Birth Control Coverage May Soon Come Without a Co-Pay

(Flickr/brains the head)

Today the New York Times reports that things are looking up for pro-choice advocates who hope to have birth control classified as preventative care under the Affordable Care Act.

Administration officials said they expected the list to include contraception and family planning because a large body of scientific evidence showed the effectiveness of those services. But the officials said they preferred to have the panel of independent experts make the initial recommendations so the public would see them as based on science, not politics.

Making birth control more affordable (that is, without a co-pay under the Affordable Care Act) makes sense when you consider how insurance companies have been putting financial pressure on women:

Brand-name versions of oral contraceptives can cost $45 to $60 a month or more, not including the cost of a doctor visit for a prescription. In recent years, many health plans have increased co-payments for prescription drugs, so even women with insurance may end up paying half the cost of birth-control pills.

While there has been some anticipation among pro-choice advocates that birth control would be classified as such, the push to classify birth control as preventative care has generated some controversy -- mostly in the form of protests from extreme anti-choice groups like the United States Conference of Catholic Bishops (prominent lobbyists favoring the Stupak amendment) and the Family Research Council (which has recently been classified as a hate group by the Southern Poverty Law Center).

But much as these groups have managed to use their influence on issues of abortion, birth control may be an issue that they've already lost on.

According to Guttmacher Institute data, more than 99 percent of all women ages 15-44 who have had sex use at least one form of contraception. The data also estimates that only 7 percent of women are at risk of unintended pregnancy but aren't using some form of contraception. Additionally, 63 percent of sexually active women use some form of what is called temporary birth control (hormonal contraceptions like the pill, the patch, or the NuvaRing, as well as an IUD or condoms). More than 30 percent rely on some form of sterilization.

The number of women actively using some form of birth control while sexually active is so great that the notion of opposing birth control seems crazy or outlandish. And it is. Allowing women to have more control over their bodies through family planning is better for maternal and child health. Pretending otherwise is simply ignoring what's good public policy and good science.

The Senate Doesn't Wear 'I'm With Stupak' T-Shirt

Today, Rep. Lois Capps (D-CA) is smiling. (Flickr/jdlasica)

The Senate released its health care bill last night, named the Patient Protection and Affordable Care Act (you can read it yourself, in PDF form). The Senate bill has some things about abortion that give the pro-choice community hope after the Stupak-Pitts amendment.

The New York Times has a nice side-by-side comparison of the two bills, and on abortion, the Senate bill looks much closer to what the pro-choice community was pushing for initially in the House bill -- closer to what's called the Capps amendment. Huffington Post reports that Capps herself is somewhat happy with the Senate compromise. "'I am pleased that the Senate has adopted a reasonable, common ground approach on this difficult question,' she said in a statement."

The Senate bill allows insurers to decide if they want to include abortion in each plan (much as they do now, and 87 percent of private plans already choose to provide such coverage). The Senate plan also says that private plans that receive federal subsidies to make the plans more affordable to individuals can provide abortion coverage, so long as they don't use the federal money to pay for the abortion coverage. The Senate bill also allows the public option to provide abortion, again, as long as it federal dollars aren't used to pay for it.

Under the Senate bill, each state is required to have at least one plan that provides abortion coverage and at least one plan does not include abortion coverage.

But, as Eleanor Clift pointed out at Newsweek, the abortion fight isn't over yet:

There are two numbers to watch: (1) Can an anti-abortion amendment offered by, say, Utah Republican Orrin Hatch, or pro-life Democrat Bob Casey, get 60 votes? Probably not, but Reid will have to get 60 votes to even proceed with debate on the bill. (2) Getting that 60 could mean putting stronger anti-abortion language in the bill to get those red-state Democrats.

But in the meantime, the pro-life community is pretty mad. The National Right to Life, one of the biggest pro-life groups in America, said in a statement that the Senate bill "substituted completely unacceptable language that would result in coverage of abortion on demand in two big new federal government programs ... National Right to Life will continue to fight for the Stupak-Pitts Amendment."

