Friday, February 10, 2012

It's money that matters....

The issue often arises in the argument about what institutions should provide what kind of health insurance, that money is fungible, and that money is an expression of morality. That is, what money is not spent on one effort, can still make money available to spend on objectionable efforts (this is the common argument raised against any funding to Planned Parenthood, which provides both healthcare, such as mammogram screenings, and abortions). Money, too, we are told, bears moral agency, because money we spend on something we object to, means we are forced to support something objectionable to our moral imperatives.

But what is the moral agency of money? How directly must it be connected to me in order to have any agency at all? In other words, when does your money stop being your money?

We think it obvious: money stops being your money when it leaves your hands. So if I buy a product from a company that engages in, say, sweatshop practices, I haven't supported those practices because I didn't directly pay the manager of that sweatshop. I paid a company that profits from cheap labor. Oh, no, that's no good. I've directly supported a sweatshop. That's morally objectionable.

What if I invest in a money market fund that buys stock in a company that owns a subsidiary that employs sweatshop labor to make clothing, and the clothing line is profitable because of that sweatshop? Am I still supporting the sweatshop? What if I buy an Apple computer? Am I supporting the working conditions in China? And if I buy a used Apple computer, rather than a new one? Is the connection now tenuous enough that I am free of responsibility?

How direct does the connection have to be?

If I employ people, and I believe drinking is a sin, may I fire my employees who use the money I pay them to buy alcohol? Why not? My money is going directly to support a practice I find morally and religiously objectionable. I may even find it an abomination. As the owner of a Taco Bell, say, am I not being required under federal law to not discriminate on such a basis, even if I think I have a moral right to do so? If I employ people in a community where they can buy alcohol, even if they have to drive to another county to buy the alcohol, am I not supporting the sales of alcohol, something I consider an abomination and a violation of my religious beliefs? Why can't I fire my employees who engage in this legal practice? Or what if one of my employees supports a child who is living with a person of the opposite sex without being married? What if one of my employees is married to a person of another race? Can I fire them because of that marriage, if I consider mixed race marriages an abomination?

Why not? They are using my money to engage in practices I find morally objectionable. But are they using my money? Isn't it theirs, the moment it is earned?

Why does an employer provide health insurance? As a benefit of employment? Is it, then, the employer's, even if it is provided for the employee? Even if the employee has to pay some of the cost of the insurance? Is such insurance any different from money? If I provide health insurance, can I limit how my employee uses that insurance? Can I insist they patronize only hospitals I support, say, a Catholic hospital rather than a Jewish, Methodist, or UCC one? What if I disagree with the moral stance of the UCC or the Methodist church? Can I insist my employees use their health insurance only at hospitals I find morally acceptable, based on the religious group that supports them? Again, why not? I am paying for the health insurance; why can't I direct how it is used?

Indeed, if money is fungible, does my support of a health insurance company make it easier for them to provide coverage for abortions and contraception, even if I insist on paying for a policy that doesn't provide such coverage? Am I not supporting those abominable practices by putting my money into a company that does provide coverage of those practices for other policy holders?

The limitations on my reach as this hypothetical employer seem obvious. But why? What's the basis for these limitations? The "fungible goods" argument seems absurd in most of its applications, but why? When does money lose its agency? When do I stop being responsible for how it is spent?

I've known people to give homeless people crackers, or a gift certificate for a hamburger, on the theory that money would just be spent on alcohol. Perhaps it would be. But the logical extension of the "fungible goods" argument is that even the gift certificate just allows them to spend the next dollars they accumulate on alcohol. Am I responsible for that, because my gift certificate fed them and kept them alive long enough to buy beer? Clearly not; but why not?

Am I responsible for how my employees spend their wages? Once upon a time, employers were so paternalistic. They still can be, with clergy. But most other employees enjoy a wide latitude in how they spend their money, because society at large considers it "their" money. It is the earnings of their labor, they are entitled to use it as they see fit. Are they not also entitled to use their health insurance as they see fit? Have they not also earned that benefit as a result of their labor? Or is health insurance a beneficent grant from a paternalistic employer, like a bonus or a gift? Does it come with strings attached, such as how it can be used? Can employers fire employees who use their health benefits in ways the employer doesn't like, even finds abominable, even if that use is otherwise legal? Why?

When does money lose its agency?

Addendum: after I wrote this, a compromise was announced:

Senior administration officials announced early this morning that President Obama will announce a new “accommodation” for religious liberties in the rule requiring all employers to offer contraception coverage without additional cost sharing. Under the new policy, “all women will still have access to free preventive care, including contraception,” no matter where they work.” However, if a nonprofit religiously affiliated organization objects to offering birth control, the insurance company will be required to provide the coverage free of charge and the employer will not pay for it. Sister Carol Keehan, President of the US Catholic Health Association, and Planned Parenthood head Cecile Richards support the compromise, the administration officials said.

Significantly, unlike the Hawaii model, religiously affiliated organizations will not have to refer employees to contraception coverage. Instead, the same insurer that provides insurance to the employer, will be offering contraception coverage to the employee directly.
The reaction of the US bishops was to reject this on the grounds of agency:

Bishop William Lori, chair of the U.S. bishops’ Ad Hoc Committee on Religious Liberty, has also described the Hawaii model as a failure, arguing that it forces Catholic institutions to make a referral “to a service that it regards as intrinsically immoral.”
This isn't, as it turns out, the "Hawaii model," so the referral argument seems to be moot.* But the issue of fungible goods remains, since no insurance company is going to make a charitable donation of its coverage, and the money the employer is paying for the coverage is still, at least arguably, supporting that which is "intrinsically immoral." When does money finally lose its agency? When your morality treads on my equal protection of law, which should the government uphold?

*Separately, this is a curious argument. I know Catholic hospitals that will not allow fertility treatments such as in vitro fertilization to be performed on their premises, and I have no problem with such a refusal. But if a patient presents with a condition that requires contraceptives to treat it (and there are such conditions), and the hospital refuses to administer such treatment, but refers the patient to another hospital, is that not making a referral "to a service that it regards as intrinsically immoral"? If the hospital diagnoses the condition but refuses the treatment, is it intrinsically immoral to pass that diagnosis on to another physician, or another hospital? Is any referral to another hospital or caregiver that doesn't share the moral prerogatives of the Bishops intrinsically immoral? When is participation in the healthcare system itself "intrinsically immoral"? At what point is the connection attenuated enough that it is morally acceptable? Is it more moral to refuse to treat the patient altogether, and so refuse the referral? And is such a position any more defensible than that of the Spanish king in medieval Europe ordering the consumption of pork by all the Jews in the country?

1 comment:

  1. From the comments at my blog soon after the decision about contraceptive coverage was announced.

    Tobias Stanislas Haller said...

    I keep trying to remind these folks of their beloved Double Effect doctrine, but they clearly don't want that as a way out. The actual use of contraception in the cases in point are so far removed from their actual agency or action that it should not pose any moral qualm at all -- except for the reality that they don't want it no how, no way, by none!

    church sponsors, supervises, etc. school > school provides health insurance > health insurer covers contraception > insured takes advantage of coverage and has contraceptive prescription > person fills prescription and > uses contraception. Only the last step is (under their concept) morally objectionable.