Really?

 

Like many women, I’m amazed that our national political conversation has returned to a topic I thought we settled long ago: birth control.

As a young woman contemplating my first sexual experience, the most important question after “when” was: how do I make sure I don’t get pregnant? I knew one thing: I wanted control over the decision about when to have a child.

When I entered the workforce in the mid ‘70’s, birth control pills were the only regularly prescribed medication not covered by my company’s insurance plan. That didn’t change until women gained a larger share of responsibility and became more valued contributors.   

Fast forward to 2012 and we’re arguing, again, about whether insurers should cover birth control. The Obama Administration says yes, and mandated that the Affordable Care Act should fully fund those costs. Many conservatives (and the Catholic Church) say no, citing religious and/or First Amendment rights. While I don’t agree with the Catholic Church on this issue, I respect their belief, which has been nothing but consistent as long as I’ve walked this earth (even as every Catholic I’m related to or acquainted with chooses to ignore their teachings on this topic). And while my conservative friends will disagree with me, I think Obama has done an admirable job of trying to work within this constraint while still holding true to the principle of universal coverage. 

Like most non-religious people, I respect those with strong religious beliefs, and my circle includes both close friends and family members who fit that description (including my nephew, who plans to enter the Catholic priesthood). This makes me inclined to roll up my sleeves when faced with religious objections and say, “OK – what can we do to make sure women who want this coverage can obtain it under the same conditions as every other woman in the country, in a way that won’t violate your beliefs?” If self-insured Catholic institutions say that putting the onus on their insurance companies, as Obama proposed, is still a violation, what are other possible solutions? 

The other conservative complaint I see goes something like, “I don’t want to pay for your sex life,” with the implication that covering birth control comes out of your own pocket. Yet that’s how insurance works: it pools the costs of members’ coverage across the insured population. Your premiums help pay the cost of other participants’ health care expenses with the expectation that their premiums will also help pay yours. Do we really want people (or the companies who insure us) choosing what they pay for? Taking this to its logical extreme, should non-smokers be required to pay for a smoker’s lung cancer?  A recovering alcoholic’s liver transplant? 

Keeping insurance costs down involves balancing the pool of participants so that healthy people pay more into the system than they draw from it. The excess funds they generate help pay for the higher costs of those who withdraw more than they pay in. I accept this trade-off as a citizen who values living in a community where we take care of each other. I’m fine with having some of my health care dollars support those who need it more; after all, I might find myself in their shoes someday. 

Many insurers increasingly realize the cost benefits of fully covering the cost of certain health care procedures as part of their wellness programs. That’s one of the reasons why my plan now fully covers annual mammograms for women and colonoscopies for people over 50. Birth control falls within this category as well, particularly for low income women, whose rates of unplanned pregnancy are far higher (and whose complications from pregnancy are correspondingly higher as well). And contrary to what some pundits say, the cost can be considerable, especially for the most effective options and for those with fewer resources.

I’m not comfortable with painting this discussion as a “war on women.” In fact, I’m not comfortable with retreating into either side’s talking points vacuum. What concerns me is that at the same time we’re heading to our usual corners and shouting at each other, many states are making it increasingly difficult for women to have access to affordable health care coverage (including reproductive health services). That means more women will lose access to cervical and breast cancer screenings, testing for sexually transmitted diseases, and other services. This will certainly result in more women dying from preventable diseases. 

 I would like to think this would concern us all.