There's also funding set aside for abstinence only education:

Leave it to the United States Senate to prove my prediction slightly off. Their provision would restore a program called Title V, which, since the Welfare Reform Act of 1996, has allocated a yearly $50 million in grants to abstinence-only education programs. Obama let the program lapse in June, leaving some abstinence-only groups in dire straits. So in September, Sen. Orrin Hatch offered an amendment to restore Title V via heath-care reform, which (much to the outrage of liberal groups) just squeaked through the Senate Finance Committee with a 12–11 vote. A similar amendment, offered in the House by Rep. Terry Lee from Nebraska, died in committee.

If the Senate language survives reconciliation, the Title V program will be extended through 2014. This will not, however, bring abstinence funding back to the levels of the past decade. In 2008, Title V grants accounted for just under 25 percent of the federal abstinence budget (the rest of the budget came from other abstinence-only funding sources not restored in the Senate bill, including Community Based Abstinence Education Grants and the Adolescent Family Life Act).

On another reproductive health front, abstinence only groups are declaring victory. “It is encouraging that the hard work of grassroots constituencies from across the country have prevailed to ensure these common-sense programs will continue,” said executive director of the National Abstinence Education Association, Valerie Huber to The Americano. But abstinence-only programming has been scientifically proven to be ineffective.

UPDATE: Jodi Jacobson over at RH Reality Check has a more in-depth look at abortion in the Senate health care bill.

Cross posted.

Study: 'Industry-Wide Effect' of Stupak Amendment Will Eliminate Abortion Coverage

(Flickr/Brian Rendel)

Via TPMDC, a George Washington University School of Public Health study of public health shows that the Stupak-Pitts amendment would eventually eliminate all abortion coverage. "We conclude that treatment exclusions required under the Stupak-Pitts Amendment will have an industry-wide effect, eliminating coverage of medically indicated abortions over time for all women, not only those whose coverage is derived through a health insurance exchange," the study says.

The study also calls out the rider alternative, an add-on women could purchase separately to cover abortion (incidentally, this is how many insurance providers handle coverage for pregnancy now), as bullshit:

In our view, the terms and impact of the Amendment will work to defeat the development of a supplemental coverage market for medically indicated abortions. In any supplemental coverage arrangement, it is essential that the supplemental coverage be administered in conjunction with basic coverage. This intertwined administration approach is barred under Stupak/Pitts because of the prohibition against financial comingling. This bar is in addition to the challenges inherent in administering any supplemental policy. These challenges would be magnified in the case of medically indicated abortions because, given the relatively low number of medically indicated abortions, the coverage supplement would apply to only a handful of procedures for a handful of conditions. Furthermore, the House legislation contains no direct economic incentive to create such a market. Indeed, it is not clear how such a market even would be regulated or whether it would be subject to the requirements that apply to all products offered inside the exchange. Finally, because supplemental coverage must of necessity commingle funds with basic coverage, the impact of Stupak/Pitts on states’ ability to offer supplemental Medicaid coverage to women insured through a subsidized exchange plan is in doubt.

In other words, the Stupak/Pitts amendment is just as bad as feminists have been saying all along.

Cross posted.

How Health Care Reform Screws Over Women (and All of Us)

Over the weekend, the House of Representatives passed a (somewhat final) version of the health care reform bill. There are a lot of good things about this bill. It'll provide coverage to a lot of people that didn't previously have coverage, make health care more affordable, and increase options for health insurance. These are good things. But I'm still not happy. Because this health care reform bill, although it has a lot of good aims, falls short in key ways.

One of the biggest problems with the bill the House voted on this weekend is that it includes the Stupak-Pitts amendment, one that, according to a Planned Parenthood press release, would:

• Prohibit individuals who receive the affordability tax credits from purchasing a private insurance plan that covers abortion, despite the fact that a majority of health insurance plans currently cover abortion.
• Result in a de facto ban on private insurance companies providing abortion coverage in the health insurance exchange, since the vast majority of participants would receive affordability tax credits.
• Prohibit the public option from providing abortion care, despite the fact that it would be funded through private premium dollars.

This means that the Stupak-Pitts amendment is actually an amendment that outlaws federal funding for a legal and sometimes medically necessary procedure, abortion.

Rachel Maddow, on Meet The Press this weekend, said, "[The Stupak amendment] is the biggest restriction on abortion funding since the Hyde amendment. It's the biggest restriction on abortion access in a generation."

