Sunday, March 4, 2012

Birth control and democracy

The 7 - 2 Supreme Court decision Griswold vs. Connecticut (1965) established the right of married people to purchase and use birth control devices. Six years later, Eisenstadt vs. Baird extended this to unmarried couples as well. (I was living in Massachusetts when that happened and remember Bill Baird's courage and dedication in risking his freedom to make this test case.)

Given the virtually total acceptance of birth control by Americans -- even, or especially among Catholics -- it is highly unlikely that this right can be denied. I would venture to say it is less likely than the re-imposition of Prohibition -- in spite of ravings from lunatics like Rick Santorum and the hierarchy of the Catholic Church.

So, despite a lot of hyperbole, the issue these days is mostly: Who pays for it?

As it stands now, it is the issuers of health insurance, under the Affordable Health Care Act (popularly called "ObamaCare"), that are required to foot the bill. It is important to note, in this context, that it is not the "American Taxpayer" who pays for anyone's contraception: that's simply not the way it works, Rush Limbaugh to the contrary (except possibly in the case of Medicaid, which is barely in the controversy here anyway).

Arguments pro and con involve the following

1. The Viagra argument
2. The Mental Health argument
3. The Running Shoes argument

4. The Prescription Drug argument.

1. Currently, both Viagra and The Pill are covered by ObamaCare, and neither is restricted by marital status or even one's sex. It is possible to make distinctions, however. Some (mostly men) might claim that sex -- for procreation or otherwise -- is possible without The Pill, but in many cases is not without Viagra (or its equivalents). If you take the narrow and exceedingly unpopular view that sex is only for procreation, then this argument might have some force, however, medically, one can obtain semen without erection or ejaculation, so the argument from this perspective is not accurate. The many women who are on The Pill would claim that without it sex would be much more encumbered and far less enjoyable (hence less likely to happen). Furthermore, sex without The Pill would almost surely result in more dependence on condoms and other physical contraceptives, hence result in more unintended and unwanted pregnancies. This in turn would result in higher healthcare costs and/or more abortions. Thus, it is hard to make a realistic distinction between coverage of Viagra and coverage of The Pill, and from an economic perspective, paying for The Pill will, statistically, save money in insurance premiums.

2. The effectiveness of The Pill has enabled several generations of women to feel "in control" of their bodies with respect to sex and reproduction. Supposedly this has lead to an increase in overall mental health, though that is difficult to quantify; nevertheless, this has led to the argument that paying for The Pill is appropriate because its use is a women's health issue -- sort of like regular gynecological checkups. Of course there are other contraceptives available. Some are simply variations on the The Pill such as various "patches" or timed-release doses; others are doctor-based such as diaphragms and IUDs. Then there are condoms which, though not always under a woman's control and subject to failure, do prevent sexually transmitted diseases. Whatever the validity of the argument for The Pill as important for women's health, it is safe to say that the vast majority of women support this argument and hence are in favor of coverage under medical insurance; probably the opinion of men on this issue -- though pretty nearly in agreement -- is irrelevant.

3. Limbaugh et. al. have suggested that arguing the health benefits of contraceptives is similar to arguing the health benefits of running shoes; since the shoes are not covered under healthcare policies, neither should the contraceptives be. In point of fact, even though running shoes themselves may not be covered, many health insurance plans (including my own) regularly cover gym and fitness club memberships. The reason is that insurers know that having members physically fit -- especially non-obese -- actually decreases their chances for contracting chronic debilitating diseases such at diabetes and heart conditions. This in turn reduces insurance payments for treating these diseases.  This is sound economics and makes health care less expensive for all (since the reduced risks are spread around). By the same token, reducing the risk of unwanted pregnancy reduces the costs of pregnancies and instances of abortions. Once again, paying for contraceptives is good competitive economics for insurers. The particular example of (the cost of) running shoes is probably too trivial, but the argument for covering preventative fitness programs is a good one and is already being widely implemented. The analogy with contraception reverses the argument (if there was a serious one) of Limbaugh and others who had hoped to mock it.

