Morality as Word Magic

by Mario Rizzo

I am disturbed by the Obama administration’s revised rule regarding the provision of birth-control products and service under the new health insurance system they have created.  The original rule required all employers, particularly for our purposes institutions affiliated with the Catholic Church, to provide insurance that covers birth control without copayment , coinsurance or deductible.  The Church hierarchy and others protested that they should not have to provide insurance that reimburses or pays for activities they regard as immoral. So then after a politically troublesome firestorm, President Obama and Secretary of Health and Human Services Kathleen Sebelius announced a revised rule.

The revised rule requires all employers, particularly for our purposes institutions affiliated with the Catholic Church, to provide insurance that covers birth control without copayment, coinsurance or deductible. What a relief.

Re-read that sentence. It is exactly the same as the previous rule. Can it be?

Previously, the Catholic institutions would have had to pay for the birth control coverage in the insurance. Now they have been relieved of that by their masters. The insurance companies will be required to provide the coverage free of charge.

The first thought of a rational person should be that the costs will simply be spread over all of the insured in the institution. The insurance company will make a single estimate of the payouts and come up with appropriate premiums. The law, as I understand it, does not permit the federal government to make sure that the insurance company absorbs the cost. (But I do not know what schemes they may come up with.)

But we need not worry about this. Secretary Kathleen Sebelius assures us that the coverage is costless. She said that experience tells us that the savings in child birth and child services will more than offset the costs of birth-control pills and sterilization. But, to be on the safe side, she said we shall just assume that it offsets the cost.

But that was true (presumably) under the old rule. Under the old rule the Catholic institutions would be paying nothing extra for the coverage. Under the new rule the Catholic institutions will be paying nothing extra for the coverage. I am repeating myself…

Perhaps there will be some different paperwork for reimbursement.  Yes, I insist. The government could at least include that as a token of the difference between the two rules.

What foolishness this is.

But let’s go back. Was the Catholic hierarchy wrong in objecting to the old rule because under the Sebelius  actuarial calculus they would not have been paying (extra) for it all along?!

Let’s look more closely at that. Is the objection paying for coverage or providing access to coverage in the course of employment at a Catholic institution? The fact that I do not pay the provider of such services does not mean that I am not responsible for letting him on my property, so to speak.  In any event, people need not take jobs at institutions whose values they do not share.

There is more. Of course the institution is paying for the services. A woman gets a prescription for birth-control pills. She fills out a form for reimbursement. The insurance company goes into the pot of money into which the premiums have been paid and takes out the appropriate amount and pays her. Simple. The institution pays.

It is true that the woman did not, in a counterfactual state of the world, seek reimbursement for birth services and child medical services. That is where the savings come in. But that is not what is happening. What is happening is that she is getting reimbursed for birth control out of the premiums paid by the institution.

One more point, (I am really getting tired now.)  In those institutions which self-insure – that is, collect the premiums, run the risk of shortfall themselves and allocate to the insurance companies only the task of management – there can be no pretext that the “insurance company pays.”

So far the Catholic bishops are resisting this. They are right to do so. First, the rights of religious institutions as independent moral agents were denied by the first rule. Second, their intelligence is mocked by the second rule which is the first rule restated.

There are two lessons in all of this. The first lesson is that Obama and his team are what Adam Smith referred to as men of system. They cannot tolerate foci of different values in their world:  

“The man of system, on the contrary, is apt to be very wise in his own conceit; and is often so enamoured with the supposed beauty of his own ideal plan of government, that he cannot suffer the smallest deviation from any part of it. He goes on to establish it completely and in all its parts, without any regard either to the great interests, or to the strong prejudices which may oppose it. He seems to imagine that he can arrange the different members of a great society with as much ease as the hand arranges the different pieces upon a chess-board. He does not consider that the pieces upon the chess-board have no other principle of motion besides that which the hand impresses upon them; but that, in the great chess-board of human society, every single piece has a principle of motion of its own, altogether different from that which the legislature might chuse to impress upon it. If those two principles coincide and act in the same direction, the game of human society will go on easily and harmoniously, and is very likely to be happy and successful. If they are opposite or different, the game will go on miserably, and the society must be at all times in the highest degree of disorder. (Theory of Moral Sentiments, VI,ii, 42) “  

Secondly, the Catholic bishops must realize that they are reaping what they sowed. By and large, they supported Obamacare. Furthermore, they should realize the broader point that religious values are not the only important values in a free society. Policies which suppress the free choices of employers and employees alike through diktat are immoral.