US Politics: 1950's edition

[Former Lord of Winterfell]

That's true, but I wasn't disputing that. I was disputing the notion that this will cost anyone any more money.

FLOW, there is zero evidence your plan's costs will increase and many points of evidence that it will decrease.

Actuarial data (meaning real numbers minus political assumptions) doesn't show that.

The direct costs of providing contraception as part of a health insurance plan are very low and do not add more than approximately 0.5 percent to the premium costs per adult enrollee, as per studies from three actuarial firms--Buck Consultants, PriceWaterhouseCoopers (PwC), and the Actuarial Research Corporation (ARC)--which estimated the direct costs of providing contraception coverage. More recent analysis of actuarial data conducted in July 2011 by the Actuarial Research Corporation and using data from 2010 estimated that contraceptive coverage without a co-pay costs roughly $26 per year per enrolled female.

http://www.rhrealitycheck.org/article/2012/02/13/cost-contraception-in-insurance-plans-what-data-say?quicktabs_popular=1

But what happens is that this is clearly an issue with a lot of politics behind it, so you get lots of folks hopping on board with various assumptions and data to show it "really" doesn't cost anything. And because the additional costs just get rolled into other total costs used to compute premiums, the insurance companies don't have much of an interest in fighting this. Why bother? They'll increase premiums based on the total actuarial costs of their policies anyway, and whether outside groups argue that contraception isn't a net cost doesn't really matter. So what you get is a one-sided argument.

Factcheck has done a good summary of a bunch of the studies out there:

http://factcheck.org/2012/02/cloudy-contraception-costs/

Also, all these this overlook the additional cost of the no-copay element that has been added by the ACA, which clearly increases costs significantly for insurers.

But in any case, I'll just fall back on common sense. Insurance companies employ masses of people to figure out precisely what their costs are, and how their costs are affected by various types of coverage. If it is true that covering contraceptives and having no copay actually reduces their net costs, the vast majority (other than religious objectors) of them would be doing that anyway. But they're not. The overwhelming majority still charge a copay. Why?

And there's another part of this. There are obviously plenty of maintenance medications that cost less than the medical complications that would result if the medicine was no longer being taken. There are lots and lots of other drugs out there that make treatment cheaper than it would be in their absence. Antibiotics are cheaper than amputation, massive infection, etc. But that doesn't mean you charge zero for those drugs. You still pay something for those drugs because they still have a cost. So even if true, the rationale for "zero copay" for contraceptives doesn't hold up.

[Shryke]

How so? The investment in Solyndra was 1.3% of the total amount spent in green energy loans. It was a very minor failure that Republicans turned into a major controversy, as both sides are apt to do. It really was and is inconsequential.

It's not even a major controversy. Like so many other things (the teleprompter is a big one), it's a conservative meme that only circulates in the Fox News/Limbaugh/Beck/etc closed loop ecosystem and pretty much only effects people who already weren't voting for Obama.

Soylndra was pretty bad. It's not whitewater bad, but hundreds of millions in money lost on something that looked fairly fishy and doubled down after it was shown to pretty well suck is not a great mark no matter how you spin it.

But I don't see it as some giant thing that will kill him.

Huh? Solyndra died because materials prices changed on them rather unexpectedly and because the Chinese are quadrupling down on their investment in solar energy.

Before that, Solyndra looked very promising with new tech for solar energy.

[Shryke]

If having birth control on your insurance plan does somehow cost you more, it's because your insurance company is taking the opportunity to dick you over.

And you are dumb enough to fall for it when they try and find an excuse for it.

[Former Lord of Winterfell]

FLOW - I find your constant reiteration that birth control should not be covered to the extent that it is only being used so that the person taking the birth control can have "recreational sex" intellectually unsatisfying.

1. Take the following example - person has painful, irregular periods. Person could certainly live with them (with some unpleasant disruption to life) but a hormonal pill makes the periods both regular and, while not pain free, at least not at a level causing vomiting. Does that person get covered? I'm thinking under your example the answer is "no" even though I think that person would be comparable to, for instance, a person with a non-crippling auto-immune disease who takes a prescription anti-inflammatory every morning to help manage stiffness (except for the fact that, it is true, the person who takes the anti-inflammatory, I guess, has to swing for their own birth control, which, I suppose means that dual purpose drugs shouldn't be allowed - if you get a nice side effect, whammo, you pay twice).

There are two issues here. The first is the purely moral, "what should the policy be" issue. On that, I come down on the side of your example being covered as being the better policy.

The second issue is that of a government mandate with no copay. And on that issue, I say the government should butt out.

2. What about a person for whom pregnancy, except under specifically monitored conditions, would be dangerous? Ok? What about that same person, or you know, any person, getting her tubes tied. Covered? How is it different? In both cases the goal is recreational sex (though in the first its allowing it while preserving a chance for fertility).

Again, there's a difference between what I personally prefer and the issue of a mandate. But on a policy level, the first example is due to involuntarily physical dysfunction, and I think should be covered. The second, for me, would come down to purely economics. I was snipped, and it wasn't covered. I didn't have a problem with that because I figured it was my choice to have something done for which there was no medical necessity/reason. But at the minimum, even on a policy level, I would oppose any kind of purely voluntary treatment treated preferentially with regard to copays.

In terms of a mandate, I'm against it period.

[Guest Raidne]

FLOW, IMO, your paradigm of viewing everything through the lens of entitlement to entitlements has weighted you with a pretty hefty straw man bias that results in an inability to really understand any other possible goals that anyone supporting a policy different than what you support might have.

For that reason, it gets pretty unsatisfying to debate these issues with you vs. say, fiscal policy or some other political issue that isn't subject to your pre-existing (empirically unsupported) belief that people want entitlements because they want them.

I am a positivist, and so are many, many liberals. I don't believe we have inherent rights because we have them as a descriptive statement. That is a hollow, dumb, and meaningless statement to me. As such, you're just not talking to me or any other liberal-to-moderate Democrat like me when you level these objections about entitlement to entitlements.

It's very frustrating to state the actual goals sought, the policy put forth for meeting those goals, and the empirical evidence behind why those goals will meet that policy and have your answer be nothing more than an assertion that you don't think the policy promoted should be a goal in itself when nobody is saying that.

[Former Lord of Winterfell]

FLOW, IMO, your paradigm of viewing everything through the lens of entitlement to entitlements has weighted you with a pretty hefty straw man bias that results in an inability to really understand any other possible goals that anyone supporting a policy different than what you support might have.

For that reason, it gets pretty unsatisfying to debate these issues with you vs. say, fiscal policy or some other political issue that isn't subject to your pre-existing (empirically unsupported) belief that people want entitlements because they want them.

I stated above that I see the argument for Medicare/contraception for the poor differently than I do for those able to afford it, despite the fact that Medicaid is an entitlement by definition. The economic rationale and evidence is strongest there.

But I think it would be disingenuous to claim that everyone on your side in this discussion has argued from a pure "it's cheaper for everyone" perspective. Crtainly, there are some who have opined that there is some kind of individual, moral right to it. And frankly, given how a lot of folks here have affirmatively made the issue of healthcare for all a moral imperative, I'm not sure how the issue of morality of the entitlement is avoidable. In that case, though, I'm still puzzled as to the moral reasons behind co-pays for all sort of other drugs, but not birth control. Nobody has even attempted that one yet.

It's very frustrating to state the actual goals sought, the policy put forth for meeting those goals, and the empirical evidence behind why those goals will meet that policy and have your answer be nothing more than an assertion that you don't think the policy promoted should be a goal in itself when nobody is saying that.

Raidne, if someone affirmatively disclaims any argument based on a moral theory of an individual right to copay-free birth control, and wants to argue economic utility exclusively, that's fine. Kalbear has sort of done that. But other than him, I'm not sure. I mean, would you agree that it shouldn't be covered without copays for everyone unless that option is shown to actually save mone or be completely cost neutral? Or do you think there is an individual right, based on moral principles, to have co-pay free birth control mandated by the government?

I just tossed up the Factcheck article that pointed out that the research on this is all over the place, and that's not even considering that the research doesn't address cost not just in the context of coverage, but eliminating all copays as well. Yet if the rationale is primarily that of simple cost, shouldn't that be a threshhold area of inquiry?

[TerraPrime]

I think if you're going to be fair about that, you'd have to concede that there are aspects of this debate that I haven't viewed through that paradigm. For example, I said earlier that I see the argument for Medicare/contraception for the poor differently than I do for those able to afford it, despite the fact that Medicaid is an entitlement by definition. The economic rationale is strongest there.

so, soak the rich is "class warfare" for income tax, but when it comes to health insurance, it's fair game? How does that work?

[Arthmail]

For those that supported the war in Iraq, there is no room to claim moral legitimacy for anything.

[drawkcabi]

For those that supported the war in Iraq, there is no room to claim moral legitimacy for anything.

I supported the war in Iraq, I was too stupid to listen to people like Relic and Shryke, instead I listened to my Preisident. At least until the whole "Mission Accomplished" thing on the air craft carrier and my eyes were opened to grand standing and smoke and mirrors while nothing had changed... except the lives of brave military men, innocent civilians, and a waste or resources, and my country's street cred in the world, that is.

