A Featured Response
By Michael A. Kelly
Ray,
I want to respond to your post via personal letter since I am finding it hard to have a conversation about this issue where people actually listen. I’m frankly frustrated by the idea that someone yells, “Women’s health issue!” and most evidence-based conversation is expected to cease.
To start, I’d like to say that Rush Limbaugh is an ass. He’s sloppy, stupid, and is getting what he deserves. For those of us who are not left-of-center, he’s an embarrassment and an impediment to reasoned debate about important topics. What he said about Ms. Fluke was unacceptable. While the government should have no role in his demise, people are completely free to hang him in the court of public opinion and not do business with him or his sponsors.
Second, I believe that Ms. Fluke’s testimony to Congress was, at best, misleading because she’s an “advocate”. If you read her testimony, I think that you’ll see my point. Rush’s inability to actually critically analyze and respond to her testimony has imbued her with a saintly persona drawing attention away from her actual testimony.
Her testimony is here:
http://www.buzzfeed.com/boxofficebuz/transcript-of-testimony-by-sandra-fluke-48z2
There are so many misleading statements, like where she actually admits that Georgetown covers birth control for non-contraceptive use after she’s painted a horror story whose basis was the lack of coverage, but let’s just focus on affordability and access:
Without insurance coverage, contraception, as you know, can cost a woman over $3,000 during law school. For a lot of students who, like me, are on public interest scholarships, that’s practically an entire summer’s salary. 40% of the female students at Georgetown Law reported to us that they struggle financially as a result of this policy.
One told us about how embarrassed and just powerless she felt when she was standing at the pharmacy counter and learned for the first time that contraception was not covered on her insurance and she had to turn and walk away because she couldn’t afford that prescription. Women like her have no choice but to go without contraception.
Just last week, a married female student told me that she had to stop using contraception because she and her husband just couldn’t fit it into their budget anymore. Women employed in low-wage jobs without contraceptive coverage face the same choice.
And some might respond that contraception is accessible in lots of other ways. Unfortunately, that’s just not true.
Women’s health clinic provide a vital medical service, but as the Guttmacher Institute has definitely documented, these clinics are unable to meet the crushing demand for these services. Clinics are closing, and women are being forced to go without the medical care they need.
Law school is three years, so her estimate is that birth control “can” cost $1000/year. She insinuates that cheap and affordable birth control is unavailable without insurance. Her statements, as I’ll show below, don’t even come close to reality. First, a little primer on birth control in the United States.
In 2002, 61.9% of all women used some method of contraception (over 99% had used contraception at least once in their lives). Of women who use birth control, female sterilization is the choice of 27% of those using contraception (primarily in the 25-34 and 35-44 age range). Male sterilization is 10.4%, once again mostly in the higher age ranges. The pill is used by 31.0% of women (with 53.5% of those aged 15-19 and 52.5% of those aged 20-24). Condoms are used by 23.8% of women’s partners (with 44.6% of those aged 15-19 and 36.0% of those aged 20-24). (All of this data comes from “Vital Statistics of the United States 2010: Births, Life Expectancy, Deaths, and Selected Health Data” edited by Mary Meghan Ryan and published by Bernan Press. It uses mostly CDC and National Center for Health Statistics data. The private publisher took over when the US stopped publishing the data.)
So condoms and the pill are the primary birth control of “young” women. Since condoms are over-the-counter and not covered by health insurance, Ms. Fluke confined her comments to oral contraception.
But the pill is not just cheap. It’s REALLY cheap. Nearly all of the commonly used formulations of the pill are generic drugs since these drugs were invented decades ago.
Wal-Mart offers generic versions of Ortho Cyclen and Ortho Tri-Cyclen, which, in 2007, comprised 20% of all oral contraception prescription in the US (according to a Sep 28, 2007 NY Times article). Wal-Mart charges $4/month or $10/quarter, i.e., $40/year if purchased quarterly. Target offers Tri-Sprintec (which is generic Ortho Tri-Cyclen) for the same price. Walgreens is more expensive. They’ll charge you $48/year ($4/month) for the Ortho products and $12/month for Mononessa and Trinessa, an alternative form of birth control. Rite Aid charges $20 per month but goes off the chart with availability. They offer 25 different contraception prescriptions. One is offered at $60 per quarter. The others are offered at $20 per month. See http://www.riteaid.com/www.riteaid.com/w-content/images/pharmacy/RxSavings_Directory.pdf.
Let’s compare these prices, which are available at tens of thousands of locations in the US, to Ms. Fluke’s statement. “Without insurance coverage, contraception, as you know, can cost a woman over $3,000 during law school.” We all know that? Really? Over a thousand dollar per year? Of course, she used the classic lawyer weasel word “can” in her statement. That means that she “can” say that anything is true.
A car “can” cost a quarter of a million dollars, but cars, in general, cost about a tenth that amount. If you can take the generic Ortho pills, you’ll pay $48/year, 95% less than what Ms. Fluke says the pill “can” cost. If you can’t and use Mononessa or Trinessa, they are $144/year at Walgreens, or 85% less. Rite Aid gives you a list of 25 drugs that cost $240/year, i.e., 75% less than what she quotes.
