Birth Control And Health Care

If the pandemic has taught Americans anything, it is just how inadequate–and let’s be honest, discriminatory and stupid–our healthcare system is. (Actually, every time I write “healthcare system” I am reminded of the student who was studying to be a hospital administrator, who told me the phrase was inaccurate–“We don’t have a healthcare system. We have a healthcare industry.”)

A few days ago, the Supreme Court handed down an indefensible decision that denied women healthcare if they are unlucky enough to have an employer who has “religious qualms” about allowing their health insurance to include birth control.  Gail Collins provided a perfect analogy:

Let’s pretend there was an order of nuns with a particular devotion to the Sacred Heart of Jesus. So much so that the order had, over the years, decided that any human heart was a holy symbol, and it was immoral to mess with it, even if you were a physician doing cardiac surgery.

Following their consciences, these nuns banned heart-related care from their employees’ health policies. That affected thousands of workers, many of whom did not share their religious convictions. Still, the nuns noted, their insurance coverage was generous. Except for that one thing.

The Court affirmed the right of employers to omit birth control coverage from their group health policies. But that “right” is misleading.  The Obama administration had arranged for the federal government to intervene when religious employers had ethical objections. All the employer had to do was file a form, and they’d be off the hook; the government and the health insurance companies would provide the coverage. The employer wouldn’t need to spend a penny on a sinful women’s health measure.

But that wasn’t good enough. Filing a form would make them complicit. Trump, of course, pandered to the “religious” employers who placed their purported moral purity above the actual health and well-being of their female employees, and the Court acquiesced.

An  estimated 70,000 to 126,000 women will lose their current free contraceptive coverage–and contraception isn’t cheap. As the Times Editorial Board wrote, 

It bears reminding that the cost of birth control can be significant, and that many women rely on it not just to prevent pregnancy but to treat medical issues. Sometimes, the contraceptive method that works best — or the only one a person can tolerate — costs many hundreds of dollars without insurance coverage.

As the Editorial Board also noted,

It’s hard to imagine the conservative justices of this court, especially, allowing employers to claim a moral exemption and require their employees to pay out of pocket for, say, a treatment for Covid-19. That sounds absurd. And yet, when it comes to birth control, such state interference with personal health decisions is considered a legitimate matter for public debate.

The health care industry in this country is the real “American Exceptionalism.”

America could solve conflicts like this one–not to mention racial and economic inequities in access to health care–by emulating other advanced, civilized nations and moving to a single-payer system of health insurance. Not only would such a move eliminate the ability of some Americans to impose their religious convictions on others, not only would it ameliorate a number of racial and economic inequities, not only would it vastly reduce personal stress and the country’s high rate of personal bankruptcies, it would introduce cost-controls to a system that costs far more and delivers far poorer results than others.

How much of our stubborn refusal to provide universal health insurance is due to inertia, to misunderstanding of how markets work or don’t, or a false belief in American superiority–and how much of it is due to a shameful reluctance to extend the social safety net to “others”–minorities and women?

Comments

Religion, Vouchers And The Court

I was sitting at my desk Wednesday when the news alert came across my screen. The New York Times was reporting on the most recent decisions being handed down the Supreme Court.

I will comment on the truly offensive decision in Little Sisters of the Poor tomorrow. Today, I want to address the decision allowing religious schools to discriminate in employment.

Here’s the lede:

The Supreme Court ruled on Wednesday that federal employment discrimination laws do not apply to teachers whose duties include instruction in religion at schools run by churches.

The vote was 7 to 2, with Justices Ruth Bader Ginsburg and Sonia Sotomayor in dissent.

The court has been active in considering the relationship between church and state, generally siding with religious groups. It has ruled in recent years that a state must let a church participate in a government aid program, that a war memorial in the shape of a cross could remain on public property and that town boards may start their meetings with sectarian prayers. Last week, it said state programs that provide scholarships to students in private schools may not exclude religious schools.

The new cases considered another aspect of the church-and-state divide — what role the government can play in regulating religious institutions.

I have my reservations about several of these cases–not to mention my suspicions about the religious and ideological perspectives of the more conservative Justices–but I actually don’t disagree with this one.

What I do disagree with–strongly–is those “state programs that provide scholarships to students in private schools.”

I have written before about voucher programs. Not only have I blogged about them, but I’ve written academic articles explaining the multiple reasons these programs were ill-conceived to begin with, and  pointing out that–in addition to the substantial harms they have caused– they have failed to deliver the benefits they promised (they now have been functioning long enough to permit assessment).

They are also a scam. 

How wasteful/counterproductive is our state’s largesse to private (mostly religious) schools? Let me count the ways: the promised improvement in student achievement did not materialize; badly-needed funds are being diverted from the public schools that most Hoosier children still attend; taxpayers are subsidizing discrimination (schools getting millions of dollars are discharging teachers and counselors for the “sin” of being in same-sex marriages); and there are no requirements that recipients of vouchers teach civics.

