Word that the bishops are rejecting the Obama administration compromise on the HHS mandate means further conversations. DotCommonweal has a great update, but the comment thread made me think that before we Catholics devolve into the usual, unfortunate camps, I want to highlight three lessons that the events up to now should invite us as moral theologians to develop further:
One, the compromise and its rejection display how sorely inadequate our current thinking about “cooperation with evil” is. It would seem the administration has taken advantage of a quirk in the present situation: it may very well be cheaper for insurance companies to offer contraceptive services, and therefore they can be “mandated” to do so, in a separate, “free” agreement between employee and insurer. In principle, given that the institution is not a party to such an agreement, nor is any individual in the organization compelled to enter into the agreement, the problem of cooperation is solved. David Brooks terms this a “polite fiction” – polite, because it does honor the consciences of those who wish not to be party to the agreement, but a fiction, because at the end of the day, the insurance company is simply a pot of money, and so unless the insurer is not providing contraception to anyone, anywhere, premiums are “paying” for contraception. The bishops are objecting to this, and, as Dana points out, they may have good reason to do so. But given the nature of larger insurers, it is difficult to know where they will stand (except for self-funded insurance plans, which will be dealt with in some way that respects conscience, according to the administration). Thus, it is the very practice of collective insurance which renders “cooperation” a difficult problem. It seems to me that such cooperation was worked out most carefully in situations where individual agents either assisted or did not assisted other agents in individual acts. That is, it was not about money, but about acts. Should you drive the cab or clean the abortion clinic? But extending this principle to money makes things complicated. On the one hand, one can set up whatever kinds of segregated accounts one wants. On the other hand, such segregated accounts are obviously fictional when what is being purchased is “collective coverage” – that is, in cases like insurance or taxes. And this is further complicated by the fact that it does seem entirely plausible that insurers would in general find it financially advantageous to provide cheap, “preventative” services – pregnancy is not a disease, true, but it does incur large health costs! The point here is that we need to get much clearer on what “cooperation with evil” really means when we are dealing with collective practices like a modern insurance system. And getting clearer on this would surely be very interesting for Catholic moral theology – for example, what are the odds that my university’s endowment or TIAA-CREF funds are invested in biotech firms using embryonic stem cells? Or firms employing child labor? Or firms selling contraception (whether manufacturers or retailers)?! The collective practice both of mutual funds and of joint-stock corporations are at issue here.
Two, what counts as “health care” is a large issue. At base, the bishops object that contraception, like abortion, should not be understood as medical care. We might rightly discuss how this plays out in complicated cases, like the Phoenix case or cases where a woman is in need of some such services for a medical condition. But in principle, it is unclear why routine contraception should be understood as a “medical” issue… whereas, for example, my diet and my fitness center membership are not so understood. The contemporary problem of “medicalization” is actually a huge reason why health care costs are difficult. Insurance is best suited to systems (like home and auto) where a small number of high-cost occurrences which are difficult for individuals to predict can be smoothed out by pooling the risk. Such is the case for major medical catastrophes. But we mostly do not have collective insurance to cover routine auto maintenance or home maintenance. So, why have insurance for routine care? And what happens when we enter the difficult area of chronic conditions? Especially when those conditions are “invented” to fit new drugs (e.g. Viagra)? We rightly recognize that health care should be a basic right, but the problem of what counts as “health care” requires further reflection.
Three, whatever happens after this, I must admit that in my lifetime, I cannot remember a case where the Catholic leadership has mobilized so swiftly and effectively to highlight an issue, foster a consensus among Catholic groups, and impact a public policy decision in short order. Moreover, it has immediately highlighted the importance for Catholic organizations of living out their mission and identity in concrete ways. Wouldn’t it be nice if we could do this more often, say, on all of the issues highlighted in the second half of Gaudium et spes?