Poor women’s health as ‘political bargaining chip’

Poor women’s health as ‘political bargaining chip’ February 6, 2012

William D. Lindsey is not pleased that his church’s leaders are rallying all their political power in order to avoid providing health care to women:

I’m well aware that Planned Parenthood does also provide abortion services in some areas. I’m also well aware that the vast bulk of the services Planned Parenthood provides are not abortions, and many Planned Parenthood affiliates throughout the U.S. do not provide abortion services at all. If [supporters of the bishops] wish, as I assume they do — and as I myself do — to see abortions diminished, then I am unclear about precisely how we’re pursuing that end on which we all agree by seeking to have Planned Parenthood defunded and shut down.

… I must part company with Catholic centrists who make common cause with the religious and political right vis-a-vis these issues because my own Catholic pro-life ethic forbids me to use the provision of health care to poor women as a political bargaining chip to score anti-abortion points. I also conclude that I do not see abortion per se as the defining characteristic of a Catholic or a pro-life Catholic.

I see being pro-life across the board and consistently as the defining characteristic of a pro-life Catholic. And so as a pro-life Catholic, I find it incomprehensible — I find it outrageous and shameful — that my church’s leaders are willing to ally themselves with political leaders whose goals are in no sense at all pro-life, except that these political leaders continue to promise to outlaw abortion if they’re elected. (But they haven’t done so when elected and given a chance to move in that direction.)

In short, I refuse to be herded where the bishops, the political and religious right, and centrist Catholic media spokespersons like Zagano and Clarke wish to herd me. I refuse to be herded onto the Catholic tribal reserve designated for me by their definition of Catholicism, for which opposing abortion at all costs is a defining characteristic of a true Catholic. I refuse to be so herded because I’m a pro-life Catholic.

At Religion Dispatches, Sarah Posner provides my favorite headline of the day: “OB/GYN Corrects Bishop’s False Claim About How Contraceptives Work.”

Mr. Dolan? About your son Timmy — the archbishop and president of the U.S. Conference of Catholic Bishops? It’s time to have that little talk. He’s a bit confused about how this works.

At least I hope he’s confused. Because if the archbishop is not confused, then the archbishop is lying. …

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  • B

    That is also my understanding: that the available evidence suggests that Plan B doesn’t affect implantation and thus has no affect after conception takes place.

    I suspect it’s impossible to rule out that anything that disrupts the menstrual cycle might occasionally cause a fertilized egg that would otherwise have implanted, not to implant. (Or, for that matter, cause a fertilized egg that otherwise would have hit the uterus at the wrong time of the cycle and failed to implant, to implant.)  But there’s a lot of things that disrupt the menstrual cycle besides Plan B.  Are we gonging to rage against stress and heavy exercise?

  • B

    So, yeah… that “OB/GYN Corrects Bishop’s False Claim About How Contraceptives Work” article is rather strange.  Even if you accept the definition of “abortifacient” as preventing implantation rather than ending an (implanted) pregnancy — which I think would be a non-standard definition — Plan B is not an abortifacient.

  • FangsFirst

     

    To be fair though, this is an unfortunately easy mistake to make: They are to be taken after intercourse,

    Which is *exactly* why I thought the classification was correct, and why I think it could be worth noting….(by now my comment on the original article has indeed also appeared, hopefully anyone that would actually have a problem with abortifacients will see that and at least stop opposing this!)

  • FangsFirst

     

    But as you said, once implantation occurs, Plan B won’t do jack. It
    won’t terminate an established pregnancy. Hence it is in no sense
    abortion.

    Thanks, by the way, for clearing that up COMPLETELY. I had gathered that they were chemically considered contraceptives and not abortifacients, but that clarifies the exact details for me. Cheers!

    *That is not intended as a rape joke. I’ve read more than one feminist
    thinker claim that legally mandated penetration of a woman’s bodies
    constitutes rape.

