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Jens 'n' Frens
Idle thoughts of a relatively libertarian Republican in Cambridge, MA, and whomever he invites. Mostly political.
"A strong conviction that something must be done is the parent of many bad measures." -- Daniel Webster
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Saturday, August 26, 2006 :::
Chetly Zarko (clearly one of the coolest names in the blogosphere) reports thatThe [Michigan Civil Rights] Commission has declared that all "comprehensive" health plans must reimburse prescription "contraceptive" programs for women because pregnancy only directly affects women. He links to the source material, which presumably describes "comprehensive" more precisely. Zarko notes:Page 4 of the report makes this observation:
Exclusion of contraceptives becomes more obvious when, as is often the case, a health plan covers medication like Viagra, a prescription used solely by men.
If the decision were limited to such cases, where employers reimbursed male-sex-related drugs but didn't for contraceptives, I would have no problem with it. In fact, that sounds like a mighty good standard, one that strikes at the heart of common-sense. Nonetheless, the Commission chose to focus on all "comprehensive" plans, and defines comprehensive for the market. I've seen this analogy between Viagra and birth control before. I reject it for a couple of reasons.
First, erectile disfunction is a disfunction in a way that fertility is not. It's hardly life-threatening for a man not to be able to get an erection, but one expects that a typical, healthy adult male can do so. If a woman between 15-45 is fertile, this is not generally considered unfortunate or embarassing or abnormal.
Beyond any subjective sense of what is "normal" or "healthy", though, I think we need to keep in mind what the purpose of insurance is. Insurance is not supposed to cover all expenses, it is supposed to cover surprising expenses. Insurance premiums tend to be 35% higher than expected losses (give or take a large amount). Spending this extra amount to reduce risk makes sense. Spending $135 for a certain number of birth control pills so the insurance company will buy you $100-worth doesn't.
Fertility treatment might be a better analogy, since a heterosexual couple in which the woman is between 15 and 45 (well, 40) generally expects to be fertile, and incurs a large expense trying to have kids only if the couple is unusually unfortunate. I suppose this analogy is flawed, too; fertility treatment isn't really a woman's health issue more than a man's, since fertility treatment is a large expense incurred by a couple such that the couple can have kids, with the bulk of the burden being on the woman. Also, it's my understanding that when a young couple is infertile, it's usually a problem in the man's plumbing rather than the woman's.
Of course, health care coverage has generally gone way beyond actual insurance. And I think it makes sense for health care payors to pay for preventive care, even though this goes beyond the mandate of "insurance", since it can reduce their future expenses. But a lot of health-care plans cover everything under the sun, including many expenses which are elective and expectable. It may make sense for such programs to include birth control in their mandates, especially if they treat non-life-threatening problems like erectile disfunction. But paying for Viagra and not paying for the pill is not at odds with rationality and fairness, the way treating prostate cancer but not breast cancer would be.
::: posted by Steven at 12:32 PM
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