Insurance and Birth Control
In this Forbes article, Tim Worstall says he agrees with generally available birth control, but questions why health insurance should pay for it. Specifically he says: “But I really cannot see the point of trying to have health care insurance which then covers a multitude of treatments that aren’t really insurable matters, contraception being just one of these (regular shots, ‘flu vaccines, general everyday low level treatments in fact).” This is after he points out that, per Wikipedia, “Insurance is a form of risk management primarily used to hedge against the risk of a contingent, uncertain loss.“
The first question this prompts in my mind regarding insuring against (unwanted) pregnancy is what loss does that pregnancy entail? The answer is large measures of personal freedom, hundreds of thousands of dollars in unplanned child-rearing expenses, and quality of life for the potential child resulting from the pregnancy. These are significant risks, with ramifications for society at large, involving the employability and productivity (in a purely economic sense) of the involved woman, and her uses of discretionary income. Furthermore, unwanted children, particularly if the mother is single, are more liable to live in poverty and neglect, suffer from illness and abuse, become delinquent, and develop into adults that are psychologically disturbed, draw welfare, and commit crimes.
So, there are significant personal hardships and costly negative externalities that result form unwanted pregnancies.
Is it ironic that in the past right-wingers have proposed the forced sterilization of welfare mothers?
Also, the hormone therapy we call “birth control” has many other preventive medial uses, including controlling endometriosis. So a focus in the merely contraceptive attributes is misplaced.
Currently, more than half the states mandate that hormonal birth control be included in prescription coverage, and since 1998, this coverage has been included for all federal employees. There is ample precedent for this coverage, and insurance companies are well equipped to handle it.
Worstall conducts this thought experiment.
Just to make up some numbers, say that the preferred method costs $30 a month. But that having the contraception covered by insurance will raise the premium by $50 a month. The insurance company does, after all, have certain costs associated with taking the premium then paying it straight back out again to buy the pill. Why would anyone do this? Why not purchase the pill for $30, stiff the insurance company bureaucrats the $20 and spend it on a couple of cocktails at a place where you might meet someone who thinks that your being a contraceptive user is a good idea?
Of course, when you’re just making up numbers, its easy to have them suit whatever fell purpose you have in mind. Suppose a much more realistic $16 per month, and the whole make-believe argument collapses.
Besides, in terms of brute economics, the insurance company is better off paying for decades of contraception in $30 increments than one avoidable pregnancy at many thousands of dollars, if everything goes smoothly. Let’s just say you can’t count on that.
So far, this has been a basically economic argument. Now let’s look at an issue of fairness and parity. More than half of the prescription programs cover Viagra. Need I say more?
Worstall’s argument has some logical consistency – he seems opposed to insurance coverage of other types of preventive care. But this is ignorant and short-sighted. A flu-shot is less than $25. An office call is $90 and up. Prevention, in general, is cheap, and treatment is expensive. If cost minimization is your goal, then the clear focus should be on prevention.
Worstall’s problem, I think, is in relating contraception to a free-market business model, though, as I have indicated, he isn’t even understanding that properly. The proper focus also includes the high costs of the externalities that he conveniently ignores.
The real root problem though, is in trying to force-fit any health insurance system into a for-profit model. There is simply no way to reconcile the conflicting goals of profit maximization and providing the needed services. In fact, there are only three avenues to profit maximization: raise premiums, deny coverage, or emphasize prevention.
Whether this leads to the conclusion that a single payer, government mandated program is the best overall approach is left as an exercise for the interested reader.
UPDATE: I forgot the great positive externality of contraception – it prevents hundreds of thousands of abortions every year.
Cross posed at Retirement Blues.
He might have more of a point if medical insurance functioned solely as medical insurance. Arguably many people would be best served by purchasing catastrophic coverage and paying for regular medical expenses out of pocket. But insurance companies also serve as a sort of “patient’s union” when negotiating the price of medical proceedures with providers.
“ Just to make up some numbers, say that the preferred method costs $30 a month. But that having the contraception covered by insurance will raise the premium by $50 a month.”
Wow. That screams that either Worstall doesn’t understand how insurance works or he bets Forbes readers don’t.
Worstall: “Just to make up some numbers, say that the preferred method costs $30 a month. But that having the contraception covered by insurance will raise the premium by $50 a month.”
Well, with regulated insurance companies having that much monopoly power, the state should definitely provide medical insurance. 😉
“Is it ironic that in the past right-wingers have proposed the forced sterilization of welfare mothers?”
Over here in Europe it was always the left wingers who supported the eugenics programs. But that’s just an aside.
I am getting really rather mystified at all the people who seem to be so deliberately missing the point I was making.