    Thanks for that (not sarcastic).
    I’d say that the “legally mandated” + “not universally guaranteed to be desired” part would cover that. If a probe were *necessary* for *pure health reasons* then I imagine most women would at least accept it occurring, versus, “Okay you want to do this, so we are going to do a totally unrelated thing…by law.”

    If, for some reason, legal or no, all women were okay with it, I imagine that would be okay. But that would be really, really weird if it were true. “Yes, perform a totally unnecessary procedure on me so that I can have an unrelated one performed, especially considering your only motivation is to try and stop me having the unrelated one, not anything related to my health or well-being. Cool!”

  • FangsFirst

     

    Related to the topic at hand—Karen Handel has resigned from her position as VP of public policy at Komen.

    Good riddance all the same.

  • FangsFirst

    (Also, dad? Gross. I don’t need to hear about what song you listened to while you were boning mom.)

    Unless it was at exactly the moment that the guitar starts fading in to that crescendoed bend. That would be AWESOME.

  • Dan Audy

     

    What the hell. If the law is unconstitutional per the most recent court
    decision, why would they extend the stay? How long do they expect people
    to wait to be able to exercise rights that the court has affirmed them
    to possess on multiple occasions?

    It is actually extremely typical for stays to remain in place until the period for filling appeals expires so that you don’t have a ping-pong of things being legal for a month, then illegal for 6 months, then legal for another week, then illegal again for a year before finally being ruled permanently legal while each court hears the case and rules on it.  It sucks when you are on this side of the case but when it is restraining horrible laws like the various union busting laws you don’t want to have all the problems it could create being valid for even one day.

  • Matri

    Unless it was at exactly the moment that the guitar starts fading in to that crescendoed bend. That would be AWESOME.

    …Great. Now I can never listen to that song ever again. Thanks. :P

  • @11246c259a589439da38a207344b6bfa:disqus : Ever seen a fat guy in a dress?

    Yes, and it was fan-fuckin’-tastic.

    …What?

  • @Matt McIrvin: This also squares with colloquial use of the term: “Son, you were conceived to the tune of “Don’t Stop Believin’ by Journey.”

    Which is, of course, patently ridiculous. As anyone who’s seen Heavy Metal knows, the canonical Journey make-out tune is “Open Arms.”

  • Wednesday

     @TooManyJens — thanks for the link. That’s really good news — not that the anti-EC activists will pay attention to the science, but there are fence-sitters who might care about the actual facts, plus some women using EC. For example, I had a Catholic friend in college who as a bio major understood quite well that fertilization != pregnancy, but she decided not to get a copper IUD because she wasn’t comfortable with the possible ‘preventing implantation’ aspect of its mechanism.

  • FangsFirst

     

    Which is, of course, patently ridiculous. As anyone who’s seen Heavy Metal knows, the canonical Journey make-out tune is “Open Arms.”

    Oh…oh the awful puns x.x

    …Great. Now I can never listen to that song ever again. Thanks. :P

    Hahaha! Sorry :S
    I should not misuse my gift of “not automatically imagining such things” for evil…

  • P J Evans

    zygotes only retain those rights while they remain unborn

    And about a third of them (at least – I’ve seen higher estimates) never get there, in the normal course of nature. Which is conveniently never brought up by the ‘pro-life’ people.

  • P J Evans

     In a lot of rural areas, it’s church-sponsored hospital or nothing (regardless of church affiliation), and even in urban areas, a lot of hospitals are religious-based organizations. The nearest major hospital to me is run by Catholics….

  • P J Evans

     If you’re being paid minimum wage, that’s a big expense every month. (It’s not cheap.) That also is what insurance is for: the cost of covering contraceptives for several hundred people as a group is lower than the cost of the same number of people buying it as single individuals.

  • P J Evans

    I wonder what they’d say if the fundamentalist Protestants decided to not serve Roman Catholics because “OMGPapistUnamerican!” (which is not at all far fetched: these are churches that don’t recognize other Protestant churches as actual Christians).

