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August 7, 2008

Viagra v. Birth Control: The Debate

We've posted some opposing views on the issue of insurance companies covering Viagra but not birth control this week. First, I weighed in on Bill O'Reilly's rant against the Planned Parenthood "fanatics" and their claims that birth control should be covered. Then, Adam gave us his take on why it might make sense to the insurance companies to cover one but not the other. Then we had a huge debate about the issue. Then we said "hey, let's put this on the blog!", so here it is. Our debate kept coming back to a handful of key points, so we thought it might be helpful to lay them out and try to see what the most important issues are and how they could possibly be resolved.


Viagra treats a medical condition. But isn't pregnancy a medical condition too?

I have some issues with this statement: "Pregnancy, as defined by the medical community and medterms.com, is not a harmful medical condition. While it may be something to avoid for social or economic reasons, becoming pregnant is not something to avoid for health concerns". Pregnancy does have health risks.

True, thus the followup sentence, where I said "for most women".
I'll reply with a quote from yours: "Birth control is used to help prevent pregnancy, which enables women to have more full and satisfying sex lives. "

Women are able to have full and satisfying sex lives without birth control.

And men are able to have full and satisfying lives without sex if they have ED. Doesn't mean they should have to.

No, they aren't. You're equating two very different things.
ED = no sex. No birth control = normal sex.

No birth control doesn't equal normal sex if you rely on birth control to prevent you from getting pregnant, and you don't want to be pregnant.

Yeah, there's a lot of 'want' in there.

Well, isn't this a separate issue from my point about your pregnancy statement?

Then let's go back to the pregnancy thing. Are you telling me that pregnancy is something to be avoided for medical reasons by all women? Would you say pregnancy, as a medical condition, is bad for the woman? And we're not talking "it's a bad time of my life for this" bad.

That depends on the woman, because there are health risks.

For the vast majority of cases, because in the cases where there are health risks, that's a different story.

We have a higher maternal mortality rate than quite a few other countries do. And 'it's a bad time of my life for this' can have mental health consequences for some women.

How is it a different story? Women don't always know ahead of time that they're going to have complications with their pregnancy.

People who bungee jump don't know ahead of time that they're going to have a problem either.

What the fuck does that have to do with anything?

It's a different story because in cases where it is a foreseeable health issue, it should be covered. If you're engaging in a risky activity, it is not the job of the insurance company to prepare you ahead of time for the consequences.

What about the costs? And who benefits?

That's another thing - you also raised the issue of the cost of covering birth control. What about the cost of pregnancy and childbirth?

I'd need figures, but it's pretty easy to say that the cost of covering pregnancy and childbirth, as a percent of the potentially child rearing population, is less than covering the cost pill for everyone who doesn't get pregnant. How many women are pregnant at a given time?

Also, you pay a higher premium for family coverage... so that's included.

Well, it's not 'pretty easy to say' since you just admitted that you don't have any numbers to back you up

Well, it is easy to say cause I just said it :-P

Family coverage? That gets at another issue. If I get pregnant unexpectedly, who is paying for this family coverage? Just like if I'm on birth control to prevent pregnancy, who pays for that?

Well, the way it works at my company is that life changing events (moving, marriage, childbirth) allow you to make changes in your coverage. So if you want them on your insurance...you'd better start covering it.

The woman pays and the man benefits.

Ok, that's just not true or fair.

It's a generalization but it does have plenty of truth to it.

Sex is a consensual act between two adults. If neither one wants a child, they need to either abstain, or both take responsibility. That's like saying it's unfair because I buy the condoms all the time. You know, with all the girls I sleep with. Who's looking out for me? Why shouldn't they pay sometimes?

Well yeah. But not unfair for you. Compare the cost of a pack of condoms to the cost of not-covered-by-insurance birth control pills.

Not the point. You're saying the man benefits. All women could be off of birth control, and it doesn't change my behavior. I don't benefit.

Well, if you've noticed, there is no male pill. All forms of birth control except for condoms fall on the woman.

That's because you carry the child. You 'own the equipment' so to speak. And they're working on a male pill.

Haha, they've been saying that for what, 500 years?

Seriously, it was working in tests a couple years ago.

"we're working on it!"

I think I've made my point pretty clear. Sex takes two. Each are responsible. And pregnancy is natural.

But women are more responsible because they own the equipment so they should just shut up and $$$$$$$

Well, yeah, bitch. And make me some bacon.

But if a man can't get it up, the world ends.

You're lucky for Viagra then, cause the world nearly ended like 50 times just there.

Ha ha ha

Let's put it this way. Say both parties are irresponsible - who bears the 'cost' of not being careful? Obviously, women. So you want everyone to pay for you not to get pregnant? Sounds pretty selfish... communist even :-P

I don't want 'everyone' to pay for anything. I want my insurance company to cover something that I view as an essential part of my sexual health.

Your sexual health isn't their concern.

Right, only the sexual health of men.

