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 Post subject: Obama Offers "Accomodation" On Birth Control Rule PostPosted: 2012-02-11 02:45pm
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Rule Shift on Birth Control Is Concession to Obama Allies
Stephen Crowley/The New York Times

President Obama offered “accommodations” to religious institutions on the new health insurance rule Friday, with Health and Human Services Secretary Kathleen Sebelius, left.
By HELENE COOPER and LAURIE GOODSTEIN
Published: February 10, 2012

WASHINGTON — For the White House, the decision announced Friday to soften a rule requiring religious-affiliated organizations to pay for insurance plans that offer free birth control was never really driven by a desire to mollify Roman Catholic bishops, who were strongly opposed to the plan.


Rather, the fight was for Sister Carol Keehan — head of an influential Catholic hospital group, who had supported President Obama’s health care law — and Catholic allies of the White House seen as the religious left. Sister Keehan had told the White House that the new rule, part of the health care law, went too far.

“I felt like he had made a really bad decision, and I told him that,” Sister Keehan said of the president. “I told his staff that. I felt like they had made a bad decision on principle, and politically it was a bad decision. For me another key thing was that it had the potential to threaten the future of health reform.”

Mr. Obama announced that rather than requiring religiously affiliated charities and universities to pay for contraceptives for their employees, the cost would be shifted to health insurance companies. The initial rule caused a political uproar among some Catholics and others who portrayed it as an attack on religious freedom.

Meeting with his top advisers in the Oval Office last week amid rising anger from Catholic Democrats, liberal columnists and left-leaning religious leaders — a fed-up Mr. Obama issued an order meant for Kathleen Sebelius, the secretary of health and human services. Ms. Sebelius and agency lawyers had initially told the president they needed a year to work out a compromise that had seemed obvious to some in the administration from the start: make the new rule more like that offered by the State of Hawaii, where employees of religiously affiliated institutions obtained contraceptives through a side benefit offered by insurance companies.

But in difficult internal negotiations, a group of advisers had bested Vice President Joseph R. Biden Jr. and others and sold the president on a stricter rule. Now the political furor surrounding it was threatening to consume signs of economic improvement giving a boost to the White House and put the Obama re-election campaign on the defensive.

Time was up, Mr. Obama told his advisers, according to officials in the meeting. Ms. Sebelius, a Catholic who, along with the president’s senior adviser Valerie Jarrett and domestic policy adviser Melody Barnes, had pushed hard for the new rule, was not there, but the message came through: Figure out a way to make something like the Hawaii model work.

In announcing the shift on Friday, Mr. Obama sought to quell the brewing rebellion. Not unexpectedly, the Catholic bishops issued a statement renewing their call for “legislative action on religious liberty,” and calling rescission of the mandate the “only complete solution.” And Speaker John A. Boehner’s spokesman on Friday promised that House Republicans “will continue to work toward a legislative solution.”

What had not been anticipated enough, despite warnings from Mr. Biden; the former chief of staff William Daley; Mr. Biden’s chief of staff, Bruce Reed; and the deputy national security adviser Denis McDonough, administration officials said, was that allies would be furious, too.

Tim Kaine, a Virginia Senate candidate and former head of the Democratic National Committee, echoed the concern of Sister Keehan, president of the Catholic Health Association, that it went too far. So did some liberal-leaning Catholics in the news media, like Chris Matthews of MSNBC’s “Hardball,” who called the rule “frightening,” and E. J. Dionne, the Washington Post columnist, who wrote that Mr. Obama had “utterly botched” the issue.

Meanwhile, Sister Simone Campbell, executive director of Network, a group founded by nuns decades ago to lobby on social justice issues, warned White House officials that nearly 500 Catholic activists would be in Washington this weekend for a conference, and that if no compromise had been reached by then, all of them would return to their parishes fired up about the contraception mandate.

“We were getting killed,” one administration official said Friday. The White House picked the deputy chief of staff Nancy-Ann DeParle to talk to Sister Keehan about ways the rule could be made palatable. Meanwhile, administration officials were hearing from women’s rights organizations, particularly Planned Parenthood, who warned that they would oppose any compromise that made employees pick up the tab.