  • P J Evans

    I’m hoping this will create precedents that extend beyond California.

    Only if the courts in other states read Walker’s decision and borrow his reasoning. The appeals court’s ruling is very narrowly based, and applies only to California.

  • hapax

     

    Are we going to rage against stress and heavy exercise?

    I hereby volunteer to march in that demonstration.

    Slowly. 

    If I can go and have a nice lie-down immediately afterwards.

  • Lori

     
    I wonder what they’d say if the fundamentalist Protestants decided to not serve Roman Catholics because “OMGPapistUnamerican!” (which is not at all far fetched: these are churches that don’t recognize other Protestant churches as actual Christians).  

    I imagine that they’d say the same thing they said in the past when people refused to hire, serve or rent to Catholics—that it’s wrong and horrible to treat people that way and needs to stop. 

    The fact that it wasn’t that long ago that Catholics were discriminated against in this country doesn’t make the Bishops more compassionate or more hesitant about enshrining religious beliefs in civil law. You see, when someone discriminates against Catholics they’re wrong. When Catholics discriminate they’re standing up for their beliefs. Those are totally different things because shut up, that’s why. 

  • I disagree that “Insurance is for that which one cannot budget”. I take a
    medication that would cost me $250 a month if my insurance didn’t pick
    up $200 of the tab. I will need to take it for the rest of my life (and
    no, there are no lifestyle changes like diet and exercise which could
    remove the need for the medication).

    I think it may be reasonable to suppose that if we didn’t have a system which assumed that insurance would be used to pay for “normal” medical expenses, the economics would be different and the sort of medication people need to take for the rest of their life wouldn’t cost $250 per month: the economics of healthcare and the pharma industry are both *deliberately* constructed to take advantage of the existing insurance model. I’m given to understand that’s actually how medical insurance used to work decades ago — insurance was for *catastrophic* health issues, but the cost of regular health maintenance was much much lower.  In that sense, there are really two separate problems: “not everyone has adequate insurance” and “the economics of healthcare are set up on the assumption that all medical expenses are paid by insurance”.

    I’m not sure whether or not it would be good to have a system where “everyday” medical expenses were cheap enough that they *could* be reasonably budgeted and insurance was only for catastrophic health issues.  But I do think I’d feel more secure in a system where everything was paid via insurance and insurance was guaranteed to everyone.

    Since I don’t especially trust capitalism to keep people alive.

  • Anonymous

    Ah, I thought I was being misconstrued, but I left out an important qualifier: I mildly oppose contraception being covered without cost which, I believe, is what is mandated. Contraceptives should absolutely be covered in the same way as other pharmaceuticals, medical procedures, and devices.

    By mildly opposed, I mean that I recognize that coverage is a good thing and am generally in favor of it, but I have misgivings about the “free” aspect. Nothing is free, it is included.

    Of course I understand how difficult budgeting decisions can be.

    Consider how dental insurance works, since it is rather different from medical, and has never been politicized. My employer provides two dental coverage options, basic and enhanced or something like that. They both cover preventive care at no cost, or rather at no additional cost. That isn’t really insurance, it is a payment plan, and not a good deal unless you go get the six month cleaning, checkup, x-rays and so forth. On top of that is the insurance coverage, which pay a percentage for work like fillings, crowns and so forth that you hope you won’t need. The difference between the two plans is that the enhanced version pays a higher percentage and has lower maximums.

    Now a family in the situation you describe is in a bind. Over the long haul, the lowest cost is to get the basic dental plan, which has a predictable plan, and to see the dentist every 6 months. However, the cost of even the basic plan isn’t trivial, maybe $500 a year. People who are struggling might opt to forgo the coverage, and the prophylaxis. They will eventually pay the price, but not today. That is often how it is for the poor, or even not so poor. Because I have the money, I can buy a predictable and lower cost, while the poor pay higher, less predictable, costs. There are many among the wealthy who do not realize this, or have forgotten.