In other words, in a bill that seeks to increase health care for Americans, it actually restricts abortion coverage -- health care coverage -- for thousands if not millions of women in this country. Feminist groups are mad about the Stupak-Pitts amendment. NARAL president Nancy Keenan released a statement that said,

It is unconscionable that anti-choice lawmakers would use health reform to attack women's health and privacy, but that's exactly what happened on the House floor [Saturday night]. Even though the bill already included a ban on federal funding for abortion and a requirement that only women's personal funds could pay for abortion care, Reps. Stupak and Pitts took their obsession with attacking a woman's right to choose to a whole new level. We will hold those lawmakers who sided with the extreme Stupak-Pitts amendment accountable for abandoning women and capitulating to the most extreme fringe of the anti-choice movement.

Planned Parenthood's Cecile Richards wrote in a statement released by Planned Parenthood,

Planned Parenthood strongly opposes the Stupak/Pitts amendment which would result in women losing health benefits they have today. This amendment would violate the spirit of health care reform, which is meant to guarantee quality, affordable health care coverage for all, by creating a two-tiered system that would punish women, particularly those with low and modest incomes.

But others actually blame feminist groups for the Hyde amendment. Jane Hamsher at FireDogLake wrote a scathing post blaming such feminist groups for the amendment, saying, "There is no price for bucking Planned Parenthood and NARAL."

This is perhaps because that being anti-choice is no longer a partisan issue. The Stupak-Pitts amendment was lead by many anti-choice Democrats, including the amendment's sponsors, Congressman Bart Stupak (D-MI). While there is a group called Republicans for Choice, they're mostly a fringe group that maintains little power within their party and grudgingly endorsed the McCain-Palin ticket in 2008.

Furthermore, the bill the House voted on bans undocumented immigrants from insurance exchanges (despite the fact that they receive coverage in emergency rooms -- the most expensive kind of care -- whether they can afford to pay or not and raising the cost of care fore everyone else). Without complete and comprehensive coverage and access for women and undocumented workers, we have health care reform that fundamentally exacerbates long-standing class differences.

The current situation for women seeking abortion care isn't good. Even though abortion is legal -- and has been for decades -- it is becoming increasingly likely that if you have money than you have access to abortion. If you don't than that access disappears. While the majority of health insurance plans cover abortion in some capacity, those that are insured tend to be among those employed at higher-paying salary jobs or those that can afford to purchase insurance on their own. Access is an issue even for those that can afford abortion care. Nearly 90 percent of counties in the United States have no abortion provider, meaning that a woman seeking abortion will have to travel (often several hours) to another county to obtain an abortion. Many states where abortion coverage is scarce have also passed laws that require women to make multiple appointments, meaning that a working-class woman who has no sick leave would have to give up two days of work to make the appointment. Furthermore, the Hyde amendment, a law passed decades ago, has restricted federal funds -- often the only way some poor women can obtain medical coverage -- from paying for abortions. This means that women often delay abortions later until they can save up enough money to pay for the procedure, making the abortion a more dangerous procedure for the woman.

The situation isn't completely hopeless. Some are hoping that the amendment will be pulled during reconciliation. Others are advocating for an amendment to the Senate's health care bill that would repeal the Hyde amendment. Francis Kissling, founding president of Catholics for Free Choice, wrote,

If nothing else happens as a result of this defeat, complete and total dedication to overturning Hyde must be the centerpiece, indeed the single objective of our movement. It is not clear if the effect of the Stupak Amendment will be that the door will close on ever restoring federal funds for abortion, but every effort to make sure that does not happen must be made. We must convince enough people that the only immorality is using poor women as a way of expressing one’s moral outrage. Either we all have the right to choose or none of us has it.

President Obama has always supported overturning Hyde and we now need to insist that having achieved his political objective with strong support from the women’s movement, he must take up the true moral cause – giving women with no or low resources the same right of conscience as those with sufficient money to pay for their own abortions have always had.

This seems an unlikely scenario, but it is precisely because it is unlikely that it's so worrisome. The debate over abortion (and for that matter, access on all health care) has moved unbelievably far to the right. We're no longer talking about expanding access to reproductive care, even with a pro-choice president and a pro-choice Congress. Instead, we're talking about how to combat new proposals for restricting abortion. As Latoya Peterson put it at Jezebel, "Ladies and gentlemen, we got hosed."

