July 6, 2014

Who Uses Insurance-covered Birth Control?

I've been torturing myself reading comments posted on various Burwell v. Hobby Lobby articles. And out of fairness, I've tortured myself leftly and rightly, not wanting to miss anything. Trust me, there's a lot that's worth missing.

After reading through opinions ranging from the ridiculous to the sublime, it seems that people have no clue how insurance works. There's a huge misconception out there that a health insurance policy should be completely individualized, so that for example a man would never have to pay for maternity coverage, seeing as how he would never have to use that specific benefit. And now that thinking has been extended to include contraception, because a guy would never have to use The Pill or an IUD so why the (insert curse words of your choice) should he have to pay for it for anyone else?

Have you seen or heard a lot of complaining that insurance includes coverage for other things people have no intention of needing?  Have you heard any significant griping about having to pay for coverage of any other illness or affliction, or is it forever and always going to be the pesky female nether regions that cause this angst and hand-wringing?

In the overall scheme of things, only paying for what you plan on using would be fine if the intent of health insurance was to provide a draconian, ageist, sexist form of punishment, rather than something intended to help manage --and yes, even improve people's health.
  • Only under an 'insurance as punishment' scheme would a person be required to pick and choose which benefits they think they'll need,with no coverage for anything else. Didn't think you'd get cancer? Sorry. Didn't think you'd have a stroke? Sorry. Didn't think you or a family member would ever need mental health services? Too bad, so sad. 
  • Only in an ageist insurance scheme would people my age not have to contribute towards services for kids (well child exams, pediatric cancer services, newborn care, etc.) or for nursing home care or Alzheimer's treatment or other services most typically associated with older adults.
  • Only in a sexist insurance scheme would men not have to pay for the girly services, and women not contribute towards the manly services like, I don't know, prostate cancer treatment and vasectomies (a form of contraception, in case that was unclear), and our prime-time friends erectile dysfunction and low testosterone. 
Most people would recognize this as a draconian way to finance health care, if we all were individually underwritten (that means no family coverage folks - we are all on our own), based on a complete medical history going back a few generations, a comprehensive medical exam including tests for all things known to man, God and nature, and an NSA-style examination of what we eat and drink and how we exercise or don't and how long we sleep or don't and with whom, and so on.  Full invasive medical and lifestyle exams for all -- paid for out of your own pocket, of course, because you can't have insurance that covers medical exams until you prove you're worthy. And done on a regular basis, because we know that lifestyles change, with age and circumstance and environment.

Health insurance is not a draconian, ageist, sexist punishment system. It's also never been intended to be a 1:1 premium-dollar-to-benefit-dollar investment. Nor has any other insurance I can think of.  So. Either people who have long had insurance of other kinds (homeowners or renters or auto insurance or life insurance or flood insurance) are totally clueless on how insurance works, or they're pushing an agenda under the guise of having a conversation about health insurance.

In reality, the hatred and vitriol (spliced with an occasional very detailed description of natural birth control) isn't about health insurance, it's about lifestyle and about women and about the 47%.  Because "if those whores would just keep their legs closed this wouldn't be an issue" and if they were good girls not "those skanks who sleep around and expect someone else to pay for their goddamn birth control" we probably wouldn't be having this discussion at all.

I suspect the men who are spewing this bile might know that the insurance they have has probably long covered birth control, lots of different kinds of birth control, as did the Hobby Lobby policies before the Affordable Care Act.  They might even know that their wife, teen-aged daughter, sister or mother is probably using some kind of FDA-approved birth control right now, paid for with their insurance. They might even have had a vasectomy, covered by their insurance. And certainly there are women commenting in these threads who are using or have used contraception paid for under their health insurance too.

But of course wife, daughter, sister, and mother on insurance-covered-birth control, and men with insurance paid-for vasectomies, and honest-to-God hardworking me, well, those are the antithesis of skank, whore, and 47%er.

And we know that those people are the only ones who are going to use the contraception covered under the ACA health insurance plans, right?

Because those people are the only ones whose sisters and daughters and mothers should have to trust the "$1 condoms" for birth control, right? Or keep their legs closed?

Because those people aren't like us, right?