Yet, birth control “can” cost $1000/year. 40% of Georgetown female law students “struggle financially as a result of this policy”. Wow. 40% of Georgetown female law students are either really poor or they can’t find the local Wal-mart. My bet is on a misleading survey and a survey group that wants to “send a message”.
My point is simple. Rush is poison to the reasoned discussion that we need as country; however, Ms. Fluke isn’t any help either. My opinion is that nearly everything she said was misleading, including the stories. Most oral birth control was formulated decades ago and is now off-patent, solving the issue of cost and availability for nearly all women who take the pill. The issue of “reproductive freedom” has, for the most part, been solved by normal market forces. In terms of healthcare, we have other real and pressing issues to discuss honestly.
A pox on both their houses. We need better than this crap.
Michael A. Kelly
Yes, Insurance should cover everything a Doctor prescribes for a patient. As a woman, I know there are various methods and forms of birth control / hormone pills / products on the market. If you can’t afford one, try another that is in your price range. I have had to switch several times due to price increases or availability issues with the RX. Women don’t have to purchase the top shelf $150.00 products when the $25.00 – $45.00 pill does the same job, has the same warnings, same side effects, etc. In fact, any birth control ring or IUD that needs inserted “can” become dislodged and rendered useless and “can” become embedded in the head of the baby or unwanted pregnancy. Also, the lower the dose of estrogen in the pill, the lower the risk of adverse side effects or stroke, heart attack, etc. There are many variables to consider here, it’s not just one size fits all, so to say. It’s just blatant discrimination against women to deny BC pills yet cover Viagra, Cialis, etc for men so they can “get it on anytime of day or night when the mood is right”. haha Yep that’s what the world needs, more unwanted pregnancies and men popping Viagra all day. If I thought I would get pregnant every time I had sex, I would NEVER have sex again! Children aren’t hamsters that when you’re tired of them you can give them away, it’s a life sentence and not to be taken lightly!
“Unpainted”: I agree with you that birth control is part of healthcare. That has more implications than you think. Standard healthcare practice (standard, not all plans follow this) in this country is to have co-pays for drugs. The generic co-pay is typically much lower than the branded co-pay. Some branded drugs may not even be in the formulary (essentially they are not covered). The natural life-cycle of cost is to have drug companies incentivized to create new drugs and get a monopoly price during the exclusivity period, for other companies to be incentivized to introduce generics after patent expiration, and eventually have some drugs moved to being over-the-counter, typically making them cheaper still. (As an aside, during my research I saw many arguments that many oral contraceptives should be made over-the-counter. I agree with the reasoning. There’s no reason to hold a woman’s pill access hostage to a pelvic examination, no matter how noble the motivation. Women can make up their own minds about scheduling their doctor’s appointments.) This economic cycle of branded to generic to over-the-counter is critical for making sure that we continue to have new drugs without skyrocketing costs.
The Obama administration’s policy on birth control would completely undercut this cost cycle. The Obama administration has mandated that ALL forms (forms, not individual drugs) of birth control have zero co-pay. That’s not like ED pills. That’s not like anything.
Here’s the quote:
“Health insurance plans must cover birth control as preventive care for women, with no co-pays, the Obama administration said Monday in a decision with far-reaching implications for health care as well as social mores….
The administration did allow insurers some leeway in determining what they will cover. For example, health plans will be able to charge co-pays for branded drugs in cases where a generic version is just as effective and safe for the patient. The requirement applies to all forms of birth control approved by the Food and Drug Administration. That includes the pill, intrauterine devices, the so-called morning-after pill, and newer forms of long-acting implantable hormonal contraceptives that are becoming widely used in the rest of the industrialized world.”
http://news.yahoo.com/insurers-must-cover-birth-control-no-copays-140750830.html
Do you really think that the “just as effective and safe” clause will be enforceable? Will that have to be determined on a patient-by-patient basis without guidelines? Will women be getting their congressperson involved? Do you think that politics won’t be injected into every one of those decisions? Do you think drug companies won’t be trying to get their drugs to be considered “better” than generics so they can charge 10-20 times more for the same effect? (They’ll certainly advertise as such.) Do you think that the pill will ever be made over-the-counter when you can get it for “free” with a prescription? The other commenter mentioned Nuvaring, which goes off-patent in 2018. Until then, there is no other form of birth control quite like it in generic form (as far as I know). Will Nuvaring, which is quite expensive, have a zero co-pay?
This isn’t treating birth control like standard healthcare. Birth control is being elevated above cardiac care, cancer, diabetes, and everything else. Do you think the lobby groups for these other health issues are going to sit idly back? After lots of political donations, letter writing campaigns and politicking, every “favored” health treatment will be treated similarly. The result will be considerably higher costs for us all. That’s what you get when the government runs healthcare.