Cross posted.

Taxpayer Protests

Over at Campus Progress today, I have a take on the heath care reform protesters that flooded D.C. this weekend. Go ahead and take a look.

Coverage for Pregnancy: Not All It's Cracked Up To Be

Sarah Wildman experienced the problem that the National Women's Law Center has been talking about for months. While many women's rights groups (and conservative congressmen/women) are getting up in arms about abortion coverage in the new reforms proposed by Congress, the real issue at stake is the way insurance companies deal with pregnancy for those on the individual insurance market. As Sarah points out, having a baby in this country is expensive:

One CareFirst rep we actually managed to reach explained we had maxed out because the benefit was “capped” at $3,000 per pregnancy. That means $3,000 for all pre-natal visits, tests and sonograms, labor and delivery, hospital stay and hospital care. In what mythical U.S. hospital is nine months of medical care paid for with $3,000? The study by the National Women’s Law Center found that (in 2006) a normal vaginal birth cost, on average, $7,488 in hospital charges alone. Using examples of riders similar to mine, NWLC found that women with uncomplicated vaginal births would pay between $6,780 and $9,682 out of pocket. C-sections came in around $13,000 nationally, and for them, the out of pocket costs ranged from $10,000 and up. I presented those numbers to CareFirst, and they freely admitted they knew their policy in no way came close to covering a pregnancy. “It’ s a crappy benefit,” one rep admitted to me.

And this is if women can get coverage for her pregnancy with an "opportunity to buy additional coverage—known as a “rider”—to tack a maternity benefit onto your plan. It’s almost always only available in anticipation; if you try to buy the rider once you’re already pregnant, the fetus becomes a 'pre-existing condition.'"

What Sarah's story shows is that we often think of different kinds of care not getting covered by insurance because it's experimental or unique. Sarah's lead shows this:

Our six-month-old daughter cost over $22,000.

You’d think, with a number like that, we must have used fertility treatments—but she was conceived naturally. You’d think we went through an adoption agency—but she is a biological child. So surely, we were uninsured.

Her experience shows precisely how screwed up our system is now. It's not risky proceedures or unique circumstances that aren't covered by insurance. Instead, insurance companies skimp on basic medical care that is commonplace.

Health Care Still on the Agenda

To be honest, I was relieved to see this column from Tom Daschle in the Washington Post today. A lot of people seem to be really worried that without Daschle in the seat at HHS or in the position at the White House, health care reform just won't happen. The impression I got, after seeing him withdraw from the nomination process, was that Daschle was The Guy and now we're screwed. It was a logic I didn't quite follow. If that were the case, and Daschle were the only person availible to make health care reform happen, then that would have said a lot about the lack of commitment to such an issue.

But that's not what the situation is (or at least I hope not). Daschle himself says:

The pundits were wrong because of the president's unwavering commitment to this issue. "Health-care reform cannot wait, it must not wait, and it will not wait another year," he said last month.

They were wrong because of the broad support for health reform in Congress. "Republicans are coming to the understanding that their opposition to universal coverage is misplaced," Sen. Robert Bennett (R-Utah) recently admitted. Sen. Edward Kennedy (D-Mass.) has promised: "We will not fail."

The pundits were wrong because reformers have some new and unlikely allies. "This is a great start," former Republican congressman Billy Tauzin, now president of the leading pharmaceutical lobbying group, said at the recent White House Forum on Health Reform. "You have our commitment to play, to contribute and to help pass health-care reform this year," said Karen Ignagni, chief executive of the major insurance industry lobby.

But the biggest error those pundits made was in thinking that the debate over health-care reform would be decided by who occupies certain positions in Washington. It won't. It will be decided by the American people. And at the Forum on Health Reform, those voices were finally heard.

In other words, there are a lot of people that are working on this issue. And it's getting to the point where all of the arguments that businesses and the insurance lobby used in the 1990s to stall health care reform just aren't relevant or strong anymore. People want this. And it won't just be Daschle that makes it happen.

