Wednesday, August 15, 2012

Follow-Up to prev post - Women, Independence and Sexual Freedom

I received an interesting comment on my last blog post and instead of replying to the bulk of it in the comment section, I decided to do an entire new post about it. Here is the comment:

It's kind of like arguing apples and oranges when comparing Canadian healthcare to US. As a Canadian, you DON'T pay for your doctor's visit to get the prescription, and your pill is NOW covered by extended insurance in Canada. An abortion is covered by healthcare (not that I necessarily agree with that, that's just the way it is).

My understanding of the US issues are:
1) they pay to see the doctor to get the pill
2) the insurance companies are saying they don't have to reimburse for the pill if the employer (or school) providing the insurance doesn't want to.
3) the insurance company won't pay for your abortion, or, in some new legislative cases, the ultrasound required by law prior to obtaining same.

We're not talking a few hundred dollars here, I don't think, at least w/respect to #3.

These same insurance plans WILL, however, cover Viagra.

Something is seriously wrong with that, doncha think?
I responded to some of the Viagra section in the previous posts' comment box but will also respond a bit more now. To reiterate, it seems to be a common belief that Viagra is covered by most or all insurance companies, when in fact it is not. I have spent a fair amount of time over the past year looking up this info and I'm sure I have blogged about it before, or responded on other blogs, but the supposed prevalence of Viagra coverage trumping birth control coverage is sketchy at best. I am posting a link for because it is the same information that I found in several other sites HERE that dates from 2008 because that is obviously before the new health care law existed. Also keeping in mind that Viagra originally came about as a treatment for high blood pressure/hypertension, and there are still people who take it for THAT reason, and not directly for erectile dysfunction, so the numbers can be skewed slightly. Just as there are women and girls/teens who take birth control pills for menstrual issues such as extremely heavy or violently painful cycles, or even absence or near-absence of a cycle, instead of strictly for birth control. My friend was on them from age 12 and did not have sex until she was 18 or 19, because of a horribly painful monthly cycle that left her laying on the floor in pain. After starting the pill it was greatly reduced, thank god. I also know that some women in the armed forces take the pill continuously while they are serving overseas or on extended exercises so that they do not get their period during wartime situations. A military doctor told me that herself. So both items have uses other than what people assume, but those numbers are in the minority.

Getting back to coverage, everything I have found, even going through various companies' insurance docs, showed that more covered birth control than viagra, and more covered birth control continuously with no time limit or restrictions other than the obvious of one pack each month, while the same ones restricted viagra to low levels such as one to three pills per month for a short time period (max 1 year, 3 years, etc). I was completely baffled by how this information was available on the web and how I questioned my MANY female friends in the US to find that ALL of them had insurance coverage for birth control BEFORE Obama was a household name... and yet I see and hear endless remarks about how Viagra is covered, but not the pill. 

I even found lists of states that had full birth control or partial birth control coverage back in the 80s and 90s, let alone the 2000s. It was staggering - states that required insurers to provide coverage for BCPs back in 2002, 2000, 2007, 1998, and so on. No, not all companies cover it, but they dont all cover Viagra either. It is a misconception and I do not know where people are getting their information from, other than from other people who also got the info from hearing someone else, and on down the line we go. 

There is an interesting piece AT THIS LINK and if you go through the comments section, there are some interesting remarks and rebuttals to go through. It is actually about alternatives to pills like Viagra, but touches on insurance coverage and the comments go even more in depth. 
But enough about Viagra. The beginning of the comment I wanted to address discusses the cost of going to a doctor in the US, comparisons to Canada, and the too-general remarks yet again that insurance companies will not cover BCPs but will cover Viagra. It makes it sound like all of them are doing that, when it is far from the truth. Not even close actually, as seen in the above section.

Paying for the doctor visit - yes they do, if their insurance forces them to pay a co-pay. My friends pay anywhere from $0 to $20 per visit out of pocket with their copays. We pay for it too - before we even go to the doctor, through our much higher taxes. Or through monthly health care premiums in some provinces. I paid $66 a month for basic health care premiums in Alberta when i was a single mom, and then it went up to $88 per month (family rate) until the premium was dropped just a couple/few years ago, but I only went to the doc maybe 5 times a year total for the whole family. You could then break that down to say that I paid $211 PER VISIT to my doctor/hospital in all those years that myself and my children were not sick enough to see a doc or any other medical care. Alberta no longer has a monthly premium for basic health, but other provinces do such as British Columbia, and it is paid whether you use the system or not and you do not get a refund. Just something to keep in mind. 