“After the many genuine concerns that have been raised over the last few weeks, as well as, frankly, the more cynical desire on the part of some to make this into a political football, it became clear that spending months hammering out a solution was not going to be an option,” Mr. Obama said on Friday.

(Page 2 of 2)

Some who favor the compromise wonder why it took so long. “What has happened a few times in this administration is that they get so focused on the substantive policy, they get kind of narrowly focused and lose sight of the countervailing concerns,” Sister Campbell said.




At the White House, the internal debate had raged since last fall, when administration officials started looking at how to put the rule into practice. All agreed early on that churches would be exempt. The question revolved around colleges, charities and other religiously affiliated institutions that employed people of different faiths.

Archbishop Timothy M. Dolan of New York met with Mr. Obama and argued in favor of a broad exemption. Shortly after, Cecile Richards, president of Planned Parenthood, and other proponents of the rule began a series of meetings with officials to argue against an exemption for religiously affiliated institutions.

Throughout that debate, administration officials said, Mr. Obama pushed hard for a version of the Hawaii rule. But Ms. Sebelius and others at the Department of Health and Human Services said it would take time to resolve whether the administration could emulate that approach. In the end, with the State of the Union address imminent and time passing to work out the new rules governing the carrying out of the health care law, the administration announced on Jan. 20 that religious-affiliated institutions — but not churches — would have to offer the insurance.

“All hell broke loose,” one administration official said, leading to Mr. Obama’s sharp orders in the Oval Office last week.

The result differs from Hawaii in that it shifts the cost to insurers, instead of employees. It also differs from Hawaii in that it requires companies — and not the religious institutions — to inform employees about how to arrange coverage.

Before making his announcement, Mr. Obama on Friday called three people: Sister Keehan, Ms. Richards and Archbishop Dolan. From Sister Keehan and Ms. Richards, he got unqualified endorsements. Even the archbishop offered, initially, a grudging acknowledgment that it was “a first step in the right direction” — although the bishops later said that Mr. Obama’s fix “raises serious moral concerns.”


Basically a win-win for all except for the old fossils in the Catholic hierarchy and ultra-partisans in Congress. If only every political issue was as easy as this....



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 Post subject: Re: Obama Offers "Accomodation" On Birth Control Rule PostPosted: 2012-02-11 02:48pm
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It's a smart compromise, although it's still sickening to see that something as radically idiotic as an anti-contraception agenda is still taken seriously (in the goddamned 21st century!) enough to require such accomodation.



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 Post subject: Re: Obama Offers "Accomodation" On Birth Control Rule PostPosted: 2012-02-11 04:52pm
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Our polling on the birth control issue

We've had a lot of people asking us this week if we've done any polling about the birth control issue. We did a national survey for Planned Parenthood last weekend. Here are the key things we found:

-56% of voters generally support the birth control benefit, while 37% are opposed. Independents strongly favor it, 55/36, and a lot more Republicans (36%) support it than Democrats (20%) oppose it. Women are for it by a 63/29 margin.

-Only 39% of voters support an exemption for Catholic hospitals and universities from providing the benefit, while 57% are opposed to one.

-There is a major disconnect between the leadership of the Catholic Church and rank and file Catholic voters on this issue. We did an over sample of almost 400 Catholics and found that they support the benefit overall, 53-44, and oppose an exception for Catholic hospitals and universities, 53-45. The Bishops really are not speaking for Catholics as a whole on this issue.

-Republican agitating on this issue could cause themselves trouble at the polls this year. 40% of voters say Mitt Romney's stance makes them less likely to vote for him, while only 23% consider it a positive. With the Catholic oversample it's 46% less likely and 28% more likely. And Congressional Republicans are imperiling themselves as well. 58% of voters oppose them trying to take the benefit away, while only 33% are supportive.

Republicans will win this fall if they can convince voters that the economy stinks and it's Barack Obama's fault and putting them in power will fix the problem. If they want to make it about social issues and making it easy and affordable for women to access birth control, Democrats win.


This appears to be a very intelligent, calculated move on Obama's part. More important than the media and catholic groups making this into a "controversy", polls showed that only a minority actually opposed the rule. This blog provides some insight.