In addition to all that, lack of oversight has facilitated a massive rip-off of Hoosier taxpayers. Doug Masson wrote a scathing summary of that problem last year after Chalkbeat reported on fraudulently inflated enrollment numbers at Indiana’s then-virtual schools.

Doug also succinctly summed up the actual motives of voucher supporters. The real impetus for voucher programs wasn’t the purported one: to allow poor children to escape failing schools. It was–and remains–threefold: to weaken teacher’s unions, subsidize religious institutions, and redirect public education money to cronies.

Also, a reminder: vouchers do not improve educational outcomes. I get so worked up about this because the traditional public school is an important part of what ties a community together — part of what turns a collection of individuals into a community. And community feels a little tough to come by these days. We shouldn’t be actively eroding it.

In Indiana, far from excluding religious schools from the nation’s largest voucher program, well over 90% of the schools receiving vouchers paid for by our tax dollars are religious. Some of those schools allow religious dogma to influence what they teach– creationism rather than science, for example– and a number discriminate against teachers and students on the basis of their theologies.

So here’s where I agree with the Court: if your church or mosque or synagogue wants to ensure the “purity” of your doctrine, fine. The Free Exercise Clause–as I read it, and as the Court has now read it–says okay. You don’t have to hire or retain employees who violate your religious tenets.

But as I read the Establishment Clause, your religious institution doesn’t get to do those things with my tax dollars.

So the Catholic Archdiocese gets to exclude trans kids from Catholic schools, and fire excellent teachers and counselors for the “sin” of same-sex marriage. Fine–but not with my tax dollars.

The case that was wrongly decided was Zelman versus Simmons-Harris. In that intellectually dishonest 2002 ruling, the Court pretended that the tax dollars going to vouchers were really being paid to parents, who would then exercise “independent choice.” That has never been the case.

There is now a substantial body of research confirming that vouchers are bleeding resources from our public schools (without improving student performance), eroding civic identity, benefitting religions in violation of the Establishment Clause, and– as a bonus– crippling teacher’s unions.

I’m all for letting churches and religious schools practice what they preach. However, I am adamantly opposed to having taxpayers foot the bill.

Comments

When We Can’t Look Away

I’ve been harping on the role of pictures in generating social change–how the flood of visual testimony of racism, culminating in the video of George Floyd’s murder, has forced recognition of a reality too many Americans hadn’t previously understood–or wanted to acknowledge.

But a couple of recent columns–one by Michelle Goldberg and one by Russ Douthat–have expanded on that observation. Both writers suggest that seeing Donald Trump and experiencing the travesty that has been his administration have also been “pictures.”

Goldberg notes “two big examples” of how Trump’s presidency has triggered progress.

The sudden, rapid embrace of the Black Lives Matter movement by white people is a function of the undeniable brutality of George Floyd’s videotaped killing. But public opinion has also moved left on racial issues in reaction to an unpopular president who behaves like a cross between Bull Connor and Andrew Dice Clay.

And the thrilling 6-3 decision the Supreme Court just issued upholding L.G.B.T. equality wouldn’t be as devastating to the religious right if it had happened under a President Clinton.

Goldberg suggests that the Supreme Court’s LGBTQ decision dealt a real blow to the “but the Supreme Court!” argument made by conservative supporters of Trump. (And this was before the Court slapped him down on DACA.)

We’ve all encountered those people: yes, they’ll admit, Trump is an offensive ignoramus, someone we’d never socialize with or hire, but we need to support him in order to put conservative judges on the courts. (The argument used to be accompanied by “and look at your 401K!”–but that justification disappeared with Trump’s criminally incompetent “management” of the pandemic.)

The phrase “But Gorsuch” is shorthand for how conservatives justify all the moral compromises they’ve made in supporting Trump; controlling the Supreme Court makes it all worth it. So there’s a special sweetness in Gorsuch spearheading the most important L.G.B.T. rights decision since the 2015 ruling in Obergefell v. Hodges, which established a constitutional right to same-sex marriage.

Goldberg quotes one conservative for the sentiment that, if Trump’s appointees can’t  deliver Supreme Court victories to social conservatives, “there’s no point.” If that reaction means that social conservatives will be less enthusiastic about heading to the polls in November, it makes the Court’s decision even more satisfying.

On the Sunday before announcement of the Court’s decision (which, I am happy to report, was accompanied by others that cheered me: refusal to hear a challenge to California’s refusal to co-operate with ICE, refusal to hear challenges to state gun control laws, and one protecting the Clean Water Act) Russ Douthat, one of the conservative columnists at the Times, attributed the increasingly leftward shift of public opinion to Trump’s Presidency, suggesting that “so long as he remains in office, Trump will be an accelerant of the right’s erasure, an agent of its marginalization and defeat, no matter how many of his appointees occupy the federal bench.”