4. It has been traditional for health insurance to cover medicines and treatments that are prescribed by doctors. The physician-patient bond has long been recognized legally in many forms. The specter of the old HMO plans standing between a patient and doctor is still a source of discomfort, so modern plans attempt to give at least the appearance of granting the doctor the final say in treatment. Since The Pill, IUD and diaphragm are always doctor-prescribed, they tend to be covered by health insurance. That's why condoms are not covered even though they could be even more expensive than other birth control methods -- they are bought over-the-counter without doctor intervention.

In short, then, there is no one overwhelming and unanswerable argument that "proves" birth-control pills should be covered under "ObamaCare". Probably the best talking points are that they promote women's psychological health, and that they actually reduce the cost of health insurance premiums for all by largely eliminating the expenses of unwanted pregnancies; they also avoid many abortions. In any case, claims that tax-payers are financing anyone's sex is total nonsense.

12 comments:

  1. As an aside, non-surgical treatment of endometriosis (which causes debilitating pain for many, including myself) and severe dysmenorrhea is birth control pills. I believe there are other medical conditions treated by BCPs as well. Seems to me that my insurance company should cover medication that prevents surgery and/or medical leave from work several days per month. That said, these conditions are so common I'm not sure how anyone could prove whether the pills were prescribed for birth control or treatment of a medical condition.

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  2. As an aside, non-surgical treatment of endometriosis (which causes debilitating pain for many, including myself) and severe dysmenorrhea is birth control pills. I believe there are other medical conditions treated by BCPs as well. Seems to me that my insurance company should cover medication that prevents surgery and/or medical leave from work several days per month. That said, these conditions are so common I'm not sure how anyone could prove whether the pills were prescribed for birth control or treatment of a medical condition.

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  3. This issue is about forcing religious institutions to do something which is at odds with their religious beliefs.

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    1. If religious institutions want to meddle in politics then they should NOT have tax exempt status. The ACA is a law passed by our constitutionally elected representatives in Congress. Religion & religious institutions should NOT have any influence over our laws or our government! When the Bible trumps the constitution--AMERICA BECOMES LIKE IRAN WHERE RELIGION IS THE GOVERNMENT!

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  4. No. Catholics are not supposed to use birth control devices according to some church leaders including the Pope (although a commission appointed by several Popes came to a different conclusion which was suppressed). However, Catholic business ventures (hospitals, schools etc.) are not forbidden to pay premiums on a medical plan that might pay the expenses for others to use contraceptives. Applying ones own morality to others is a perfect example of imposing ones religious beliefs on them. This is a subtle but important point.

    For example, Jews themselves are forbidden to eat pork, but they are not exempt from paying taxes that may be used for ham sandwiches in school lunches. Religion should be about personal morality, not public morality. Don't use contraception if you don't want to, but don't get in the way of others who chose to. No insurance plan forces anyone to use contraceptives.

    Finally, the Constitution says that there shall be no establishment of religion. The Catholic religion is not established and has no more say over public policy that any other religion or set of beliefs. In fact, the vast majority of Catholics routinely practice supposedly forbidden methods of birth control. The handful of old men who run the Catholic church don't represent very much, actually, but even if they did, they shouldn't have any say in democratically established public policy.

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    1. No, you're missing the point. Or being obtuse. Saying Catholic businesses are not forbidden from carrying plans that cover contraception is not the same thing as saying that Catholic businesses must carry such insurance. This isn't about insurance plans forcing someone to use contraceptives. It's about requiring religious institutions to cover birth control.

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    2. So what if a non-religious person works for a religious institution? Now you're potentially pissing off two groups of people; the insurance company that this place tries to buy insurance from, and the employers of this institution.

      Firstly, insurance works kind of like a casino - the more likely it is that they have to pay you, the more expensive it is for you to buy in (IE: higher premiums.)
      To me, it just seems like common sense that a plan that does not cover female contraception, but does cover the cost of a birth (even if the female isn't married - also frowned upon in the particular religion that you're sticking up for), would be significantly more expensive than the plans that aren't tailor-made for these whiny religious places. Apparently all women working for Catholic businesses are recovering sexoholics that absolutely cannot have the temptation of sex without the risk of pregnancy? I don't know. Next thing you know, maybe they will start requesting that they make plans that don't cover the births of unwed mothers, which totally goes along with that whole, "love thy neighbor" mantra, right?