    Now, back to the health insurance. Even before the new law, many insurance plans included preventive care at no additional cost. Not free. Included. The cost of providing the preventive care and mandates is included in the premium, which goes up accordingly. It is a bad deal unless you go to the doctor every year and have all the covered diagnostics. It is a good deal, however, if everyone does do that, if it ultimately lowers total costs by keeping people healthier and treating diseases earlier when it is presumably cheaper. That is why “free” preventive care was mandated. It might have been better to give people a premium rebate if they go for preventive care. The downside is that “free” preventive care is more like a payment plan than insurance, and it shows up pretty directly in the premium.

    AFAIK, there is no mandated split of insurance costs between the employer and employee. The trend has been for employees to pay more. (There is yet another out for the bishops — just find out what the additional premium is and shift it to the employees.) When the mandated costs rise, the employer is likely to shift them to employees. The working poor then have to decide whether to buy the coverage or decline it. The smart move, of course, is to buy it, but living day to day do you worry about tomorrow, or just deal with it when it comes.

    So, adding a new “free” benefit is not all sunshine and light. It increases the premium. It gets complicated. Of course, in the case of birth control the premium would not go up as much as the cost to the individual if they were on normal prescription drug coverage, because it is spread across a broader population. I would explicitly reject the argument that people other than women of childbearing years don’t benefit and shouldn’t have to pay. Anyone making that argument shouldn’t have a mother or sister or daughter or daughter-in-law. Men benefit from the health and well-being of women as women do from the health and well-being of men.

    I don’t think it is wrong, though, to question whether something should be covered “free”. Some might suggest that fertility treatments should be covered at no additional cost as an affirmation of life, while others might question whether they should be covered at all since people can live wonderful happy lives without children. There is even a point of view that no-cost birth control is tantamount to paying the bottom 25% or so to not have children, which could be construed as a form of eugenics. That is a bit silly, or maybe a worthwhile question.

     Of course, wouldn’t it be nice if the bishops were to see to it that all of their employees get a living wage such that they don’t have to juggle which bills to pay or which medicines they can afford, and maybe could welcome a child or two.

  • Anonymous

     Especially considering that the clinical definition of pregnancy is the period between implantation and birth.  That embryo is just sort of floating around for a week.

    Since an abortifacient ends pregnancy, and Plan B flushes out a zygote well before it can implant in the uterine wall, Plan B is not an abortifacient.

    Considering how many embryos fail to implant even without interference, I am always unnerved by suggestions that something is wrong with Plan B.

  • Anonymous

     My parents are acting like it’s the end of the world because, in their words, “We’ll be forced to pay for other peoples’ abortions!!!”  Apparently, the fact that they are currently paying for unwanted kids to be shuffled through the foster system, or fed through welfare programs, doesn’t occur to them.

  • Anonymous

     “That said, I am mildly opposed to covering birth control because it is an expense that can be reasonably budgeted.”

    It depends.  I’ve been taking generic BCP’s for a year and a half now ($10/refill; total cost $130/yr).  When I moved and changed gynos, the new doc tried to put me on a new pill (BeYaz) specifically formulated for PMDD.  Cost?  $98/refill (about $1300/yr).  If I hadn’t known about the cheaper generic (BeYaz doesn’t come in a generic version), I would be paying 10 times as much for BCP, unaware that there was a better option.

    Also, in order to get birth control pills, you have to have annual gynecological appointments at an addition $100 each.  Some women may have trouble fitting that into their budgets.

  • Anonymous

     What’s even more fun is when you learn that 9-month average…and then remember that you were born less than a year after a relative’s tragic death.  SO MANY unfortunate implications.

  • Anonymous

     It made sense when women couldn’t own property, and inheritance was passed from father to son–but those things aren’t the case anymore.

  • Anonymous

     Dude.  Meatloaf.  “Paradise by the Dashboard Light.”  Has the added bonus of creating extra Fridge Horror when the kids remember what the song is about.