I’m not against birth control, think it should indeed be widely available, to all who need or desire it. Yes, to those who desire it just so they can have lots of fun sex as well as those in marriages but trying to mlimit family size and yes, to those who9 are taking what is as a side effect a contraceptive but are taking it to cure or treat some other condition.
I’ve no problem at all with any of this.
Yes, of course pregnancy is costly.
But that still doesn’t make using health care insurance the right, best or proper way of financing access to it for all those who want it. Which was my point. My one and only point in fact.
I’ve often written about the difference between insurance and assurance. Insurance is where we have a low probability high cost event and we want to use risk pooling to assuage those costs if the low probability even comes to happen. Hurricane, fire, catastrophic health care, all of these are suited to an insurance model (BTW, I’m just fine with the idea that the government be that catastrophic health insurance provider, doesn’t bother me in the slightest if they are).
Assurance is something quite different. This is more aking to, say, burial insurance. Apart from those lost at sea everyone gets buried. It’s not really an insurable event. There’s no risk pooling for a start. However, there might well be good policy reasons for having some privileged (perhaps tax privileged) method of saving for this known to be coming but uncertain of date event.
Burial insurance is thus assurance, not insurance.
Now, if we’re going to try and design a system of heath care, one in which we’re going to use insurance (as opposed to single payer, single provider, all the other possible variants) we’d probably better make sure that we put into hte insurance part the things which are insurable events. And over in the assurance part those that are assurance.
Regular monthly payments for something that the vast majority of women are going to use for a substantial fraction of their lives really are not suited to the insurance model. They are suited to the assurance model, to single payer, to single provider, heck, to the free handout of birth control pills by the Federal Government (as, umm, the government already does under a law from 1970).
That was the point I was making. Indeed, the piece links to another at Forbes where I discuss exactly these points, about assurance and insurance.
Indeed, if you want my opinion then I think that the largest part of what is wrong with the American health care system is that way too much is being shoehorned into the insurance model, things that really aren’t suited to insurance.
I think you’d be vastly better off if you explicitly thought about the insurance/assurance models. Yes, insurance for things that are insurable, for the risk pooling. Can be the government running that if you’d like. The hospital stays, the cancers, the heart attacks, yes, even the pregnancies if you like.
But the low level ongoing costs, the contraceptives (just as your dental insurance covers needing a crown but doesn’t buy your toothpaste for you), the regular checkups, the day to day running costs of a human body, these should be provided through an assurance model. Personal medical savings accounts for example.
Like perhaps the […]
Worstall’s problem is worse than that. He has been trapped in an age-old philosiphical pit, on that has lots of labels but can best be explained as the Logical Positivist World to Word Fit Fallacy.
We have a good-medical care that is largely though not entirely delivered through ‘insurance’. Now ‘insurance’ has a definition, and if we were of a Positivist bent, almost scientists and quasi-scientists are, we might well maintain that the most precise definition and particularly the one favored by specialists is the ‘True’ or ‘Real’ one and any deviation from that is intrinsically erroneous.
In the case of ‘health insurance’ Worstall goes all Positivist on us, he simply privileges the Word to the World. If the real world good that is being delivered doesn’t precisely match up with the dictionary meaning of the label we put on the delivery system for that good, we are logically, or perhaps Logically, compelled to embrace our inner Procrustes and lop away or stretch the good to fit the bed/label.
But this surely is the wrong way around. After all we could fix this defect by renaming the delivery vehicle ‘health assurance’ and so swap in the concept of ‘guarantee’ while taking away the ‘casualty’ factor. And in a literal swipe of the pen gut Tim’s argument which rests on a particular linguistic ID of ‘insurance’ with ‘risk management’. Take away the equal sign and the logical structure collapses.
But while that might just be seen as a cheap trick it seems to me to be just as cheap to concede the ID and confine our role to Stretching Procrustes in contention with Lopping Procrustes when all our legendary traveller wants is a good nights sleep.
This is particularly true since most health care delivery, even that mediated through something labeled ‘health insurance’, is not really so delivered on a casualty basis. For example a big sticking point in the current contraceptive battle is that many large employers self-insure. In so doing they almost always contract with existing insurance companies to administer the service delivery even as they relieve that insurance company of most of the risk management component, at least as regards individual enrollees. And this of course was the rationale for exempting ‘largest’ employers from many provisions of ACA, their statistical pools were large enough to take them out of the ‘insurance’ realm and into the ‘assurance’ realm of a defined benefit package.
Now even ‘assurance’ is not free from underwriting, there are costs and tradeoffs and so cost-analysis in delivery of any defined set of services to a statistically valid sample. And that is where the cost of monthly contraception vs less predictable life events like pregnancy or certain cancers kick in. But there is no extra-linguistic reason to confine ourself to a model that rules out the predictable cost of prevention services, however defined, simply because ‘predictable prevention’ doesn’t fit neatly into the bed of ‘casualty insurance’. Who cares? Call it something else or just ignore labeling and get right to cost and utility functions. Rather than having a spirited game of verbal gymnastics and pettifoggery over whether the Insurance Angel can REALLY dance on the head of the Verbal Pin.
