“Well, that’s the real question, isn’t it: Why? The ‘How’ and the ‘Who’ is just scenery for the public . . . Keeps ‘em guessing like some kind of parlor game. Prevents ‘em from asking the most important question, ‘Why’?”
—Donald Sutherland as “X” in JFK
I really thought we’d be past this by now, but I see there remains some confusion about the contraception mandate. The Left has flogged this issue as being about women’s right to "preventative healthcare," and if you oppose that—however legitimate your religious or Constitutional objection may be—you’re a woman-hater. There’s just one problem:
The contraception mandate has nothing to do with healthcare.
It doesn’t. And that’s so no matter how many times the Leftist media, or Kathleen Sebelius, or Debbie Wasserman-Schultz shriek that it does.
Of course it does, Rusty. Don’t you know that The Pill is used for lots of other medical applications besides preventing pregnancy?
True enough, so far as it goes. The Pill has indeed been shown to have some benefits in reducing the incidence of certain forms of cancer. It is also prescribed for PMS, uterine cysts, and severe cases of acne (among other things). Never discussed is the fact that The Pill is also associated with negative side effects such as severe clinical depression and increased incidence of certain potentially fatal embolisms, but I’ll leave those things aside and accept for purposes of this discussion the notion that The Pill has legitimate medical uses other than the prevention of pregnancy.
That misses the point almost entirely.
First, according to a Time e-magazine piece (referencing a study by the Guttmacher Institute, whose testimony is frequently cited by HHS in support of the mandate), only 14% of women use The Pill exclusively for non-contraceptive purposes (the percentage given for teens is higher—33%—but still a distinct minority). What this tells us is that, despite the presence of these other healthcare applications, the vast majority of women who use The Pill are not doing so to realize those ancillary health benefits, but to avoid getting pregnant. So for all the hysteria on the Left about objections to the contraceptive mandate being part of a “war on women,” you can’t hang it on the idea that women need The Pill as part of a health regimen apart from avoiding pregnancy, because it appears that by and large that simply isn’t how they’re using it.
Second, and maybe more to the point, this isn’t really the argument being advanced by Obamacare advocates to justify the contraception insurance mandate. To the contrary, the focus is, and always has been, that the avoidance of pregnancy in and of itself is “preventative health care” (as though pregnancy, and the resulting children, are a disease to be prevented, just like malaria). Secretary Sebelius—the one who actually issued the contraceptive mandate—testified last week before Congress that “the reduction in a number of pregnancies compensates for the cost of contraception.” In other words, the plan pays for itself not by reducing the cost of treating these other conditions impacted by The Pill, but by reducing the number of pregnancies. And the regs themselves echo this idea:
“In addition, there are significant cost savings to employers from the coverage of contraceptives. A 2000 study estimated that it would cost employers 15 to 17 percent more not to provide contraceptive coverage in employee health plans than to provide such coverage, after accounting for both the direct medical costs of pregnancy and the indirect costs such as employee absence and productivity . . . Contraceptive coverage, by reducing the number of unintended and potentially unhealthy pregnancies, furthers the goal of eliminating [the economic disparity between men and women resulting from the fact that women get pregnant and men don’t] by allowing women to achieve equal status as healthy and productive members of the job force.
Final rules at 10-11 (emphasis added).
I’ve posted on this before: if this is about women’s healthcare in the form of preventing pregnancy, as HHS suggests, you shouldn’t be pushing an insurance mandate covering contraception. What you should be pushing is abstinence, which is infinitely cheaper, safer, and more effective than anything a doctor can prescribe or an insurance company can pay for. Yet there’s not a peep about it.
Even if this were about women’s legitimate health issues beyond pregnancy, that would only extend the argument to condoms (which are far cheaper than other methods of contraception) and The Pill (which, as I’ve noted, by and large isn’t in fact used for these non-contraceptive purposes). The argument would not extend to IUDs, diaphragms, sponges, spermicidal foams, and the early abortion drugs “Ella” and “Plan B,” none of which have any legitimate claim to ancillary medical benefits outside the prevention of pregnancy (and some aren’t even very good at that), yet all of which are included among the methods insurers will be required to cover.
Why, if this is about the healthcare benefits of preventing pregnancy, would we not be focused on the safest, most effective, and least costly methods available? Why, if this is about women’s preventative health care apart from the prevention of pregnancy, does the Obamacare mandate extend to contraceptive mechanisms that have no—no—medical utility whatsoever beyond their capacity to prevent pregnancy?
The answer is simple: because this debate is not, and it never has been, about “women’s preventative healthcare.” That phrase is a deliberately charged label the Left has devised to posture the debate as one of the Right vs. women—after all, only a misogynist could be against women’s preventative healthcare—and they’re manipulating you with it. They want you to equate (read: "confuse") the phrase "my combined oral contraceptive pill is a drug" with the phrase "all contraception is a matter of women's health," which simply isn't true. It’s an iteration of the “Big Lie”; they repeat it over and over, and like Orwell’s sheep, many have picked up the cadence, unaware of what they’re saying or why they’re saying it. Once we recognize that the mandate extends to every FDA-approved contraceptive mechanism regardless of its relative effectiveness or expense, and regardless of whether the mechanism has any conceivable health benefit outside of the prevention of pregnancy, it becomes clear that this is in fact not about women’s healthcare. It is about providing access to whatever contraceptive mechanism people want, and making someone else pay for it. Otherwise, there is no explanation for the mandate covering, for example, spermicidal sponges, which are about 15 times more expensive than a condom, have an effective rate according to the FDA as poor as 68%, and carry none of The Pill’s ancillary medical benefits.
That’s not healthcare, that’s a matter of sexual convenience.
Once again, no one—not me, not Rush, not the Republican Party, not the Catholic Church, nobody—is stopping you from getting a prescription for The Pill, or buying a condom, or using a diaphragm, or otherwise using whatever contraceptive you choose, for whatever reason, whether it’s preventing pregnancy, reducing your acne, or whatever. Moreover, as HHS itself notes in its final rules, 89% of insured plans already cover contraceptives, so the chances are very high that you’re already covered. And I defy anyone to find an actual example of a live human being who wanted contraception but literally could not get it.
So why insist on not only pushing forward with the contraception mandate, but also with hiding behind this charade that this a debate about women’s health when it’s demonstrably not? Could it have something to do with deflecting attention from the real question of where the constitutional authority is for the federal government to force people who don’t want it to obtain from their employers insurance coverage covering something the employers don’t want to cover, paid for by insurance companies who (absent a premium adjustment) don’t want to pay for it? As Representative Kathy Hochul (D-NY) responded to that very question in a town hall meeting February 24, “Well, basically, we’re not looking to the Constitution on that aspect . . . basically, the decision has been made by this Congress that American citizens are entitled to healthcare[.]”
We're not looking to the Constitution, because the decision has been made by Congress.