Health Insurance and 'Choice'

I agree with Scott Lemieux, and thought this column by Eugene Robinson today was kind of weird. Although it seems to strengthen Robinson's resolve for some kind of health care reform, as Scott says, there's a weird moment at the beginning where he talks more about choice. It was heavily hinged on his personal experience with a bacterial infection and right before he went into surgery, his doctor said to him:

"You know, if you and Obama had your way with health care, it wouldn't be me doing this operation. It would just be some guy."

At the end of the column, Robinson says this:

What's changed is that I also feel more strongly about the ability to make my own choices. I decided where I would be treated and, ultimately, what would or wouldn't be done. I'm willing to pay for that, too.

This reasoning always baffles me. In an attempt to tap into libertarian sensiblities (or whatever it is) people who promote "individual choice" in health care seem to completely ignore the fact that most people don't get to choose their doctors already. Most health care plans have something called "in network" doctors and "out of network" doctors. You certainly can "choose" to go to an out of network doctor, but that would be crazy. You would end up paying hundreds -- or, more likely thousands -- of dollars for your "choice." So you go to the doctor outlined on your insurance providor's website. We should just stop pretending that now everyone can choose whatever doctor they want.

Jindal on Health Care

I also watched Bobby Jindal's response to Obama's not-state-of-the-union speech last night. One thing, among all the pretty weird things in his speech stuck out to me:

To strengthen our economy, we also need to address the crisis in health care. Republicans believe in a simple principle: No American should have to worry about losing their health coverage -- period. We stand for universal access to affordable health care coverage. What we oppose is universal government-run health care. Health care decisions should be made by doctors and patients, not by government bureaucrats. We believe Americans can do anything, and if we put aside partisan politics and work together, we can make our system of private medicine affordable and accessible for every one of our citizens.

It's an obvious point that probably a million people have made by now, but the reality is that patients aren't making decisions about their health with just their doctors. It may not be a government bureaucrat that's making decisions about what kind of treatments you have (unless you're on Medicare or Medicaid) but it is an associate in an insurance office that's approving or denying a medical procedure.

The idea that a doctor and a patient are making sound decisions about your medical future is a nice one, but it's not very realistic. After all, few people can actually pay for the medical procedures they need out of pocket, so what they need is an insurance company or a public plan to pick up the rest of the cost.

Jindal's speech revealed a lot of the right-wing criticisms we're probably going to be hearing about health care reform in the next few months or years. Prepare yourself.

Dear Gossip Blogs: Elizabeth Edwards Knows Things About Health Care!

Well this is annoying. Campus Progress, our sister organization, sponsored an event with Elizabeth Edwards and Ezra Klein to talk about health care on Monday. Since then, the story that has come out of the event was that– gasp!–Edwards wasn’t wearing her wedding ring (presumably fallout from her husband’s messy and publicly exposed affair).

Megan said it first, but I’ll second it: Edwards is a smart, wonky person who knows her stuff when it comes to health care. As a victim of breast cancer, she’s had some invaluable up-close-and-personal encounters with the health care system. She’s critical of both the health care plans proposed by the major party candidates and is a committed advocate of comprehensive health care reform. How obnoxious, then, that after an hour-and-a-half discussion about the intricacies of the health care system all anyone can talk about is her personal life.

I’ve said it before, but quite frankly John Edwards’ affair and the fallout from it is none of the public’s business. It’s clearly a very private issue, and it’s a shame that the gossip blogs have seized on this. And if we’re really honest and take a long hard look at this, affairs aren’t all that uncommon. They happen to people every day, and have for centuries. To single one family out for public judgment is unfair and unwarranted.

Yes, I know that this is what gossip blogs do, but come on, people. Rather than pegging her as a victim, we should allow her to do her public work. Edwards is an intelligent human being with a lot to say about one of the most important issues today. Can we at least acknowledge that she deserves credit for that?

Cross posted at Pushback.

Women and the Individual Health Insurance Market

Via Megan at Jezebel. So the New York Times reports something that I wrote about last week: The individual health insurance market is much more expensive for women than it is for men. Thanks to a report by the National Women’s Law Center, people are discovering that insurance companies are charging higher premiums–and often skipping out on key pieces of coverage like maternity care–for women that buy their insurance on the individual market. This graphic that the Times produced shows how women pay more across the board even if they live in different locations or are in different age groups.

