Contraception vs. Viagra

Unpublished; written May 26, 1999
Dear Editor:

I found the editorial "HMOs cover Viagra, but not The Pill" in the May 24 Free Lance interesting. However, it seems to ignore reality. The reason Viagra is covered while birth control (The Pill or any other kind) is not covered is because Viagra helps with a medical problem -- impotence. Birth control does not address a specific medical problem (emphasis on "problem"). I suspect it's as simple as that. Any argument comparing Viagra to birth control is comparing apples to oranges.

You could argue that HMOs were founded based on prevention, and that contraception is certainly prevention. Unfortunately, that would also miss the point. HMOs are focused on prevention of disease and injury, and pregnancy is neither. There are plenty of women who are glad to get pregnant, but I suspect there are very few men who are glad to be impotent.

The editorial also mentions a bill by state Senator Jackie Speier, laughably cited as the "Women's Contraceptive Equity Act". Where is the equity? Viagra has nothing to do with contraception; if anything, it is anti-contraceptive because it allows completion of conception. We already seem to have "contraceptive equity" -- most plans do not cover contraception for men or women.

If Ms. Speier wants another type of equity, does her bill require HMOs to cover ALL contraception, including contraception for men such as condoms? If not, there is no equity there. You could argue that male contraception doesn't require a prescription, but there has been talk for years about male birth control pills. Does Ms. Speier's bill cover that eventuality?

Let's also not forget that there are non-prescriptive forms of birth control for women -- probably more than there are for men. Women don't need The Pill or Norplant; they can use topical contraceptives such as a diaphragm, foam, or the female condom. I believe I've even heard the sponge is back. Granted, they probably aren't as effective individually as prescriptive contraception, but in combination they probably are. Of course, they suffer from the "spontaneity problem" -- but so does the condom, the only common form of male contraception.

I personally agree with the editorial that birth control is far preferable to abortion, and would have no problem if an HMO covered contraception (for both sexes, of course). However, I suspect HMOs have done the math and determined that it's cheaper to pay for abortions than for birth control in the long run. You may not like that, but let's face it, an HMO is a business.

In fact, I suspect the only reason they cover abortions at all is because it's cheaper to pay for an abortion than for delivering a baby. Pregnancy is not a disease, so they really have no obligation to provide for abortions except in the case where the mother's life is in danger.

So why do HMOs cover maternity care at all? Again, I suspect its market-driven. HMOs are competing with other medical plans. Those plans cover maternity, and if an HMO didn't, that would be a strong disincentive for women to join that HMO. Also, it's not uncommon for medical problems to develop when delivering a baby, so it's certainly prudent to ensure trained medical support is available during birth.

When the editorial concludes that covering Viagra while not covering birth control "is an unfair bias against women", it is again comparing apples to oranges. If an insurance company covers Viagra, but does not cover any drugs for "frigidity", menstrual problems, menopausal problems, or other "female problems", THAT would clearly be a bias against women.

However, if an insurer is forced to cover birth control for women but not for men, that is a bias against men. Unfortunately, the editorial seems to be arguing for that inequity. In fact, not only does the editorial support a bias against men, it supports legislating that bias. Haven't we had enough legislated biases in the past? We don't need to take a step backwards.

UPDATE: A reader E-mailed me telling me that she used birth control pills to control persistent bleeding. I consider that a medical problem that should be covered by an HMO.

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