{"id":392,"date":"2014-07-05T23:59:00","date_gmt":"2014-07-05T23:59:00","guid":{"rendered":"http:\/\/admin.patheos.com\/blogs\/janetheactuary\/2014\/07\/the-war-on-women-has-gotten-out-of-hand.html"},"modified":"2014-07-05T23:59:00","modified_gmt":"2014-07-05T23:59:00","slug":"the-war-on-women-has-gotten-out-of-hand","status":"publish","type":"post","link":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/2014\/07\/the-war-on-women-has-gotten-out-of-hand.html","title":{"rendered":"The “War on Women” has gotten out of hand"},"content":{"rendered":"\n<\/head>

So just how many \u201csky is falling\u201d articles have your socially-liberal friends on facebook shared? \u00a0Because you know that, if you tend to read socially-conservative websites, you still get your daily dose of liberal ideology that way, even if you don\u2019t happen on any given day to stop by and see what clickbait Slate has to offer. <\/p>\n

(Today, George Takei had a picture of two weepy men holding an infant just born to a surrogate they had contracted with; it was a fairly odd photograph as the men were shirtless for no discernable reason \u2014 my guess was that they\u2019d just been in the birthing tub or that the photographer thought the photographs would be more artistic that way, but it makes them more artificial and more creepy than moving. \u00a0But I digress.)<\/p>\n

The core, fundamental idea seems to be that women are uniquely disadvantaged by virtue of their ability to become pregnant, so the world at large must compensate for that. \u00a0Activists are conflating the opportunity to obtain contraception with no out-of-pocket cost with its access in the first place, and are taking it for granted that the natural order of things is for contraception to be a part of an employer-provided healthcare plan.<\/p>\n

But what, really, is the rationale for mandating its inclusion, specifically with no out-of-pocket cost?<\/p>\n

According to the feds themselves, in the official regulations<\/a>,<\/p>\n

Individuals are more likely to use preventive services if they do not have to satisfy cost-sharing requirements (such as a copayment, coinsurance, or a deductible). Use of preventive services results in a healthier population and reduces health care costs by helping individuals avoid preventable conditions and receive treatment earlier.<\/p><\/blockquote>\n

And what are the preventive services, other than contraception?\n

According to the official list<\/a>, developed by the Institute of Medicine, it\u2019s mostly a lot of screenings: \u00a0for high cholesterol, high blood pressure, depression, diabetes, and certain other ailments. \u00a0Some preventive measures, such as low-dose aspirin (as if the cost of something as cheap as aspirin makes a difference in compliance with a daily regimen), some booster-type vaccines, and weight-loss counseling and smoking cessation counseling and treatment. \u00a0(Interesting that only counseling is covered for weight loss for those at risk, but smoking cessation treatment<\/i>\u00a0is covered. \u00a0Consistency would dictate that treatments be covered for both or neither \u2014 does this mean that the Institute made the compromise of concluding that it\u2019d be opening up a can of worms in declaring weight-loss treatments covered at no out-of-pocket cost, or that smoking is more dire than obesity in terms of health risks?<\/p>\n

For children, too, the list consists mostly of screenings, plus vaccinations, and a small number of ongoing preventive treatments: \u00a0fluoride supplements where water is unfluoridated, and iron supplements for infants with low iron levels. <\/p>\n<\/div>\n

For women, specifically, there are additional recommended screenings such as for gestational diabetes. \u00a0And then, the Big Two:<\/p>\n

Breastfeeding comprehensive support and counseling from trained providers, and access to breastfeeding supplies, for pregnant and nursing women\u201d and<\/p>\n

Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, as prescribed by a health care provider for women with reproductive capacity (not including abortifacient drugs).\u00a0<\/p><\/blockquote>\n

(Of course, \u201cabortifacient drugs\u201d means very narrowly, in the feds\u2019 definition, drugs exclusively intended to produce an abortion, which means that they shouldn\u2019t even be implying that it\u2019s a \u201ccontraceptive method\u201d in the first place.)<\/p>\n

This context really makes the contraceptive mandate very out-of-place, given that most of the other items on the list ought to be a part of a single routine check-up, and that I would expect that the biggest issue with cost-related patient non-compliance is really more with first-line treatments than with these basic screenings: wasn\u2019t the paper full of stories of grateful new Obamacare enrollees with diabetes or high blood pressure or other ailments who were headed towards health crises because they couldn\u2019t afford their medications or ongoing doctor visits?<\/p>\n

So what\u2019s the rationale for requiring coverage of contraception?<\/p>\n

My memory was that the statement was, no, of course being pregnant isn\u2019t in itself a disease we need to prevent, but too-closely-spaced pregnancies are \u2014 which would warrant no-out-of-pocket-cost contraceptive coverage for women who had recently given birth but not all women, universally.<\/p>\n