Quote:
Obama Punks the GOP on Contraception

After two solid weeks of Republicans rapidly escalating attacks on contraception access under the banner of "religous freedom," Obama finally announced what the White House is proposing an accomodation of religiously affiliated employers who don't want to offer birth control coverage as part of their insurance plans. In those situations, the insurance companies will have to reach out directly to employees and offer contraception coverage for free, without going through the employer. Insurance companies are down with the plan, because as Matt Yglesias explained at Moneybox, contraception actually saves insurance companies money, since it's cheaper than abortion and far cheaper than childbirth. Because the insurance companies have to reach out to employees directly, there's very little danger of women not getting coverage because they are unaware they're eligible.

That's the nitty-gritty. The fun part of this is that Obama just pulled a fast one on Republicans. He drew this out for two weeks, letting Republicans work themselves into a frenzy of anti-contraception rhetoric, all thinly disguised as concern for religious liberty, and then created a compromise that addressed their purported concerns but without actually reducing women's access to contraception, which is what this has always been about. (As Dana Goldstein reported in 2010, before the religious liberty gambit was brought up, the Catholic bishops were just demanding that women be denied access and told to abstain from sex instead.) With the fig leaf of religious liberty removed, Republicans are in a bad situation. They can either drop this and slink away knowing they've been punked, or they can double down. But in order to do so, they'll have to be more blatantly anti-contraception, a politically toxic move in a country where 99% of women have used contraception.

My guess is that they'll take their knocks and go home, but a lot of the damage has already been done.
Romney was provoked repeatedly to go on the record saying negative things about contraception. Sure, it was in the frame of concern about religious liberty, but as this incident fades into memory, what most people will remember is that Republicans picked a fight with Obama over contraception coverage and lost. This also gave Obama a chance to highlight this benefit and take full credit for it. Obama needs young female voters to turn out at the polls in November, and hijacking two weeks of the news cycle to send the message that he's going to get you your birth control for free is a big win for him in that department. I expect to see some ads in the fall showing Romney saying hostile things about contraception and health care reform, with the message that free birth control is going away if he's elected. It's all so perfect that I'm inclined to think this was Obama's plan all along.


In other words, this wasn't something that Obama needed to do that much about, except let the outrage run its course and die until the next controversy came. He appears to have chosen this compromise specifically because it riled up the GOP, and trapped them into making it into a "religious freedom" issue.

I remember back when I was an undergrad, during a course on Leadership and American Studies, we spent a good few weeks focusing on LBJ during 1964-1965. This was right around the Affordable Care Act was first being introduced in Congress, and the teacher was trying to get us to draw parallels. We watched most of the famous PBS "American Experience: LBJ" documentary. One of the most fascinating parts I remember from it:

McCullough: [voice-over]Richard Goodwin, Presidential Speechwriter: At that very precise moment, fortunately, Wallace sent a telegram to the White House, saying he'd like to meet with the President to discuss the situation. Johnson said, "Well, you just come right ahead."

Nicholas Katzenbach, Attorney General: That was the most amazing conversation I've ever been present at, because here was Lyndon Johnson, the consummate politician, and George Wallace didn't know what was going on at that meeting.

Richard Goodwin, Presidential Speechwriter: Wallace is about five-four and Johnson is about six-four, so he leads Wallace in and he sits him down on the couch -- Wallace sinks down so he's now about three feet tall -- and Johnson sits on the edge of the rocking chair, leaning over him.

Nicholas Katzenbach, Attorney General: "George," he said, "Do you see all of those demonstrators out in front of the White House?" "Oh, yes, Mr. President, I saw them." He said, "Wouldn't it be just wonderful if we could put an end to all those demonstrations?" "Oh, yes, Mr. President, that would be wonderful." He said, "Well, why don't you and I go out there, George, with all those television cameras -- do you see those television cameras?" "Oh, yes, I saw them." He says, "Let's you and I go out there and let's announce that you've decided to integrate every school in Alabama."

