“You Can’t Fix Stupid”: Birth Control Is Different Than Starbucks
The controversy over contraception has faded a bit. Congressional Republicans are rethinking efforts to overturn a requirement that would make birth control coverage a mandatory part of health insurance. Rush Limbaugh has stopped talking about the issue, at least for the moment.
But the issue hasn’t gone away entirely. The administration is still working on ways to accommodate the wishes of some large religious institutions opposed, for reasons of faith, to sponsoring employee benefits that cover contraception. (On Friday, it unveiled a few options and announced it was seeking public comment on them.) Conservatives, meanwhile, continue to press their case.
With that in mind, let’s talk about a conservative argument that isn’t simply about religion or the morality of birth control. It’s the suggestion that birth control coverage simply doesn’t belong in health insurance, because it’s not an expense that all of us should be subsidizing.
Among those making that argument recently was syndicated columnist Mona Charen. After arguing that contraception costs “less than the cost of a weekly trip to Starbucks” and that a variety of programs, public and private, make free contraception available to the poor, Charen draws a distinction between birth control and other types of drugs:
Contraceptives are not a matter of life and death. But even if they were, such as cancer drugs are, is that an argument for forcing insurance companies to provide them free? Why not force free distribution of all medicines? The mandate makes no economic, social or moral sense.
Actually, it makes economic, social and moral sense.
Let’s put aside the question of whether contraception coverage should be “free,” because that’s not really the issue anymore. Republican Senators Roy Blunt and Marco Rubio, along with the Conference of Catholic Bishops, have said they oppose any requirement that forces employers to cover contraception, regardless of whether such coverage requires out-of-pocket expenses.
And, one more time, let’s dispense with this notion that every woman can get birth control for less than the weekly cost of Starbucks. As noted here previously, the cheap drugs at Target, Walmart, and the other big chains are great if you take the standard combination hormonal pills, which combine estrogen and progestin. But some people cannot or should not take those pills. They’re not good for postpartum women who are breast-feeding, for example, and they cause side effects for many others. They may not be as effective, for some women, as methods like intrauterine devices, depo-provera, or surgical sterilization.
How many women fall into those categories? It’s a minority of the population, to be sure. But that’s always the story with health care and health insurance. At any one time, most people don’t require expensive medical care. Only a small number of people do. It’s precisely for the sake of that group – the ones who face high expenses, and could face financial or medical turmoil without assistance – that insurance exists.
Keep in mind that, at some point or another, pretty much everybody falls into that category. Maybe you’re not a woman who needs expensive birth control. You might still be a woman, or a man, who ends up with heart disease. Or allergies. Or a chronic gastro-intestinal problem. Or cancer. Insurance is there to take care of you, so why shouldn’t insurance be there to take care of a woman who needs more expensive forms of contraception?
No, birth control isn’t treatment for an acute condition. It’s routine, preventative care. But that hardly undermines the case for coverage. Think about eye exams for a moment. Or blood pressure checks. Both of these are widely available, for very low cost. In fact, if you do the math, over the course of a year either one would cost less than a year’s supply of even generic hormonal contraception. But insurance typically covers those costs and, under the Affordable Care Act, insurance must cover those costs – because this sort of care keeps people from getting serious medical conditions and, quite possibly, saves money in the long run.
The very same things are true of birth control. Pregnancy is a wonderful thing, but it’s also a serious medical condition that requires serious medical attention. (Those of you unfamiliar with what pregnancy entails might want to consult this page from the American Academy of Family Physicians – or ask a woman who has been pregnant.) Don’t forget, too, that some women take contraception to control their menstrual cycles or for reasons that aren’t really related to avoiding pregnancy.
Some critics insist there’s a difference between screening for hypertension or vision problems, on the one hand, and controlling the timing of pregnancy, on the other. Non-procreative sex, they say, is a purely voluntary act, for which others should not have to pay. “No one is touching your birth control, ladies,” conservative writer Amanda Carpenter tweeted on Friday. “We just don’t want to be forced to pay for it.” But, according to statistics from the Guttmacher Institute, 99 percent of women use birth control at times during their reproductive years. Based on that, I think it’s safe to assume that non-procreative sex is an activity in which virtually everybody engages, at some point or another, and for which a large majority will need birth control.
And so we’re back to the question that’s always been at the very heart of our health insurance debate: Do we think responsibility for medical expenses should lie primarily with individuals, even if that means some won’t be able to afford it? Or is it a burden we wish to spread more broadly, across society, so that everybody can get the care they need, at a price they can afford?