There are some states that have already legislated regulation that bans gender bias, but many states don’t. Even fewer require maternity coverage on the individual market. And perhaps the most shocking part of the NWLC report is that in nine states and the District of Columbia, it is still legal to deny coverage for a victim of domestic violence–on the grounds that it is a pre-existing condition.

The reason that you won’t find such biases in employer-based coverage is because the courts have determined that many of the non-discrimination workplace laws (including the Pregnancy Discrimination Act of 1978) also apply to employer-sponsored insurance coverage. So it seems that those same protections need to exist on the individual market, even though only about 7 percent of women get insured that way. Far more women–about 18 percent–are uninsured, perhaps because it’s so expensive to buy coverage on the individual market.

Cross posted at Pushback.

Health Care Wonkery

Yesterday I saw a pretty wonkarific health care event with Ezra and Elizabeth Edwards. Here's a crappy little video I filmed with my digital camera and edited with iMovie, but the full professional video can be seen here.

Health Care Reform and Women

Today I'm going a bit off topic to talk about how the proposed health care reforms might help or hurt women in the next administration in my column over at RH Reality Check. It gets pretty wonkariffic, but it really gets into the nuts and bolts of how women -- who tend to use health care very differently than men -- may see changes in their heath care if there are future reforms:

Republican presidential nominee Sen. John McCain's plan promotes the individual health care market. Currently, Americans pay for employer-sponsored health care premiums with pre-tax income. McCain's plan would require workers to pay for insurance out of post-tax income; his plan would offset this by extending a tax credit of $2,500 for individuals and $5,000 for families. This tax credit can either be applied to a person's employer-sponsored plan or to one on the individual market. Additionally, McCain calls for opening up options by allowing people to purchase health care plans from providers in other states.

But this push to the individual market isn't optimal for women. According to a report recently released by the National Women's Law Center, women have a hard time finding equitable coverage on the individual market, often paying more and getting less. Right now about two-thirds of women get coverage though an employer, 16 percent of women get coverage through public programs like Medicaid, and just 7 percent of women currently get coverage through the individual market.

Of women who bought insurance on the individual market, the NWLC report found that they pay more in monthly premiums at almost every age than men--6 to 45 percent more for women aged 25 and 4 to 48 percent more at age 40. How can this be legal in the individual market and not in employer-sponsored coverage? Courts have ruled that Title VII of Civil Rights Act applies to employer insurance coverage. Only ten states prohibit such discrepancies in individual market premiums, and two states limit it.

Read the whole thing here.

Obama’s Health Care Plan

Today Kaiser Network had a webcast with David Cutler, health care adviser to Barack Obama and a professor of economics at Harvard. (Kaiser will broadcast a similar discussion with McCain’s adviser Jay Khosla next week.) Cutler talked about some of the details of Obama’s plan to reform health care.

• The plan puts a big emphasis on revamping information technology in health care. The idea is to subsidize smaller provider’s switch to digital record keeping so that records are more holistic and transferred more easily. The goal is to reduce mistakes in treatment due to incomplete medical information.
• The plan doesn’t include a mandate, meaning each individual wouldn’t be required by law to carry insurance coverage, but the goal is to reduce costs so that individuals have options to buy into an affordable plan.
• Although the plan calls for an investment of $50-65 billion a year at the outset, ultimately part of rising national debt is related to skyrocketing medical costs, so the hope is to reduce costs in the long run and actually save money. Obama’s plan hopes to save those with private insurance about 8 percent per year.
• The plan wants to put a greater emphasis on preventative care. Cutler noted that roughly three-quarters of medical costs are spent on treating preventable illnesses. Changing the system to emphasize preventative medicine would require incentives for doctors to make follow up calls to patients, create comprehensive treatment, or invest in electronic medical records.
• Cutler insists that Obama’s plan isn’t rigid because he wants to bring many groups to the table to discuss priorities and care and ways to alter the current health care system.

Many feared that health care would fall back on the candidates’ list of priorities because of the expensive bailout plan. But given that both campaigns are willing to sit down and discuss their health care plans in greater detail, it appears this may not be the case.

Cross posted at Pushback.