But according to the regulations I dug out today, it\u2019s only partially about spacing and mostly about unplannedness:<\/p>\n

Women experiencing an unintended pregnancy may not immediately be aware that they are pregnant, and thus delay prenatal care. They also may be less motivated to cease behaviors during pregnancy, such as smoking and consumption of alcohol, that pose pregnancy-related risks. Studies show a greater risk of preterm birth and low birth weight among unintended pregnancies. In addition, contraceptive use helps women improve birth spacing and therefore avoid the increased risk of adverse pregnancy outcomes that comes with pregnancies that are too closely spaced.<\/p><\/blockquote>\n

I\u2019m not sure if I buy this. \u00a0In the first place, \u201cprenatal care\u201d doesn\u2019t really start until the second trimester \u2014 or, at least, I remember being all excited about being pregnant the first time around and calling to make an appointment, and being surprised that the receptionist was in no hurry to schedule me. \u00a0I would also expect that there\u2019s a substantial correlation between low-income women and both unplanned pregnancies (both in terms of true unwanted pregnancies, and a more generally lack of interest in trying to time pregnancy for a specific time) and smoking and alcohol use. <\/p>\n

And here\u2019s the kicker: \u00a0\u201cfree\u201d contraceptives are promoted as a money-saver:<\/p>\n

Covering contraceptives also yields significant cost savings. A 2000 study estimated that it would cost 15 to 17 percent more not to provide contraceptive coverage in employee health plans than to provide such\u00a0coverage, after accounting for both the direct medical costs of pregnancy and the indirect costs, such as employee absence. \u00a0Consistent with this finding, when contraceptive coverage was added to the Federal Employees Health Benefits Program, premiums did not increase because there was no resulting net health care cost increase.<\/p><\/blockquote>\n

The publication gives references for each of these claims, though I presume they\u2019re behind paywalls or otherwise inaccessible. \u00a0A 15% \u2013 17% cost increase in not providing contraceptive coverage in employee health plans? \u00a0That seems to be a hypothetical calculation based on a model, assuming women are more likely to use less reliable contraception and have more children on average, if contraception isn\u2019t covered. \u00a0These studies also speak of coverage of contraception in general, not specifically the \u201cno-out-of-pocket-cost\u201d requirement now being imposed.<\/p>\n

Ann Althouse, in her comments within her post on the topic<\/a>, takes the approach that every woman is going to have some fixed number of children in her lifetime, so that the goal of free contraception is to move women onto more long-lasting contraception so that they have their children later in life (though not so late, presumably, as to make these planned pregnancies high-risk due to \u201cadvanced maternal age\u201d). \u00a0Arguments on cost savings assume the opposite, that women will have fewer lifetime children, when they say that an IUD is cheaper than childbirth expenses (because, let\u2019s face it, a marginal reduction in the number of high-risk pregnancies isn\u2019t going to drive costs down this much). \u00a0Which is right? \u00a0I don\u2019t know. \u00a0But the behavior of low-income women is not terribly relevant to employer-provided healthcare plans.<\/p>\n

But at any rate, are contraceptives covered because the administration figured it would be a good weapon to bludgeon Republicans with? \u00a0Probably not. \u00a0It looks much more like the Public Health crowd saw in the \u201cpreventive care\u201d guidelines an opportunity to push an agenda of greater contraceptive use, and more widespread use of long-lasting, no-compliance-required contraceptives, and ran with it. <\/p>\n

And here\u2019s a final, tangential irony of the \u201cfree contraception\u201d rule: \u00a0it will destroy any hope of developing a \u201cmale pill\u201d as the market for it will be virtually nil, given the human tendency to choose the \u201cfree\u201d option even if the with-cost option is really the better choice.<\/p>\n<\/body><\/html>\n","protected":false},"excerpt":{"rendered":"

So just how many \u201csky is falling\u201d articles have your socially-liberal friends on facebook shared? \u00a0Because you know that, if you tend to read socially-conservative websites, you still get your daily dose of liberal ideology that way, even if you don\u2019t happen on any given day to stop by and see what clickbait Slate has […]<\/p>\n","protected":false},"author":2209,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-392","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"yoast_head":"\nThe "War on Women" has gotten out of hand<\/title>\n<meta name=\"description\" content=\"So just how many "sky is falling" articles have your socially-liberal friends on facebook shared?  Because you know that, if you tend to read\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.patheos.com\/blogs\/janetheactuary\/2014\/07\/the-war-on-women-has-gotten-out-of-hand.html\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"The "War on Women" has gotten out of hand\" \/>\n<meta property=\"og:description\" content=\"So just how many "sky is falling" articles have your socially-liberal friends on facebook shared? 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