Winning Progressive

(By Mark Bridger, cross-posted at ThatMansScope)

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.

GOP Presidential candidate Rick Santorum (R-13th Century) is a social troglodyte whose obsession with limiting reproductive freedom has led him to be a leader in the conservative effort to stop coverage of birth control as preventive care for which there would be no insurance co-pays, and to make the absolutely ridiculous and offensive claim that pre-natal testing is little more than a liberal plot to increase abortions.  In a concession to the political popularity of access to contraception, however, Santorum has also made a recent push to claim that he has no interest in outlawing birth control, telling the Washington Post that “the idea I’m coming after your birth control is absurd.”  Predictably, conservative commentators have echoed this claim to assert that Santorum doesn’t pose a threat to access to birth control, with Ross Douthat at the New York Times claiming:

Even the fiercest conservative critics of the White House’s contraception mandate — yes, Rick Santorum included — agree that artificial birth control should be legal and available.

But the only thing absurd here is the suggestion that we should not be concerned about the legality or availability of contraception if, heaven forbid, Santorum were to become President.  In fact, there are at least three reasons why supporters of access to contraception should be terrified of a Santorum Presidency:

1. Santorum has made clear that he objects to birth control: In an interview last October, Santorum said the following about birth control:

One of the things that I will talk about that no president has talked about before is I think the dangers of contraception in this country, the sexual liberty idea and many in the Christian faith have said, you know contraception is OK. It’s not OK because it’s a license to do things in a sexual realm that is counter to how things are supposed to be.

Similarly, in 2006, Santorum expressed the following views about contraception:

I don’t think it works. I think it’s harmful to women. I think it’s harmful to our society to have a society that says that sex outside of marriage is something that should be encouraged or tolerated …, particularly among the young and it has I think we’ve seen very, very harmful long-term consequences to the society. Birth control to me enables that and I don’t think it’s  a healthy thing for our country.

Certainly a person could have these personal beliefs while still supporting the right to birth control as a matter of government policy.  But given how focused Santorum is on restricting reproductive freedoms, that is not a risk I’d be willing to take.

2. Santorum Rejects the Right to Privacy: Santorum’s statements regarding contraception become even more problematic when combined with his opposition to a Constitutional right to privacy.  In particular, Santorum has been very vocal in his opposition to the groundbreaking 1965 Supreme Court decision of Griswold v. Connecticut.  That decision established the Constitutional right to privacy that protects many of the individual liberties that we take for granted today.  It also struck down as unconstitutional a Connecticut law that made the use of contraception illegal.  Reversing Griswold, as Santorum would like to see happen, would once again allow states to outlaw the use of birth control.

3. Santorum is Not a True Supporter of Federal Funding for Contraception Services - In attempting to appear reasonable, Santorum has noted that, despite his personal beliefs about contraception, he has in the past voted in favor of funding for Title X, the federal program that supports family planning clinics that provide access to contraception and other preventive services to millions of low income families.  But more recently, Santorum has pledged to end federal funding for contraception.  Those Title X programs that Santorum wishes to defund annually provide contraception and other family planning services to millions of low income women.

The simple fact is that Santorum is a politician who cannot be trusted with any issue relating to family planning or reproductive freedom.  Commentators of any stripe should know better than to accept his claims regarding support for contraception at face value.

For this weekend’s reading list we have articles on contraception and gender equality, how the safety net helps those in need, the lessons we can learn from the success of schools in Finland, the dangers of fracking, and what needs to occur in Afghanistan as our troops start coming home next year.

If you have comments on any of these articles, or would like to recommend an article for next weekend’s reading list, please let us know below or at the Winning Progressive Facebook page.

10 Facts About Contraception (and How It Changed the World) – a good overview of how contraception has helped increase gender equality throughout the world

Contrary to ‘Entitlement Society’ Rhetoric, Over Nine-Tenths of Entitlement Benefits Go to Elderly, Disabled, or Working Households – deconstructing the conservative myth that social safety net programs are somehow destroying the work ethic in the US

Schools We Can Envy – an overview of education success in Finland, and how it contradicts the testing and anti-teacher union agenda of education “reform” advocates here in the US

Why Not Frack? – a review of two books and a movie about the dangers of fracking and the impacts that the natural gas industry is having on local communities

Beginning of the End – a good overview of things that need to occur in Afghanistan as we prepare to begin bringing our troops home.

(By Mark McCutchan)

Thanks to a provision in the Affordable Care Act signed by President Obama last year, women may soon be able to obtain birth control cost-free.  The law could require insurance companies to offer prescription contraceptives without charging a co-pay, whether that insurance is employer-provided or purchased on the individual marketplace, whether inside or outside of the new subsidized health insurance exchanges.  Help make sure this happens by signing Planned Parenthood’s petition discussed below and by “Sharing” this post with family, friends, and colleagues.

An Institute of Medicine panel recommended Tuesday that the federal government require health insurance companies to cover contraception as one of eight recommended preventive services for women to be covered without copayments. Katherine Sebelius, head of the Department of Health and Human Services, is expected to issue the final coverage decision in August.

This is great news for all Americans, as the high cost of birth control has prevented some women from having the same control of their lives that men have always enjoyed.  Nationally,  one in three women has struggled with the high cost of prescription birth control.  Generic birth control pills can be as cheap as $10 per month, but some women can’t tolerate the side effects of the additional hormones.  An interuterine device (IUD) or other methods can cost upwards of $1000, making it unaffordable for many women.

The additional cost of these services will be picked up by health insurance companies, but it will be recovered by the savings in maternity and child care expenses for the children not born.  Birth control costs for women under Medicaid were estimated at $1.9 billion in 2008, but $7 billion was saved from the reduction in births. Employers who pay for some portion of their employee’s health insurance policies should see a similar reduction in costs related to maternal and child care, as a result of the ACA provision.

Almost half of all pregnancies are unintended, and over 800,000 legal abortions are performed each year in the U.S.  The fact that many of those abortions can be prevented through access to free birth control should have conservatives cheering about this rule.  Such is not the case, however. First, conservatives routinely condemn everything accomplished under the Obama administration in a bid to win back the White House in 2012, and calling for the repeal or defunding of the entire Affordable Care Act is part of that strategy.

Secondly, anti-abortion groups like the Heritage Foundation and the National Abstinence Education say they are worried about teenage girls and young women having coverage under their parents’ health insurance plan. “People who are insured don’t want to pay for services they don’t need or to which they have moral objections,” said Chuck Donovan, senior researcher at the Heritage Foundation. “Parents want to have a say over what’s covered and what’s not for their children.”

Jeanne Monahan, director of the Center for Human Dignity at the Family Research Council, also argues that some emergency contraceptives – “morning-after pills” – can cause very early abortions by preventing the implantation of fertilized eggs into a woman’s uterus.

“So those 7 to 10 days before a baby can implant, Plan B can prevent implantation and thereby cause the demise of that baby. So we’d be opposed to those drugs being included [in ACA coverage] because they act as abortifacients.” It is, of course, misleading wordplay to call a 0.1 mm blastocyst a “baby.”  The National Institutes of Health and the American College of Obstetricians and Gynecologists have been clear that this is factually incorrect; pregnancy does not begin until a fertilized egg is implanted. Plan B is recommended for a number of reasons: in cases of rape or incest or when a condom breaks.

Action:

Please sign Planned Parenthood’s petition asking Kathleen Sebelius to act on the IOM’s recommendation that requires insurance plans to cover prescription birth control with no co-pays. There is also a follow-up action that encourages you to email your friends about this petition.  You could also share the link which will be posted on the Winning Progressive Facebook page.