Richard Goodwin, Presidential Speechwriter: And his southern voice always deepened when he spoke to other southerners. He says, "Now, you agree the Negroes got the right to vote, don't you?" He says, "Oh, yes, there's no quarrel with that." He says, "Well, then, why don't you let them vote?" And he said, "Well, you know," he said, "I don't have that power. That belongs to the country registrars in the state of Alabama."

Nicholas Katzenbach, Attorney General: And Johnson leaned back and he says, "George," he said, "don't you shit me as to who runs Alabama."

Richard Goodwin, Presidential Speechwriter: And Wallace insisted; no, he didn't have the legal authority, he said. He said, "Well, why don't you persuade them, George?" He said, "Well, I don't think I could do that." He said, "Now, don't shit me about your persuasive power, George." He says, "You know, I sit down in bed in the morning when I get up, and I got three TV sets lined one right out back of the other. And I got a little button I can press, and I click it whenever I see something I'm interested in. I press the button and the sound goes on. And I had it on this morning, and I saw you, and I pressed the button and you were talking," he said, "and you were attacking me, George." He says, "Oh, I wasn't attacking you, Mr. President. I was attacking the whole principle of states' rights." He says, "You was attacking me, George." He says, "And you were so damn persuasive, I almost changed my mind."

Well, this goes on for half an hour or more, and then, finally, he turns to Wallace. He says, "George, you and I shouldn't be thinking about 1964. We should be thinking about 1984. We'll both be dead and gone then," he said. "Now, you've got a lot of poor people down there in Alabama, a lot of ignorant people. A lot of people need jobs. A lot of people need a future." He said, "You could do a lot for them." He says, "Now, in 1984, George, what do you want left behind?" He said, "You want a great big marble monument that says, 'George Wallace: He Built', or do you want a little piece of scrawny pine laying there along that hot Caliche soil that says, 'George Wallace: He Hated'?"

McCullough: [voice-over] In the end, Wallace agreed to ask the President to mobilize the National Guard to protect the marchers. The Governor was reported to have said afterwards, "If I hadn't left when I did, he'd have had me coming out for civil rights." Two days later, on national television, Johnson presented a tough voting rights bill to a joint session of Congress.

Pres. Johnson: But even if we pass this bill, the battle will not be over. What happened in Selma is part of a far larger movement which reaches into every section and state of America. It is the effort of American Negroes to secure for themselves the full blessings of American life. Their cause must be our cause, too, because it's not just Negroes, but really it's all of us who must overcome the crippling legacy of bigotry and injustice. And we shall overcome.


Wallace didn't really want voting rights at all, so he hid behind the excuse that he couldn't do anything about it. So LBJ let Wallace scream about it until everyone knew that was where he stood, until he had more than enough rope to hang himself with. This example is what immediately comes to mind whenever I see the GOP fall for a trap Obama sets up.

As the blog stated, if they keep pressing it, then it becomes a "women's health" issue, something that Obama easily wins on. This is in keeping with Obama's overall rope-a-dope strategy that he's been playing heavily ever since the debt-ceiling crisis: Take an issue the GOP loves to misrepresent because it's the only way they can win on it, let them scream and shout about it at the top of their lungs, and present a compromise which doesn't necessarily get everything you want, but solves the 'problem' GOP made it out to be over, and appears to be a win-win for all sides. This either forces them to back down, or exposes what they really want.

And as the American Public sees more and more of the true GOP, they are less and less pleased. Eventually, of course, it will be an 'economy' fight this election, but it is surprisingly difficult to convince someone that a candidate who is absolutely nuts on every issue but the economy will somehow be a magical cure-all for the economy. I am currently working on my Masters degree, and despite what one usually hears about Evil Liberal Universities (TM), I'd say there's a fair mix of liberals, conservatives, and independents here on campus. I know a lot of all types around 2010 who were furious at Obama for either not being an usherer of a "Great Progressive Era," a "Stinkin' Big Gubment Socialist", or just apathetic in general.

