Thursday, March 08, 2012

Catholics and the health insurance (ie, birth control) Mandate

The American Catholic has answered the most cited arguments against the Catholic Church's refusal to cover birth control for it's employees in an article called the 10 Most Cited Arguments in Favor of the HHS Mandate I've rebutted their most pertinent "answers" below:

10. Yes the Catholic Bishops have spoken in favor of universal health care, I guess it just depends on what you consider "health" and it would fall back to the usual and customary use of the word.  Is birth control "health" care? Society can debate it and find a consensus (that word again). Why am I paying for knee or shoulder surgery for teens who play football or 50 y/o's who downhill ski?  It's immoral I tell ya!

5. The Jehovah's Witness analogy is actually very close to the point. Jehovah's Witnesses are arguing that blood transfusions are elective just like contraception, and these decisions are respected to the point that Jehovah's who are in dire need die for lack of blood.  Why should they pay for coverage for a benefit they will never use and think immoral? Isn't this the same argument made by Catholics about birth control? The second part of the answer is closer to the mark--- why are employers involved in health  insurance at all? It's an anachronism that should be eliminated; my employer does not pay for my auto insurance, so why my health insurance? (More on this at the end of this post.)
The writer lists the "side" effects of hormonal contraception but does list the health benefits: lower incidence of ovarian cancer, lower incidence of endometrial cancer, higher hemoglobin levels (less anemia), fewer missed work days from menstrual disorders, lower incidence of ectopic pregnancies, greater feeling of well-being and less worry about unwanted pregnancies. If we are going to be complete, let's be complete and not commit lies of omission.  I realize that this a superfluous argument to true believers: if one believes they are sinning by using birth control, then none of this matters compared to an eternity in hell.

The fact is that contraceptive pills are not a singular entity called "birth control", they fall under the broader classification called "hormonal medication" (I'll leave out IUD's and sterilization for the purpose of this discussion), and hormonal manipulation is used to treat a plethora of diagnoses including prostate cancer (depo-provera and luprolide), premenstrual dysphoric disorder (cyclic hormones), and endometriosis (provera, luprolide, cyclic hormones), among others. Should my employer be allowed to refuse to pay for all hormonal medication?

I'm not sure what the ramifications would be if every employer could pick and choose what benefits are covered by their health insurance plan. After I get my gall bladder taken out would I then discover that my employer belongs to a religion that has a special devotion to bile storage organs and thus has chosen not to cover cholecystectomies, leaving me with a $7,000 bill? What if my employer is a Christian Scientist? How responsible should individuals be for reading all the fine print of every policy? A less facetious argument might surround Lipitor, the cholesterol-lowering medication, and it's analogs, which many medical authorities feel are overprescribed and not without side effects every bit as problematic as hormonal medication. Should my employer have a say in whether my Lipitor is covered?  

1. "98% of Catholics use birth control." Yes, that number seems high, just factoring in the 10% of Catholics who are likely lesbian lowers it to 90% (although I would refrain from invoking Glenn Beck for any serious discussion). Does the Catholic Church have a number? My informal sampling of family and friends is above 50%.  (I know of many patients, friends and family members who use or have used birth control to avoid pregnancy due to the teratogenic effects of other medications they were taking. Is this okay with the Church? According to conservative Catholics: No, they are going to hell. This has led some to re-think their faith in the Church altogether, but that's another story.)  Okay, it doesn't matter--- I'll buy that, and it goes back again to the question as to why any employer is buying my health insurance in the first place.

My further comment:  Employer based health insurance is an anachronism left over from the wage freeze of 1943 when employers could not legally raise salaries so they offered other benefits to entice workers. It's unnecessary now and should be fazed out.  Maybe President Obama is playing eleventy-dimensional chess to make the US population realize how divisive the process of universal health will become without government-supplied and regulated health insurance. Obama and the Democrats chose not to include such a public option in the Affordable Care Act, but maybe this was a circuitous master plan to get citizens (finally) screaming for a Medicare-for-all option like other developed nations have-- like a reverse-psychology approach to waken the masses from their slumber. I doubt it, but who knows?

The bottom line: Catholics now pay for birth control all the time by contributing tax support to Medicare and Medicaid. This is the precedent that would argue for birth control in a public option, universal health Medicare-for-all plan, if it were ever instituted.  Why are they complaining now? In addition, insurance regulation historically requires coverage for any therapy that is determined to be safe and effective.  Using the "safe and effective" standard, birth control (hormones, IUD's and sterilization) meet criteria as a reasonable intervention.   


antipundit said...

On a slightly related note:

Danny Haszard said...

Jehovah's Witnesses blood transfusion confusion.

*NEWS* Jehovahs Witnesses take blood products now in 2012.
They take all fractions of blood. This includes hemoglobin, albumin, clotting factors, cryosupernatant and cryopoor too, and many, many, others.
If one adds up all the blood fractions the JWs takes, it equals a whole unit of blood. Any, many of these fractions are made from thousands upon thousands of units of donated blood.
Jehovah’s Witnesses can take Bovine *cows blood* as long as it is euphemistically called synthetic Hemopure.
Jehovah's Witnesses now accept every fraction of blood except the membrane of the red blood cell. JWs now accept blood transfusions.

The fact that the JW blood issue is so unclear is downright dangerous in the emergency room.
Danny Haszard

Tony said...

In my experience there is some variation is what Jehovah's will consent to, as far as blood products. Some will accept various blood products and up to 55% will consent to cell-saver usages, but others will not. I've spoken to representatives of various churches as well (which can be problematic with issues of patient confidentiality) and every case is specific and care must be individualized. If you have a reference to the contrary, I'd be interested.