Paying Attention to Mental Health

Yesterday, amid all the wrangling over the debates and the bailout bill, Congress managed to pass a long-overdue bill with bipartisan support. The bill, once championed by the late Sen. Paul Wellstone, requires private insurers to provide benefits for mental health treatment to equal those of physical ailments. The bill’s chief co-sponsors in the House, Rep. Jim Ramstead (R-MN) and Rep. Pat Kennedy (D-RI), have both experienced problems with addiction firsthand.

Although the legislation still only addresses the mental health of those already insured, it signals a significant change in the way we approach health care in this country. There has already been an effort to include preventative care in health insurance plans, but sometimes the best way to address health care is to pay attention to other problems that are typically classified as “mental problems”: depression, anxiety, alcoholism, or drug addition. The last thing to add to such struggles is hours of wrangling with insurance companies.

Cross posted at Pushback.

Hillary Clinton's Speech at the DNC

That was probably the best speech I've seen Hillary Clinton deliver. I think now, after calling for unity in the party, she sees her role as putting health care reform at the top of the agenda. In the speech, she hinted that she would be pressuring Barack Obama to include a mandate on health care reform if he's elected.

Also, her shoutout to Michelle Obama was amazing, and made me want Clinton to depart endless amounts of wisdom to Michelle should she become First Lady.

Harry and Louise: the Remix

Via Wonk Room. The ad largely credited with killing health care reform in the 1990s starred Harry and Louise, sitting at a kitchen table talking about how they didn't like health insurance plans drummed up by the "bureaucrats" in Washington:


But now, Harry and Louise are back, lobbying for health care reform:


The ad is funded by the Cancer Association Network, Families USA, the America's Hospital Association, the Catholic Health Association, and--probably most surprising of all--the National Federation of Independent Business, a small business association that's historically been to the right of the Chamber of Commerce.

Small businesses seem to be terrified. They increasingly can't afford to pay for insurance plans and have joined major national coalitions in lobbying for universal coverage. It's an interesting shift in the health care debate, and seems to suggest that real change might be more possible than it was in the 1990s.

Cross posted at pushback.

Living with Vulvodynia

There's a great (anonymous) personal account on Feministing of living with a form of vulvodynia, or a chronic and unexplained pain in the vagina that makes sex pretty much impossible. The detailed account of her treatment is a wonderful look into what it's like to live with this little-talked-about condition. But she's grateful:

Most people with vulvodynia and vulvar vestibulitis don’t have it as easy as I did, with relatively good health insurance, good care, and a partner willing to invent endless jokes about “vestibules” to make me feel better. My physical therapist told me about a very conservative religious patient who’d begun to experience vulvodynia after losing her virginity to her husband on their wedding night; the husband had just left her after 7 months of sexless marriage. Another couple she knew split up after about 7 years of painful sex. Fifty years ago, we all would have been called frigid and psychoanalyzed to death; 500 years ago, we might have just avoided sex our whole lives. Even now, with more public discussion of vaginal disorders in the health care community and in the media, there’s clearly a long way to go in terms of awareness and understanding before vulvodynia will come out of the closet like male impotence did (and, of course, since there’s no drugs for vulvodynia yet, we don’t have Big Pharma on our side making normalizing ads).

I highly recommend reading the whole thing.

Health Care Recession

Via MM, it seems that Minneapolis Mayor R.T. Rybak is raising concern about the city's "most important industry" -- health care. It seems he's worried that health care isn't recession-proof. This makes sense to me. Because our health care is so tied to employment, it makes sense that when fewer people are employed, they go to the doctor less. After all, people will still go to the hospital for all of the necessary emergency room kind of treatment, but there are plenty of other kinds of treatment people will forego without health insurance from an employer. Because we've put so much faith in the market when it comes to health care, that industry is just as likely as all others to be threatened in a recession.

Health Care Advocates

Something like this demonstrates the extreme disparities we have in our health care system today. There is now a profession where you can charge $150 an hour, $3,000 a year, or $30,000 for a lifetime membership to someone who can consult with you on your medical services. That's all well and good, but there are people out there struggling to buy and receive medical care out there, so why are we creating new professions for the affluent to navigate this care? Shouldn't this be a model we use for the low-income people, who have to fill out endless Medicaid forms and don't even know where to go to the doctor when they're sick? It kind of shows how fucked up things are.