But I honestly admit I should not have supported it from the beginning and made a mistake.

So, is claiming moral legitimacy a person without sin casting the first stone kind of thing or will I ever be able to claim it on any issue?

Sorry if this is threadjack.

[Ser Greguh]

I still have yet to hear a good reason as to why all these people who incessantly bitch about "entitlements" remain remarkably silent on the subject of public schools, of clean tap water, of public roads, of public restrooms, of National Parks, and of public libraries (just to name a few). Even Medicare only comes into the equation because its resemblance to a contemporarily "contentious" issue are too obvious to ignore.

Just admit it: you're addicted to the status quo beyond any consistent rationality. In 100 years the troglodytes speaking out against progress will treat public health care as every bit as much the given that you treat having roads to drive on today.

[Tormund Ukrainesbane]

I'm a total hypocrite on National Parks. I love love love love the National Parks. I would completely privatize schooling, healthcare, retirement, everything. But you'll pry the Grand Canyon out of my cold, dead, hiking boots. Hell, I think there should be more national parks. We can start by blowing up the Glen Canyon Dam and getting Glen Canyon back. Then the Maine Woods, and the Frank Church and Bob Marshall wilderness areas, and a portion of the Oregon Coast.

[Former Lord of Winterfell]

I'm a total hypocrite on National Parks. I love love love love the National Parks. I would completely privatize schooling, healthcare, retirement, everything. But you'll pry the Grand Canyon out of my cold, dead, hiking boots. Hell, I think there should be more national parks. We can start by blowing up the Glen Canyon Dam and getting Glen Canyon back. Then the Maine Woods, and the Frank Church and Bob Marshall wilderness areas, and a portion of the Oregon Coast.

Eh, I don't have a problem with national parks. A government necessarily must have rules regarding property ownership, and I don't see anything horribly inconsistent with the government actually owning and maintaining some land held in common. Certainly, the 5th Amendment contemplates public ownership of some lands, so why not national parks?

[TrackerNeil]

So, is claiming moral legitimacy a person without sin casting the first stone kind of thing or will I ever be able to claim it on any issue?

Sorry if this is threadjack.

If it is a threadjack, it's a welcome one.

That's a tough question. I think the answer depends on just why you held the previous opinion, why you abandoned it, and what you learned in the process. Some people who switched sides did so simply because support for the invasion fell out of vogue. (These are many of the same who have already begun to warm to the idea of bombing Iran even though the war drums have barely begun to beat.) Those people lack all moral authority, in my view. If, as seems to be the case with you, you've learned why you made the mistake you did, I think it is possible to regain legitimacy, tempered with humility. One does not need to be error-free to point out the errors of others.

[Guest Raidne]

I think if you're going to be fair about that, you'd have to concede that there are aspects of this debate that I haven't viewed through that paradigm. For example, I said earlier that I see the argument for Medicare/contraception for the poor differently than I do for those able to afford it, despite the fact that Medicaid is an entitlement by definition. The economic rationale is strongest there.

But I'm also capable of reading particular arguments presented by folks, and recognizing that the belief by some that there is some kind of individual, moral right to something also is a key part of this debate. And frankly, given how a lot of folks here have affirmatively made the issue of healthcare for all as a moral imperative, I'm not sure how the issue of morality of the entitlement is avoidable.

This is not my position, but a person could think that there is a moral right to health care - in a prescriptive sense, i.e. a desirable government would create and protect that right - and then still decide that birth control should be included in the resulting health care coverage for reasons that aren't based in ethics, e.g. it is among the services that are generally included in health care plans such that the reasonable person assumes that coverage is part of the plan (promoting contractual legitimacy between the consumer and their health-care provider), it saves money as preventative care, etc., or even for a moral reason that has nothing to do with entitlements, i.e. to deny women birth control prescription coverage while covering other prescriptions is discriminatory on the basis of sex, etc.

Deciding that we should have universal health care can be a moral issue without every included piece of coverage also being a moral issue.

If someone affirmatively disclaims any argument based on a moral theory of an individual right to copay-free birth control, and argue economic utility exclusively, that's fine. But has anyone actually done that? I mean, would you agree that it shouldn't be covered without copays for everyone unless that option is shown to actually save money?

Well, yeah. That's the whole point - under the bill, the only services exempt from co-pays are those which have been shown by the commission to constitute cost-saving preventative care, which is how it should be. I pay co-pays now, and I surely expect to them in the future. OTOH, if removing any possible barrier to some service promotes its use and results in a reduction of more expensive services down the line, than covering it fully is just good policy.