Now, there seems to be a huge amount of buyers remorse with the GOP. Many of the liberal progressives have either come around and admitted that there was no way he could get everything done in 2 years, and the number of firebrand progressives who would rather not vote at all than vote for someone other than Ralph Nader or something. Same with the number of GOP "anyone but Obama" crazies. Most of them are die-hard Ron Paul libertarians who were gonna vote for Paul anyway like they did in 2008. Most strikingly, the number of first-time-voting independents who got swept up in the "hope and change" phase of 2008 but were apathetically "disappointing" about him are starting to come around, and its over little issues like this one. In general, the political atmosphere among them feels like Obama is the best chance for turning things around, because it sure as hell isn't gonna be one of those crazies who wants to outlaw birth control and execute gay people.



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 Post subject: Re: Obama Offers "Accomodation" On Birth Control Rule PostPosted: 2012-02-11 05:12pm
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Darth Wong wrote:
It's a smart compromise, although it's still sickening to see that something as radically idiotic as an anti-contraception agenda is still taken seriously (in the goddamned 21st century!) enough to require such accomodation.

I think it's a step in the right direction for all the wrong reasons. Contraception is either very cheap or very regular and either way its necessity is under your own control. As such, it's not a product that benefits from an insurance mandate.

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 Post subject: Re: Obama Offers "Accomodation" On Birth Control Rule PostPosted: 2012-02-11 06:02pm
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Grumman wrote:
Darth Wong wrote:
It's a smart compromise, although it's still sickening to see that something as radically idiotic as an anti-contraception agenda is still taken seriously (in the goddamned 21st century!) enough to require such accomodation.

I think it's a step in the right direction for all the wrong reasons. Contraception is either very cheap or very regular and either way its necessity is under your own control. As such, it's not a product that benefits from an insurance mandate.


How many months of birth control have you paid for, Grumman? How much do you know about the alternate uses of it for basic health, not merely preventing pregnancy?

They can go from 60-80 bucks depending where and what kind, and there's a number of health conditions which birth control is prescribed to treat, Polycistic Ovarian Syndrome being just one.



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 Post subject: Re: Obama Offers "Accomodation" On Birth Control Rule PostPosted: 2012-02-11 06:08pm
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Quote:
Contraception is either very cheap


Do you have any figures for contraception? This is not meant to contradict you, but I read that it could cost as much as 50 quid a month. That article did not post sources either so I won't trust it. Back in India women's pills wee fairly cheap - around two dollars for a month's worth I think - and they're all available over the counter at any chemist's (and with the population issues they damn well be).

(edit: Nitram posted before I clicked submit - 60/80 quid is serious money. If the median wage is 50k/year, 700-1000 quid per year is a LOT of money for at least a quarter of the working population, let alone the stay-at-home ones.)



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 Post subject: Re: Obama Offers "Accomodation" On Birth Control Rule PostPosted: 2012-02-11 06:30pm
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SirNitram wrote:
How many months of birth control have you paid for, Grumman? How much do you know about the alternate uses of it for basic health, not merely preventing pregnancy?

Does your health insurance refuse to cover medicines that also have alternative uses? I was assuming that if you were using a drug for basic health, basic health insurance would cover it, regardless of whether it's also a contraceptive.

UnderAGreySky wrote:
Quote:
Contraception is either very cheap

Do you have any figures for contraception? This is not meant to contradict you, but I read that it could cost as much as 50 quid a month.

According to Google, you can buy condoms in the United States for $7 for a dozen. That is the contraceptive method I was referring to as "very cheap".

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 Post subject: Re: Obama Offers "Accomodation" On Birth Control Rule PostPosted: 2012-02-11 07:02pm
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This is like the payroll tax 50-50 employer-employee split: a completely symbolic gesture. If the insurance companies are required to provide free birth control coverage to employees of religious organizations, they'll just pass along the cost of that coverage to the religious organizations in higher premiums, so the religious organizations end up paying it anyway. It's a pretty shrewd political maneuver, but as far as actual policy effects it's a complete non-move from the White House's original position.



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 Post subject: Re: Obama Offers "Accomodation" On Birth Control Rule PostPosted: 2012-02-11 07:10pm
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Grumman wrote:
According to Google, you can buy condoms in the United States for $7 for a dozen. That is the contraceptive method I was referring to as "very cheap".