No, that's wrong. 'Sexual health' has not been determined as essential coverage in this country yet.

Don't tell them that now, since I'd like them to cover my gyno appointment from last week.

Hey, your gyno appointment ACTUALLY looks at your medical health. You know, like making sure your body is in working order.

It's also preventative care. And I also think that, leaving Viagra aside, the issue with birth control gets at the larger issue of insurance companies rejecting preventative measures in favor of just covering treatment when conditions do arise, when covering the preventatives could often save money for them in the long run by, you know, preventing.

Except in the case of birth control - no other preventative coverage would be so widespread and constant, and the costs would easily outweigh those of covering pregnancy care.

Like I said, you haven't shown me numbers on that. Pregnancy and childbirth are expensive, and remember you also have to factor in pre-natal care including ultrasounds and all that good stuff, and if anything goes wrong at all with the pregnancy, or anything requires additional tests to be done. Then there's well baby visits once the baby's born, and then the insurance company is often covering health care for the child after that.

That gets into child care, and I think that's outside the scope of our argument. How long into the child's life do you count their 'expense' as part of the cost of not covering BC? Their whole life?

I don't know, good question. My general point is just that birth control is more of a 'predictable' expense, where with pregnancy and childbirth there can be a lot of additional things that cost money that may or may not be needed.

True. But there's also the question of how you differentiate planned from unplanned pregancy costs. That's a cost factor we never really got into...the fact that it's only unplanned pregnancies that are prevented, so the ratio is even harder to get to in terms of what's cost effective.

Yes, and I'm not suggesting that we even attempt to get there. Just saying - unplanned pregnancies mean unplanned expenses for the insurance company too and I think that should be a consideration if we're talking about what makes sense for the company in terms of costs.

True, but I think it's too broad and expensive a stroke to use. They'd rather treat the unplanned pregnancies. Also, consider the number of women who wouldn't go on the pill, even if it's available from the insurance company, and still have unplanned pregnancies.

And also considering all of the unplanned pregnancies that will be caused by all of the men getting free Viagra from their insurance companies and going out and having lots of sex.

Hahaha...I'd love to see that statistic.

They should cover the BC just to counteract all that Viagra power!

Birth control is a lifestyle choice, Viagra is a treatment for a medical condition

Okay, here's an issue. O'Reilly said it, and I've heard it before.
This argument that birth control is a choice but Viagra is a treatment for a medical condition. That's kinda sorta true, but I think there are problems with it.

I agree there are problems. Unfortunately, the problems have to do with allowing you to live a 'free sexual life', which has nothing to do with you being healthy.

Well, think of it like this: 'unfortunately, the problems that Viagra treats have to do with allowing you to live a free sexual life, which has nothing to do with you being healthy'. You'd take issue with that statement, right?

Yeah, I do take issue, because Viagra does have something to do with you being healthy.

And that's fair enough.

Related to that, here's where I think the comparison between the two kinda works. I think it's just as unfair to say 'you don't need Viagra if you have ED, you can just stop having sex and you'll be fine' as to say 'women don't need birth control, they can just keep their legs closed if they don't want to get pregnant'.

I'd agree that it's just as unfair, but I don't think that's a valid argument, because insurance companies aren't telling women to just 'shut up and keep their legs closed'.

Maybe not. But I guess that goes back to the discussion about whether birth control is essential to sexual health the way Viagra can be. And I didn't say the two situations were exactly the same, but I do think it works.

When it comes down to it, is the Viagra/birth control comparison really helpful?

Let me tell you the analogy I was going to say earlier. Imagine a women who has chronic dryness - she can't get aroused, at least to the point of having safe intercourse. The condition, and its treatment, would be covered by insurance. Her body is not working as it's supposed to.

Right, and I see where you're going but it's not really necessary, since I'm not saying that Viagra shouldn't be covered.

Right, but do you see my point as to why BC and Viagra are not a direct analogy?

Yeah, of course they're not, but I think they're worth comparing.

I don't think so, because there are a lot better arguments for supporting cheap, affordable birth control. By going up against Viagra, you set yourself up because it really isn't a just comparison.

Because the penis is sacred.

Well, not everyone's. Just mine.


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1 comment:

Lilith said...

I think Viagra is as much as a choice as birth control. Men don't really need erections. I get that it's a medical condition to be unable to get/maintain an erection... but it's not really a medical need.

Actually, the definition of ED is "the repeated inability to get or keep an erection firm enough for sexual intercourse." The sole purpose of treating ED is so men can have sex.

Also, men can have "sex" without an erection. It's just not going to include penile penetration (which is possibly the kind of "sex" women might opt to have if they don't want to risk pregnancy and can't afford contraception).

So viagra really only serves to make men's sex lives better, just as birth control does for women who do not want to get pregnant. It doesn't treat a harmful medical condition, so much as a medical condition that makes men's sex lives less fulfilling. With that definition, I would say that pregnancy sort of falls under a similar category after all.