Income taxes tend to be higher, GST on numerous items, and taxes embedded in each product we buy (which accounts for some of the higher prices we pay for the same goods even living close to the US border), and a portion of each tax we pay also goes toward our system. Gasoline tax, for example, has been listed at 35% in Canada, or between 10 and 20% of the price in the US, plus adding in that we tend to pay more for our gasoline, that is even more money going into the provincial and federal tax coffers, of which much goes to health care across the country. Each province handles their health care costs through taxes and/or premiums, with a transfer from the Federal taxes as well. It is difficult to pinpoint exactly how much Canada spends on Health Care as a portion of tax income, but it shows that Canada's spending a few years ago was at over 10% of GDP. That makes it sound quite small really, even though it is steadily increasing. But it should be looked at by how much of our tax contribution is spent on health care, since that is the largest wallet the system is paid through.... Federal, provincial, and dont forget that Municipal tax should also be included in that for it's contributions to hospitals, etc. There is a lot more going on than most people can even fathom, or bother to take the time to think about. The Fraser Institute has an interesting breakdown of tax costs to Canadians for the healthcare system HERE (pdf file). Some may roll their eyes at using the 'right wing think tank' the Fraser Institute gets branded as, but this link simply takes what Canada says it spends on health care per capita and breaks it down into what the individual working people and families actually end up paying toward it in the end. 

I have heard and read that Canada actually spends at least 40% of its tax income on health care right now and that it could increase to 80% by 2025 in some provinces. I have heard this many times. That is SCARY. I looked it up and there have been papers and information releases from govt officials such as provincial finance ministers (BC to name one) stating that at current cost increase and tax levels, they are projecting to reach 71% of their tax revenue being spent on health care by 2017. That's in 5 years, people. How on EARTH could we pay for everything else these taxes are supposed to cover if we only have 30% left to spread around?? Or less. That is scary and unreal. The US has been listed as spending MORE per capita on health care (about double actually) than Canada, but they want more things covered like contraception covered across the board now? What could that do to the system? Keep in mind that many insurance companies are govt based such as state, university, public servants, etc so a lot of that 'coverage' is going to come from the tax coffers, not from regular people paying their premiums into the pool. Is that going to be sustainable? 

The commenter above noted that birth control is covered now. Mine has always been, actually, back to the 80s, and it is still 100% covered now, through a private insurance company that my partner's employer made himself. He owns his oil and gas service company, and made his own health care insurance system instead of going along with ones like Sun Life. It is paid through their social club/premiums. But my friends that work for the govt and are paid their wages with our tax dollars, and pay for their insurance premiums into the govt Blue Cross system with our tax dollars, and pay the pharmacy $2 or $4 for fill-fees with our tax dollars, are not really paying anything 'new' into the system. It is all recycled tax income coming from fully private companies and individuals. I hope they say Thank You to all of us who are off the govt grid and pay our REAL income into the system for them to use.  But that is beside the point - people in Canada keep saying that they dont have to pay to see the doctor. 

We don't take a $20 out of our wallet and pass it to the receptionist in most cases, but we have already paid for it or are going to pay for it through our taxes. Personally, after so many years of my family being lucky and not having to deal with too much illness, I would rather have a lower tax rate and use that money each month on food and items for my family, and pay my doc $20 at the door if I do have to see him. Just a 1% drop in my income taxes each month would give me an extra $15 per month to spend how I wanted. That does not sound like much, but if my family keeps at the rate it has been going, I could have an extra $45 in my bank and pay $20 every 3 months to see the doc, and keep the extra $25 left over for myself. I would be willing to pay an actual user fee to my doc as a copay in exchange for a very minor tax decrease. Or to at least have the choice. Maybe a family with sicker members would choose to keep the higher tax rate and not have a copay at the doc, and another would choose to do the copay. Why not have that choice? If you factor in what my partner pays in taxes each month, a 1% decrease would mean an extra $50 per month on top of my $15 that we would have. An extra $65 a month total to use how we wish. That could cover a lot more copays if it became necessary, or could mean a savings of $175 every 3 months if we only went to the doc on our current schedule. That's an extra week's worth of groceries, which means a lot to a family of 5 with a grandson on the way. I would love to have such a choice.

In the case of abortions, while it is covered in Canada and there is no time limit in which to have one (ex by 12 weeks, 20 weeks, etc), it is not exactly easy to get it done. In my city serving over 100,000 people, NO doctors perform abortions. Patients must travel to Calgary (or perhaps one city that is closer, but I have not heard that they have started this service), and the further a woman is along in her pregnancy, the harder it is to find a doctor willing to perform it if there is not an extreme medical issue. A woman I know just had a termination a couple of years ago after learning at 5 months gestation that her infant was extremely ill and would most likely not survive. She had to travel 3 hours to get this done, after having several appts up there, even though we have a perfectly good hospital with plenty of surgeons and ob-gyns right here. So while Canadians may state that we dont have to pay directly for abortions, it is not as simple as showing up at the hospital and booking an appt. If you are a woman who is 8 months pregnant and just dont want to have the baby, you may have to travel a very very long way to find a doctor willing to perform such a thing. 20 years ago, the clinics in Calgary would not perform an abortion past 12 weeks unless it was a medical emergency. I know because I went there with a pregnant friend 3 times for her counselling sessions and she just made it under the deadline at 11 weeks. If she went past that, she was told she would have to make arrangements to travel to Vancouver or Toronto for an abortion. I do not know what is available today, but that is an example I can give from personal experience. 