I don't think that's a smart idea for couples at all. Assuming that couples in a relationship have intercourse a hundred times a year, even if a condom is reliable 85% of the time that leaves the question of FIFTEEN occasions where they have to rush and buy Plan B or whatever the morning-after pill is. Fifteen pills a year might not even be a healthy thing (I don't know). Oral contraceptives are 99.7% reliable (all figures wiki-sourced) and hence significantly safer.

This doesn't get around the fact that some people need 'the pill' for medical reasons such as normalising periods.

That said, a dozen condoms for seven quid? I wonder what brand. Durex ones here are around ten British pounds for a half dozen!



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 Post subject: Re: Obama Offers "Accomodation" On Birth Control Rule PostPosted: 2012-02-11 07:42pm
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On the other hand, anal sex is free :)



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 Post subject: Re: Obama Offers "Accomodation" On Birth Control Rule PostPosted: 2012-02-11 07:44pm
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That depends on how well you manage the relationship. ;)



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 Post subject: Re: Obama Offers "Accomodation" On Birth Control Rule PostPosted: 2012-02-11 08:08pm
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Grumman wrote:
SirNitram wrote:
How many months of birth control have you paid for, Grumman? How much do you know about the alternate uses of it for basic health, not merely preventing pregnancy?

Does your health insurance refuse to cover medicines that also have alternative uses? I was assuming that if you were using a drug for basic health, basic health insurance would cover it, regardless of whether it's also a contraceptive.


Do you have any experience with US health insurance at all?

Quote:
UnderAGreySky wrote:
Quote:
Contraception is either very cheap

Do you have any figures for contraception? This is not meant to contradict you, but I read that it could cost as much as 50 quid a month.

According to Google, you can buy condoms in the United States for $7 for a dozen. That is the contraceptive method I was referring to as "very cheap".


Well, given this whole spat is about birth control pills, I think you're being either purposefully obtuse, or need to learn about subjects before wading in making definitive statements.



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 Post subject: Re: Obama Offers "Accomodation" On Birth Control Rule PostPosted: 2012-02-11 09:00pm
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Quote:
I don't think that's a smart idea for couples at all. Assuming that couples in a relationship have intercourse a hundred times a year, even if a condom is reliable 85% of the time that leaves the question of FIFTEEN occasions where they have to rush and buy Plan B or whatever the morning-after pill is. Fifteen pills a year might not even be a healthy thing (I don't know). Oral contraceptives are 99.7% reliable (all figures wiki-sourced) and hence significantly safer.

This doesn't get around the fact that some people need 'the pill' for medical reasons such as normalising periods.

That said, a dozen condoms for seven quid? I wonder what brand. Durex ones here are around ten British pounds for a half dozen!


Condoms, when used correctly, have a similar rate of effectiveness when preventing pregnancy. It is not per-incident of sex that measures that success rate. Said rates are derived from a couple having regular sex 2-3 times a week over a year. They would have a 99ish percent chance of not getting pregnant. By contrast, a couple doing the same thing over the course of three months, assuming both partners are fertile, will have a 25% chance of becoming pregnant if I remember my numbers correctly.

Hormonal birth control also treats a variety of other conditions, some actually diagnosed, others are just issues with having particularly unpleasant periods, and the right type of birth control reduces the frequency and severity of menstruation. Often times, this is something men just dont understand. Girls start taking birth control at puberty not because they are going to have sex, but because having a period is fucking painful (I know women for whom the period cramps are completely debilitating), and birth control pills help.



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 Post subject: Re: Obama Offers "Accomodation" On Birth Control Rule PostPosted: 2012-02-11 09:29pm
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UnderAGreySky wrote:
Grumman wrote:
According to Google, you can buy condoms in the United States for $7 for a dozen. That is the contraceptive method I was referring to as "very cheap".


I don't think that's a smart idea for couples at all. Assuming that couples in a relationship have intercourse a hundred times a year, even if a condom is reliable 85% of the time that leaves the question of FIFTEEN occasions where they have to rush and buy Plan B or whatever the morning-after pill is. Fifteen pills a year might not even be a healthy thing (I don't know). Oral contraceptives are 99.7% reliable (all figures wiki-sourced) and hence significantly safer.

This doesn't get around the fact that some people need 'the pill' for medical reasons such as normalising periods.

