Good news for those of us more concerned with reducing the number of abortions than in playing footsie with what a bunch of celibate old white dudes in robes think about our health care system.
(CNN) -- The U.S. Department of Health and Human Services announced new guidelines in Washington Monday requiring health insurance plans beginning on or after August 1, 2012 to cover several women's preventive services, including birth control and voluntary sterilization.The guidelines do provide an exemption for religious institutions that offer health insurance to their employees. But considering that 98% of sexually active Catholic women have used birth control, I suspect the dudes in the robes should spend more time worrying about the efficacy of their own teaching.
According to HHS Secretary Kathleen Sebelius the decision is a part of the Affordable Care Act's move to stop problems before they start.
"These historic guidelines are based on science and existing literature and will help ensure women get the preventive health benefits they need," she said in a news release.
In July, the Institute of Medicine issued the results of a scientific review of
women's health needs and provided recommendations on specific preventive measures to help them. Today HHS approved those recommendations.
11 comments:
According to HHS Secretary Kathleen Sebelius the decision is a part of the Affordable Care Act's move to stop problems before they start.
I agree completely that this and other proven preventative measures should be covered. I wonder how widespread this actually is. Our insurance has covered it for the 15 years we've had it. I'd think any insurer who listens to their actuaries would know that it's the prudent, financial responsible decision. But then, at least from this article, it's not necessarily clear what "free" really means. Will this force coverage of premium drugs when generic equivalents are available? That in itself is an absolute hornet's nest that regulations from Washington simply can't handle. Sometimes generics are 100% identical. Sometimes they're similar and work just fine for 95%, but poorly for the rest. The decision of what drug needs to be between the woman and her doctor. But by the same means, when neither have any financial skin in the game, that's a problem too and is one (of many) reasons for inflation. Does free mean they're not allowed to charge co-pays? To think government can successfully manage our health care system is both funny and hopelessly misguided.
Also...I don't for a second believe that stopping problems before they start is a goal or priority of the ACA as a whole.
I think there are something like 28 states that require contraceptive coverage already, although this decision would seem to indicate that, as part of preventative coverage, insurers can't charge co-pays for contraceptive devices. I presume what method is chosen will be between a woman and her doctor. And since conservatives tell me loudly all the time that government needs to butt out of the decision-making process in health care, I would presume that philosophical consistency would dictate the same position here.
"To think government can successfully manage our health care system is both funny and hopelessly misguided."
Government? Or *our* government? Because most health care experts can point to a large number of government-managed systems around the world that, on the whole, provide far better health outcomes for a far smaller percentage of GDP than what we're getting in America.
We seem to be the only ones trying to do it differently, even in the face of a vast body of data that would suggest our way may not be financially wise. I guess as a true fiscal conservative, I'd rather our decisions by guided by data and not blind, unsubstantiated ideology.
I presume what method is chosen will be between a woman and her doctor.
But, if it is the case that neither of them have any financial responsibility, that's a problem too. Hopefully we can all agree that what a drug or procedure costs should not be the only factor in healthcare decisions - but by the same means, it should be A factor.
Government? Or *our* government?
Caught me there - there's certainly a difference. Which is a good point in general. The U.S. is not Europe, good bad or otherwise. We should be very careful at making too large of conclusions about the outcomes as well. As a nation, we eat crappy and drive instead of walk or bike, work and play hard. Those things contribute significantly to health outcomes.
We seem to be the only ones trying to do it differently, even in the face of a vast body of data that would suggest our way may not be financially wise. I guess as a true fiscal conservative, I'd rather our decisions by guided by data and not blind, unsubstantiated ideology.
Doing it differently is neither here nor there - different really has no bearing on whether it will work or not. What are you considering "our way."
There are two (relatively ) easy things we could do that would be universally supported and make a real improvement. We need to separate health coverage from employment. And more importantly, we need to separate health care from health insurance. They aren't the same thing. Insurance works very well as a means of protection from relatively unlikely major financial hardships. It doesn't work very well when maintenance and minor, certain-to-happen things are included. We don't expect auto insurance to pay for new tires, oil changes or to put gas in our tanks. But that's exactly what health insurance does. Take every checkup, stitches, anti-biotic, etc that you'll ever have - in today's dollars, only double the rate of inflation. Now divide it out and see what the payments are.
These are all excellent points. I think any reasonable person would quickly acknowledge that one of the biggest problems with our nation's health is the overall quality of the inputs, so to say.
Unfortunately, many conservatives are often quick to make a stink over the rights of people to make bad decisions, without recognizing that we are in a system (and likely always will be in a system) where the costs of those bad choices do not fall on just the chooser. I have no problems with companies offering financial incentives to participate in wellness or disease management plans (or conversely, imposing financial penalties on those who need such plans and do not participate). I also have no problems with levying taxes on unhealthy foods and using that money to subsidize the cost of healthier options.
I agree that insurance should be decoupled from employment. Of course then, the question becomes how do consumers, who cannot reasonably be expected to become sophisticated consumers of elaborate procedures and pharmaceuticals, negotiate fair prices with providers. I suspect there's a reason that in countries where insurance isn't connected to a job, government tends to become the negotiator of first choice. Even setting aside its lawmaking and regulatory capacity, by representing the entire group, it has maximum leverage.
Of course, it also must make reasonable decisions about how it wants to prioritize care in order to stay within a defined budget, but you yourself recognized the essential reality of that point in address the cost of brand-name vs. generic forms of birth control.