You know where I stand on that question.
P.S. When the administration announced its options for accommodating religious institutions on Friday, it also released a rule about health plans for college students – and, in so doing, revealed that, for legal reasons, it does not have the authority to regulate all the plans. Sarah Kliff has the story. It doesn’t sound like a huge deal, but, as she notes, it’s yet another reminder of how complex insurance regulation is in the U.S.
By: Jonathan Cohn, The New Republic, March 16, 2012
Hurray For Health Reform: “Protecting Those Who Are Falling Through The Cracks”
It’s said that you can judge a man by the quality of his enemies. If the same principle applies to legislation, the Affordable Care Act — which was signed into law two years ago, but for the most part has yet to take effect — sits in a place of high honor.
Now, the act — known to its foes as Obamacare, and to the cognoscenti as ObamaRomneycare — isn’t easy to love, since it’s very much a compromise, dictated by the perceived political need to change existing coverage and challenge entrenched interests as little as possible. But the perfect is the enemy of the good; for all its imperfections, this reform would do an enormous amount of good. And one indicator of just how good it is comes from the apparent inability of its opponents to make an honest case against it.
To understand the lies, you first have to understand the truth. How would ObamaRomneycare change American health care?
For most people the answer is, not at all. In particular, those receiving good health benefits from employers would keep them. The act is aimed, instead, at Americans who fall through the cracks, either going without coverage or relying on the miserably malfunctioning individual, “non-group” insurance market.
The fact is that individual health insurance, as currently constituted, just doesn’t work. If insurers are left free to deny coverage at will — as they are in, say, California — they offer cheap policies to the young and healthy (and try to yank coverage if you get sick) but refuse to cover anyone likely to need expensive care. Yet simply requiring that insurers cover people with pre-existing conditions, as in New York, doesn’t work either: premiums are sky-high because only the sick buy insurance.
The solution — originally proposed, believe it or not, by analysts at the ultra-right-wing Heritage Foundation — is a three-legged stool of regulation and subsidies. As in New York, insurers are required to cover everyone; in return, everyone is required to buy insurance, so that healthy as well as sick people are in the risk pool. Finally, subsidies make those mandated insurance purchases affordable for lower-income families.
Can such a system work? It’s already working! Massachusetts enacted a very similar reform six years ago — yes, while Mitt Romney was governor. Jonathan Gruber of the Massachusetts Institute of Technology, who played a key role in developing both the local and the national reforms (and has published an illustrated guide to reform) has surveyed the results — and finds that Romneycare is working pretty much as advertised. The number of people without insurance has dropped sharply, the quality of care hasn’t suffered, and the program’s cost has been very close to initial projections.
Oh, and the budgetary cost per newly insured resident of Massachusetts was actually lower than the projected cost per American insured by the Affordable Care Act.
Given this evidence, what’s a virulent opponent of reform to do? The answer is, make stuff up.
We all know how the act’s proposal that Medicare evaluate medical procedures for effectiveness became, in the fevered imagination of the right, an evil plan to create death panels. And rest assured, this lie will be back in force once the general election campaign is in full swing.
For now, however, most of the disinformation involves claims about costs. Each new report from the Congressional Budget Office is touted as proof that the true cost of Obamacare is exploding, even when — as was the case with the latest report — the document says on its very first page that projected costs have actually fallen slightly. Nor are we talking about random pundits making these false claims. We are, instead, talking about people like the chairman of the House Republican Policy Committee, who issued a completely fraudulent press release after the latest budget office report.
Because the truth does not, sad to say, always prevail, there is a real chance that these lies will succeed in killing health reform before it really gets started. And that would be an immense tragedy for America, because this health reform is coming just in time.
As I said, the reform is mainly aimed at Americans who fall through the cracks in our current system — an important goal in its own right. But what makes reform truly urgent is the fact that the cracks are rapidly getting wider, because fewer and fewer jobs come with health benefits; employment-based coverage actually declined even during the “Bush boom” of 2003 to 2007, and has plunged since.
What this means is that the Affordable Care Act is the only thing protecting us from an imminent surge in the number of Americans who can’t afford essential care. So this reform had better survive — because if it doesn’t, many Americans who need health care won’t.