I just tossed up the Factcheck article that pointed out that the research on this is all over the place, and that's not even considering that the research doesn't address cost not just in the context of coverage, but eliminating all copays as well. Yet if the rationale is other than one of primarily morality, shouldn't that be a threshhold area of inquiry?

The question is (1) does providing coverage of this service reduce costs, and then (2) if so, copays should not be required in order to remove all barriers to cost-saving behaviors.

For instance, in the VA system, certain data on physicals will prompt other preventative screenings. If you have high blood sugar, diabetes pre-screening is prompted. In the short term, you might see an increase in costs for that individual when they attend preventative sessions on weight control or blood sugar self-monitoring, but overall, costs are significantly less than treating uncontrolled diabetes with diabetic neuropathy, retinopathy, and other complications down the line, etc.

Similarly, the typical retail cost of birth control is about $40/month. The average cost of delivery alone is $6-8K. You can cover birth control for 12 years before you hit just the cost of delivery, without even considering pre-natal care, etc.

FEHB plans have a co-pay - mine is $10 for my birth control. I think it's unlikely that adding another $10 to the $30/month already being covered is going to significantly change the FEHB data, and if covering birth control removes barriers to its usage - as it must to see overall cost decreases under any coverage - removing further barriers would generate more of the same effect.

Of course, it's also possible that people who were going to use birth control coverage were already signing on to plans that offered it before it became mandatory coverage for federal employees, which would also generate no change in the data. And that's an empirical question. If, at some point, it is shown that fully covering birth control without a co-pay overall increases the cost of health care, than I would fully support removing it from the cost-savings preventative care section of health care coverage and allow co-pays, absolutely. It's not like all prescriptions are exempt from co-pays under the Act, so if the finding that it decreases costs or results in no change to cost turns out not to be true, there is absolutely no reason to exempt birth control from co-pays.

[drawkcabi]

If it is a threadjack, it's a welcome one.

That's a tough question. I think the answer depends on just why you held the previous opinion, why you abandoned it, and what you learned in the process. Some people who switched sides did so simply because support for the invasion fell out of vogue. (These are many of the same who have already begun to warm to the idea of bombing Iran even though the war drums have barely begun to beat.) Those people lack all moral authority, in my view. If, as seems to be the case with you, you've learned why you made the mistake you did, I think it is possible to regain legitimacy, tempered with humility. One does not need to be error-free to point out the errors of others.

The way I remember it, at the time of "Mission Accomplished" the war was still very in vogue with a majority of the country. But the site of that stunt was like a splash of water in my face and I turned against it for the reasons I stated above. Nothing was accomplished except for negatives.

Why I was for it, I was still in shock, it being less than 2 years after 9/11. I believed Hussien was an evil man (and I still believe that) but also more dangerous than he was. I didn't think he had anything to do with 9/11, but I thought he was a hit-them-while-they're-down kind of guy and WMD's in his country was conceivable.

I didn't forsee the quagmire. I thought it would be step 1 or 1 1/2 toward making the middle east a lesser breeding ground for terrorists, and a quick step at that.

What I've learned is war should always be the last resort and even then it is most of the time the last resort of the incompetent. There are times when you see the fist coming at you and you need to duck and then swing back but there was lots and lots of time to try other things and map out all the consequences in Iraq and I feel the same about Iran.

[drawkcabi]

I'm a total hypocrite on National Parks. I love love love love the National Parks. I would completely privatize schooling, healthcare, retirement, everything. But you'll pry the Grand Canyon out of my cold, dead, hiking boots. Hell, I think there should be more national parks. We can start by blowing up the Glen Canyon Dam and getting Glen Canyon back. Then the Maine Woods, and the Frank Church and Bob Marshall wilderness areas, and a portion of the Oregon Coast.

And the Everglades! Fuck Disneyworld!

[Tormund Ukrainesbane]

The Everglades are a national park

http://en.wikipedia.org/wiki/Everglades_National_Park

And they aren't really anywhere near Disney World.

[Mlle. Zabzie]

@ FLOW (having problems quoting right this short second) - is your argument at its simplest that the government should not have the right to regulate what is covered by a private health insurance plan offered by a private employer to its employees (i.e, more or less the status quo ante ACA)?

[Tempra]

The way I remember it, at the time of "Mission Accomplished" the war was still very in vogue with a majority of the country. But the site of that stunt was like a splash of water in my face and I turned against it for the reasons I stated above. Nothing was accomplished except for negatives.

Why I was for it, I was still in shock, it being less than 2 years after 9/11. I believed Hussien was an evil man (and I still believe that) but also more dangerous than he was. I didn't think he had anything to do with 9/11, but I thought he was a hit-them-while-they're-down kind of guy and WMD's in his country was conceivable.

