Premiums buy health care, not sex

Friday , March 09, 2012 - 12:45 PM

Linda P. Campbell

More than plenty of opinion has been expressed about the revolting comments made last week by the talk-radio blowhard best described by Jon Stewart of Comedy Central's "The Daily Show" as "Extremely Loud & Incredibly Gross."

Much of it has drowned out reasoned discussion about what services private medical insurance properly should cover.

Despite the misrepresentations out there, the Georgetown law student Rush Limbaugh took after wasn't begging Congress for a federal handout or asking taxpayers to fund wanton fornication. She was talking about having the health insurance she pays for -- just as many individuals, workers and their employers do from their own pockets -- cover the cost of prescription drugs that many American women use in a perfectly legal and responsible way.

The whole reason to buy insurance is to help make medical care affordable. What's the point of paying premiums without getting what you need in return?

Now, we could debate all day the morality of sexual activity by law school students (some of whom are married, by the way), and it would mostly be beside the point regarding more substantial issues surrounding health-care services and health-care costs: Who gets to choose what's available? How should it be funded? What is government's role in it all?

Among other things, the Patient Protection and Affordable Care Act has answered some of those questions by expanding what insurance must cover without charging co-pays, the goal being to focus on preventive care for many conditions.

Private plans generally have been shifting to prevention as employers look for ways to reduce health-care costs: helping workers stop smoking, urging healthier eating, providing assistance to better manage chronic diseases, that sort of thing. But before the health-care law passed in 2010, not all coverage extended to what many people would argue are basic, common-sense services -- or at least not without charges that deterred some people from seeking care.

My personal tale of woe is dated, but it shapes my thinking on this.

In the early 1990s, it seemed responsible and pro-active to get a physical before starting a family. But my plan at the time didn't cover routine well-woman checkups or the rubella shot I needed to avoid contracting a disease that could cause a miscarriage or birth defects.

It seemed absurd -- and still does -- for insurance to exclude sensible precautions, instead gambling that costly treatment wouldn't be needed down the road.

That experience is why I appreciate the argument that government should step in when market forces don't create enough incentives to expand access to affordable preventive care. The new law requires plans to cover a variety of services, including mammograms, colonoscopies, and prenatal and new baby care, without co-pays or deductibles.

Other services specifically for women are supposed to kick in this August, and that started the ruckus over religious institutions including birth control in their plans.

The additions weren't pulled from a political goody bag; they were recommended by the independent, nonprofit Institute of Medicine after careful scientific study (Read the report by the Committee on Preventive Services for Women: bit.ly/yYZB8s)

Besides prescription contraceptives (not including abortifacients), other no-co-pay services include breastfeeding supplies, gestational diabetes screening, cervical cancer testing and well-woman visits. (Fact sheet: 1.usa.gov/owdgEX)

That doesn't make them free -- unless someone else is paying your premiums.

Researchers and policymakers continue to debate how much preventive care can reduce medical costs -- and they should. It's important to determine which types of screening can deter more costly treatment and what kinds of care are worthwhile, even though expensive, because they significantly improve individuals' health.

It's unfortunate that so much of the debate over the health-care law is about right-left politics. And while the Supreme Court's ruling later this year on the law's constitutionality (six hours of arguments are scheduled for March 26-28) will turn on complicated legal questions, opposing factions surely will frame it as a referendum on whether President Barack Obama should be re-elected.

After Limbaugh denigrated Sandra Fluke, Georgetown University President John J. DeGioia issued a thoughtful statement, and this sentence stood out:

"The greatest contribution of the American project is the recognition that together, we can rely on civil discourse to engage the tensions that characterize these difficult issues, and work towards resolutions that balance deeply held and different perspectives." (bit.ly/zrJBBB)

I like that phrase, "American project."

Because isn't one of our responsibilities to continue the work of building something enduring?

Linda P. Campbell is a columnist and editorial writer for the Fort Worth Star-Telegram. Readers may write to her at 400 W. 7th Street, Fort Worth, Texas 76102, or via email at lcampbell@star-telegram.com.

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