I've been following the controversy over birth control coverage for some time. It touches on an experience I had several months back, when I discovered that my student health insurance (I'm a graduate student at a private Catholic university). I was either misinformed or else the policy changed, because I recently learned that I could get birth control if I saw a private doctor and the insurance would pay for it. But I remember how upset I was when I thought I was being forced to live by someone else's morality – and do bear in mind I don't actually need or use birth control! – so I have a lot of empathy for the women whose health care choices are being forced into the public square.
I also empathize with religious groups who don't want to be forced to violate their policies. Freedom of religion is a good thing, in my opinion, as is freedom of conscience for religious and non-religious people alike. And for that matter freedom of conscience for people like me who are religious but don't practice the religion of the group offering their health insurance. There's a part of me that actually feels guilty for not using birth control – because even though I don't plan to be sexually active, if I was raped or even if I just had sex I wasn't planning on, there's a possibility of pregnancy. I don't particularly want to be pregnant and I'd have to choose between an abortion and an pregnancy and child-raising, with all that means for the opportunities my religion tells me I should be a good steward of. So there's a part of me that thinks you can make a religious case for the necessity of birth control, at least in certain circumstances. It's not something I think much about, let alone have done a lot about, but it's worth noting that for some people and groups, free access to birth control might actually be essential to making choices consistent with their religion.
I bring all that up not because I want to shame people who aren't on the pill on the off-chance they might get raped. Rather, I think it teases out an interesting distinction people have been overlooking. Folks opposed to the birth control mandate usually talk about freedom of conscience and freedom of religion, as if those are the same thing. They really, really aren't, especially in this situation. In fact, I'd say that in most cases they are pretty well opposed to each other when it comes to the birth control issue.
Now, I'm so not a lawyer, and I know both of these concepts have a legal meaning. I'm not qualified to talk about that, so I want to have this discussion more philosophically. That means we need some definitions. By freedom of conscience, I mean the idea that we should not make it unduly hard for people to choose their beliefs and act on them. Now, a church (or any other group) can try to educate people or change their mind through dialogue, convince them that they shouldn't be using birth control. That's perfectly fair game. But once I have made my choice, the church (or secular group, or government, etc.) shouldn't make it unduly hard for me to act on my belief.
Sometimes there's a reason to restrict freedom of conscience. Actions have consequences, and society has a right to keep people from acting destructively. And sometimes two beliefs can't both be acted upon. If two toddlers believe they should be able to play with a certain toy right now, at most one of them can act on that belief. Similarly, if one person believes they should be able to use healthcare to purchase a certain service, and someone else thinks that person's health insurance shouldn't be used for that service, at most one of those beliefs can be acted upon. They conflict. The issue that needs to be resolved (and I'll get to that in a minute) is whose belief should take priority. But I want to make one point absolutely clear right now: only individuals have freedom of conscience. Fr. Dolan and the rest of the Catholic bishops don't get more weight for their freedom of conscience than I do, unless they're accurately speaking for more people. And maybe not even then; it may not be as simple as saying "whoever has the most vote wins." But what I'm saying is that the RCC, simply by virtue of prestige and history, doesn't get conscience protections as the RCC; it only gets that right if its speaking for actual people.
Here's the tricky part though: many individual Catholics don't have a problem with birth control. And more to the point, this doesn't (and shouldn't) change the RCC's position on birth control. That means there's something else going on here, which I think we can reasonably call freedom of religion. This means that a religion can teach whatever it wants and the government won't get involved. Similarly, individual people are free to join up with any religion they agree with, and again, the government won't interfere. But religions as I am thinking about them aren't just a "union" for their members, where the religious doctrines are up for a majority vote. Religions represent a tradition, and while smart religions will be responsive to their adherents' views, the way believers (or non-believers) vote is with their feet. If they no longer accept a religion they are free to leave.
But you can't expect a religion to change just to reflect the priorities and beliefs of its members. That's backwards from how religion works; religions try to work within a certain literary, ethical, and historical tradition, and people then decide whether those groups are worth being a part of. The individual can say they will be a member or not; or s/he can maybe even be a "part-way" member, going along with the Roman Catholic church on social justice but not agreeing with their track-record on women's rights. Sometimes the different parts of a church's theology are too interwoven to be adopted piecemeal like that; sometimes it works okay for the practitioner. But this doesn't change what the church is, though it may change what you mean and agree to when you say you're a Catholic (or whatever).
The question becomes, how do we balance these two issues? That's really at the heart of the current debate. On the other hand we have people who want to make their own decisions regarding birth control. I can easily see Fr. Dolan saying that he doesn't want to outlaw birth control, simply keep church $$$ from going to support it; otherwise you would force a religion to support something it finds immoral, which comes very close (if not crossing into) to requiring the church to teach contraception is okay. Churches teach by more than just their words, just like we all do.
So based on just this, it seems like the RCC has a point. Here's the thing, though: this isn't the whole picture, because like I said we have to worry about freedom of conscience as well as religion. Freedom of conscience is at least on par with freedom of religion, and I'd go so far as to say in most cases it trumps religion. If the Sandusky scandal taught us anything, it's that bad things often happen when we let the need to preserve an institution take precedence over the well-being of individual people. But that kind of argument only works if you're going to say the individual really has a right to expect the church to help pay for birth control. Freedom of conscience doesn't mean you have to help everyone achieve their ends – only that you need a good reason to get in the way.
