Taxes for RH: Public Funding for a Public Good

Imagine if advocates of laissez-faire capitalism say to Congress, “Our taxes pay for government agencies that regulate our businesses and impose labor standards. But we are fundamentally opposed to such regulations and labor standards! Forcing us to pay is unjust and oppressive.” Should Congress cave in and eliminate these tax-funded measures that anger preachers of laissez-faire and objectivism? I think majority will say no. Most people want the goals of regulations and standards—like safe products, honest services and decent pay for employees and workers—and view them as established rights that must be protected.

Preachers of Catholic fundamentalism say something eerily similar about reproductive health (RH): “Our taxes will pay for artificial contraception. But we are fundamentally opposed to such services! Forcing us to pay is unjust and oppressive.” Should Congress heed this argument?

Public acceptability

It is true that Humanae Vitae forbids Catholics to use artificial contraception. But majority of Filipino Catholics do not believe or follow this papal encyclical. According to a 2010 SWS survey^[1], 69% of Catholics favor access to all legal means of family planning in government health facilities. The 2008 NDHS^[2] survey of 13,594 women—80% of whom are Catholics—shows that some 60% of currently married women had “ever used” a modern family planning method disapproved by Vatican. Another 38% had tried withdrawal^[3], a traditional method similarly banned by Vatican. In addition to Catholics who do not follow Humanae Vitae, other Filipinos have religions or norms that view artificial contraception as moral, and government will violate their freedom of religion and thought if such methods are singled out and excluded from public health services.

Thankfully, Catholic voices of reason and moderation are also being heard. Among them is Fr. Joaquin Bernas, Dean Emeritus of Ateneo Law School, who wrote the following in his blog:

The official Catholic teaching is that artificial contraception is immoral. Other religions believe in good faith otherwise. Seeking to impose Catholic belief and practices on non-Catholics and others violates freedom of religion. Freedom of religion does not merely mean freedom to believe. It also means freedom to act or not to act according to one’s belief.

Religious objections

Using taxes for purposes that some people oppose on religious grounds is neither new nor unique to RH. Both Muslim and Jewish communities forbid drugs derived from pigs, yet example products like heparin (a drug for preventing blood clots) and MMR (measles, mumps & rubella) vaccines are in the Philippines’ core list of essential medicines, available in public health facilities and reimbursable through PhilHealth. Members of the Jehova’s Witness oppose medical blood products, yet we spend taxes for blood transfusion and organ transplant services. To manage these religious objections, individuals are simply allowed to refuse drugs and treatment and seek out alternatives.

Catholic bishops oppose the mere reading of Jose Rizals’ two novels, as expressed in the following statement they issued in 1956:

… [Noli Me Tangere and El Filibusterismo] have included such substantial defects in their religious aspect as to render them objectionable reading in such sense that only with due permission obtained from ecclesiastical authority may these books be read by Catholics.  This permission, however, is readily granted for a justifiable reason, whenever the person concerned has sufficient knowledge of the Catholic doctrine in question.

Despite the bishops’ opposition, we spend taxes teaching Rizal’s novels in public schools as mandated by Republic Act No. 1425.

Cost effectivity

Finally, some people fear the tax burden of RH, especially the cost of supporting contraception. The fear is unfounded. Local and international studies by the Guttmacher Institute show that voluntary contraception will reduce total health costs by lowering the maternal and newborn care spending that come with unintended pregnancies.

In the Philippines, providing modern contraception to all women who need them^[4] would increase the total public and private spending from P1.9 billion to P4.0 billion^[5]. However, the increase would be offset by contraception’s impact on health spending for unintended pregnancies, which would fall from P3.5 billion to P0.6 billion. In sum: family planning costs would rise by P2.1 billion; medical costs for unintended pregnancies would fall by P2.9 billion; a net savings of P0.8 billion would be realized.

The details of the estimate are available online, but the following scenario may help explain the projected savings in public health. A woman belonging to the poorest 20% of families would, on the average, plan for three children but end up with five. If she has been enrolled in PhilHealth as required by regulations, the state health insurance agency would have to spend P6,500 for each normal childbirth; around P17,800 for each caesarean delivery; and P1,000 for each infant given a newborn care package. Two unplanned births would therefore cost P15,000 to P37,600. Around half would be paid for by PhilHealth^[6] and the rest shouldered by the woman or, if not yet depleted, by the public hospital’s funds for indigent patients. In comparison, PhilHealth spends only P4,000 for each tubal ligation or vasectomy, and less than P500 for a copper-IUD that could last for up to 10 years.

Public goods deserve public funding. Reproductive health is a public good with a wide range of benefits. It is understood and supported by most people. For the minority with objections on religious or other grounds, the freedom to use or not use such services should suffice. And on top of all these, RH services saves money. What more can anyone ask for?