God to Congress: OK to Gang Up on Women's Rights

"It is not our job as Catholics to tell God what we should do.  It is our job to learn and follow his teachings.  Conscience is not convenience. We must enforce the laws of God." Rep. Tim Murphy, Republican of Pennsylvania, having ascertained that the supreme deity is male, explained why Congress should deprive the employees of Catholic schools, hospitals and charities of the right to purchase affordable birth control, regardless of the employees' own beliefs or practices. The  hearing of the Health Subcommittee of the House Committee on Energy and Commerce took place on Wednesday, November 2, 2011.

Republicans in Congress are truly on the warpath against women's rights, and in many cases against reason. 

Just a few points here about women and contraception.  For starters, while it usually takes two to conceive a child, only women get pregnant. The right and ability to make independent decisions about whether and when to become a parent are fundamental to every other aspect of a woman's life: whether society recognizes women as autonomous, independent, responsible and competent; and whether women themselves experience the same opportunities as men to acquire education and employment, and to construct a meaningful life based on loving relationships.

Cost is a barrier to purchasing birth control for lower-income women.  More effective forms like new, safe intrauterine devices (IUDs) cost more than birth control pills or devices like diaphragms that can be bought in smaller, cheaper quantities, but also are less reliable. The rate of unintended pregnancies is soaring among low-income women, and at 132 per thousand (women aged 15-44) is 5 times higher than the rate for higher income women (those over 200% of poverty).  Low income women are more likely to have unplanned births. The costs of contraception are minute compared to the costs of pregnancy and delivery, in dollars as well as in human health. 

The new health reform law, the Affordable Care Act (ACA), calls for covering preventive health care services without requiring copayments, effective in 2010.  Copayments are fees individuals must pay when they go for care, in addition to their premiums, and are intended to discourage health care visits.  The problem is that they discourage people from getting care they need, particularly low-income people.  Preventive health care services like flu shots can protect health by avoiding illnesses entirely or catching them early, and also save money. The ACA eliminated these copayments for prevention. 

Except in the case of contraception.

In 1968, despite the recommendation of the majority of Catholic bishops, the Pope adopted the minority recommendation to declare that using birth control was inconsistent with the Church's beliefs.  Nevertheless, U.S. Catholics continue to use birth control, to the same extent as other Americans. The U.S. Conference of Catholic Bishops has grown increasingly insistent on enforcing the birth control ban.

Virtually all heterosexually active couples in the U.S. of child-bearing age use birth control at times, including Catholics.

As of August, 2011, after a year of studying whether or not contraception is a preventive health care service, the federal Department of Health and Human Services ruled that birth control would count as a preventive health care service.

In covering contraception as a preventive service without copayments, HHS granted an exception for actual churches who provide health insurance to their employees, but required all other religiously sponsored institutions such as hospitals that offer health benefits to follow the rule.

Catholic organizations have gone to court in the past to avoid state rules that require including coverage for birth control in the health care plans they provide for employees, and failed every time.  The Church sponsors large organizations including health care providers, universities and social service agencies, as well as churches. They employ millions of Americans, many of whom are not Catholic. Their work generates the funds their employers use to pay for health insurance.  Most economists assert that the costs of employee health benefits are reflected in lower pay; that is, employers calculate benefits as a form of compensation, and many reduce wages accordingly.  In effect, the money that pays for health insurance is really money that employees generate, and belongs to them.

Not good enough for the U.S. Conference of Catholic Bishops and the extremist Republicans running Congress.  While dire economic threats face many Americans, Rep. Joe Pitts of Pennsylvania decided to change the subject.  He called a hearing entitled “Do New Health Law Mandates Threaten Conscience Rights and Access to Care?”  [http://republicans.energycommerce.house.gov/Media/file/Hearings/Health/110211/Memo.pdf]

Now let's be very clear here.  The Republicans and the Bishops are claiming that institutions have a conscience.  Not a policy.  A conscience.

Here is Joe Pitts' description of his concern [and my comments in brackets]:

"Many entities feel that it [the proposed policy] is inadequate and violates their conscience rights by forcing them to provide coverage for services for which they have a moral or ethical objection. The religious employer exemption allowed under the preventive services rule -- at the discretion of the HRSA [Health Resources Services Agency] -- is very narrow.