In situations of crisis or grave difficulty, Trump displays three qualities, three spirits, that all redound against the movement that he leads. His spirit of authoritarianism creates a sense of perpetual crisis among his opponents, uniting left-wingers and liberals despite their differences. His spirit of chaos, the sense that nothing is planned or under control, turns moderates and normies against him. And finally his spirit of incompetence means that conservatives get far less out of his administration than they would from a genuine imperial president, a man of iron rather than of pasteboard.

Douthat concludes that Trump has been little short of a disaster for conservatives.

What we are seeing right now in America, an accelerated leftward shift, probably won’t continue at this pace through 2024. But it’s likely to continue in some form so long as Trump is conservatism, and conservatism is Trump — and four more years of trying to use him as a defensive salient is not a strategy of survival, but defeat.

For principled conservatives–in contrast to the more numerous racists and homophobes who’ve adopted the label–the Trump Presidency has been that very bad car wreck at the side of the road–the one every passing car slows down to gape at. 

It’s a horrifying picture, and they can’t look away. None of us can–and the compelling pileups keep coming.

Friday’s effort to fire the U.S. Attorney for the Southern District of New York–this administration’s “Saturday night massacre”– looks to usher in an even more dramatic and compelling collision, as Barr frantically tries to keep the lid on pending disclosures and indictments…

Popcorn, anyone?

As a friend recently posted to Facebook, this isn’t government–it’s the Days of Our Lives. 

Comments

Frame Me A Story

When I think about what I learned in law school all those years ago, it really boils down to one truism: he who frames the issue wins the debate.

Okay, that might be a wee bit of overstatement, but a recent column by Linda Greenhouse— one of the most savvy reporters covering the Supreme Court–reminded me just how important framing is, not just in litigation but also in politics.

Greenhouse was writing about two “religious liberty” cases on the Court’s docket this term. As she noted, these cases involve a constitutional gray area; we know that the  Free Exercise Clause requires government to give religious believers room to practice their faith without undue interference. Courts must decide how much room, under what circumstances, and what interference is “undue.”

The cases the Justices must decide this term–Little Sisters of the Poor v. Pennsylvania and Our Lady of Guadalupe School v. Morrissey-Berru— both lend themselves to what Greenhouse calls “alternative narrative” packaging. Religious organizations have been in court ever since the Affordable Care Act was passed, protesting the Act’s requirement that health insurers cover contraception for employees that want it.

Which gets us to posturing. Despite Little Sisters’ name on one of the lawsuits, it has virtually no interest in the decision.

That’s because the order’s lay employees, not all of whom are Catholic, are covered by a church-sponsored insurer, the Christian Brothers Trust, which the government conceded in earlier litigation can’t be penalized for its refusal to provide the disputed contraception coverage.

In other words, the Little Sisters have already won. The actual dispute before the court is between Pennsylvania and New Jersey, on one side, and the Trump administration on the other. The states sued to block the administration’s rule that lifts the contraception mandate entirely from any employer — profit, nonprofit, privately held or publicly traded — with a religious objection to covering birth control, as well as from any privately held employer that claims a “moral” objection.

The actual issue raised by the states is whether the Trump administration complied with the Administrative Procedure Act when it issued the rules.

But that hardly comes through from headlines like “The Endless War on the Little Sisters of the Poor” on a Wall Street Journal op-ed by Helen Alvaré….. And Ramesh Ponnuru’s Bloomberg opinion column declaring that “The Left Is at War With the Little Sisters of the Poor” concluded by demanding, “Leave the nuns alone.”

Talk about a compelling story line. Except that it isn’t accurate, not by a long shot. On the table when the Obama administration left office was a proposed accommodation under which religious nonprofits would not have to do anything — hands off, completely, nothing to sign, no forms to fill out — to have the insurer, with reimbursement by the government, provide “seamless” contraception coverage. That was the Obama administration’s one nonnegotiable requirement. (The administration didn’t want women to have to shop for a stand-alone birth-control insurance policy.)

In other words, the nuns and all other religious employers, were not being asked to “pay for birth control,” far from it, and would have been untouched by the bureaucratic hand. But that still wasn’t sufficient, the religious employers said, to avoid their complicity in the sin of contraception because their insurance policy would still provide the link, however attenuated, between their female employees and contraception.

The court’s second religion case involves the “ministerial exception,” a doctrine that exempts churches from having to follow federal nondiscrimination laws when it comes to employees whose jobs are essentially religious. (As I tell my students, that means that a synagogue can’t be required to hire a Baptist as Rabbi, or a Baptist Church compelled to employ an atheist Sunday school teacher.)

