Saturday, July 12, 2008

False Doctrine on the News

I briefly saw a cable news segment tonight criticizing John McCain for his reluctance to offer an on-the-spot opinion on insurance companies which cover medicine for erectile dysfunction but not oral contraceptives. The logic behind this report peeves me.

We're talking about equivalent situations here, right? Many men need medication for erectile dysfunction in order to have sex; many women need oral contraception in order to have sex. Paying for only one situation is a clear case of sexism!

I disagree. In the man's case, there is something wrong with his body, albeit often a natural result of aging.* In the woman's case, the only thing "wrong" with her is fertility. I resent calling this natural state a condition to be methodically subdued.

Americans today would much rather sex and reproduction were two noninteracting spheres, but nature nags otherwise. Many demand contraception to accomplish this divorce and maintain the modern life, but I do not acknowledge a fundamental human right to be barren.

Deeper than the insistence that sex be enjoyed without fear of attachment to another human being, or of the catastrophe that would be creation of new life, is the loud insistence that all people are exactly the same. For decades academics have obsessed over promulgating the worldview that no difference among humans is fundamental, and therefore any existing difference can and should be eradicated.

Society is constructed, they say. Morality is constructed. Emotions are constructed. Gender is constructed. "If it is constructed, then I will demolish it, and build my own."

Vanity and Babel. No amount of scholarly analysis or advance of medicine will bring a man to give birth.

We are stuck with the we that we are.

*I don't necessarily think ED should be covered by insurance. It probably depends on the situation. As my friend Josh puts it, "if a 70-year-old guy wants to pretend he's 40, he can do it without me picking up any of the tab."


jaeyde said...

Honestly, you don't know shit about oral contraceptives if you think the only thing they're used for is preventing pregnancy.

I have been dealing with this issue personally lately as I have to take oral contraceptives in order to NOT become barren. And I have been fighting with the insurance company to get them to pay for it. Why am I taking them? Because I don't cycle normally. If I don't take those little pink and white pills, I don't have a period. The body is supposed to flush and doesn't. If it doesn't flush for too long, it can result in a buildup that can be not only *toxic*, but can result in barrenness. I've been denied medical insurance because of this, so it's not a little piddling inconsequential thing.

Have you heard of the bleeding woman? Her medical condition is usually treatable today with oral contraceptives and is more common than you think. I know more than one woman who is taking the pill so she doesn't bleed to death.

A less medically necessary reason to take the pill that is still unrelated to pregnancy is PMS. I have never had it bad. Some women however, have debilitating cramps, severe psych issues, migranes, relentless back pain, etc associated with their period. Being on the pill almost always makes PMS symptoms less severe. Granted in some cases this is more of a convenience issure, but in others it's a big deal. Even this I would count as greater importance than an elderly man being able to get an erection.

So does my insurance company pay for a medication that can prevent potentially severe future medical problems? Only if it is generic. But remember this is hormones we're talking about. The wrong dosage, the wrong chemical mix and you can have really strange side effects. My favorite: unable to get out of bed because the drug that is supposed to be helping me has caused a severe depression. So finding the right pill is important. The one that I have to take, the one that does it's job without making me psycho, is a brand name pill that is not on the list of acceptable, covered medications from my insurance company. So every month, I pay for that little pack out of pocket. (the cost of the pack I use: $53. the cost of the copay on that pack if I run it through insurance: $70. my copay on regular, preferred prescriptions: $10. I have had not nice words with my insurance company about this.)

If medical insurance is going to consider a man's ability to "get it up" worth paying for, they damn well better pay for what they're *supposed* to be paying for: MEDICALLY NECESSARY treatments.

So would I be pissed off if I heard a presidential candidate waffle on this publically? Maybe not furious, but being unable to address it wouldn't be points in the positive for him.

The cultural stuff you talk about makes sense. Fine. But I think the foundation for the discussion is well.. clearly I think it's a bit flawed.

Jonathan said...

Jaeyde, I'm sure Nick was referring strictly to oral contraceptives used for contraception, not to treat legitimate medical conditions.

It's entirely possible for insurance companies, doctors, and the law to distinguish between those. It's like how AAS are illegal, but you can get a prescription for them for certain medical conditions and they're covered by insurance.

I don't know the context of the issue, but I assumed the question was insurance companies covering oral contraceptives for contraception vs. covering ED drugs to treat ED.

Viagra has other medical uses as well. Treating ED was an accidental and highly lucrative side-effect.

jaeyde said...

You may be right Jonathan. I don't know what the question was. But usually, when oral contraceptives are brought up in the public sphere, it is assumed that the only purpose is for contraception, and this post was discussed only in that mode, so that was what I was responding to. When it comes to the insurance companies, they don't care why you're taking them, they simply won't cover it. So in the end, it's not an issue of recreational use versus medical use, because that question is never brought up.

And yes, ED medications were designed to deal with bloodflow issues for more medical purposes... move the blood away from certain areas by diverting it.

Both types of medications have medically necessary and medically convenient functions, but the reason for the prescription is not how the insurance companies determine what gets covered and what doesn't. The determining factor for coverage is a list of cheap (covered) versus expensive (not covered) medications. It is possible to contest this with some insurance companies by getting your doctor to write a letter and by sending the insurance company proof that you have tried all the hundreds of alternatives, but that is more of a paperwork nightmare than most people are able or willing to deal with, especially when it is usually a lot of effort for no result. (even companies that allow patients to make requests regarding specific prescriptions often fail to respond to those requests in a positive way)

I guess long story short is, whether Nick is considering the different reasons for such medications or not is kind of secondary, because those who are in authority are not. They are thinking about the baseline numbers. Or about placating a conservative constituency who hears "oral contraceptive" and thinks "slut." [NOT implying that anyone reading or writing on this blog would think like that but there are people who do.]

Nicholas said...

Hey jaeyde,

I wasn't aware of the difficulty in getting insurance coverage for medically necessary uses - I would have assumed, as Jon said, that such would be covered like any other chronic problem. Thanks for filling me in.

I do believe that the television segment in question was juxtaposing more recreational uses of both kinds of medication. My objection was in viewing fertility as something wrong with women, something that must be done away with in order to enable the recreational view of sex that is dominant in our society. This is using medicine to re-create ourselves, which I'm saying is wrong and futile anyway.

As you say, there are many who use contraceptives for reasons other than the ones I was speaking about, and they probably have to deal with some undeserved stigma. For uses like you mention, it is a very good thing that we have such treatment available, and they are the kind of thing it seems insurance ought to cover. If what I wrote seemed to delegitimize such uses, then I apologize.

Interestingly, as Josh pointed out to me, erectile dysfunction medication serves to sustain cultures of promiscuity rampant in many communities of seniors today, which is also problematic, but another post.