Last week – amidst the debt crisis meltdown that seemed invented to distract America from any substantative topic on the horizon - the Obama administration proved that congressional dog-and-pony shows do have some function in the reality-osphere: to allow a space for unpopular but well-deserved policies to be implemented almost unnoticed by the rank-and-file mud-slingers. While the GOP was busy playing the dual role of bratty child and beleaguered daddy – and the Democrats were busy caving to the freshman tantrums of the lowest rung of the Tea Party – Obama tossed out a quick directive that, starting in 2013, under the new health care rules, contraceptive coverage for women will be free of all copayments and other charges.
Fresh from having nearly brought the American economy to its knees, the far right was quieter on this topic than you might have guessed given the near-open warfare on contraception of late. In fact, there seems to be less anti-contraception yammering, and more outrage that a benefit has been given to a particular demographic who – gasp! – won’t be asked to pay specifically for this increased coverage.
This particular article links from a Fox New affiliate, but it actually came across the AP wire and can’t be blamed on Fox alone:
“Although the new women's preventive services will be free of any additional charge to patients, somebody will have to pay. The cost will be spread among other people with health insurance, resulting in slightly higher premiums.” [Emphasis mine.]
Somebody will have to pay.
Ominous, isn’t it? That somebody might be your neighbor. That somebody might be your destitute fixed-income grandmother. That somebody might be…you.
This rhetoric – however popular it has proven in the last week – relies on a willful mis-reading of how insurance works. It should not be shocking that someone has to pay for someone else’s benefits: this is how all insurance works, all of the time.
When you pay insurance premiums, they are not held in a magical trust for your future use. They are not aside for you specifically; they are pooled together for the common use. This applies if you are a low-income Medicare patient or a premium BlueCross BlueShield patient; even if you have Medicaid, you pay into the pooled risk group via taxes, and draw out not your own cash but the grouped funds. Every benefit under the sun operates in the same way as this new one. And yes, some plans have copays, and deductibles, and dozens of other variations on that theme, but many have specified benefits that do not require patient contribution, because someone somewhere has decided that the whole group benefits more if people just go get that service upfront without any barriers. Title X – the federal program that funds a good portion of low-income access to contraception already – already requires that participating clinics offer a sliding scale that slides to zero contribution on the patient’s part for very low-income patients…and the contraceptive products covered are also free. Believe it or not, this new rule simply asks private insurers to come up to the standard of what the feds already provide.
And another rhetorical sleight-0f-hand: the cost of this new benefit will not be spread among other people with health insurance – that cost will be spread among the beneficiaries (ie. women who use contraception) AND others with health insurance. That is, the cost will be spread among the not-quite-50% of the population that will use the service during their lifetime (as this covers only women, according to most reports), and possibly also the others half of the population that doesn’t use the service.
But wait a minute still: who really does benefit from contraceptive coverage? At last check, men could obtain vasectomies and both sexes can buy condoms, but otherwise women get the default bill for the entire amount of most of this service that benefits both men and women. The details of who actually pays for insurance premiums, credit card bills, and the like is variable between couples, but the reality remains that many men benefit immensely from the assumed responsibility that women take for chunking out the cash for contraception: for pills, for shots, for IUDs, for diaphragms…and also, for terminations when the above is not available or fails to function properly and a pregnancy is an untenable alternative. All in all, copay-free mammograms would be a far fairer mark for unfair sex-specific coverage, because birth control is a good that one gender consumes to her own risk and at her own expense, but to the benefit of both herself and her partner(s).
It is in this last twist that the guffawing over this new regulation reveals itself to be exactly what it is: not a protest over health care cost distribution, but a crosshairs placed over women’s health concerns, and another episode in the right's bizarre war against contraception. By marking contraception a special interest, we play into the lie that women use contraception and men are innocent bystanders to the wiles of the sexuality of women. Or, more simply, men simply have no responsibility for their role in the birth of children – or the prevention thereof.
In a common pooled insurance system, we all pay for things for other people; it’s how we get our own needs covered when it comes time. We all have services we’d like to see come down the pipeline for free, and somehow those services tend to line up with our own particular needs at the moment. Prescription contraception is a need that affects the vast majority of people at some point in their lives: it transcends women and men (and also transcends gay and lesbian – lesbians can forget about contraception the day that rape stops happening on this planet, and gay men can forget about contraception the day they stop having sisters and mothers). The net good from easy access far outweighs the net cost of a few collected copays.
So for all the epic fouls of the last week, I’ll be one to say: Obama, ya did good. Keep at it.
Cross-posted from my recently relocated and re-launched blog, America, Love It or Heal It.