This particular administration made it a goal to provide just such coverage, at the same time trying to be sensitive to the one religion that forbids contraception of any kind--Catholicism.  (The Bishop's Catholicism, that is, and not that the vast majority of the parishioners, who willfully ignore the no contraception mandate.) Obama's solution might be considered a compromise by some, but I see it as a graceful way to satisfy everyone.  The bottom line is that every woman will be covered and it's no skin off the Bishops' noses.

    I agree with Doc that employee insurance is a contractual benefit, in lieu of additional wages.  It's an agreement between parties, a promise made at hiring, part of the package.  The company expects loyalty from their employees but never seems to think the same should be expected from them.

    But since the Catholic church already provides insurance coverage for birth control at certain facilities operating for the public, why wouldn't women who work for them assume the new mandate would cover their birth control costs?  They can't have it both ways.  Either the Bishops believe in their own tenets or they don't.


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