That's what this issue really boils down to, for me. Do I have a right to expect my school – in spite of its Catholic identity – to pay for my birth control if I needed it? Not as such, perhaps, but then that's not how student insurance works. As I understand it, students pay a fee and co-pays and deductibles and everything, and the school doesn't typically contribute. My case is a bit different from how most schools handle it because my school pays part of the premium (though even that is explicitly tied to how many courses I teach so arguably it's part of my compensation). Everywhere else I've studied, the insurance is paid for by the student or student's family and the school just administers it.
And as for the other situations – you know, where you do a job and in exchange get certain benefits, including health care – that's usually presented as part of your pay. All my career counselors at my undergrad school urged us to look not at salary but salary + value of benefits (primarily health insurance) and recently, when people have been talking about wage stagnation and economic inequality, a lot of times they say that employers consider healthcare expenses to be part of your compensation – so more health expenses rightly meant fewer raises. The message, intended or not, is that we should view our health care costs as part of what we earn for a job well done. And just like I wouldn't be okay with my employer putting restrictions on how I can spend my paycheck, I shouldn't be okay with them telling me the ways I can use my health insurance. That has nothing to do with freedom of religion, and everything to do with my right to use my resources as I see fit.
There's a bigger issue, though. Outside of the audience of Republican presidential debates, most people think we all deserve adequate health care; certainly the people who work deserve it. But we've also rejected the idea of a public option for two reasons: first, efficiency, and second, freedom to choose the range of services we want. The idea was that private insurance meant not only less bureaucratic waste but also more freedom for the people buying into the system. In exchange for less taxes and less restrictions, people and the businesses they work for would pay for their own healthcare. This is a responsibility society has taken upon itself and through it, the institutions (including churches) that choose to be part of that society. To not provide that service – or to try to control how people use it – is to steal liberty away from your employees.
One last issue that might get the RCC off the hook. We could say that, in general, companies have a responsibility to pay for their workers' health care, and that this is part of the employees' compensation (so it's the employees' right to decide how to use it, not the institution). But what if the employee made an implied promise to live by their employees' ethos? I think we need to draw an important distinction between a company that hires (say) the best Baptists and one that hires the best employee. I worked for a while at a Christian non-profit where it was assumed we would live by certain ethical principles. I knew that going in, and I don't think I would have had a right to insist that SP pay for a health procedure tied to something they didn't improve of – say, liver schlerosis tied to heavy drinking.
But that's not really the situation the Catholic hospitals and schools are facing. Students and faculty are hired not because they're good Catholics and agree to be good Catholics, but because I'm a good scholar. Or for that matter because I'm a good IT technician or facilities manager or nurse practitioner or payroll clerk. Quite often (with the hospitals especially) you'll have hospitals merge where a once-secular hospital is suddenly brought in with a Catholic hospital. Or even where that's not the case, quite often people choose to work or study at a Catholic facility because it's the best opportunity in their area. Did they agree to live as Catholics? In some roles, maybe. (I don't think you can agree to be a chaplain at a Catholic university without also agreeing to be a Catholic.) But certainly there are all kinds of jobs that don't carry with it the implication that the people filling those jobs have to be Catholics. In many cases, the universities in particular go out of their way to tell their students and employees they don't have to be Catholics, in the name of diversity or even just in the name of getting the best people to be part of the university. I know I was told as much. Is it really fair for the church to turn around and say they get to decide what kind of health care I should have?
This post seems technical and meandering and dry, so maybe I should put in a summary of my basic points. Essentially here's what I'm trying to say:
· Churches have freedom of religion – which protects their institutions, not the people.
· People (whether a member of a church or not) has freedom of conscience – the right to act on her beliefs, to the extent it's possible.
· Health care isn't a special favor companies do for their employees – it's part compensation for the work the employees do, part the employees' own contributions.
· So churches and quasi-church groups don't have the right to impose restrictions on how the health insurance will be used...
· ... unless they hired the people / accepted the students with the understanding they would live by the church's guidelines
· ... which isn't the case for most universities and hospitals affiliated with the RCC
So my bottom-line conclusion is that the health care provided through RCC institutes should cover birth control. Not because they don't have freedom of religion (they do) but because in that case they gave up their right to act according to their doctrines when they reached out to people of other faiths or no faith. There are accommodations that can be made – my school's covering contraception but not prescribing them from the on-campus health clinic seems a good one – but a blanket refusal to pay for them is an abrogation of their duties to their employees. It's also giving more liberty to those who can afford to pay for contraceptives out of pocket, which strikes me as very un-Christlike, though that's neither here nor there.
But I'd be interested in people's thoughts. Does this argument track? If you disagree, why? This is something I have very strong opinions about and I feel like I'm not seeing it at all clearly, so I'd be interested to have people's opinions.
(Btw – thanks to Turner and Brendan, too fellow Fordham doctoral students who have been discussing this issue and helped me shape up my thoughts, though they may not even realize it. Brendan discussed it with me specifically; I happened to overhear a conversation Turner had with other people. It's possible I integrated parts of what they said into what I've said above; certainly, they've given me things to think about and react to.)