Saturday, March 3, 2012

More on the Fluke thing

As Beverly Mann points out, it's not even clear what the hell people are talking about when they jabber about how "we" are going to pay for Fluke's birth control. Mann writes:

"The government doesn’t pay student medical insurance premiums; the students do. Nor does the government pay the medical insurance premiums of employees at any of the other employers who will be obligated under the ACA to provide minimum healthcare benefits; the employer and the employee together do. That, of course, is what’s caused all the controversy about whether it violates freedom-of-religion guarantees of the government to require that the healthcare insurance that Catholic universities hospitals and charities provide their employees include contraception. If the government were paying these premiums, this controversy wouldn’t exist."

Fluke may never get what she wants. She did, after all, accept the offer from Georgetown with full knowledge of the terms of the health insurance. But I see nothing wrong with drawing attention to this, nor do I see anything wrong with trying to change Georgetown's mind over this. Any responsible employer or school providing group insurance ought to discuss these things with their employees or students. I'm sure readers who get their health insurance through employers or schools have experience with these sorts of internal discussions of coverage and contracts with insurance providers.

So what are Limbaugh and Boudreaux thinking exactly? I'm not sure... is it about a low income subsidy or something like that? I just don't know, and they apparently don't feel the need to elaborate.

This isn't a unique concern for Fluke at Georgetown. Kate got into her master's program at Georgetown in our senior year at William and Mary before I heard back from the Urban Institute, and the issue of whether she would have to get her insurance through Georgetown (and therefore loose coverage for contraception) came up. Fortunately, I did get a job with Urban and they provided great coverage and domestic partner coverage so Kate would be covered before we even got married. Not everyone was so lucky - we had a lot of friends who attended Georgetown because of the excellent education provided there, but who struggled on the health insurance front as a result.


  1. The entire issue of healthcare would be mitigated greatly if we didn't receive it from schools or jobs. Once we can look at different policies and choose precisely what we want personally, there's no squabble. How many student protests have there been for liability insurance? How many for hurricane insurance?

    1. People want a guarantee for something this major - they want it as a part of their compensation package. The average health insurance cost for a family are something like $13,000 last I heard. The average car insurance costs are under $1,000. And you can justify going without a car in a way you can't justify going without health insurance (particularly if you have kids).

      I agree there are big problems with employer provided insurance, but I think it's perfectly reasonable that people would want the group bargaining benefit and that they would want this as part of their compensation package.

  2. Daniel, employees who are not using contraception are now paying for part of the cost of those who are. Just like, if you forbid charging smokers higher premiums, you are forcing non-smokers to pay some of the cost of smokers' heart attacks. You may or may not like either subsidy, but it is straightforward that there is some subsidy involved.

    In equilibrium, A) previous insurance + contraceptive coverage - salary reduction = B) previous insurance

    The employees who prefer B) or subsidizing those who prefer A) if A) is mandated.

    As you know, I am not a market fundamentalist: sometimes, we want to run such a subsidy, says I. But it is a subsidy.

    1. This is all quite true - indeed it's the whole point of insurance. But if this were what everyone was referring to, I'd think they'd be using the third person plural rather than continuing to use the first person plural.

    2. This is all quite true - indeed it's the whole point of insurance.

      No, someone wanting the group to defray her costs for a pre-planned expense for something that (in many cases) is a lifestyle choice, is not "the whole point of insurance." That's partly what bothers me about this whole thing; people have forgotten the original "whole point of insurance." You have car insurance on the off-chance you get into a bad collision. You don't have car insurance to pay for your oil changes.

      And btw, Rush Limbaugh is a jerk and I can't believe people are defending him without a paragraph of caveats saying what a jerk he is.

    3. Same with doctor's appointments (like checkups). Should doctor's appointments not be covered?

      I don't put much stock in this argument. Different insurances do things slightly differently. Title insurance is this way too, and they get a lot of flack because such a small portion of their premiums go to claims. In title insurance you're not insuring against small-probability, high-cost future events either. Who cares if not everything functions like car insurance? Is there a reason it should?

      One way to look at it is that checkups help you manage your health and your body to minimize future costs (financial or otherwise). Contraception does precisely the same thing. It's a maintenance/management cost.

    4. I of course agree with you entirely on Limbaugh, Bob - and I'm glad we're on the same page.

      There is a way to disagree on these issues. One can do it without even mentioning Fluke. When Limbaugh crossed that line, piling on Fluke and calling her uncivilized is just giving cover to Limbaugh. Any decent person is going to come to Fluke's defense, not say "well, he had a point...". You don't have to agree with Fluke to refrain from validating Limbaugh.

    5. A much simpler solution would be to make birth control pills, etc. an OTC drug.

  3. Daniel OK I realized after I posted that insurance companies could have a legit interest in avoiding expensive future procedures (like childbirth), so maybe even in a "true free market" (a phrase that drives Callahan nuts) you might see contraception covered. However, that wasn't what Gene's point was, to which you said "that's the whole point of insurance." Gene was talking about some customers having to subsidize other insurance customers.

    I am prepared to admit that my analogy wasn't great, but I still think you are wrong for thinking Gene's observations are consistent with "the whole point of insurance."


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