  • Anonymous

     “Possible?”  I thought preventing implantation was the entire point of an IUD.

  • Anonymous

    It depends.  I’ve been taking generic BCP’s for a year and a half now
    ($10/refill; total cost $130/yr).  When I moved and changed gynos, the
    new doc tried to put me on a new pill (BeYaz) specifically formulated
    for PMDD.  Cost?  $98/refill (about $1300/yr).  If I hadn’t known about
    the cheaper generic (BeYaz doesn’t come in a generic version), I would
    be paying 10 times as much for BCP, unaware that there was a better
    option.

    That gets into the whole racket on Rx pricing which is, well, a racket.

    In one of my other replies, I clarified that I left out a qualifier that I have trouble with it being covered free. That puts it in a separate category from other prescriptions. Your $130/yr cost is consistent with an established generic within a prescription plan and seems to me pretty manageable for anyone with any sort of job that pays benefits in the first place.

    The problem you had with BeYaz has to do with formularies, patent rights, power plays between very large corporations, drug salesmen, and a doctor who was probably getting some sort of kickback or simply isn’t very cost sensitive. You were able to avoid the higher expense because you were willing and able to ask questions and educated enough to navigate the system.

    Too, when you take BCPs for PMDD, you aren’t only using them for
    contraceptive purposes, or maybe not at all. I suspect that there are a
    lot of men who don’t accept or grasp the distinction. I doubt the
    bishops have much awareness that there are medical reasons to BCPs. The men who know these things spend their lives living with women they love.

    When we were going through annual enrollment I did a comparative analysis of plans, including covered prescription costs for my wife’s array of medications, with tax implications. The spreadsheet I came up with was wildly complicated and the result surprised me enough that I checked it multiple times. I was very grateful that my family was able to provide me with the kind of education to do that sort of analysis, and keenly aware that there are many who would struggle to make the best choice in these very complex systems. It would be wonderful if the complexity could be reduced and/or more done to assist people in understanding and using these benefits. (The surprising result was that the HSA plan was cheaper in almost all scenarios. The caveats being that we have the reserves to absorb the deductible and that our tax bracket is high enough do get a meaningful discount. A healthy young family at a lower income level might also do best to select the high-deductible plan, roll the dice, and bank the premium difference, but they may fear the harsher impact of an injury or illness. Yet another case where people who make more money pay less.)

    The annual gyno is required to be covered at no additional cost, as preventive care. (At the very least, women can use an ob/gyn as primary physician for an annual well patient visit.) I imagine the bishops might object to that too, but probably realize they wouldn’t get any traction at all on that point. There really is no good reason that services on the USPSTF A an B lists shouldn’t be free of cost, as the cost to the group is minimal to negative.

    I guess on that argument, at least some forms of contraception should be free to minimal cost because they reduce the costs of obstetric and pediatric care, as well as providing women more incentive to take advantage of the annual well-patient visit and get the A-list screenings, but it would be nice to have some numbers there. Wouldn’t it be interesting if a religious organization would have to pay *more* to decline that coverage?

  • Anonymous

    I thought preventing implantation was the entire point of an IUD.

    Nope, the primary effect of an IUD is to make fertilization more difficult.  It causes a low-level inflammatory reaction, the chemical products of which are toxic to sperm and eggs.  (Basically, the uterus recognizes that it’s got a foreign body inside it, and starts trying to break down whatever’s in there.)  If it’s a copper IUD, the copper ions are also directly toxic to sperm.  If it’s a hormonal IUD, the hormones it releases make the cervical mucus thicker and hard for sperm to get through.

    Even when the eggs of a woman with an IUD do get fertilized, they tend to develop abnormally and die before they reach the implantation stage anyway.  But for the most part, they just don’t get fertilized.

    See this review article, for instance.

  • Tricksterson

    Besides the Catholic Chuirch woud suffer an enormous and shhattering blow to the public perception of them if they did.