There are also other problems associated with a 'universal' style system (though Canada does not actually have this, many people refer to it that way). For example, I lived in a small town when I had my second child, and there was no ultrasound machine. I had to travel 2 hours away and was only allowed to have ONE ultrasound unless there was reason to believe there was a serious problem. My choice to live in a small town, but my point is that perhaps if people had to pay a small fee for this, for example anything beyond the alotted 'one' ultrasound, the smaller hospitals may be able to save up for their own ultrasound machine. They are quite portable and small now, and maybe that would be a great thing for small hospitals to invest in, but with only public dollars coming in, it's low on the list of priorities. Ultrasounds can be used for all sorts of things - ive had them done on my heart and liver and kidneys. It's not just for babies obviously, but many places do not have one when they should by now. Perhaps it is unfair to require an ultrasound before performing an abortion and then charging for it - but how else is this equipment supposed to be paid for? How big a chunk of tax income should be put towards this sort of thing when there is a vast multitude of other places this money is supposed to go as well? Roads, postal system, bridges, other social care, pensions, welfare, income support, schools, hospitals, universities and colleges (and all of the staff, buildings, utilities, etc used in each of those places), etc. How much of our system can be poured into medical care and still keep us afloat?

People are screaming about contraception coverage when there are children fighting cancer who's families travel far and wide to find good care and are having a very hard time with the logistics of it all whether they have coverage or not. There are diseases out there begging for a cure or treatments that are not so harsh. People with a wide range of disabilities who are trying hard to keep their heads above water. And here we are ranting and raving that birth control pills should be covered across the board. It makes me sick, it really does. Some ED users have had prostate cancer and survive, only to discover that a body part no longer works. Many women who have had breast cancer and needed radical surgery can get their breast re-formed or get prosthesis covered, but men are wrung through the ringer if they want to try Viagra after such an incident and get it covered. If a woman loses a breast to cancer, does she need it to be rebuilt for health reasons or for how it looks. I say YES to health reasons because mental health and well-being is very important, in my opinion, but it is also why I do not have a problem with men using ED medication (for the right reasons, not those who abuse it obviously), and do not have a problem with them getting coverage. Mental and emotional health is important and I believe it can affect your physical health greatly. So why not cover it? Covering birth control pills for their main intended use does not fall into mental and emotional health to me. If you call 'wanting to sleep with someone but fear getting pregnant' a mental health issue due to fear, then fine, we are not going to agree. But if I break it down and look at the intended use of each product, all I can see is that birth control pills allow you to have sex without fear of getting pregnant if used correctly,  while ED drugs treat an actual physical problem that is very obvious to the person requiring the medication. Is the possibility of getting pregnant a physical PROBLEM? A medical PROBLEM? A disease? An infection? The result of another physical problem such as diabetes or blood pressure or obesity? No, pregnancy is not any of those things. It is the natural condition of being a woman, has been and always will be. It is not a medical problem, which is where  I think that the comparison between viagra and BCPs goes off the rails. 

It could BE a problem if a woman gets pregnant and falls ill but it is impossible to know that until it happens and it is quite rare. But if it is dangerous for a woman to become pregnant for some medical reason and this is known, I think her BCPs should be covered. Or perhaps she would consider another option such as a uterine hysterectomy, leaving ovaries intact for hormones but taking out the uterus. Who knows, that would be up to the individual patient. But if it is coverage wanted for having sex and not wanting a baby to result, I do not see why this is considered a medical need and why so many women are shouting about it. Using obscure 'facts' about viagra coverage when not discussing what the drug is actually used for, and suggesting that not wanting to get pregnant while having sex is more important than an actual medical problem, bothers me. 

I remember Sandra Fluke talking about a couple she knows who was sitting down to do their budget and realizing that they could not afford the woman's contraception - oh boooooo hooooooooooo. I want to know what else was on their list of priorities, put before birth control, before I feel sorry for them. The audience looked sympathetic during Fluke's speech but I wanted to see her friends' budget. Do they have cable tv on there? Telephone? Cell phone? Do they eat out a lot or at home (at home is far cheaper of course)? Do they have Netflix on the list? What area of the city did they choose to live in and how much was their rent? Could they move to a cheaper home instead? What exactly did they have on that little piece of paper than ended with not having enough money for such an important item as birth control? We will never know because of course that information will never be shared. But I think it is extremely important to know something like that before making a decision of whether to feel sorry for them or not and help pay their prescription choices through tax dollars, don't you?

