Marta's Mathoms

I've been following the debate over health care mandates, freedom of conscience, and religious exemptions pretty closely. It's really very interesting and (for me at least) very personal.

For those of you who aren't American or, you know, have lives to live that don't involve watching the news, the new health care bill basically requires everyone to carry insurance. If you can't afford it, you get a tax-paid subsidy to help out; if you refuse, you pay a penalty to cover the cost of health care if you get sick. The problem is that many companies only offer very minimal coverage – either really high deductibles (the amount you have to pay before insurance kicks in) or low caps (after which you're responsible for the bills). So to help with that problem, Congress said that each eligible plan – meaning, the plans that will let you avoid the penalty – have to provide a certain level of coverage in several defined areas.

And one of those areas was reproductive health for women. Anyone familiar with American politics and the *erm* heightened interest anything to do with sex seems to draw.

Even before the law passed, it was on record that no taxpayer money could go to fund abortions. I wasn't crazy about that decision, but at the time I accepted as the price of doing business. Personally the thought of people with money deciding what medically-necessary health procedures I should have access to (yes, even if they're footing the bill) really bothers me. This is basically because I recognize that yes, capitalism is great at encouraging innovation and hard work and all that, but it really and truly sucks at distributing resources in a fair way. I think that middle- and upper-class people are generally overpaid, meaning that we should give up our money to fill the actual needs of the poor. I see this as a moral duty, and I don't think I should get to say how that money is actually used. So I don't think I should be able to tell a poor woman she can't have an abortion or buy a soda out of their food stamp money (another personal bugabear, brought to you courtesy of Mayor Bloomberg) or whatever, any more than I should be able to tell a rich or middle-class person. But whatever. As I said, with the abortion provision, I do think the ends justified the means there, even if I wasn't totally comfortable with it.

Now the government is trying to work out just what insurances should have to cover. One of those areas, as I mentioned above, is reproductive health. Basically, the government wants to force all health insurance plans to cover health insurance – including plans paid for in part by employers who have traditionally opposed birth control, like the Roman Catholic Church. There are conscience clause exceptions, which basically let people whose jobs are suitably religious in nature (think pastors and priests) buy insurance plans that don't cover birth control. Sometimes the groups oppose birth control on principle, like the Catholics whose natural law ethics condemn any ejaculation that doesn't have the goal of procreation. Other times there's a concern that the some of the birth controls can act as abortifacients, opening up a back door to taxpayer-funded abortions. Still others, usually conservative Protestants, point to the connection between birth control and extramarital sex and don't want to subsidize promiscuity.

But whatever the reason, these groups don't want to limit the conscience clause to clergy and church employees. The conscience exception wouldn't apply to people whose work wasn't devoted to religious ends. Like social workers and nurses employed by Catholic charities, for instance. And plans for students at religious universities would have to cover birth control.

This is where it gets personal for me, because I am a graduate student on stipend at attend a Jesuit (Catholic) university, and I was very much surprised to discover that my health insurance (purchased through my school) doesn't cover birth control or really anything reproduction-related besides OB-GYN exams. I'm not a member of the Roman Catholic Church, nor do I think I accepted a "Catholic" ethic because I decided to study and teach here. Jesuits just happen to produce the best scholars in my corner of philosophy. As it happens, I don't need birth control because I'm not sexually active, and I actually think most premarital sex is immoral for various reason. But that's my decision, based on my moral choice. And for the majority of the culture that disagrees with me, that's there moral choice, too. To be perfectly honest, I really resent the idea that some group I never joined up with should decide what kind of health choices I'm able to access.

(To be clear: this "joined up" idea can be hard to nail down. If you were born into a church and your whole family belonged, staying on the church rosters could just be inertia at work. Or maybe you joined because you agreed with most of the beliefs but not this one. Or maybe you took a job at a Catholic hospital or teaching Spanish at an evangelical high school because it was the only or best opening in your area. None of these should take away your access to medical procedures. But this is doubly so for college students, given how little emphasis students put on the school's ideology when choosing to go there.)

This, right here, is why the whole idea of relying on charity for basic needs doesn't work. The Catholic Church (and the other groups taking similar stances) are saying it's an affront to their freedom of conscience if they have to pay for my birth control (if I decided I wanted it). I would maybe be okay with that (maybe) if not for the refrain I keep hearing in politics. We're told that government is inefficient, that it's wrong to make people give up their money to support people who didn't earn it. That Americans are the most generous nation and to just let people hold on to their money so they can donate it willingly. But many, many charities have religious ideologies. Those that don't tend to have their own ideologies, and many attach requirements to people using their money. That doesn't sit right with me.

Think about an analogy. Say someone proposes we slash the budget for Section 8 housing. [for Non-Americans: government $$$ paid to private landlords, to provide lower-income housing for the poor] This is in exchange for a taxcut, with the assumption people will turn around and donate that money to private charities working in their local area. Only those charities have their own ideology, as most do. Say a certain charity has a strong ideological position against smoking. (Perhaps it's Mormon-backed, whose church considers tobacco use a sin; perhaps the group's founder just lost a favorite uncle to emphysema and hates smoking.) What would we say if that charity only took people who pledged not to smoke in their apartments? I can't help thinking low-income people would be less free under this system than the current one.

I guess it all comes down to this for me: you can only use those rights you have the power to exercise. I'm all for personal responsibility and saying that if you have enough money to meet your needs if you were smart about it and you squander it, that you're responsible for. Maybe those people need to suffer, or maybe there's room for honest-to-goodness charity there. But if someone isn't making enough to have a basic standard of living, if they're trying to find a job and can't or if the jobs available pay too little, that's not what charity's for. They need public funds – yes, taken from my tax $$$ – and it's really not up to me how they spend it. That's justice.

Your thoughts?