Worstall
in my heart i know you are right. but if the insurance companies, or the government, decides that given the realities of human behavior it is cheaper to pay for birth control than not to, then that might be sufficient reason for them to do it, and for us to pay for it even though we are not the primary beneficiaries.
i think you are wrong about burial costs. if you buy burial “insurance,” you are not paying for your burial on the installment plan, or even taking advantage of “present value.” you are buying insurance against the possibility that you will need a burial before you “could have” saved enough to afford one.
don’t know if jazzabumpa will read this, but he makes a similar case and unfortunately buries it with a lot of emotional arm waving.
if the argument is indeed about womens desire to have someone else pay for their costs… and are they 15 dollars a month, or a thousand a year as beverly said above?… vs mens desire to control womens sexual behavior, color me “don’t give a damn either way.”
but if there is a rational argument regarding actual costs and actual human behavior… well, it would be nice to see one for a change.
what i take as your… worstall’s… ideology about “collective” benefits, whether government or private, i take to be part of the emotional beside the point…
Bruce
I hope you noticed I was agreeing with you, in part, in my non scholarly way, in reply to Worstall.
yes we can have an “insurance” system that pays for all “medical” costs, whether predictable or in some sense unpredictable.
but until we agree that that’s what we have, and that’s what we want to pay for, and that I am willing to pay for YOUR predictable expenses, we are not going to avoid the argument.
So convince me that I should pay for your predictable expenses in this thing called “insurance”.
I would be much easier to convince than you might suppose, but I do get annoyed with emotional appeals, and, well, the opposite:
that is, i think you correctly identify a “fallacy” or at least an ideology that Worstall may be making, but I am not sure it automatically follows that I should pay for all of your expected expenses in this collective undertaking we are calling “insurance.”
bruce said
“many large employers self-insure. In so doing they almost always contract with existing insurance companies to administer the service delivery even as they relieve that insurance company of most of the risk management component, at least as regards individual enrollees.”
and this is exactly the model i have been proposing for “universal care” except the government takes over the role of the employer, writes up a health care plan based on “what works,” divides the population up, randomly (without regard to prior condition) and contracts, by bid, with insurance companies to administer the service delivery.
as far as i can tell this will never happen because the “serious people” can’t think outside the one or two models they have spent their lives learning about.
I was writing my post while your and Tim’s comments were going up and so is not a ‘response’ at all.
Which makes it all the more interesting that both Tim and I came up with the insurance/assurance distinction independently. But leaving him with the same challenge, why is he still letting labels establish norms? Particularly when he ultimately concedes that in his opinion as assurance model makes more sense. Which seems to leave him carrying the water for a particular advocacy position: “This House holds that Men should not Pay for Purely Preventive Services”, just layered over with a libertarian gloss on ‘insurance’
To all you men out there asking why they should pay for reproductive health care, aka birth control.
Don’t you have any part in making babies? What is your reponsibility, do you use a condom, much cheaper than the pills? Maybe you don’t use a condom because it is more fun without it?
Women bear the whole responsibility for child birth, their life their health is at stake being pregnant. I know of no man who died while giving birth, neither do I know of unwanted pregnancies without a male making it so.
Just simple human decency obligates you to share the health insurance expense, that is not much to ask of you.
Hi Bruce:
insurance : assurance = unpreventable : preventable = unpredictible : predictable
You three are losing me in the reassignment of titles which appear to mean pretty much the same when detailing each.
The history of healthcare insurance was pretty much not to cover what was preventable such as measels, mumps, flu, hepatitis, etc. the burden of which fell on the individual or the company in which the person worked if that person traveled. Over time, child illness started to be covered because of the impact of epidemics in elementary schools.
Going the opposite way, the ACA puts an emphasis on prevention in such things as “0” payment physicals, immunization, HPV/DNA testing, breasting feeding support, mammograms; blood pressure & cholesteral testing, etc. http://www.kff.org/healthreform/upload/8219.pdf The ACA also places an emphasis on primary care as opposed to specialists.
The costs as suggested by Jazz would be regulated by the ACA at either 80-20% or 85-15% in terms of healthcare provided and administrative. There are still ratios for the degree of risk amongst the population. I am sure you already know this as a mtter of fact.
Coberly my answer to your specific question will only seem glib.