By: Paul Krugman, Op-Ed Columnist, The New York Times, March 18, 2012
“Just A Reminder”: Congress, Sometimes You Guys Are An Embarrassment
We’re 15 days out from the expiration of our eighth stopgap — yes, our eighth stopgap — to extend funding for transportation infrastructure. The last long-term transportation bill ended in 2009, and here we are, three years later, with no replacement.
It looked, this week, like perhaps we had finally broken the impasse when 72 senators joined together to pass the Boxer-Inhofe transportation bill. But Hill staffers tell Politico that the House won’t take the Senate bill up before the end of the month. Which means, yes, a ninth transportation stopgap. A ninth bill that doesn’t give states any predictable framework in which to make long-term investments. A ninth failure, in other words.
Congress, sometimes you guys are an embarrassment.
And so long as we’re taking the dim view here at Wonkbook, let’s just be honest about it: Boxer-Inhofe won’t solve our transportation problems, either. It’s much better than nothing, of course. And it’s better than yet another stopgap. But both on the spending and funding sides, it’s inadequate.
On the spending side, it only lasts for two years — the House wants a five-year bill, as does the White House — and, at $109 billion, it’s only about two-thirds the size of the president’s budget request for infrastructure, which was, in turn, smaller than what most infrastructure experts thought was needed.
This is a bad time to do a half-measure on infrastructure. We have literally trillions of dollars in unmet infrastructure needs. We have massive unemployment in the construction sector. Materials are unusually cheap because of a depressed global economy. Borrowing is unusually cheap because we’re one of the few safe havens left in the global financial market. And it’s cheaper to repair an aging bridge today than rebuild a crumbled one 10 years from now. So waiting to do the bulk of our infrastructure passing a half-measure on infrastructure investment later is like waiting till after the big sale ends to buy your groceries. It’s just bad financial planning.
Further, as my colleague Brad Plumer reports, Boxer-Inhofe does nothing to stop the Highway Trust Fund, which is paid for by the federal gas tax, from going broke. There are all sorts of reasons the fund is going broke — more fuel-efficient cars, the gas tax isn’t indexed to inflation, etc — but the bottom line is that the primary mechanism we use to pay for infrastructure in this country is in crisis. President Ronald Reagan, you’ll recall, actually raised the gas tax to fund his infrastructure bill, and Sen. Mike Enzi (R-WY) offered an amendment to index the gas tax to inflation in this bill. But that amendment was defeated, and so rather than actually fixing the Highway Trust Fund, we’re exhausting it, and patching the rest of the bill with one-time pay-fors and gimmicks. So the central problem in transportation funding — the problem that has arguably led to these nine stopgaps — will be left for another day.
Boxer-Inhofe is a lot better than doing nothing. It’s a lot better than another stopgap. And Sens. Barbara Boxer and James Inhofe deserve credit for actually moving a bipartisan infrastructure bill through the Senate. But it’s a reminder that, these days, even when Congress does get around to doing its job, it doesn’t do it particularly well.
By: Ezra Klein, The Washington Post Wonkbook, March 16, 2012
“Affordable Care Act For The Wealthy”: The Rest Of You Can Have Vouchers
It’s not uncommon for the über-wealthy to equip their mega-mansions with pricey private home theaters, spa-worthy washrooms, and palatial pools. Now an increasing number of the super-rich are setting aside space in their homes for another purpose: top-notch medical care.
According to Bloomberg, more well-off families are paying up to install at-home emergency rooms, which can cost upwards of $1 million, and forking over as much as $30,000 a year for “concierge care,” which puts the best-of-the-best physicians at their disposal anytime, anywhere.
“Wealthy people want to have a little exclusivity and want better service than they can get at their normal healthcare facility, and they’re willing to pay for it,” Rick Flynn, principal and head of the Family Office Group with Rothstein Kass, told Bloomberg.
Guardian 24/7, a Virginia-based medical care company founded by former White House physician Sean O’Mara, charges as much as $12,000 a month for its ReadyRooms, Bloomberg reported, which feature discreetly installed medical equipment available at the touch of a button.
If a medical emergency arises, homeowners can immediately contact an on-call emergency physician—a much faster response than waiting for an ambulance to arrive and transport the ailing homeowner to the hospital, the company’s website notes.
“Before Guardian, this kind of medical protection was only available to one person,” the company’s website says. “Now, presidential-level care can be yours—on your schedule and your terms.”
And if you thought for a minute the super-rich might have to be without immediate access to medical care outside the confines of their estates, think again. Guardian 24/7 installs any number of medical apparatuses from X-ray machines to CT scanners on yachts, motor coaches, and aircraft.