I didn't forsee the quagmire. I thought it would be step 1 or 1 1/2 toward making the middle east a lesser breeding ground for terrorists, and a quick step at that.

What I've learned is war should always be the last resort and even then it is most of the time the last resort of the incompetent. There are times when you see the fist coming at you and you need to duck and then swing back but there was lots and lots of time to try other things and map out all the consequences in Iraq and I feel the same about Iran.

I declare you once again fit to pass (legitimate) moral judgments. Go forth and judge, young one.

[Former Lord of Winterfell]

...and then still decide that birth control should be included in the resulting health care coverage for reasons that aren't based in ethics, e.g. it is among the services that are generally included in health care plans such that the reasonable person assumes that coverage is part of the plan (promoting contractual legitimacy between the consumer and their health-care provider), it saves money as preventative care, etc., or even for a moral reason that has nothing to do with entitlements, i.e. to deny women birth control prescription coverage while covering other prescriptions is discriminatory on the basis of sex, etc.

The contract argument isn't all that persuasive to me because it could easily be addressed by mandatory disclosures at the time of hiring. As to the latter argument, that's a bit of a rabbit hole, but I agree it's a point that can be argued.

Deciding that we should have universal health care can be a moral issue without every included piece of coverage also being a moral issue.

Ah, okay. I get your point a bit better now. I think what happens is that when you end up talking about a very specific type of coverage, it has the effect of focusing on the whole question of "rights" or "entitlements" more directly because you're on a specific issue. That's particularly true when there is a unique objection (as in the religious issue here), or if there is a relatively unique form of benefit -- no copay. We do the normal balancing test thing at that point. The Church objects to providing birth control because it offends their faith on the one hand, and what,exactly, is on the other? I think it is at the point where you are doing that balancing test that brings the entitlement aspect into more clear, specific focus.

Well, yeah. That's the whole point - under the bill, the only services exempt from co-pays are those which have been shown by the commission to constitute cost-saving preventative care, which is how it should be. I pay co-pays now, and I surely expect to them in the future. OTOH, if removing any possible barrier to some service promotes its use and results in a reduction of more expensive services down the line, than covering it fully is just good policy.

That's the part to which I have a factual objection, but I'll let that go. I think screenings, etc. fall within that mandate, but I don't think BC does. But that's not really worthy of a separate debate.

The question is (1) does providing coverage of this service reduce costs, and then (2) if so, copays should not be required in order to remove all barriers to cost-saving behaviors.

I understand the logic but don't agree with it absent evidence that copays are truly barriers to entry.

For instance, in the VA system, certain data on physicals will prompt other preventative screenings. If you have high blood sugar, diabetes pre-screening is prompted. In the short term, you might see an increase in costs for that individual when they attend preventative sessions on weight control or blood sugar self-monitoring, but overall, costs are significantly less than treating uncontrolled diabetes with diabetic neuropathy, retinopathy, and other complications down the line, etc.

Similarly, the typical retail cost of birth control is about $40/month. The average cost of delivery alone is $6-8K. You can cover birth control for 12 years before you hit just the cost of delivery, without even considering pre-natal care, etc.

I get all that. But what you're doing is describing the regs, and then pointing out how BC fits within them. I'm questioning the wisdom of the regs themselves and/or the rationale that applies them to BC. And I do not think the numbers would show that co-pay free BC actually reduces the insurers costs. And again, I think your by the numbers application of the regs to BC overlooks the real discretion than HHS had, particularly in the area of the religious exemptions. This was a policy choice.

If, at some point, it is shown that fully covering birth control without a co-pay overall increases the cost of health care, than I would fully support removing it from the cost-savings preventative care section of health care coverage and allow co-pays, absolutely.

Ah, that's really fair as far as I'm concerned. I strongly suspect the data already shows this. Given that Factcheck found that the economics on coverage (including a copay requirement) were unclear, it seems to me that not paying copays is just going to tilt that much more in the direction of costing more than it saves. But that's a factual disagreement. In a way, the "no copay" part of it has some questionable logic. Just because coverage may be cost neutral (or reduce costs), does not suggest that eliminating copays will improve that even more. Not unless there is evidence that copays were discouraging a significant number of purchases.

One question, though. If this really is a matter of economics in terms of making insurance cheaper for employers, then what is the rationale for compelling Catholic employers to cover it at no cost? After all, they'll be the ones hurt in the pocketbook by it. I don't think the contract argument carries much weight because you could just as easily require specific disclosure at the time of hiring that contraceptives aren't covered.