"And the definition offers no conscience protection to individuals," [there is no involvement of any individual employer in this matter, or any issue of an individual's conscience except that of employees deciding to purchase and use contraceptives] "schools, hospitals, or charities that hire or serve people of all faiths in their communities. It is ironic that the proponents of the health care law talked about the need to expand access to services but the administration issues rules that could force providers to stop seeing patients because to do so could violate the core tenants of their religion."  [The rule requires employers' health plans to cover contraception without any additional copayment.  There are three parties involved here: employers, employees, and health plans.  No provider or caregiver is involved, nor is any patient, student, or recipient of charity. At the most extreme, every Catholic institution could claim it will close their doors absent this exclusion.  So far no such institution has done so where state requirements are in effect, and when Rep. Jan Schakowsky asked representatives of Catholic institutions at the hearing if they would close, they affirmed that they would not.]

Rep. Gingrey, GA, opined: "Imposing the dictates of the state on the will of employers sounds un-American to me."

And another gem: "Should we force religious employers to violate their consciences?  To recognize same-sex marriage?  Will we ethically neuter health care professionals?"

Articulate Democrats on the committee - Henry Waxman, Frank Pallone, John Dingell, Lois Capps, Tammy Baldwin, Jan Schakowsky, Edolphus Towns, Eliot Engel - to a person challenged this tripe.

Tammy Baldwin: "This is a war on women."

Lois Capps: "An employer is not a person. Your boss' conscience is not your own."

Witnesses Jon O'Brien of Catholics for Choice and Dr. Steve Hathaway were articulate and brilliant in defending the truth.

But Rep. Tim Murphy, a psychologist in his fifth term in the House, was on fire:

"Conscience is at the core of Catholic teachings... and it is not left up to individuals to decide, thank goodness. Father Anthony Fisher tells us that ...there is an objective standard of moral conduct.  Vatican II teaches us that the moral character of actions is determined by objective criteria, not merely by the sincerity of intentions or the goodness of motives. It is not, I repeat, it is not our duty as Catholics to tell God what he should do or what image he should adhere to, or what he should think, but it's up to us to shape our conscience to conform with the teachings he's given us.

"Conscience, sir, is not convenience.

"Conscience is formed through prayer, attention to the sacred and adherence to the teachings of the church, and the authority of Christ's teachings in the church.  So asking a group in a survey whether or not they have ever acted or thought of acting in a certain way that runs counter to the Church's teachings is no more a moral code than asking people if they ever drove over the speed limit as a foundation for eliminating all traffic laws.

"I end with a quote from John Adams, in 1776, when he was writing our Declaration of Independence of the United States:  'It is the duty of all men in society, publicly and at stated seasons to worship the creator and preserver of the universe, and no subject shall be hurt, molested or constrained from worshipping God in the manner most agreeable to the dictates of his own conscience, or for religious profession or sentiments, provided he does not disturb the public peace or obstruct others in their religious worship.' The foundation of our nation is not to impose laws that restrict a person's ability to practice their faith, sir."

Well, actually, Tim: Exactly.

Health Reform: Declaring and Winning Victories on the Way Forward

Invitation to a Discussion

Many are mad as hell this election season, including some progressives. Absent the funding of the madly rich and insanely right-wing Koch brothers, what are we to do?

For one thing, take a sober look at the policy and politics associated with the Affordable Care Act.

This is not the single payer system many staunch health care reform advocates - including me - preferred, but lacked the power to enact. As we continue the campaign for a single payer, it is essential to recognize, vigorously defend and advance the victories we achieved in the Affordable Care Act, in order to preserve the gains for people in need and also to shore up the valuable activists, and activism, we will need for what is going to be a long haul ahead.

Here's what the ACA accomplishes, what single payer systems do, why we're absolutely right to continue to advocate for them, and how we can shape policy to get there from here.