  • Tricksterson

    Several.  Fat hairy guys at that.

  • Anonymous

     I have learned something new.  This whole time, I thought it worked because the device itself was in the right places to form a barrier against implantation.

  • Anonymous

     “Your $130/yr cost is consistent with an established generic within a
    prescription plan and seems to me pretty manageable for anyone with any
    sort of job that pays benefits in the first place.”

    Um, those are prices to the uninsured; BCP tends to be a lot cheaper than other forms of medication.  Adderall (ADHD medication; chemically similar to Ritalin) costs around $250/month; the generic is around $150/month.  With insurance, that cost plummets to around $5-10/month.

    My workplace benefits operate under the assumption that there is no such thing as a college professor under 40; there are family options, colonoscopy/mammogram/prostate exam coverage, and other stuff that’s great for older people, but simply aren’t usable by a single, childless 20-something.  BCBS costs less and allows me to cover my gyno visits, so that’s what I use.

    “You were able to avoid the higher expense because you were willing and
    able to ask questions and educated enough to navigate the system.”

    No, I was able to avoid the higher expense only because I was lucky. Lucky to have a mom who was already on BCP and knew how ridiculous Beyaz’s price is.  Lucky to have had a previous gyno who wasn’t being pressured to prescribe the expensive stuff, knew I was on a budget, and prescribed me a cheap brand (Loestrin) that comes in a generic.  I didn’t go out and research any of this; I tend to be very trusting of doctors, and would have paid whatever the first gyno said it was going to cost.  I was just extremely lucky.

    Also, the RCC does in fact allow the use of BCP for PMDD, as long as preventing conception is not the primary reason one wishes to use it.  However, I was exposed to so much anti-birth-control propaganda* that I never would have dared, even when my condition got bad enough that I was too dizzy to get out of bed once a month.  Thank the Gods I was an apostate by that point and didn’t care what the Vatican thought of me anymore!

    “At the very least, women can use an ob/gyn as primary physician for an annual well patient visit.”

    YOU CAN DO THAT? O__O  My plan covers one doctor visit and one visit to a dentist OR specialist.  Now that I know this, I won’t have to pay for dental visits out-of-pocket anymore!  Thank you SO much!

    ————————————————-
    *There really is no other word for it.  It is a misinformation campaign designed to make you think that condoms and BCPs are even less reliable than the rhythm method.  The people behind the campaign apparently think that this is somehow more likely to get teens to abstain than to convince them to just have unprotected sex.

  • Anonymous

    YOU CAN DO THAT? O__O  My plan covers one doctor visit and one visit to a
    dentist OR specialist.  Now that I know this, I won’t have to pay for
    dental visits out-of-pocket anymore!  Thank you SO much!

    Well, please don’t take my word for it, check the Summary Plan Description and plan materials. Every plan I’ve seen allows an OB/Gyn as Primary Care Physician, but maybe it isn’t universal.

    My workplace benefits operate under the assumption that there is no such
    thing as a college professor under 40; there are family options,
    colonoscopy/mammogram/prostate exam coverage, and other stuff that’s
    great for older people, but simply aren’t usable by a single, childless
    20-something.  BCBS costs less and allows me to cover my gyno visits, so
    that’s what I use.

    Under the new regulations, all health insurance has to cover preventive screenings 100%. You will need it eventually. Insurance works by spreading risks and costs across a broad population and across time. You may be 30 years from needing a colonoscopy, but you are paying for it a little bit at a time rather than all at once. If only people over 50 paid for that coverage, it would be hugely expensive and unobtainable. The problem of adverse selection is exactly why a mandate or public system is necessary.

  • Anonymous

     I know I’ll need it eventually, but there’s no guarantee that I’ll even work for that college by the time I do need it.  Also, the vast majority of full-timers DO have the insurance, because they are either a good bit older than me, have families, or both.

    I can afford BCBS, and it provides coverage that is useful for me at this point in my life, so I go with BCBS.