Those are my views. Perhaps birth control is some special form of healthcare that should have a zero co-pay. Perhaps we should be debating how drug patents work in this country. Perhaps there’s another point of view that has more validity. That’s the debate we need to have. Both Mr. Limbaugh and Ms. Fluke kept us for having that debate. Mr Limbaugh did so by being his normal porcine self. Ms. Fluke did so by ringing what I call the “woman’s health crisis alarm bell”.
I don’t see a woman’s healthcare crisis here. Half of women between 15-24 who use contraception use the pill. The other half primarily use condoms. All other forms of birth control (including Nuvaring) combined make up a single digit percent of usage (somewhere arounf 7 percent). For the women who use the pill, there a $4/month version available, which is $11 cheaper than the generic co-pay in my plan. There are 25 formulations available for $20/month. That’s cheap and accessible. There is no birth control accessibility crisis in this country.
Does that mean that every woman can get the exact birth control that they want “for free”. No. But no one can get the exact healthcare that they want “for free”. That’s because someone has to pay for that healthcare. That’s why we have co-pays.
By the way, The issue that you bring up about pre-natal care, if true, is unconscionable (and I’ll look into it). No one should ever be denied medical information. That goes for any health issue. I thought we got rid of that “doctors are like god” thing a long time ago. By the way, that’s what you also get when the government runs healthcare. Politicians love to tell people how to live their lives. (We just complain about the ones we don’t like.) However, the existence of such politicians and laws does not make Ms. Fluke’s comments concerning access to birth control any less misleading.
JV, I want to discuss your comment briefly. To show that Ms. Fluke was misleading, I didn’t have to show that all forms of birth control are inexpensive. Ms. Fluke’s statements like 40% of Georgetown female law students “struggle financially as a result of this policy”, that women are doing without birth control, and that women are running away from drugstore counters crying after being made to feel powerless don’t hold much water when there are 25 different formulations of the pill available without insurance for $20/month and two formulations available for $4/month. Please read her testimony. It’s classic, misleading, “advocacy” tripe. I wonder if she was under oath.
If Ms. Fluke said that a meal “can” cost $100 (so there’s a “food” crisis) when there are some meals that cost $5 and many others that cost $20, I think that most people would say that she was being misleading. That was my argument. More importantly, her testimony has led us away from discussing the major flaws in the administration’s policy and will actually help make healthcare less affordable in this country.
I repeat:
“A pox on both their houses. We need better than this crap.”
I almost hesitate to write here as I fear I am not as able to spit out facts and statistics nor am nearly as eloquent. But I do know this; my daughter used to use the pill only intermittently (very bad idea) because some months she just didn’t have the 25 bucks. And you know what- some people really are that poor. And yes- it cost her 25 bucks, not $4 or $12, but $25. And that is subway fare for over a week.
But I don’t want to get into a pissing match over costs. Because it is nothing but diversion.
The rebuttal is a diversion. The actual cost of contraception is a diversion. The name calling is a diversion. And maybe even Flukes presentation was a diversion, (I say maybe because I am not sure I agree with your analysis. I would have to do some fact checking- Forget Georgetown- I really want to hear about anybody on that all male religious panel getting behind the use of contraceptives for health issues other than birth control. Not. very. likely.) But let’s just say for the fun of it that Fluke constructed her testimony to garner sympathy and intentionally obfuscate the truth.
Why would she do that? Because if she came right out and said the simple unadulterated truth she wouldn’t have been heard either.This is not about and never has been about freedom of religion.
Obama exempted religious institutions from having to cover their employees cost of contraception on February 10th. Done. http://www.politico.com/news/stories/0212/72719.html
But no. Not done.
Not good enough. What is enough? Where does it end? Transvaginal ultra sounds… nope it doesn’t end there… laws in Arizona and Kansas that allow a doctor to lie about the results of prenatal testing if said doctor fears the parents may choose to terminate .. does it end there? National discourse debating (really? debating?) on just how bad were Mr Limbaugh’s comments after all? Come on it was just a joke, laughing at the absurd. Really? replace racial epithets for “slut” and “prostitute” and see how far you get on that logic. Will it end here with this humiliating public debate?
No- it will never end. And anybody with even a modicum of knowledge of history can figure that out The denial of even “small” equalities, like getting contraception paid for is an erosion of equality. Is it a “right”? Well, if men’s sexual heath concerns are covered by insurance (Viagra etc) then I would say, yes because to deny insurance coverage for sexual heath care for one gender but then provide it for another is blatantly discriminatory and that is illegal. Unless of course you create laws to make discrimination legal which is exactly what is happening.
Enough diversion.
We are talking about singling out and denying a form of health care, (yes, sexual health care- get over it), because of a person’s gender. Period. End of story.
Mr. Kelly. Your points are well made and thoughtful. I would however suggest that you check out the price of the Nuvaring per month. With very good insurance, I know it cost $40-60 a month. Without insurance, I believe it costs in the range of $130-150 per month. Only providing part of an argument weakens your own. To ignore a very popular female contraceptive option because it supports a position you oppose weakens your argument as much as leaving out low cost options weakened Ms. Flukes’.
Is it possible that once again the truth is somewhere in the middle?