If I was ranting about wanting my prescription covered by the province so I could avoid a higher premium on my private insurance, would it make a difference if you knew I was spending $30 to $50 a week on cigarettes? I might want to stomp my feet and demand, for my womanly health, that I receive free bcps like in the UK, while puffing away on my third pack this week. Would that make you think differently about what some of these other women are asking for? If you discovered that I was paying $300 a month for ciggies, but getting my $30/month prescription for free after a long fight to get it, would you support that? What if I didn't want to pay $30 a month for my pills, but paid $80 a month for the new uber high speed internet, or $120 a month for my high speed net and HD tv package (I don't have that, but since I got another note in the mail today from my cable company trying to get me to buy it, I am using it as an example), would you still feel the same way about my apparent rights to free birth control for my health and be happy to continue paying taxes to support myself and others like me? Just so you know, I am no longer on the pill because I had my tubes tied after having 3 kiddos, but it would be covered if I was on it. My operation was covered as well, but I had no real choice in the matter since there is no private clinic around here. But I was also extremely ill during all three pregnancies and the last one nearly resulted in the death of my baby, and he had to be born 7 weeks early, so tax payers covering the cost of my operation could be called a medical necessity rather than just a choice. But between my partner and I, we paid over $66,000 in personal income taxes, let alone product and property taxes,  between the birth of my second and third children, so maybe we paid for it ourselves eh?

It's just something to think about. I also recently spent some time looking at various city and state Planned Parenthood sites in the US, trying to find out how much women would have to pay out of pocket if they went there for the pill prescriptions. Most had lists of breakdown pricing based on the woman's income and their costs ranged from $0 to $20 per month for the pills. I also found a HUGE number of planned parenthood clinics available in 1 hour diameters on the maps, sometimes 14 different clinics all within an hour's diameter. Whoa. Lots of places to choose from, and not needing much, if any, copay either. These things were available for eons before the current President took his spot in the White House, so it's not all new and based on his healthcare plan. Maybe if a woman does not like what her doc and pharmacy are charging, she can head on over to planned parenthood. There are current issues about funding cuts to the program, but there are also other clinics out there that pass out free condoms like candy if you are really stuck. Or put a couple bucks in a vending machine and you are set to go for that night.
In an entirely different issue, why do women have to pay for their feminine products like tampons or pads? This is something we do not have a choice about, it happens to the vast majority of us, and if not properly protected or unable to afford the constantly rising product prices, it leads to very uncomfortable, embarrassing, and distressing situations. It was difficult being a single mom and having to pay $20 a month for those products. I think I got some from the food bank once when I asked about it, but the woman said they very rarely have those on hand to give out. Why not? Some women have very heavy cycles, myself included, that are a huge pain in the neck and cause problems from time to time when accidents happen. But we have to pay for them and they are not cheap! The only way I could assure myself of not dealing with it would be to have my ovaries removed, which leads to other medical issues like hormone problems, early menopause, and obviously interferes with the wish to have a child. I think that's a pretty important product but we are slaves to whatever the companies want to charge. Some girls get it at 8 or 9 years old and it depends on their parent's income for what products they can use. I have had to borrow money and scrape together change when my cycle went wacky and showed up early, before my pay day. It's unpleasant to deal with when you are on a low income but it doesnt come up in mainstream news. I would rather that low income women had help with that than the pill, to be honest. They have no choice but to deal with this monthly issue, it is a happenstance of being born a female, as is pregnancy possibilities. But at least a woman has a true choice 99.99999% of the time over whether to have sex and get pregnant or not, where there is no option for menstrual issues. Why not have a big fit about that and talk about it in front of Congress? Maybe that day will come, but right now it's all about the female right to have sex and have free or cheap contraception choice and coverage. I think if you are going to go that far, tampons and pads or other such products should be considered a medical health item and be offered under insurance coverage. If you are shaking your head at that comparison, why? It would cost a hell of a lot to the system but it is something almost every woman has to deal with every month for 40 years and is something that directly affects their life and is caused by their body - aka health- with no choice in the matter.

And why do we have to pay for food, anyway? We would all absolutely die if we did not eat regularly, and drink water, so why do we have to pay for that stuff? Why isnt everyone given an amount of food that would sustain their life each month or week or day, and anything you want to eat over and above that amount each day would come out of your own pocket. If that sounds ridiculous to you, but you feel that birth control pills are essential to women's health, then we have a serious disagreement on our hands.

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These are my views and opinions. If you don't agree or think I am sadly misguided, that is your view. Feel free to share your thoughts but I also reserve my right to moderate content (IE foul language, excessive flaming, etc).