By: Meg Handley, Washington Whispers, U. S. News and World Report, March 16, 2012
“White Like Me”: The Re-Racialization Of American Politics
The conditions are converging for another presidential election that will sharply divide the country along racial lines, with troubling implications no matter which side prevails.
From one direction, the Republican presidential primaries have witnessed an epic failure by the GOP contenders to attract and engage minority voters. White voters, especially older ones, are routinely casting 90 percent or more of the votes in GOP contests this year, at least as high a proportion as in 2008.
Simultaneously, despite some recent gains, President Obama continues to struggle among white voters, especially the white working class. In 2008, he became the first presidential nominee ever to lose white voters by double digits and still win the White House. In 2012, as minorities loom larger in the vote, Obama could lose whites even more lopsidedly and still win reelection.
As these trends intensify, the election could reinforce the hardening re-racialization of American politics. Republicans today rely on a preponderantly white coalition centered on older and blue-collar voters, many of whom express great unease not only about activist government but also about the demographic changes swelling the minority population. Democrats depend on a coalition of minorities and of white voters (particularly those with college degrees) who are the most comfortable with government activism and the propulsive demographic transformation.
This year’s tumultuous Republican presidential race has underscored the dominance of whites, especially older white voters, in the GOP. After Tuesday’s contests in Alabama and Mississippi, exit polls have been conducted in 16 states that have held Republican primaries or caucuses. In all but two, whites cast at least 90 percent of the ballots. Indeed, whites delivered at least 94 percent of the votes in all but five GOP contests this year. Whites represented only 74 percent of all voters in the 2008 general election.
Among those 16 states, only Michigan has seen its minority vote share increase by more than a trace (to 8 percent, from 4 percent in 2008). Whites are dominating the GOP electorate even in rapidly diversifying states. In Nevada, whites were just 69 percent of all voters in the 2008 general election, but they cast 90 percent of the votes in last month’s Republican caucus. Similar gaps are evident in GOP primaries from Georgia, Mississippi, and Virginia, to Arizona, Ohio, and Oklahoma.
This year’s Republican electorate shades not only white but also gray. In 12 of the 16 states where exit polls have been conducted, voters over 50 cast at least 60 percent of the GOP primary votes; in the other four, they represented at least 55 percent of the vote. Just 43 percent of 2008 general-election voters were that old. Even compared with the 2008 GOP primaries, the gray tint is much more pronounced.
All of this flags near- and long-term challenges for the Republican Party. The problem this fall will be to attract minority (and younger) voters who are uninspired, or even alienated, by the primaries. As GOP front-runner Mitt Romney has hurtled to the right on immigration, recent surveys have shown Obama’s support against him matching, or exceeding, the president’s 67 percent showing among Hispanics in 2008. Hispanic Republicans such as Jennifer Korn, executive director of the Hispanic Leadership Network, say that if Romney wins the nomination, he will need to vastly expand his outreach “to explain his [immigration] position.” But outreach may go only so far for a candidate who touts “self-deportation” for illegal immigrants.
As population trends continue, the electoral math will grow more daunting for Republicans. If the GOP allows Democrats to continue winning four-fifths of all minority voters—as Obama did in 2008—Republicans will need to attract an implausibly high percentage of whites to win presidential elections. The conundrum is that the party’s current reliance on the most conservative whites constrains its ability to embrace policies attractive to minorities, as the harsh primary debate on immigration demonstrates.
Today, however, the GOP’s white strength can still overcome its minority weakness. Obama could win reelection with backing from only about 39 percent of whites if he duplicates his 2008 showing among minorities (and if their vote share rises slightly). But Democrats couldn’t muster even that much white support during the 2010 Republican congressional landslide. And Obama has no guarantee of crossing that bar this fall. In the Allstate/National Journal Heartland Monitor poll released on Friday, his approval rating among whites reached just 41 percent, a meager level that he has exceeded only once in the poll since October 2009.
These contrasting racial patterns signal another tough election in November. Equally important, they show how closely the ideological divisions between the parties track racial lines, with minorities more open than most whites to an activist role for Washington in promoting opportunity and providing a safety net. That divergence is a formula for social tension and polarized debate. But it’s the future that appears increasingly likely as Obama marshals a coalition powered at its core by the diversity reshaping American life, and his Republican rivals compete for an electorate that remains almost entirely untouched by it.
By: Ronald Brownstein, National Journal, March 17, 2012
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