That said, a dozen condoms for seven quid? I wonder what brand. Durex ones here are around ten British pounds for a half dozen!


Not every condom failure is obvious. A condom can fail almost invisibly and the first you know is when the woman misses her next period. By then, it's too late for Plan B or other emergency contraception.

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 Post subject: Re: Obama Offers "Accomodation" On Birth Control Rule PostPosted: 2012-02-11 10:50pm
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Alyrium Denryle wrote:
Hormonal birth control also treats a variety of other conditions, some actually diagnosed, others are just issues with having particularly unpleasant periods, and the right type of birth control reduces the frequency and severity of menstruation. Often times, this is something men just dont understand. Girls start taking birth control at puberty not because they are going to have sex, but because having a period is fucking painful (I know women for whom the period cramps are completely debilitating), and birth control pills help.

As one of the women who had the debilitating cramps, YES, birth control helped. One of the causes behind painful cramps is the 'bottoming out' of estrogen at the end of the menstrual cycle. Birth control hormones, even the low-dose, can prevent the bottom-out and if not prevent the cramps, ease them a little.

You might have wondered why Nitram mentioned Poly-cystic Ovarian Syndrome (or as I call it POS). It's because it runs rampant in my maternal line, and birth control pills have a safe level of estrogen treatment for the cysts and other symptoms of the disease. Right now, I have a 11mm cyst and a 9.5mm cyst. They have remained those sizes for the last 4yrs, thanks to the birth control I take. BTW: without insurance, each month's supply of GENERIC pills would cost me $72. With insurance, it's still $10, which means I spend $120/yr for these pills, which I've been on for the last 15yrs.
Considering my mother underwent a full hysterectomy for her cysts, and several of my cousins have had surgeries to remove their cysts, I am happy that my birth control has prevented surgery for mine.



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 Post subject: Re: Obama Offers "Accomodation" On Birth Control Rule PostPosted: 2012-02-12 04:59am
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SirNitram wrote:
Do you have any experience with US health insurance at all?

If your argument is that the US health insurance industry sucks, I fail to see how forcing people to have greater dealings with them is going to fix the problem.

Grumman wrote:
Contraception is either very cheap

SirNitram wrote:
Well, given this whole spat is about birth control pills, I think you're being either purposefully obtuse, or need to learn about subjects before wading in making definitive statements.

Do you notice the word "either" there? That's because the other half of that sentence was talking about things like birth control pills. Widespread, predictable, stable expenses are poor targets for insurance because the whole point of insurance is to take isolated, unpredictable, unstable expenses and smooth them out into widespread, predictable, stable expenses.

If you want to subsidise the cost of birth control, good for you. I am not arguing against your goal, only your methodology. I would rather see a direct government subsidy than a mandate to buy insurance from a third party intended to achieve the same goal.

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 Post subject: Re: Obama Offers "Accomodation" On Birth Control Rule PostPosted: 2012-02-12 05:54am
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Grumman wrote:
Do you notice the word "either" there? That's because the other half of that sentence was talking about things like birth control pills. Widespread, predictable, stable expenses are poor targets for insurance because the whole point of insurance is to take isolated, unpredictable, unstable expenses and smooth them out into widespread, predictable, stable expenses.
Not really. Health insurance covers plenty of widespread, predictable, stable expenses, including yearly checkups with GPs, dentists, and gynecologists (relatively cheap) and regular, constantly-needed prescriptions (often expensive). Birth control pills are more like yearly checkups: they save money in the long run, so insurance companies have an extra, self-interested reason to cover them, in addition to their usual reasons for covering health-related expenses that do not save money (such as, say, insulin).

The insurance companies are still whining about having to cover it, but that can be attributed to a combination of institutional inertia (Red can tell you how much health insurance bureaucrats grouse when they have to change anything) and discounting the future (the savings associated with covering birth control will not appear instantly, and the costs will, so they'll lose money for a while).