Given that the label ‘insurance’ is already a bad fit for the delivery system why get tied up with the lopping and stretching process? To some degree that just leaves us enmeshed in the 2500 or so year struggle between the ‘Real’ and the ‘Ideal’ which both in my mind committ the Word to World Fit fallacy. Does this word refer to something preceding the world as we experience it “an Ideal” or does it refer to something that exists in that World “the Real”. Well in my mind the Oxford School that came out of Austin and now represented by Searle and the Later Wittengenstein in different ways erased the distinction as meaningless, instead words have uses, and the agreement on those uses depends crucial on what Sir Karl Popper dubbed the Third World. Which I would describe as a social space existing outside any individual mind but not in a traditional sense ‘realized’.
Which seems to take us a long way from parsing “insurance” but is meant to show the limits of “parsing” to start with. That is “don’t call it insurance” only seems glib even as it ties back into something more intricate.
But the bigger answer to your question is not linguistic or logical at all. It is instead a moral question: what are our responsibilities to “the least of us”. And maybe the answer falls short of contraception for law school students in a pricey private school. But all too many of the people trying to make that narrow argument seem motivated by the Paulite-Randite-Uncle Miltie position that we don’t owe anyone anything at any time.
So rather than concede to “Fuck You, I got Mine Libertarianism” I am just going to adopt the starting position of “First they came for the co-eds—” and not wait for them to come after my hard won VA medical coverage.
And for good measure a smaller answer. Like many people my age I take a variety of pills every day. One for blood pressure, another for kidney protection, a third to control uric acid, a fourth for my stomach, and a baby aspirin for stroke. Now three out of these five are clearly ‘treatment’, I had medical conditions that left untreated landed me in the hospital, twice, with life threatening conditions. On the other hand my blood pressure, while high at times was not actually life threatening nor do I have an actual history of strokes. So maybe the VA should pay for the three ‘treatments’ leaving me on the hook for the two ‘preventions’. On the other hand it is more than likely that proper prevention, including taking some of the pills I am using for ‘treatment’ would have kept me out of hospital altogether. All of a sudden that clear line between insurable treatments and non-insurable predictable prevention starts blurring. Which suggests an answer of “The hell with it. let’s ID minimal and optimal outcomes and chart an effective course past the former and as close to the latter as resources allow given all other demands”. Leaving of course the debate over how to quantify “minimal”. Itself ultimately as much a moral as fiscal question.
The way you look at it is to be female is a pre-existing condition, similar to old age and having some illness even when born with it.
The real problem is that reproductive health care can’t just be measured in $$$ bills. The mere fact that a fetus can be born premarure or very ill, or needing medical care for the rest of life makes it different.
You want to unload it all on the shoulders of one parent, not both, what does he have to do with it? His responsibility is more than limited, right?
And I think you are in turn wrong about burial insurance maybe because you are too quick to jump from the social to the individual.
In traditional societies burials are fundamentally as much social as familial and pious. As such it made good sense to provide for the wake or whatever on a subscription basis. If you were lucky you would live long enough to have a farewell drink at each of your friends’ funeral. Or maybe they have a drink on you. But it wasn’t about grim accrual of assets and hedges. For the fundamental model think New Orleans Jazz Funeral.
In passing let me tell a parallel tale. Most people “know” that medieval Lords took rents in kind, that is rent was paid in a combination of cash, field crops, eggs, chickens, beer, mead, honey, fish whatever. And the assumption was that this was straight extraction from the peasants in favor of the lord and immediate household. But in the days before refrigeration this assumes some sort of timed delivery, so many eggs per day that the Lord was in residence, with only relatively imperishable goods (wheat and honey) being collected come what may. But on examination of certain medieval estate ‘extents’ a curious fact often popped up: all the tenants being expected to deliver all those rents in kind at the same time every year. Which often were the major Holidays which in those days meant Feastdays (relative to non-Holidays). And in some cases the responsibility for throwing the feast fell on the landlord or more often his representative the bailiff. All of a sudden what all assumed was simple rent extraction from starving peasants in the form of goods in kind starts looking suspiciously like a tenant potluck. Which isn’t meant to endorse the 18th century Merrie Olde England myth, very few if any English villages actually looked or operated like Hobbiton, but that everything doesn’t reduce to all out class warfare and rent extraction down to subsistance. Things were more complicated and certainly more social than modern depictions.
What does this have to do with the topic? Well I think it is all too easy for moderns to fall into a mindset that reduces humanity to individual economic actors working calculators in their head to maximize individual self-interest and thus fall prey to the insurance fallacy of “what’s in it for me? Or my family?” because unless you define ‘family’ pretty broadly that doesn’t seem to have been the organizing principle.
As I have noted in related contexts, rarely if ever in human myth or folklore is the miser celebrated as a hero. Which would be odd if humans were really the self-maximizers Randian Glibs make them out to be. Life doesn’t reduce to individual profit and loss. or shouldn’t.
Dale –
Of course I will read this. Maybe I didn’t read my post though. I missed all my emotional arm waving. Maybe you can hepl me find it?
Cheers!
