There was lots of excitable talk last week about birth control, with President Obama dialing back his initial plan for mandating contraceptive coverage to exempt employers who object to such coverage on religious grounds. In those cases, the health-insurance provider, rather than the employer, will be on the hook to pay for the services. Tellingly, health-insurance companies seem quite happy with this compromise, knowing, as they do, that paying for contraceptives is a lot less costly than paying for pregnancies and neonatal care.
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Despite the support of a healthy majority of Americans of all faiths, Republican presidential candidate Newt Gingrich inexplicably described the compromise as “even worse” than the original plan. Gingrich’s opponent Rick Santorum scoffed at the need for contraception coverage, calling birth control a “minor expense.” Foster Friess, a major Santorum donor, suggested that “gals” might want to hold aspirin between their knees as a birth-control device.
With this hysteria at a fever pitch, it’s easy to forget a few simple truths. Taxpayers spend more than $11 billion each year (in 2001 dollars) on costs associated with unintended pregnancy. It’s a conservative figure that only includes public insurance costs and not the larger financial burden of bringing unwanted children into the world.
An estimated half of all pregnancies in the U.S. are unintended according to an analysis by researchers at the Guttmacher Institute and published in the journal Perspectives on Sexual and Reproductive Health, and of those unplanned pregnancies, a further half end in abortion. That’s an awful lot of unwanted children and fetuses. By age 45, more than 40% of all American women will have had at least one abortion, a rate almost twice that of Western Europe. A comprehensive study by the World Health Organization confirmed that abortion rates in countries that prohibit or restrict legal abortion are no different than abortion rates in countries with liberal abortion laws; the only reliable way to reduce abortion is through the provision of affordable, accessible contraception. To cap off last week’s debate came the news that there has been a surge in births outside marriage, the fastest growth being among white women in their twenties with some college education. More than half of births to women under 30 now occur outside of marriage. Is this really a time to try to limit contraception? What about the reckoning of the reality of human lives?
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People who cry moral indignation about government-mandated contraception coverage appear unwilling to concede that the exercise of their deeply held convictions might infringe on the rights of millions of people who are burdened by unplanned pregnancy or want to reduce abortion or would like to see their tax dollars committed to a different purpose.
Why should an employer’s right to reject birth-control coverage trump a society’s collective imperative to reduce unintended pregnancy? Should employers be allowed to withhold a polio vaccine or cataract surgery or safe working conditions on similar “moral” grounds?
We all enjoy the multifold benefits of a plural society, but the social contract requires that we must occasionally stomach government policies that offend and outrage us. Most Americans choose to live with this trade-off because, on balance, the benefits of being part of a civil society far outweigh the costs. We are assured a level of comfort and safety, for example, that is unheard of in much of the world. We travel on relatively safe roads and airplanes; we rarely get sick from our drinking water. We can call the fire department in an emergency and hire publicly educated employees; we undergo surgery and cancer treatments developed from taxpayer-funded medical research. Our armies are voluntary. We can worship where and with whom we want. Our legal disputes are solved by the state, not an irate neighbor with a pitchfork.
Americans generally understand that their world doesn’t collapse when they are forced to live with decisions and values with which they disagree. It seems people are quite willing to be flexible on most matters, except in an election year and where sex is involved.
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The cost of living in a democracy is tolerating moral judgments we don’t always like. For those who object, there’s a clear alternative. Protesting the Mexican-American War in the 1840s, Henry David Thoreau withheld his taxes with the understanding that he would have to go to jail for his principles. In reality, he only served one night in jail, but he was willing to pay the price for his convictions. Martin Luther King Jr. and Nelson Mandela paid a much higher price for theirs.
Let’s see what our society would look like if we all had the luxury of imposing our unfettered will. At a minimum, the Catholic bishops and employers resisting contraceptive coverage should be willing to pay for the care of all those unwanted children. Or perhaps they’d be willing to spend some time in jail in protest. At my taxpaying expense, of course.