      Anyhoo...enough about the logical part of this - let's get to the people that would be covered under this. The females. Or the females covered under family plans of males working for these companies. These people need to make money some how, right? Just because the job opportunity that came to them is affiliated with one religion or another shouldn't mean that they get second-class insurance, which is exactly what you're asking for.

      Personally, I wouldn't think twice about working for an institution associated with one religion or another, so long as they paid competitively, and DID NOT attempt to shove their belief system down my throat. Now...at this point, you're probably squirming in your chair, already half-way through your reply-rant that says, "BUT YOU'RE OPPRESSING OUR RELIGIOUS RIIIIIIIIGHTS!!! AND NOW YOU DON'T EVEN WANT TO HEAR ABOUT IT?!?!?!?!" - damn straight, I don't.

      There's a huge difference between tolerance of someone's religion (or lack thereof, or even the relaxed practicing of a given religion - not everyone is an extremist), and being an overbearing dick about it.

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  5. Massachusetts required the Catholic Church to pay for insurance coverage covering contraception. They have been doing it for years here. Why complain now, when they didn't before?

    Catholic hospitals when faced with a choice of saving the life of a pregnant women by aborting her fetus, or letting them both die will let them both die. A nun was recently excommunicated for doing the life saving abortion. Do you think (for anonymous) that an employer who feels that the life of the mother is more important than the life of the fetus can refuse to cover any procedure done in a catholic hospital or by a catholic doctor because of the immorality of letting the mother die? If the Catholic Church can refuse coverage it doesn't like, can others do the same?

    M

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  6. Anonymous: You misinterpreted what I said. You wrote: "Saying Catholic businesses are not forbidden from carrying plans that cover contraception is not the same thing as saying that Catholic businesses must carry such insurance."

    Catholic businesses are not forbidden by *the Catholic religion* from carrying plans that pay for contraception. In other words, it isn't violating their religion to carry such plans. Only Catholics themselves are not supposed to use birth control. Thus, their businesses can and should obey the laws of the land and provide required services to all citizens since doing so doesn't violate their religion's injunction to eschew birth control for themselves. Just as I said, Jews can't refuse to pay taxes that provide ham sandwiches to schoolkids. That's democracy: we can't get to pick and choose which projects our tax dollars support. Hindus must pay for inspectors to make sure that the beef supply is safe (though they themselves don't have to eat the beef). Christian Scientists must pay for the development of new medical technologies, even if they themselves may choose not to use them. Catholics likewise must be prepared to be good citizens.

    (I personally believe that all religions should pay all taxes on properties and income not directly related to religious activities. I will not get my way on this, but that's my position.)

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  7. It is absolutely a violation to force them to do something which is against their religious beliefs. And supporting birth control would certainly fall into that category.

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    1. using that "argument or logic": one Religion already stated that vaccinations are against it's beliefs so should it NOT pay for vaccinations that are a national health threat issue? Remember the epidemic of polio. Should the government have aquisced to religion our population could have been wiped out internationally. Many times government has to do what is in the best interest of the people--"FOR THE COMMON GOOD" not to favor the beliefs of a select religious group. Reproduction is one such area where government has to do what is in the best interest of THE COMMON GOOD of the nation and its people--not in the interest of one religious group.

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  8. They are not "supporting birth control" they are simply paying the premiums on insurance policies that cover, among other things, birth control. If you start enlarging the definition of "support" than you can end up with allowing churches to refuse to pay the taxes that build roads that allow people to drive to Planned Parenthood.

    I have some sympathy for not requiring the Catholic church to provide birth control coverage for workers involved in religious activities, but operating a public hospital with non-Catholic employees who need healthcare coverage (including birth control) is another matter.


    Anyway, if you are insistent about the right of churches in impose their religious beliefs on their secular employees, then we will have to remain in disagreement.

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