Two Catholic schools in California dismissed fifth-grade teachers, each of whom taught fifth-grade subjects– including, twice a week, a class taught from a religious workbook. One was fired after she developed breast cancer and needed time off for treatment, who sued under the Americans With Disabilities Act. The other woman alleged age discrimination.

Both schools claim that the ministerial exception applies, and federal anti-discrimination laws don’t.

During last week’s argument, the justices and lawyers jousted over hypothetical questions: Would the exception apply to a janitor? To a football coach? To a football coach who led the team in prayer? An employee at a soup kitchen who leads grace before meals?

The case is being framed as the right of religious schools to select religion teachers. The actual issue is whether a teacher who teaches religion for two hours a week, along with math, social studies, English and everything else, is a “religion teacher.”

Here’s the real question raised by both of these cases: do Americans employed by religious employers forfeit their Constitutional rights?

Would framing these cases accurately win the debate?

Comments

Protecting The Privileged

The composition of the U.S. Supreme Court is a key area of dispute between Republicans and Democrats. I share the concern, but for rather different reasons than most of the people vocally involved in this debate.

It’s clear that Trump’s cult will sacrifice fundamental fairness and a competent (or even barely functional) federal government in return for reversal of Roe v. Wade.  I have increasingly come to file that possibility under “be careful what you wish for”–not only would abortion still be available in blue (and probably purple) states, but the backlash would be profound; it’s hard to think of any other ruling that would activate more more opponents of the fundamentalist cult that is today’s GOP.

My concerns with the Supreme Court are grounded in its less obvious and more dangerous retreat from the civil liberties jurisprudence of the Warren Court. The current Court’s most predictable bias can be seen a steady stream of decisions favoring the rich and powerful over the poor and disenfranchised.

A recent book by Adam Cohen–Supreme Inequality— is one of the emerging discussions of that bias. An article in Time Magazine by Cohen outlined the book’s central thesis–the conservative Court’s  “deep and abiding sympathy” for the rich. That sympathy is a hugely consequential change from the 1960s, when the Warren Court protected the rights of the poor–from welfare recipients’ right to due process to poor defendants’ right to appointed counsel in criminal cases.

As Cohen documents, however, for the past 50 years, “the Court’s sympathies have been the reverse: on one legal doctrine after another, it has expanded the rights of wealthy individuals and corporations.”

After the Warren Court, Nixon was able to appoint conservatives who shaped the Court we have today. Cohen provides striking examples of the consequences.

One of the first groups the new conservative Court came to the rescue of was rich children, or at least children in wealthy school districts. There was a growing consensus among lower federal courts, state courts, and law professors that the Equal Protection Clause required states to equalize spending between rich and poor school districts. In 1973, however, the Court, by a 5-4 vote, declared that Texas, and other states, had the right to spend more money on children in rich districts than children in poor ones.

As a result of that decision, today there are gaping disparities in school spending nationwide. An analysis of funding in Pennsylvania a few years ago found that one wealthy district spent more than three times as much as the state’s lowest-spending district. In the aggregate, these disparities mean that children from wealthy families across the country begin life with greater educational opportunities, and a better chance at success later on.

Other decisions that elevate the interests of the privileged over others include Citizens United and its forerunners–rulings that gave rich people and corporate “people (!)” a disproportionate voice in American politics.

Cohen isn’t the only person to notice. This week, James Dannenberg resigned from the Supreme Court Bar in a letter to Chief Justice John Roberts that has been widely published. Dannenberg has been a member of that bar since 1972. His letter compares the current Supreme Court, with its solicitude for the rights of the wealthy, privileged and  comfortable, to the widely-reviled Lochner court of the early 20th century that favored big business, banking, and insurance interests, and ruled consistently against child labor, fair wages, and labor regulations.

Dannenberg pulled no punches.

You are doing far more— and far worse– than “calling balls and strikes.” You are allowing the Court to become an “errand boy” for an administration that has little respect for the rule of law.

The Court, under your leadership and with your votes, has wantonly flouted established precedent. Your “conservative” majority has cynically undermined basic freedoms by hypocritically weaponizing others. The ideas of free speech and religious liberty have been transmogrified to allow officially sanctioned bigotry and discrimination, as well as to elevate the grossest forms of political bribery beyond the ability of the federal government or states to rationally regulate it. More than a score of decisions during your tenure have overturned established precedents—some more than forty years old– and you voted with the majority in most. There is nothing “conservative” about this trend. This is radical “legal activism” at its worst.

When a respected member of the Supreme Court bar questions the Court’s commitment to the rule of law, it’s an ominous sign.

The question is, as always, what should we do?

We should certainly think very seriously about the recommendation by legal scholars that the number of Justices be increased–a recommendation that long preceded the current administration.

And most obviously, we need to vote blue up and down the ticket, to ensure that people who will be elevated to the court in the future are “throwbacks” to the Warren Court, rather than pro-plutocrat right-wingers.

Comments