What began as an effort by the federal government to improve health services for American women has devolved into another round in the culture wars—this time focused on the alleged primacy of religious "conscience" versus scientific knowledge and medical practice.
While Health and Human Services Secretary Kathleen Sebelius likely expected some push-back on her technical alteration of federal rules governing employer supplied health coverage—expanding that coverage to eventually require non-profit religious employers to "cover contraceptive services"—the timing of the change has proven politically potent and quite controversial for the Obama administration.
Since the announcement was first issued by DHHS, the nation's focus on the religious and political questions surrounding women's health services, and especially access to contraceptive services, has increasingly become the dominant political story.
First came word from the breast cancer group, Susan G. Komen, that it was defunding its contribution to breast cancer screening for Planned Parenthood. This resulted in one of the most immediate, widespread and vituperative reactions in recent memory, with Komen and its officers being harshly attacked in numerous venues, and especially online for its decision.
As more details surfaced about the decision to defund, Komen realized that its preparation for the potential public backlash was even more ill-considered than DHHS in announcing its rules change. Within days, Komen reversed itself and apologized to the American public, and shortly afterward accepted the resignation of Karen Handel, who was viewed as the instigator of the defunding idea.
Handel's conservative and anti-Planned-Parenthood credentials prior to taking her job at Komen, led many critics to accuse Komen of having hid its true conservative agenda from donors for years. The crisis is still playing out for Komen, as Handel has confirmed in interviews that an anti-Planned-Parenthood attitude was certainly already in place at Komen when she came onboard.
Then, on Tuesday, in a decision that was less surprising than it was confirming of social conservatives' biggest fears of alleged government overreach, the Ninth Circuit Court of Appeals overturned a voter-approved constitutional amendment, popularly known as Proposition 8, which had taken away the right of marriage for same-sex couples in California. That matter may now be headed for a final resolution in the United States Supreme Court.
The political implications of these developments, and especially the DHHS contraceptive coverage rule change, was also revealed on Tuesday, as Rick Santorum, a Catholic, staged a shocking comeback in the Republican nominating process, winning in three states, and by such large margins over the alleged frontrunner Mitt Romney, it suggested Santorum had achieved what Newt Gingrich claimed was necessary—consolidation of the conservative vote.
Ironically, Gingrich had made this suggestion while indicating he thought the best way for conservative consolidation to occur was for Rick Santorum to bow out of the race.
In the media storm surrounding the contraception question, the debate has surrounded the question whether the federal government had the right to force Catholic institutions, such as hospitals to violate their "conscience", in complying with the rule change to supply contraceptive coverage to women employees.
Linda Greenhouse, who today explored this question in the NY Times, points out:
"[I]t’s important to be clear that the conscientious objection to the regulation comes from an institution [i.e. the Catholic Church] rather than from those whose consciences it purports to represent."
Greenhouse linked in that statement to a Guttmacher Institute study from last year showing widespread use and support for contraceptives among religious and even Catholic women.
In addition to the issues of whose conscience is being threatened by the rule change, what has been lost in battle over these issues, and what is almost always given short shrift in media treatments of the contraceptive services debate, is that the opinions of doctors, the applied scientists supplying medical services to women, are widely ignored.
For example, in the DHHS statement, we read the following:
"Today the department is announcing that the final rule on preventive health services will ensure that women with health insurance coverage will have access to the full range of the Institute of Medicine’s recommended preventive services."
What is the Institute of Medicine?
According to its website:
"The Institute of Medicine (IOM) is an independent, nonprofit organization that works outside of government to provide unbiased and authoritative advice to decision makers and the public. Established in 1970, the IOM is the health arm of the National Academy of Sciences, which was chartered under President Abraham Lincoln in 1863."
While this group is frequently, but briefly, mentioned in some news stories about the contraception coverage controversy, it generally is relegated to one-liners about how some "experts" at the Institute of Medicine recommended the contraceptive services being argued over.
Yet, the opinions of these doctors and scientists are not mentioned at all. Again, in the DHHS statement, a scientific, and not a religious, determination is given preference in the rule change:
"Scientists have abundant evidence that birth control has significant health benefits for women and their families, is documented to significantly reduce health costs, and is the most commonly taken drug in America by young and middle-aged women. This rule will provide women with greater access to contraception by requiring coverage and by prohibiting cost sharing."
Precisely why a medical issue, concerning "the most commonly taken drug in America by young and middle-aged women", should be decided by the Catholic pope, or Pat Robertson (for example), claiming to be talking for God and to American women, has never been clearly explained, or in most cases explained at all.
An example of the confusion over the proper role of religious "conscience" and supposed First Amendment issues regarding the DHHS rule change was expressed on the MSNBC program, "Morning Joe", where host Joe Scarborough, attempting to explain what he called the "middle" position, offered this analysis:
"The White House is saying 'we're not trampling on religious freedoms', but what we are saying, and what Catholic leaders are saying, and what the USA Today is saying, and what David Brooks is saying, and what a lot of people are saying in the middle is—you're gonna give us one year to go back on 2000 years of religious teaching? And again, for people that are just not intelligent enough to understand what we are saying here—I've got not problem with contraceptives—most Americans have got no problem with contraceptives—but the Catholic Church does. So it's not the federal government's business to them what they have to do."
While Joe Scarborough is certainly correct that the First Amendment substantially protects Catholic churches from being dictated to by government on the nature of doctrine and religious practices within the church, the question is whether that protection extends to an organization such as a hospital, which is not a religious institution, though it may be owned and run by one.
And so, contradicting Scarborough's conclusion, it is actually the federal government's business to tell Catholic hospitals what to do.
In countless ways, these organizations are already subject to US government regulations, and are not able to employ their own religious version of sound medical practice without risking losing their licenses to operate. Few have seriously argued those professional medical requirements are a threat to the Catholic Church's First Amendment freedom.
Instead, the concern has been predominantly to protect the health and safety of patients who might use the hospital.
In the USA presently, given the severe constraints on educated discourse in the political arena, the incredibly important issue of women's health has been used for a long time as a football by conservatives hoping to stir up the passions of the social conservative base.
This particular battle in the culture wars may now become increasingly attractive to Republicans, as their moderate, and seemingly more rational candidate and message have fallen on very unreceptive ears in the Republican primaries. In the end, in 2012, Rick Santorum's passionate opposition to contraceptive services and abortion rights, may trump Mitt Romney's claim of being able to do a better job of improving the US economy.
Meanwhile, Barack Obama has to determine which side of the religion-science divide he will stand on in these and other questions (for example, climate change), and with how much commitment, in a contest against whichever Republican is chosen to be his opponent.
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