“Family Planning and Health Care Reform: The Benefits and Challenges of Prioritizing Prevention.” Rachel B. Gold. Winter 2009.
http://www.guttmacher.org/pubs/gpr/12/1/gpr120119.html
In the midst of health care reform, the success of new biotechnologies is being threatened by the possibility of exclusion from the new health coverage. As the government deliberates over what should be covered in this publicly funded plan, new and innovative methods of birth control could easily go by the wayside.
It is an indisputable fact that abstinence-only sex education is ineffective in preventing pregnancy.Therefore, it follows that a health care plan that ignores the need for basic gynecological care and birth control contradicts itself when the politicians in power attempt to prevent inclusion of coverage for abortions. While all of the methods of birth control covered in this blog can be incredibly successful in preventing unwanted pregnancies, they will not be used by women who cannot afford them. Although Federally Qualified Health Centers are currently successful at providing contraceptives to their patients, this model of health care is not available to many women, and doctors in private practice will often shy away from accepting patients on Medicaid because the reimbursements will be nowhere near their regular fees. Under the current health care system, only 27 states require coverage for all FDA approved contraceptive medications and devices. Even among these states, 20 have legal exceptions for all organizations with religious affiliation. It is disturbing to think that so many women lack essential items involved in modern sexual health. The image below clearly displays the unacceptable insurance gap that exists among women in the U.S. based on economic standing. Thus, addressing the need for universal coverage must come first in the debate over health care reform--next should be the issue of determining coverage of birth control biotechnologies, which indeed are a necessary portion of health care.
“If the Obama administration and key members of Congress are consistent about one thing, it is that the health care reform they seek for the nation must place a high priority on prevention,” and, currently, health insurance “is still largely based on a curative model that emphasizes ‘doing’ rather than ‘talking.’” Ignoring the need for birth control coverage is counter-productive, since the costs of providing preventative care are miniscule when compared to the amount of money that the government must pay to support these children: for every dollar that is spent on pregnancy prevention, $4.02 is saved in later costs to taxpayers.
Moreover, an extensive and effective course of treatment and consultation must be attained to guarantee maximum benefits for the patients. Thus, the "talking" role of doctors should be emphasized in the future of health care, with physicians discussing all methods of birth control with patients--as discussed in the example article concerning misinformation about Plan B. The current health care system, in which patients are shuffled through an office as quickly as possible, and many doctors are compensated based upon the number of procedures they complete, not upon the success of their care, is not conducive to a successful, widespread implementation of birth control coverage. Because women are often not satisfied by the first method they try because it is too difficult or inconvenient to use on a regular basis, they often have to return for multiple visits and work with their physician to find a type that works for them. These visits are not profitable for the doctors, as they only receive a consultation fee, which is usually less than they would receive for other types of appointments they could schedule during that time period. There must be a change from this current method of compensation if contraception is to successfully be made widely available.
While it seems clear that contraceptive coverage is necessary for a successful health care plan, the question of what types of birth control and how many choices the government is required to cover still remains open. Even though private health care plans have the luxury of providing a broad range of options, ensuring that the women they cover have the opportunity to use the method that will be most successful for them personally, a publicly-funded plan may not have this luxury. The higher rates of unintended pregnancies and abortions for women receiving care from public family planning centers is depicted by the chart below. However, because the costs of supporting the children produced by these unwanted pregnancies is so high, it likely would be more cost-effective for taxpayers if women are provided a broad array of choices and can select the one that they are likely to use successfully.
Yet, the topic of new health care legislation is complicated further by opposition presented by major religious groups towards government funding of birth control and future developments that would encourage widespread use of contraceptives. This ethically charged debate is rooted in the question of when life truly begins—and it thus is closely tied to the subject of abortion. For years, government officials have tended to dodge the abortion controversy, and now, with health care reform looming in the near future, they have put birth control to the side in another attempt to avoid stirring the pot regarding morality and religions. However, one must ask how these wealthy individuals have managed to avoid having large families. With their immense salaries, it is most likely that they had no problem affording birth control within their own personal situations. So, if a majority of the American population embraces use of birth control, shouldn’t all individuals be granted access to the wide range of contraceptive technologies? Pro Choice America states that "Contraception is basic health care and should be treated as such as a matter of public policy." Indeed, while it might heighten tensions among religious organizations, one must consider the great benefits that can be reaped from such liberal legislation.
The field of birth control is a sustainable technology, for women will always need to prevent undesired pregnancies. However, the survival of new and experimental methods, such iRNA, Essure, and male contraceptives, depends upon their coverage in future health care plans. These types of birth control are likely to be too expensive for most to pay for out-of-pocket, so they will not succeed unless covered by insurance. Because the proposed health care plan is currently skirting the issue of contraception, these new innovations are in serious danger of going to waste. For now, we can only hope that perhaps the reform in health care will at least guarantee coverage of the most predominantly used methods of birth control, like the patch, the pill, surgical sterilization, and IUDs for all citizens. Yet, the perfect situation would grant these birth control biotechnologies which are still in phases of research the optimism that they may one day be offered to all. Current scientific developments offer a huge amount of promise in the field of effect contraceptives, but actually reaching the consumer is the only major gray area that remains. Who knows what the future may bring in biotechnology of birth control--and the legislation that governs its use?
Additional sources:
