We're in the middle of a heated debate about contraception, and who pays for it, sparked by a provision in the recent health care law requiring health insurance providers to cover contraception. I have heard a lot of disgusting hate speech, and I have heard a lot of entitlement that is ugly in its own way. Both groups of speakers exclaim loudly about their rights, and neither listens too closely to what the other is saying. I could add my voice to this debate with a one-liner on Facebook; that would serve to identify which camp I belong to. Since I've never liked the idea of choosing camps in the first place, I'm going to tell you what I actually believe. Read ahead at your own risk.
First, a definition of terms: In this world, there are choices, and there are the consequences of those choices. Rights have to do with the former. You have a right to make a certain choice if you would be capable of making that choice in an environment free of coercion. Such rights are often called "natural rights" because no one has to give them to you; you have them from birth, until someone takes them away from you. The items enumerated in the Bill of Rights in the U.S. constitution are all in this category: to believe what you will; to speak those beliefs; to spend time with your fellows, if they will have you; to maintain the security of your person and property.
A second's reflection will tell you that you cannot have any rights with respect to consequences. You may have the right to choose whether to step out into the rain; you cannot have a right not to get wet.
Likewise, you cannot have a right to buy or sell a good or service -- because the other party to the transaction was born with the same rights you were! What does it mean for you to have a right to own something that costs money you can't afford? Does it mean you are entitled to take it by force from someone who has it?
Second, to the matter at hand: You have a right to refuse to have sex with anyone, at any time, in any place, for any reason or no reason at all. If you do want to have sex with someone, you have a right to state the conditions under which you are willing to do so -- for example, only when a certain type of contraception is available, perhaps, or only if the partner is married to you first in a ceremony conducted in a Roman Catholic church. You have a right to negotiate these conditions, and whether to follow through with them, free of coercion. You have a right to spend your financial resources how you will -- on contraception, clothing, shelter, Pez, or on any other available good or service. You have a right to express your desires, intentions, conditions, and the values behind them, through the various means of communication available to you.
You do not have a right to become pregnant or a right not to become pregnant -- any more than you have a right not to become sick or a right not to grow old. If you should become pregnant, and you did not wish to be, you have a right to take action in response -- in consultation with the other persons impacted by the pregnancy and consistent with their rights. (And I, as the author of this essay, have the right to withhold from you for the time being my opinions on what constitutes a "person" or an "impact" in such a situation, including how many such persons there might be; another time, perhaps.)
Finally, with respect to public policy: It is important to recognize that some "contraceptive" products also treat disease, in addition to preventing pregnancy. For some women, in fact, the availability of such medication earlier in life is crucial to maintaining the ability to conceive children later in life. For insurance companies that cover services related to childbirth, also covering contraception lowers their costs. With respect to the prevention of pregnancy, a majority of Americans believe that the use of contraceptives is moral and even beneficial. I believe that the availability of contraceptive products is good for women, it is good for families, and it is good for business. Most employers agree: 90% of employer-provided insurance plans cover prescription contraceptives.
That is not the point. Many people disagree with my point of view -- or let us say that they argue the issue on different bases. Catholic and Mormon authorities do not oppose contraception because of how much it costs or because their opposition is popular. They oppose it because they view human interference in reproduction to be unnatural and morally perilous. They have a right to believe so.
It would be just and reasonable for the government that represents us all to take no official stand, to treat contraceptives no differently than any other product on the market. Alternatively, in consideration of where the bulk of public sentiment lies, it would also be reasonable for the government to take a special interest in the topic, and to ensure that such popular products remain within reach for as many people as possible. For example, it might prioritize investigations into anticompetitive behavior, reduce regulatory barriers to bringing such products to market, require clear "labeling" of insurance products with respect to coverage of such products, or act to reduce the cost of health care generally.
What the government may not justly do is to mandate that a group provide products it finds immoral to those of another group. Employer-provided health insurance is part of an employee's compensation package (or not). As an employer, you have a right to make whatever offer of compensation you like. As an employee, you have a right to accept that offer, to make a counter-offer, or to seek employment elsewhere. That decision may be painful; a particular employer may be uniquely desirable. But you must live by your conscience, and they must live by theirs.
Update (3/16/2012): I have posted a follow-up.
On the topic of consequences, I think it's unfortunate that hormone medications that do things like preventing ovarian cysts and controlling migraines also act as contraceptives. Most religious groups aren't against covering those things by themselves. Couldn't the mandate say that they were only covered if prescribed for non-contraceptive use? Regardless of "rights" and "choices", fairness enters the argument, and these rules deny important treatment options to women based on what is essentially a side effect of their medication. Are they going to deny men treatments that lead to infertility, since that's contraception too?
ReplyDeleteSome plans do have exemptions like you describe. I agree they're a boon to the women who have them. (And if you haven't watched Sandra Fluke's testimony on this subject, linked above, you should.) From the point of view of anti-contraception employers, though: isn't that a loophole the size of 10-story building? I suppose it's on their consciences any way you slice it, and they're doing the best they can.
DeleteAs regards men and fairness, I'm not aware of any prescription contraceptives for men, and I'm not aware of any government mandates to cover male-specific diseases in insurance plans. And as far as I have heard and read, most people who oppose contraceptives do not have the goal of increasing the number of children; they have the goal of letting nature take its course. Therefore, drugs to treat diseases leading to infertility would not *become* targets for insurance coverage simply for that reason. Of course, I could well be wrong on any or all of the above.
I do object to the discourse of "denying treatment". Insurance is not treatment; it is a way to pay for treatment. We are not owed the means to pay for anything we might want, not even for things that might save our lives. It's not a question of being denied treatment; it's a question of whether to require other people to help pay for treatment when the patient can't or chooses not to.
I wasn't thinking of prescription contraceptives for men. I was thinking of medical procedures that either are designed to prevent pregnancy (vasectomies) or have it as a consequence (some cancer treatments, for example). I just don't get why only women's options are being debated.
DeleteI think women's options are being debated especially now because the current controversy isn't just about what's right; it's about what will be mandated under the law. There's a concrete regulation on the table to require employers to pay for prescription contraceptives for female employees; there's no such mandate that anyone pay for anyone else's vasectomy. (To put it another way: we're talking about women in this case because the government is actually proposing to do MORE for women than for men!) If the government proposed to require employers to pay for their employees' vasectomies, I'd like to think that the debate would be similar -- at least it would be interesting to see whether that would be the case.
DeleteI agree with you. I want to thank for that information which is provided here. In my review contraception is right. Appreciation in support of this very informative and sizeable article.
ReplyDeleteThank you, and thanks for reading!
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