JzB
Lysistrata –
Thank you. That thought has been in the back of my mind since this whole flap began. This is not just to protect women, of whatever marital status. It is to protect the men who interact with them, as well.
Why this isn’t blazingly obvious bafffles me.
JzB
Tim –
I don’t want you to think I’m ignoring you, so at this point I’ll add that Bruce Webb has made my responses, and in a far better way than I would have.
I do take exception to your personal medical savings account suggestion, though. That’s fine for somebody like me, who was lucky enough to have a good job that left me with enough disposable income to fund that account. The guy making $26,000 a year has to take his kid to the emergency room today, and doesn’t know quite how he’s gong to pay for that.
A health care savings account is one more libertarian idea that seems fine in the abstract, but doesn’t sack up too well against the realities facing a large percentage of the population.
JzB
but if the insurance companies, ……decides that given the realities of human behavior it is cheaper to pay for birth control than not to,
Sure, I’m just fine with that. But if that is what the decision is then we most certainly don’t need a law to force them to do so now do we?
“What does this have to do with the topic? Well I think it is all too easy for moderns to fall into a mindset that reduces humanity to individual economic actors working calculators in their head to maximize individual self-interest and thus fall prey to the insurance fallacy of “what’s in it for me? Or my family?” because unless you define ‘family’ pretty broadly that doesn’t seem to have been the organizing principle. “
This is irrelevant to the point that I am trying to make. Which is, again, purely about the method used to finance what we all agree is a desirable level of health care.
It’s also why the linguistic trick of redefining insurance and or assurance doesn’t work.
Because we do have two different economic models here. (Oh, and BTW, 18th cent England really didn’t have the feudalism you ascribe to it, peasant’s potlucks, rents in kind etc. All of that was long gone by 1700. You’re out on yourt timeline by a couple of centuries.)
And what seems to being missed here is that my argument does not lead to the statement that, as it’s assurance it should not be provided collectively, if that’s what you desire to do. I don’t think it should be, that’s true, but that’s not an implication of my argument. It’s that it shouldn’t be provided through the insurance model, that’s all. It might actually be better if it were delivered collectively, through the taxation system.
To repeat, I am critiquing the use opf the insurance model to provide such desired health care: not determining how such desired health care should be provided nor even venturing into the question of whether such health care is desirable or not.
As to my sketch of a desirable system, medical accounts plus catastrophic insurance. This is actually exactly the same as the system that Brad DeLong has suggested. It is also the Singapore system: the system that delivers health care as good as the US (and better than the UK) at something like a quarter of the US cost and half the UK cost.
And as to the guy on $26k who cannot afford it for his kid: yes, of course such systems contain a subsidy for the poor. We know very well that any health care delivery system, any health care financing system, is going to contain subsidies for the poor, will involve some redistribution. Just a simple fact of life, that.
Bruce
thanks as always for the historical perspective. i do not know, as you may have guessed, anything about the actual practices and mindset of medieval man, or woman.
but i would be glad to think of ye old peasant contributing his bit to the burial fund in a community spirit and not out of a mean calculation as between “insurance” and “npv on the installment plan.”
what i do know a little about is that back in the not so old, but maybe bad, days people in certain neighborhoods paid a dime a week for what amounted to burial insurance. i am pretty sure that over an average life expectancy they paid far more than their families got back… but that is another side of the insurance racket.
oh, jazz, no one ever sees their own arm waving.
let me cite just one example:
“enough said?” well, no. unless you go on to show that “the church” is happily paying for that viagra.
Tim
I think I agree with you. but maybe best not to push it. We are, as i think Bruce points out, and you give a name to, rather closer to an “assurance” model than to an “insurance” model. I was trying to make that clear in my own way, and have the scars to prove it.
Where I won’t go with you is insisting that we HAVE to have an “insurance” model, and that we don’t need a law to “force them.” One way or the other the law is going to “force” someone. I’d rather we were clear about what we were forcing, or resisting, conducting the argument in hysterical moral terms one way or the other, or in abstract philosophical terms, or ultimately in right wing ideological… or left wing moral-ideological… terms just makes me wish i could ignore the whole thing.
Lys
all I can really say… and that not safely… at this point is that maybe we need to be much clearer about “our” obligation to care for women and children. but i think if we are going to cast it in moral terms…as you are doing here.. you need to be prepared to hear the moral terms from the other side.
un-evolved males do not want to bring up some other male’s children. this is probably not universal biological truth. but it does seem to be related to the old fashioned “moral” code you are so desperately unhappy about. for the most part that old fashioned morality is in full retreat. but your best strategy at this point is not to push their faces in it. left alone they will let it go. make them confront it, they will fight for it.
i have tried to limit my bit here to a purely financial consideration… expected small costs vs unexpected high costs… but i can see that that’s not going to work with anyone… except maybe Tim. and I am not sure I like where I think he is going with it.
but just to uphold my proud tradition of making people mad at me: those old guys evolved a system for taking care of women and children. they called it marriage. then of course they got all hysterical about “enforcing” marriage and that led to what we have today… which is problematic from my point of view.
jazz
just because it won’t be obvious to most people who think they know what i am saying…
i agree with you about medical savings accounts. and if it turns out that “insurance” is the best way to enable (no doubt temporarily) poor people to pay for preventive medicine… including b.c…. as well as emergency, or emergent… medical care… i am all for government mandated universal care.
but i have some better ideas for paying for it that straight washed in the general budget welfare.
