Straight Talk. Yeah.

From the Wall Street Journal:

A female Los Angeles Times reporter inquired today about comments made earlier this week by McCain campaign adviser Carly Fiorina, the former head of Hewlett Packard.

At a breakfast with reporters, Fiorina suggested that individuals–and women in particular–be given more flexibility to determine what their health insurance plans should cover. “There are many health insurance plans that will cover Viagra but won’t cover birth-control medication. Those women would like a choice,” she observed.

When McCain was asked for his position on the issue, he said—with a nervous laugh–“I certainly do not want to discuss that issue.”

The reporter pressed. “But apparently you’ve voted against—“

“I don’t know what I voted,” McCain said.

The reporter explained that McCain voted against a bill in 2003 that would have required health insurance companies to cover prescription birth control. “Is that still your position?” she persisted.

During the awkward exchange, with several lengthy pauses, McCain said he had no immediate knowledge of the vote. “I’ve cast thousands of votes in the Senate,” McCain said, then continued: “I will respond to—it’s a, it’s a…”

“Delicate issue,” the reporter offered, to a relieved laugh from McCain.

“I don’t usually duck an issue, but I’m—I’ll try to get back to you,” he explained.

16 thoughts on “Straight Talk. Yeah.

  1. So it’s good to impregnate and bad to protect against it. Nice to have that perspective as part of one’s health care plan.

  2. Lame of McCain to duck the issue, but in any case… Does it actually make any sense to pay your insurance company to pay for common, regular expenses like birth control? Isn’t that like getting insurance for a haircut?

    (I assume that mandatory cover for birth control pills would lead to higher premiums for women, so the proposal wouldn’t actually have the intended redistributive effect. I suppose it might redistribute some money from women who don’t use birth control to those who do, but the benefit to the latter would probably be outweighed by the inefficiency / transaction costs. So I’m guessing the system would actually make all women worse off. Or am I missing something?)

  3. The ability of women to have birth control when they need it regardless of its “cost” (as arbitrarily determined by pharmaceuticals companies) makes no one worse off.

    Contraception, unlike haircuts, is not optional. Moreover, women bear most of the cost of contraception, and this contributes to the disparity between men and women in out-of-pocket health care expenses.

    EPICC was a good bill when it was introduced in 1997, and it’s still a good bill. I’m sure that insurance companies will find a way to punish us no matter what we demand they cover. But that’s not a good reason to oppose this legislation, even for Cranky McCain.

  4. Good post, and it makes absolute perfect sense why insurance companies don’t cover birth control, think about our “traiditional” views of people in power…btw, implications of the phrase “straight-talk”?

  5. sk – “Contraception, unlike haircuts, is not optional.

    You seem to have missed my point. Substitute ‘food’ if you don’t like ‘haircuts’ as an example.

  6. sk: That’s kind of Richard’s point, I think. In principle, insurance consists of spreading out risk over lots of people. If every sexually active person needs contraception, then it’s not really a matter of risk.

    Of course, in practice health insurance is far from being a perfectly idealized form of insurance, and there’s a lot of overlapping between the insurance of health care and the providing of health care, and as such requiring that insurance companies cover contraceptives may be necessary to assure that people have access to it in the first place. But financially I don’t see how it makes that much of a difference.

  7. UserGoogol & Richard: Cool.

    I see how insurance is supposed to manage risk, and it obviously can’t quite do that when the costs are guaranteed. This is yet another good reason why health care should not be managed primarily by for-profit insurance companies.

    Insurance is supposed to act all kinds of ways in principle, perhaps, that it doesn’t act in practice. Which is why, I suppose, health care is called a market failure. The lack of coverage of contraception is one big reason why many women seek not only contraception, but basic reproductive health, in clinics such as Planned Parenthood, who can use Title X funds to provide discounted services and medicines. That’s assuming you can get to one, and get past the protesters outside, etc.

    Until such time as for-profit health insurance companies no longer dictate health care priorities in the states, however, I don’t think requiring them to cover contraception is a problem. Especially since I would warrant 90% of women use contraception at some point in their lives. But I’m one of these folks who think elective surgery should have waits, so long as 47 million people have no insurance at all. That one’s my problem!

    At bottom, however, this is something that John McCain should at least know about, and not act all embarrassed to be asked about, since so many of his constituents had to figure all of this out for themselves the hard way.

