Today is the deadline for comments on interim regulations by the U.S. Department of Health and Human Services on what constitutes a preventive health care service. This is relevant because under the new health care reform law, the Affordable Care Act, preventive health care services are supposed to be provided without cos-sharing such as co-payments and deductibles. (See fine print below.) Which somehow raises the apparently puzzling question as to whether contraception (defined as methods to prevent pregnancy) is preventive. Or related to health. The Administration isn't sure about this, and so has asked the Institute of Medicine to study it. I think this isn't really what the question is.
I think the question that has become obscured is this: Do Men Have Sex? I assert the following conclusion, based on substantial empirical evidence, though no new primary research: They do.
I further assert, and this is recent news as of the last few thousand years, that there are statistically zero pregnancies that occur without the involvement of sperm. This is most commonly supplied by a man known to the prospective mother, but could be supplied through artificial insemination, an asexual method accounting for about eighty thousand such procedures a year, resulting in the births of thirty thousand babies. There are about 4.2 million births in the U.S. every year.
I appreciate that it is women who become pregnant. I appreciate and am an active participant in the women's health movement. There are health conditions that actually occur only in women (cervical cancer) or mostly in women (breast cancer), and gender-related factors that determine our well-being, life chances, and longevity. I admire the Women's Health Amendment incorporated into the ACA to recognize these factors.
But I submit contraception, conception and pregnancy are biological events that involve both males and females; and usually, not to be coy about it, sex.
Now here is how the new regulations will work: Every other on-its-face preventive service will be provided without extra cost-sharing such as co-pays (unless provided as part of a visit for another reason, or billed separately as part of another visit, etc. - you didn't really think it was going to be that simple, did you?). Starting on Sept. 23. HHS was so eager to get this done that it is issuing interim rather than proposed regulations, meaning we can still submit comments but the regs will go into effect meanwhile. But for contraception, the IOM is going to have to determine whether it is really preventive, and related to health, and a service. That will take until August, 2011. Then, assuming that they do so affirmatively determine, it will be about another year before you get your IUD, birth control pills - or vasectomy - without an additional copay.
I submit that we in the women's health movement are going about this all wrong. Contraception is not about protecting women, at least not alone. Contraception is about the rights of men to have sex. In fact, contraception should be the corollary of every prescription for Viagra. In fact, that was the argument Jackie Speier used, successfully, finally, to get contraception covered by MediCal.
Men, whatever else you think about health care reform, I think most of you know and like your female partners. (And LGBT adoptive and assisted technology parents generally feel the same.) You share, at least, the financial and emotional expenses of child-rearing, to say nothing of pregnancy; and if you don't, well, we have laws about that, too. So drop a note to the EQUAL Health Network, and we'll let HHS know you know where babies come from. And you support recognizing this reality now, in 2010. They need your help. You're so big and strong.