Bruce
now i think we are getting somewhere.
Bruce
hardly glib. but maybe a little too abstract for me. i like to think i invented the distinction you are making between word and world, though i didn’t call it that.
what i thought i was trying to do here was get people to focus on exactly what the argument was… which was in the first instance about what do “we” want to pay for collectively (insurance) and what do we want to leave to private decisions.
when it comes to a choice between welfare and libertarianism i’ll end up on the side of welfare…. but that has it’s perils, and i think it’s better to try to be clear, one step at a time, about what exactly we are deciding and not get lost in the upper stratosphere of philosophical meta-words.
oh, lys
impossible to argue with such deep feelings.
i am not a woman so it is hard for me to imagine what shapes her decisions. i’d like to think she is not the victim of any man who just wants to have sex, but
oh lord you are going to hate me for this: i have watched horses. and see the lovely UU’s she plants on his chest when she is not in the mood, and then seen her a week later leaning on his fence and batting her eyes and saying, oh, big boy, i am so lonely, and if you were a real man you’d just hop over this fence and….
now if that is what you mean by the inevitability of biology, then, yes, maybe us male chauvinist pig bastards need to buy your b.c. just to protect ourselves. because when you bat your eyes, we are undone.
but you know, back in the days before b.c. and government insurance mandates, people invented another way to deal with this. they called it marriage. and it had its problems. but if you are going to undo the ways of thinking that evolved trying to make it work over about ten thousand years, it’s going to take a little patience and understanding on your part.
Its really great to know that Medicare might cover my old mom’s birth control pills (she is 68), but denies her after so many days in the geriatric psych unit of the hospital. The latter is what insurance is supposed to be for. And that is the governmnet run plan. Pretty sad.
Coberly,
I am perfectly willing to listen to the other side that is more than I can say for them. At the congressional hearing there were only 5 males, 3 catholic, 1 jewish, 1 baptist, called to testify. The chairman excluded the one women who was to testify about the MEDICAL use of contraceptives, they did not request any witness with MEDICAL expertise either, so much for that.
Marriage was and still is a legal contract to protect property, women were used with or without consent and left with illegitimate children. The ideal sexual relationship is based on love and caring but life is not ideal, it is not fair.
Why do men, and they are men in charge of religious establishments, want to punish women by forcingALL the consequences on women? No man has ever died giving birth, women have and still do. It is still their health alone, their life, their future. The morality of the Catholic Church dictated to strap women to the wheel and torture them until they confessed to have copulated with Satan. The crime against women has a long history.
The men are entitled to use women and just walk away, They refuse to use condoms because they get more pleasure without it, for them to claim to be victimized is beyond the pale. It is only fair for them to pay, if they think otherwise I say, life is not fair, deal with it.
Counting only the money, the men are obligated to pay, it is only fair.
Coberly, I do understand when you have to change your way of thinking, but the facts support me. Limbaugh, the most hateful jerk stands for all that is wrong with christian morality. He meant every word he said.
Dale, I know, you are not in that corner, you are a kind and decent man.
It should be pointed out that the model of humans as economic calculating machines is the basis on which the whole psuedo science of economics is based. Of course we know the model is wrong and behavioral economics studies the deviations from this model.
Tim –
So we learn that, contra the title and the extended quote from Sandra Fluke near the beginning, your article really has nothing to do with either her or Limbaugh, and is only marginally related to contraception. The real topic, if I understand it correctly now, isn’t even the subtleties of insurance vs assurance, but rather idealized health care funding. So, yeah – I will now freely admit that I missed your point – totally – but it was not deliberate, as you asserted in your first comment.
If you want to have your readers get your point, then, instead of glibly riffing on a current hot topic, I’ll suggest that you actually write about whatever it is you are writing about, and not require your readers to either do a click-through to discover the actual topic in a different article, or have a close familiarity with your publication history. When you put something out in the public sphere, you lose control of what readers are going to make of it, and you cant expect them to know your implied context. So you need to help them along if you have a specific agenda. An article that is intended to make some point really needs to not only stand alone, but also explicitely make its central point, without a lot of distracting digressions.
I’ll also suggest that you use links to show source data, to corroborate assertions, or provide further reading for whoever might be interested in digging a little deeper, not to illustrate the implied point of the current article. I had to read your comments here to discover what I think you might have been talkng about there. And my next thought was that your point was the difference between insurance and assurance, though I guess that isn’t it, either.
That is not communicating effectively. When you find yourself mystified by the problem of people misunderstanding what you say, then I’ll further suggest that blaming your readers will not move you very far toward a solution.
But, as has been pointed out here, we have to go with the bastardized insurance-assurance chimera our health care benefit history has left us with, not the idealized pure insurance system that you would like us to have; so the whole insurance-assurance flap is a bit like tilting at windmills.
Regarding your last paragraph, it seems you don’t realize that in the U.S. anything that hints at subsidies for the poor or involves redistribution is demonized as socialism by a large poitical faction that wilfully does not understand what socialism is, and is devoted to denying the simple facts of life. These are the obstructionists who make it close to impossible to have meaningful debate on health care and most other important issues. They take their cues from Rush Limbaugh.
JzB
Tim –
That is very unrealistic. Particularly in the U.S. companies have a perspective that extends only as far as the next quarterly report. Besides, both people and institutions posing as peple often need to be prodded in the direction of what they ought to know is in their best interest. just a simple fact of life in the real world.
JzB
Coberly,
my argument is factual, not emotional. Male animals take no for an answer, not so human males. I never heard of sexual violence in the animal kingdom either.
There is also the economic dependency, one of the reasons for the women’s rights movement.
Another outrage is the very fact that women using birth control are called SLUTS, married or not.
Maybe we women will have to fight the battles all over again. A SC decision was needed to make the pill legal for MARRIED couples. Women had to fight for their rights every step of the way, that also is a fact, take the right to vote.
I have a son, I would never tolerate the kind of talk I hear from some men or the attitude to women like Limbaugh and his ilk. I have a daughter, and I am outraged on her behalf as well as mine.
Life is what is is, it is only fair for men to take responsibility, if they believe it is not fair, I say, so what, life is not fair for women either, deal with it.
The church never publicly opposed Viagra. The church, the institution, has no conscience any way, just like corporations are not people.The church does invest in pharmaceutical industries producing the pill and has no objection taking the profits.
A priests conscience concerning birth control makes absolutely no sense. He does not take the pill, he is not responsible for a women’s conscience, only she is.
The church also provides the moral justification for the use of nuclear and lots of other weapons.
Morality, who is in charge and who says what it is, Santorum and Opus Dei the pope? It is a slippery slope to start out on.
Well, kinda. If insurers, as they function in the US, functioned to hold down the price of individual procedures or medicines, the US might not have higher costs for a whole host of medical procedures and medicines than other rich countries with even better access to care.
What insurers have done, to a great extend, is limit access to care. That, too, serves to hold down the insured cost of care, with much less impact on the cost of individual procedures and medicines.
The broad point that Worstall and you have in mind is, however, correct. We use medical insurance as a payment conduit, as much as a form of insurance. That’s so employers end up paying come of the cost. Which to a large extent ends up coming out of employees paychecks. The contest between employer and employee to shift medical costs has some impact on insurers, but they have become pretty good at dealing with that contest. Meanwhile, insurance companies pick up a premium for moving money for stuff that would not be insured in analogous fashion in the automobile insurace or home insurnce and freight insurance business. Paying for birth control pills through insurance is a bit like paying for furnace maintenance through insurance. Bad things can happen if you don’t get the pill or the flue cleaning, but they are routine events, not unplanned bad news against which we protect ourselves by having insurance.
The reason, I believe, that we do things the way we do is that we have lots of employer-provided health insurance. Once we had employer-provided insurance, getting very broad coverage of costs was a goal that workers and insurance firms liked. After they got the hang of it, employers didn’t mind all that much. There is a tax thing going on here.
If want we want is to assure really good (financial) access to health care, then having broad coverage of both predictable and unpredictable events is a good idea. However, in that case we don’t want a profit-making entity handling the paperwork and money for the unpredictable part. And once profit-making firms aren’t being used for that purpose, it is unclear that we need to replicate effort – might as well go single-payer.
“…he simply privileges the Word to the World.”
No, sorry. The “simply” part is wrong. Worstall is making a perfectly legitimate point about what insurance is in general vs what it is when applied to medical care in the US. There are real consequences – like paying an insurance company a profit (if the company is doing it right) just to pipe money from the payer to the provider.
There is a perfectly good discussion to be had here. Dismissing Worstall by mis-stating his position is not part of that discussion. If memory serves, I don’t always like Mr. Worstall’s positions but the core of his position here is simply true. We pay for things through medical insurance that are not analogous to what we pay for with other forms of insurance, and we ought to consider if that’s a good idea. Are we trying to pay for “care” or are we trying to insure against unforseen, costly events? As things stand, medical insurance is (sometimes) the former case, while most other insurance is the latter case.
