Notes from My Contraception Tour (2012)

 Originally published as a Facebook Note March 21, 2012.

Hobby Lobby, Cedar Rapids, November 2015

            Contraception’s brief tenure as a major issue in the surreal 2012 presidential campaign may have already ended, but I am about to do my second invited appearance on the subject in slightly more than two weeks, making for something like a “contraception tour.” On March 7, I appeared on the local public affairs show “Ethical Perspectives on the News” as part of a panel on the subject, and tomorrow I’m speaking to the brown bag series run by Coe’s Gender Studies program. So, if everyone else is done talking about contraception, I’m not quite done. 

            The issue arose when the U.S. Department of Health and Human Services issued a directive respecting implementation of the new health law; the directive included birth control prescriptions in the preventive services employer-based insurance plans will be required to cover. The original directive exempted places of worship for which birth control is a violation of religious doctrine. It did not exempt religiously-affiliated institutions like hospitals and schools, which raised considerable controversy. In its second look, the Obama administration did exempt such institutions, and reached agreement with insurance companies to cover birth control prescriptions for affected employees at no additional cost. 

            This has not done anything to resolve the disagreement. Religiously-affiliated institutions argue that the cost of birth control will be hidden in their insurance bill, and argue that the requirement violates their free exercise of religion. Many further argue that all employers, regardless of whether they’re directly connected to a religious institution, ought to be able to claim exemption if they have religious objection to some aspect of the insurance plan. Some, such as the ever-vitriolic Rick Santorum, charge the birth control provision reflects hostility to Christianity. Birth control advocates note the enormous (98-99) percentage of women of childbearing age who use birth control, and charge the other side with being sexist, medieval, and hostile to the goals of health care reform; they find validation in the rantings of Santorum and radio goon-prophet Rush Limbaugh. 

            I don’t have the answers, but whatever the answers are, they start with acknowledging—which I’ve seen few if any commentators do—that there are multiple interests at stake here that have a claim to validity. Access to health care is, I believe, a “compelling state interest” in today’s society. The health care system in the United States, while it works very well in individual cases, covers way fewer people and costs way more than the system in any other developed country; there is no reason or excuse for this. A lot of people are not getting the care they need, and a lot more people are surprised to find their insurance doesn’t cover what they thought it did. Everyone should know in advance that whatever health insurance plan they get contains certain basic features, including coverage of preventive care. Some people—a member of the KCRG panel said quite a high percentage—take birth control pills for reasons other than preventing fertilization. Individual liberties are at stake, too: institutions do have a right to exercise their doctrine, and individuals have a right to privacy. People that are insured through their employers pay most of the cost themselves. In other words, most individuals have more skin in this game than their employers do. 

            The long-run answer is probably to move away from employer-based health insurance coverage, but that is a huge step for which America is not ready. Many people, including me, have very effective health coverage, and will not be personally affected by the new law.  Systems like Britain’s, or Germany’s, or Switzerland’s (to choose three different models) might make more sense and be more efficient, but in the short run would create a good deal of insecurity. So, for good or ill, Congress and the President chose in 2010 to expand the current system and try to regulate its less-functional aspects. So in dealing with ticklish questions like contraception coverage, we are pretty much limited for now to massaging the current structure. Given congressional gridlock since the 2010 elections, even providing a public option is out of the question for now. 

            In thinking seriously about this issue, we are immediately confronted with two realities. First, “rights talk” (a phrase coined by Marianne Glendon in the 1990s) is of limited help in resolving disputes. It draws a line in the sand and refuses to compromise, or to accommodate anyone else’s needs or wishes. I like rights a lot… but find it significant and sad that neither Catholic hospitals (which supported health care reform) nor the bishops (who opposed it) suggested any way around the impasse. Obama’s second effort was flatly rejected, on the grounds that their employees would still be getting birth control coverage. There was no counter-offer. 

            The second reality is the centrality of sex to the dispute. To say it is not about sex but about religious freedom is as silly as saying the Civil War was not about slavery but about states’ rights. It’s about sex. It’s about religious freedom to govern or restrict sex. The latest round of the culture wars, which began in the 1960s, includes issues related to civil rights and foreign/military policy, but sex is everywhere you look: gender roles, abortion, homosexuality, sex education, and now birth control. The power of these issues to inflame people cannot be overstated, however we might try to neutralize them with terms like “family values,” “traditional marriage,” and “religious freedom.” Who can have sex with whom, or more precisely who gets to decide/control who can have sex with whom, is inevitably part of the structure each society defines for itself. (For how can society survive without structure?) Control over sex is central to the traditional morality one side says it wants to restore, as well as to the individual freedom the other side is trying to achieve. 

            I'll grant there’s probably way too much sex going on. I am particularly ambivalent about “casual” sex. Americans could certainly talk more openly, and with less hypocrisy, about what contemporary sexual ethics ought to be. But I think we need to do this as adults talking to adults, with each person then making the decisions that seem appropriate. The idea that my employer should make these decisions for me, or any decisions about aspects of my private life that bear no relation to my job, is extremely repugnant. 

            A resolution would look something like this: Employers should stay out of their employees’ sex lives (except in the rare circumstances where those are job-related, such as clergy). Religiously-affiliated employers should be exempt from paying towards employees’ birth control coverage, provided that there is an “alternative means” for employees to acquire that coverage. I think that would mean either free coverage by insurance companies (the regulation on the table), provision by organizations like Planned Parenthood funded by additional government grants, or a public insurance option.