Monday, February 07, 2011

The Robust Debate About Covering Birth Control in Health Insurance Policies. Part II.

The first post on this topic (with the cumbersome title, intended to keep trollies away) was about the reasons why conservatives tend to oppose birth control as fully covered health care benefit. This post discusses how those forces actually explain their opposition. The underlying reasons and the explanations are not the same, believe it or not!

I am still waiting for the cost argument (from the stay-out-of-my-wallet people). It will come, I'm certain, but I haven't found a good example of it yet. I so hope it will remember the large savings from bulk purchases and price negotiations!

I'm even more interested in cost-benefit arguments, because just discussing the cost of something is pretty meaningless without addressing the benefits which the expenditure might create. Some of those benefits will be in the form of illness averted, others will accrue to the society on the whole. Planned pregnancies may cause less chaos, poverty or the need for social workers than unplanned ones. Abortions are likely to be reduced with cheaper birth control, too. Some of these benefits accrue to women and their families but others are diffuse benefits which arise in the society in general. Those might be hard to estimate although I hope someone makes the effort.

So we have to wait for the cost arguments. What we already have, however, is an argument that looks pretty brilliant on its surface. Here is one example, though several Catholic mouthpieces have stated the very same sentences:
But Ms. McQuade of the Catholic bishops’ conference said any requirement for coverage of contraception could violate the “rights of conscience” of religious employers and others who had moral or religious objections to it. This concern is amplified, she said, by the fact that some emergency contraceptives can act like abortion-inducing drugs.
Jeanne Monahan, the director of the Center for Human Dignity at the Family Research Council, said: “The government should focus on services that prevent disease. Fertility and babies are not diseases. Fertility occurs in healthy women.”
We get a twofer from "god-was-a-guy-so-shut-up" people! First, requiring birth control to be covered upsets the "rights of conscience" of some! This sounds familiar. As usual, my "rights of conscience" have zero impact on what is covered, just as my "rights of conscience" have zero impact on what the government chooses to subsidize. Some people have more "rights of conscience" than others! What a great country this is. I want Ms. McQuade to stop eating animals, to be tested for whether she is actually doing that and then I want her coverage removed if it turns out that she has meatballs in her belly.

Though the obvious problem beneath the uneven conscience clause interpretations in this case is the unholy marriage between work and health insurance. That way the employers can poke their noses into something which should be none of their business.

Second, and this is the really interesting point, the Jeanna Monahan (and many others) argue that pregnancy is not an illness and neither are babies. Fertility occurs in healthy women!

She has a point, you know, though she forgets that fertility occurs in men, too, at least on our planet. Still, there's no way around the fact that most people would not argue that women who are pregnant are ill.

But let's take Ms. Monahan's point a bit further: If pregnancy is not an illness, then neither is giving birth. Therefore, we shouldn't cover routine deliveries either. All that is part of a normal healthy life, after all.

What would Ms. Monahan or other Catholic spokespeople say to that? Perhaps that medical presence at birth is necessary in order to prevent something going wrong? But the same argument can be applied to the proper spacing and planning of pregnancies.

If that's not the answer, the Catholic church probably wants medical care to cover only sick people or cases where prevention clearly works in terms of illness avoidance. I'm sorry to say that evidence on the effectiveness of prevention varies wildly, and that we currently fund many kinds of prevention and screening (sometimes called secondary prevention) which might be pretty inefficient, depending on the outcome measure we adopt.

Then there's the whole definition of "illness." Is erectile dysfunction in old age an illness or simply a natural part of aging? How you answer that question would then determine whether Viagra would be covered by insurance or not. Or to return to the current example, is it natural or healthy for a woman to have a child a year for three decades, say? Even if it wears out her body? Mr. Monahan's definition does not help us in answering that question because she defines any amount of fertility as part of being healthy.

Mmm. Two long posts on these comprehensive guidelines which will not be posted until August 1, 2011. I lead such a misspent life, I do.