  8. Richard —

    It’s not clear to me why birth control’s common, regular use is a reason that it ought not be covered by health insurance. Basic childhood vaccination/immunization is a very common, regular expense that insurance companies typically cover, and it strikes me as an expense that insurance companies ought to cover. One doesn’t just pay insurance to protect one’s health from exotic or unexpected risks, one pays insurance to provide resources for everyday medical needs as well. Birth control strikes me as an everyday medical need not dissimilar in this sense to vaccination/immunizaton.

  9. Rachel,
    If your vaccination costs lest say $30 dollars a year, your insurance company is probably adding $5 a month to your insurance bill (or $60 a year), similarly for contraceptives, it is just hidden in the overall insurance bill. Generally this sort of thing is like a very bad hire purchase agreement.

    Generally if you trust yourself to have the money (or be able to borrow it) you should try not to be insured for it unless you like being a charity for large insurance companies.

    It is still good of course to be insured for major health issues just in case you draw the short straw, although ironically most health insurance caps the maximum payment, handing back the risk.

  10. Contraception is a free prescription in the UK. Interestingly, it becomes especially clear that this is a financially good idea in a state-run system, which is a part of a larger safety net than that provided in the US. Unintended pregnancies can lead to huge costs for such a system, so it becomes v. clear that it’s a wise investment to help prevent them.

  11. Yes I agree it is best if it is state subsidized, I expect we have general agreement on that point.

  12. just to be clear, contraception (at least in the states) can cost upwards of $40 per month, depending upon one’s prescription. and one can’t always opt for the less expensive option, due to the mysteries of chemistry.

    and rachel: yes, this is what i was thinking (but could not find words for). health insurance, or something like it, is (usually) necessary for all kinds of basic health maintenance practices, such as regular physical checkups, dental exams, etc. i’m not sure why contraception is treated differently. though i suppose it might be just wrong to expect sensible behaviour from health insurance companies.

  13. one pays insurance to provide resources for everyday medical needs as well

    Like GNZ says, the insurance companies are going to charge you more than what they expect to later fork out in return. So how in the world does this help?

  14. Richard —

    I admit that perhaps I am not clear on the cost/benefit analysis side of this discussion. Apologies for my ignorance on this.

    However, you didn’t quite answer my question. Most private health insurance plans already cover a slew of common, routine expenses for healthy individuals: immunization schedules for children, preventative health exams, etc. By virtue of what does it make sense for them to cover these sorts of expenses — and Viagra, for crying out loud — but not birth control? Prima facie, this is a problematic state of affairs, and the 2003 legislature that McCain voted against would appear to have been an attempt to amend it.

  15. As someone who has worn glasses or contacts every day since I was 5, and has had them covered by insurance most of the time, I’m realy not getting the whole “but it’s a regular expense!” argument.

    Yeah, so?

    So are my contacts and glasses. (Which, btw, not cheap either. Or they would cover both in the same year.)

    So are check-ups. (Again, not cheap.)

    So are a lot of things that health insurance/benefits covers.

    And preventing pregnancy is surely at least as much of a medical necessity as Viagra.

    I rather think the problem is other people not getting the whole “preventive medicine” bit. Whether it’s the “preventative” or the “medicine” bit that’s confusing them, I’m not sure. But something obviously is.

  16. Most private health insurance plans already cover a slew of common, routine expenses for healthy individuals: immunization schedules for children, preventative health exams, etc. By virtue of what does it make sense for them to cover these sorts of expenses…

    As far as I can see, it doesn’t make sense for those either. Insurance is for risk-pooling, so insuring against a predictable event (e.g. immunization schedules) seems daft. But I fail to see how legislating to add even more daftness into the system helps anyone.

    [Viagra may make more sense, insofar as erectile dysfunction is a genuinely unpredictable ‘risk’ that won’t affect all men. Though if it’s used as commonly as people say, then it may not make sense either.]

    Mickle – “I rather think the problem is other people not getting the whole “preventive medicine” bit.

    No, we’re all in favour of preventative medicine, and even plain old government subsidies for contraception. The objection is more specific: paying for predictable/foreseeable expenses through insurance makes no economic sense — because you’ll presumably end up paying more through increased premiums than you save at the other end. (Really, where do you all think the insurance money is coming from?)

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