You are making an argument about a an issue that overlaps with the one Worstall raised, but that is not the same as the one he raised. And the overlap isn’t all that great. Men contributing to the cost of raising children does not rely on a particular system of payment. French men should, under your argument, also pay to support their offspring, but France has a rather different insurance system. Worstall’s point was about a particular insurance system, not about whether men should pay. If Worstall’s argument suggests switching to another form of insurance, that doesn’t really make him responsible for impoverishing babies or their mothers.
There is a simple, lower cost alternative to paying insurance companies to stand between us and our pharmacist. Free birth control. The same is true for medical check-ups, dental cleanings and a whole host of other medical services that cost more because we pay for insurance profit, advertising, litigation, cost control efforts and overhead of all kinds along with paying for the service. In the case of mending a broken leg, the whole business of having somebody pool risk and pay for care makes sense, and paying a premium for the insurance makes (some) sense, too. Insuring routine care through private insurance vendors is bad policy. This is true for dental cleanings and for birth control.
mcwop,
At one time, before your mother went through menopause, most like she used contraceptives too. Her insurance should have paid for it, many did not. To be fair, your fathers insurance premiums should have been higher because he insured your mother’s reproductive health care if she did not have insurance on her own.
The contraceptive issue has nothing at all to do with Medicare.
If we did have a national health care system we would not even have this issue.
I remember some 30 years ago a friend of mine (devout catholic) a widow had a relation ship that ended in pregnancy because she did believe in natural birth control only. They got married, his insurance was to cover pre-natal care, so he thought. The insurance did inform them, pre-natal care was not covered because they had not been married for 12 mo, mind you, 12 month, no sex for you risking pregnancy, until you are married for a year.
Assurance or insurance is just sparcing words as far as I am concerned.
If we did have a national health care system we would not even have this issue.
Obviously we do have this issue. A national plan would cover contraceptioon, and I have to assume Medicare for all will limit hospital stays, despite them needing to stay, just like the national plan for our seniors. But its good to see where the priorities are.
mcwop,
you know all health care planes do have limits, most of all your private insurance.
kharris,
the issue is about the moral exception the Roman Catholic Church claims, The conscience of the establishment, not the conscience of the women who actually take the pills. Then the Blunt amendment excempting all employers to pay for what ever fancies their religious conscience. Not how men pay child support after the fact. That is another issue where the men of the creation don’t shine either. (Gingrich, Walsh just to name two)
The audacity of Gingrich to claim oppression by the Obama administration to expect the church to pay wages like all the other employers.
BTW, in Germany the government collects child support for the women. The government makes the monthly payments on time and collects from the men until it is paid, no matter how long it takes them.
Here are some of the empirical findings dealing with the insurance costs and cost-savings of coverage for contraceptive services.
The direct costs of providing contraception as part of a health insurance plan are very low and do not add more than approximately 0.5% to the premium costs per adult enrollee (see Daroch, J. E.). In 1998, Buck Consultants estimated that the direct cost of providing contraceptive benefits averaged $21 per enrollee per year (see Daroch, J. E.). The most recent actuarial analysis, completed by the Actuarial Research Corporation in July 2011, using data from 2010, estimated a cost of about $26 per year per enrolled female (see Callahan, C.)
However, with respect to the effect on insurance premiums when medical costs associated with unintended pregnancies are taken into account … including costs of prenatal care, pregnancy complications, and deliveries … the net effect on premiums is close to zero (see Washington Business Group on Health, Sept 2000). And when time away from work and lost productivity are considered (factors salient to employers) . . the total costs to employers are reduced. PriceWaterhouseCoopers issued a report in 2007 which found that providing contraceptive services yields a net cost-savings (see Campbell, K.P.).
The cost-savings impact of contraceptive services has also been demonstrated via the Medicaid Section 1115 Family Planning Demonstrations conducted in six states in the 1990s.
Please refer to Tthe February 2012 U.S. DHHS brief on this subject .. it contains both the content and full citations noted in abbreviated form above .. see here:
http://aspe.hhs.gov/health/reports/2012/contraceptives/ib.shtml#_ftn17
Good to know the government’s priorities, make a huge deal over the pill, kick old ladies to the street when they are really sick. What a joke from the people that keep selling government health care as the best thing since sliced bread. Sad, sad, joke. Government health care, great so long as you do not get really sick. IMO contraception is #999,000 on the list of problems with health care, but exposing all the important limitations of governmnet health care is taboo.
Dale –
One sentence?
Cheers!
JzB
mcwop,
guess what, some time ago all the medicare people were young and guess what, they too used contraceptives and all the young people today will some day be old and use Medicare.