What does the ACA accomplish? The U.S. health care system will do a better job of treating illness and improving health at an affordable cost. The Medicare Trust Fund will be solvent for an additional 12 years, through 2029. There are substantial improvements for lower and middle income people, and immediate benefits for women, younger people, seniors and small businesses. Importantly, the ACA creates policy space to continue efforts to cover everyone while controlling costs, goals that are popular with the public. It accomplishes these objectives in part by imposing new progressive taxes and fees on the wealthiest 2% of the population and on employers.

Politically, the ACA opens opportunities to challenge corporate power at the national level, in the formation of extensive regulations. It throws some leverage to the states, which progressives can use to advance our goals of equitable, quality, universal, affordable health care.

The law includes compromises that call out for revision, particularly on affordability, and on coverage for immigrants and for reproductive health care. And the political process that got us here will be grist for analysis for decades to come.

But it is just not true, as some have characterized it, that the law is primarily a victory for business as usual by the insurance industry. Furthermore, the fight to undermine and defeat the law unquestionably empowers and invigorates the most predatory anti-government political and financial interests in the country. Since the facts don't serve their agenda - to profit by destabilizing our social and financial security, including dismantling Medicare - they rely on hyperbole and distortion to mobilize the public's complicity in opposing our own real best interests. In contrast, we can and must remain critical while carefully examining sweeping generalizations that don't fit.

Single Payer: Getting There from Here

Single payer systems funnel all payments for health care to one collection point - usually a state or national government. This single payer then pays all the health care providers: doctors, hospitals, drug companies. There is overwhelming evidence that single payer systems are more cost-efficient and affordable, along with their many benefits for equity and quality of care.

This is different from our current system in at least two ways that are key to controlling health care costs.

• First, it is administratively efficient. It eliminates the middleman: the proliferation of private insurance companies that take a bite out of every health care dollar for the administrative service of paying the bills. These insurance companies, both for-profit and non-profit, now rake off about 30% or more of our insurance premiums, using ploys that at the same time restrict access to necessary health care and inflict great suffering on ailing humanity. They also add to the administrative burdens of doctors and hospitals.

• Secondly, it moderates prices. It gives a powerful negotiator - the government - the authority to negotiate prices with the health care industry: hospitals, doctors, medical supply companies, drug companies.

Largely for these reasons, single payer proposals are fiercely attacked, maligned and misrepresented and in all manner just blocked in the halls of power by the industry, which profits nicely from this mess.

The state and federal governments are now writing the rules for implementing the Affordable Care Act. Advocates can help to shape these rules to get us closer to administrative efficiency, and to expand the public sector's purview over prices. Some examples:

• In 2014, new insurance Exchanges will standardize health insurance plans. People who buy insurance now as individuals or in small groups will be grouped into much larger pools, sharply reducing cost-shifting. Advocates have the opportunity to craft and support state laws implementing the exchanges that can push limits on standardizing health plans and require financial transparency.

• The law sharply expands the number of people covered by public sector health plans. For the first time Medicaid will cover everyone under 133% of the federal poverty level, regardless of health status. State governments already do negotiate drug prices under Medicaid, in which enrollment will grow by almost half by 2014. State laws to adopt a public option would further expand the number of people who receive health care either paid for or provided directly by the public sector.

• There are numerous opportunities to regulate, review and otherwise limit premiums, depending on the rules adopted by HHS, and state implementation laws. The current policy debate on how to define and enforce the Medical Loss Ratio is an important example.

• The law also draws on the public's control over Medicare to address some of the underlying drivers of increasing health costs through new measures such as comparative effectiveness research and payment reforms to encourage more cost-effective delivery systems. It also expands primary care and public health.

• Finally, as soon as 2017 - maybe sooner - there is a defined process for states to prepare for and enact alternative systems, including single payer.

The corporate media surround us with messages - and messengers - that exhort us to succumb to cynicism (nothing will ever work, they'll always sell us out). Voluntarily taking ourselves out of the real health care fights of the day is tantamount to capitulation. Effective strategies for building the power we need will require and emerge from engagement as well as resistance. Advocates can rebuild public awareness and momentum for single payer systems, and at the same time support legislation and regulations that maximize the progressive aspects of the ACA. If done well, our work on the ACA will build the pathways we need to a single payer system.