Contraception mandate and liberalism (a.k.a Beating a dead horse) (updated 19/3/2012, 8:40am GMT+8)

Kevin Vallier over at Bleeding Heart Libertarians argues that liberals must oppose the contraception mandate.

In order to determine whether a law or policy is illiberal, we must describe the various forms of coercion it involves. For the mandate, this is easy: the Obama administration will force religious organizations to use their financial resources to support a practice they find sinful. (Under the new policy, they will coerce health insurance companies associated with religious organizations to do the same.) No other coercion is involved.

Defenders of the mandate insist that a woman’s reproductive liberty is significantly restricted if her employer refuses to pay for contraception. This is false. To see why, abstract. Is A’s liberty to X restricted if A’s boss refuses to pay for X? Especially when X is cheap and readily available? And when A can choose another employer? And when A’s government could provide X directly without using force against a voluntary association? No, no, no, and no.

I can see no way to generalize the moral relationship between women who wish to use contraception and their Roman Catholic employers into a plausible moral principle that demonstrates that the RCC is coercively blocking their employees from acquiring and using contraception.

(Emphasis added)

I am inclined to agree even though I wouldn’t state it exactly the same way. Note especially the last part of the second paragraph. Given that there are other ways to ensure that everyone had some minimum of health insurance, the insurance mandate is odious because such things could be provided without coercion. Is there a rationale with going with the mandate rather than with an alternative which would do the same thing without such coercion?

To find out, we need to explore the alternative. In my alternative, there will be a public option that covers whatever employers fail to cover. People will purchase the public option as and add-on to their normal employer-provided insurance. Presumably, we could also build in an exception such that people need not purchase what they conscientiously object to. So, this way, people who object to using contraception need not buy any and those who don’t object are covered regardless of whether their employers happen to be catholic.

What are the problems with this option? It is possibly more inefficient, might exacerbate some adverse selection problems etc. Is that a sufficient reason? If people are in grinding poverty and the marginal inefficiency is going to make them even worse off, then yes, the relative inefficiency could be sufficient reason for this kind of coercion. Whether it all things considered is depends on, to a certain extent, how much the Catholic institutions involved are being coerced. (There is a difference between threatening you with a $100 fine and the death penalty)

There is of course the meta-issue about whether it is within the bounds of acceptable discourse to say that liberals must oppose something that most actual liberals fail to oppose. I of course do think so. Political philosophers do this all the time. There are many philosophers who do ask and attempt to answer the question of what should liberals/libertarians/egalitarians want?So, here’s a question for the league: Is there anything problematic about saying that liberals should endorse something that most real life liberals don’t actually endorse?

[Update: 19/3/2012, 8:40am GMT+8]

Nob Akimoto gives us an idea of what the mandate really requires.

1. “Large” employers (more than 50 full time employees) are asked to provide health insurance to their employees under ACA’s employer mandate.

2. Employers who do not provide health insurance, have over 50 full time employees, and those employees make up to 200% of federal poverty limit are assessed a fee roughly equal to the premium support employees get on the health care exchange.

3. In effect this works as a tax. Baseline is that employers are taxed if they don’t provide health insurance. (the assessment) Small employers (less than 50 full time employees), employers who provide health insurance or employers who have employee compensation levels that keep them from getting a premium support in the exchanges are exempt.

4. The mandate on contraceptive coverage was originally intended to quantify what health insurance would be considered adequate to meet this employer mandate. This has since been changed that all health insurance plans sold in the United States (and thus eligible for participation in the Exchanges) must cover contraception if requested by the covered party.

Presumably, the tax goes to defraying the cost of insurance purchased on the exchange. If I’m reading this right, the employee will only have to pay for insurance that is more expensive than the fee. i.e. the fee actually is a kind of voucher which subsidises to a certain level, the insurance the employee wants to buy. This of course doesn’t make the PPACA unproblematic. I can still foresee some unintended consequences that follow from this system. It is also somewhat irksome on general grounds to be forced to provide a particular kind of benefit or not at all. It does however diffuse the religious freedom objection. This is because presumably, the catholic church does not object to people using their own money to buy whatever insurance they want. Also, the RCC linked organisations need not cover contraception if the employee doesn’t want them covered. And if the employee wants one covered the RCC need not subscribe to the insurance directly, but can leave it to the employee’s discretion.

If on the other hand, the employee has to pay the full cost of the insurance purchased on the exchange, then while it may qualify as a tax on a technicality, it looks an awful lot like a fine. i.e.  employers are punished for failing to provide a particular kind of benefit in a particular way. i.e. it really is a mandate. But from what Nob says, that doesn’t look to be the case.