Finally, I appreciate your analogy regarding automobiles, but people can also choose to live without a car. And in terms of health care, when people skip their oil changes, we all end up with much larger problems, since either the government pays for the tow truck and the engine repairs, or the garage raises rates on paying customers to make up for those on whom they're taking a loss.
I thoroughly enjoy the right wing position on this. "Unelected beaurocrats" blah blah blah.
Wait til Scott Walker does it... (HE DID!) yet the outrage seems to not exist.
I agree that insurance should be decoupled from employment. Of course then, the question becomes how do consumers, who cannot reasonably be expected to become sophisticated consumers of elaborate procedures and pharmaceuticals, negotiate fair prices with providers.
Which brings us back to the other point, of separating the risk/insurance aspect of it from the maintenance, etc. We're expected to purchase our own auto insurance, life, and home insurance. Those products are not substantially more complex than health insurance should be.
As a general rule, I'm one of the "the government should stay out of the way" type. But I do believe they have a role in creating infrastructure. The federal government should create a framework with guidelines for tiers of health insurance products. Private insurers then create & market the products and consumers can compare apples to apples. The "health exchange" in theory is on the right track.
Oh and the other thing of course - and I'll admit, it sounds hypocritical coming from some one who really believes in states rights & laments the death of the 10th Amendment...there is simply no good reason why investments like mutual funds are national and overseen by federal authorities (FINRA and SEC) while insurance products are done on a state by state basis. Fix that & allow all insurance to be centrally regulated & sold over state lines.
At some point, I'd be willing to concede that government-run health care is the only, best option. But we really don't have anything close to a market-based approach now. If we actually try to do a number of things to take advantage of the free market and it doesn't dramatically improve things, then fine.
I've said it before and I'll say it again.
How is it that we offer health "insurance" rather than just healthcare. Ever wonder if that's what all the other governments have correct and we do not?
Conceptually, insurance is a product to allow one to hedge against a risk. Actuaries run the numbers and set rates to appropriately cover that risk. Want car insurance, well what car do you drive and where do you live and where do you park it? All these things factor into whether or not you may one day make a claim, how often, and how big. Want homeowners insurance? Where do you live, what is your house made of, how old is it, how big is it? All these things factor into whether or not you may one day make a claim, how often, and how big. Maybe you never make a claim on your car insurance. You're a good driver and perhaps lucky at times. Still, you've been paying for it all your life. Money down the drain? No, you were hedging against the risk of a serious accident.
But health insurance? How the hell do you put an actuary on that? Every single one of us is guaranteed to need healthcare. Odds are you utilized healthcare coming into this world and odds are you will utilize healthcare when leaving this world. Then there's everything in between. You may be able to go through life without a car accident or house fire, but you cannot go through life without healthcare.
Can you imagine walking into your local State Farm office and saying: I would like homeowners insurance but I must warn you that there is a 100% chance that I will burn my house down one day, and I will likely cause it severe damage on many many occasions over the years. What insurer would actually cover you? And preventative care? That's like submitting an insurance claim for when you replace lightbulbs or paint or need a new furnace. Your homeowners insurance doesn't cover it. For cars, you change your oil as preventative care, but your car insurance doesn't pay for the oil change.
The bottom line is that as long as the dialogue discusses health *insurance* we will never fix the system.
The bottom line is that as long as the dialogue discusses health *insurance* we will never fix the system.
Close. The problem isn't discussing insurance - there is definitely an insurance component to health care, and absolutely nothing wrong with discussing it. The problem is conflating health care and health care insurance.
Instead I'd agree that as long as we refuse to separate the two things, we won't be able to fix the things that are broken in the system.
Locke,
I see your point but I'm not sure it is practical. If you want to differentiate between things like elective cosmetic surgery versus basic preventative care, it is easy. Beyond that, how and where do you draw the line between healthcare and health insurance?
Is healthcare limited to preventative matters? What about arguably preventative items like diabetes or obesity? Are preventative measures covered but then once you get it we transition to insurance coverage for treatment instead of healthcare coverage for preventative care?
Do we introduce some concept of personal responsibility into the equation? Should our tax dollars pay for treatment of things that arguably result from neglect or abuse of one's own health? (after all, aren't our tax dollars paying for the healthcare of something like 1/3 or 1/2 of the country already between Medicare, Medicaid and the VA). What about problems (again such as obesity or diabetes) that can stem from environmental factors when one is a minor? Once an adult, do we draw a distinction over some their parents should have dealt better with or do we expect a 12 year old to have a say in what shows up on the dining room table?
What is it you think is the insurance component to healthcare? Is it getting into a car accident and seriously injured? Is it the odds you get cancer? I can't imagine drawing a line between the two because I would bet that no matter where you draw that line, I could come up with examples that will fall on the wrong side of the line from where people think it should fall.
I just think the distinction sounds good in theory but utterly fails in practice.
Max - it's not impossible. It's called major medical and in some form or another, already exists.
Yes, there are certainly some difficulties in drawing the lines.* And yes, it still leaves us with many very tough to solve problems about how to pay for everything else. But the health care problem we have is not something that 2700 pages of legislation can manage. Divide & conquer. Break it down into more manageable pieces. Especially considering, many of these pieces can be done with near universal support.
* After re-reading what I've typed, let me say that I don't mean to dismiss all of the questions you asked with that sentence, though it seems that way. You certainly raise a number of good points and sticky issues - and if time allows, I'll try to respond to more of them.
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