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 Post subject: Re: Obama Offers "Accomodation" On Birth Control Rule PostPosted: 2012-02-12 09:41am
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Grumman wrote:
Do you notice the word "either" there? That's because the other half of that sentence was talking about things like birth control pills. Widespread, predictable, stable expenses are poor targets for insurance because the whole point of insurance is to take isolated, unpredictable, unstable expenses and smooth them out into widespread, predictable, stable expenses.
No, the whole point of insurance (any insurance) is to transfer risk between two parties, the insurer and the insured--in this specific case, the risk that the insured will elect to go on birth control in the future (ignoring non-contraceptive uses for simplicity's sake). There's no minimum size or maximum frequency to the risk. Otherwise, by your logic, insulin shouldn't be covered by health insurance either.

A birth control mandate increases the risk insurers are mandated to take on, and that cost find its way back to groups (women of child-bearing age are already more expensive to insure than men of the same age; this will make them marginally more so, at least in the short term before the number of unwanted pregnancies drops), but if having birth control available cheaply to anyone who wants it is a desirable societal goal, then everyone was going to have to pay for it one way or another anyhow.



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 Post subject: Re: Obama Offers "Accomodation" On Birth Control Rule PostPosted: 2012-02-12 12:33pm
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Grumman wrote:
SirNitram wrote:
How many months of birth control have you paid for, Grumman? How much do you know about the alternate uses of it for basic health, not merely preventing pregnancy?

Does your health insurance refuse to cover medicines that also have alternative uses? I was assuming that if you were using a drug for basic health, basic health insurance would cover it, regardless of whether it's also a contraceptive.

Depends on how the policy is written. Some of them DO exclude certain medications regardless of why they are prescribed, including hormonal contraception. Others will pay for it only for non-contraceptive reasons.

That's one of the issues with the jacked-up US health “system” - there is less consistency in insurance coverage than most people think there is, and the misunderstandings increase once you start discussing issues with people outside of the country who are unfamiliar with how things are done here.

Grumman wrote:
According to Google, you can buy condoms in the United States for $7 for a dozen. That is the contraceptive method I was referring to as "very cheap".

Uh-huh. The problem with condoms is a lot of men don't like them (let's be honest, some of us women prefer bare-backing, too, when it can be done safely) and getting them to wear them consistently can be difficult to impossible. The Pill means women can control the contraception without needing to depend on male cooperation (whether that's ideal or not is another question – as women suffer the most impact from failed contraception they have the highest motivation to use it consistently), or even male knowledge.

Surlethe wrote:
This is like the payroll tax 50-50 employer-employee split: a completely symbolic gesture. If the insurance companies are required to provide free birth control coverage to employees of religious organizations, they'll just pass along the cost of that coverage to the religious organizations in higher premiums, so the religious organizations end up paying it anyway. It's a pretty shrewd political maneuver, but as far as actual policy effects it's a complete non-move from the White House's original position.

SHHHH! DON'T TELL THEM THAT! Let the religious wackos save face or remain in ignorance, don't screw the pooch by cluing them in on what's really going to happen!

Darth Wong wrote:
On the other hand, anal sex is free :)

Outside of the cost of lube, yeah. Well, if it's not committed monogamy you might also want to add condoms, too. Still cheaper than the Pill, although (despite your untiring efforts at promotion) still not as wildly popular as old-fashioned vaginal sex.

Alyrium Denryle wrote:
Hormonal birth control also treats a variety of other conditions, some actually diagnosed, others are just issues with having particularly unpleasant periods, and the right type of birth control reduces the frequency and severity of menstruation. Often times, this is something men just dont understand. Girls start taking birth control at puberty not because they are going to have sex, but because having a period is fucking painful (I know women for whom the period cramps are completely debilitating), and birth control pills help.

Birth control pills can also entirely suppress menstruation, which is more and more seen as a legitimate use of them. You can imagine that, say, a women in the military deployed to a combat area might well want to suppress menstruation because, you know, mud, sand, heat, cold, snow, and being shot at are unpleasant enough all by themselves, they don't need the added joys of crotch bleeding, cramps, bloating, constipation and/or diarrhea and all the other potential complications of normal human female fertility cycles. Prostitutes have long used them to suppress menstruation so they don't have to suspend work for one week out of four or whatever – regardless of whether or not you approve of prostitution you can certainly see the economic appeal of that. There are other, less extreme reasons for cutting down on the number of periods a woman actually experiences.

This is, perhaps, seen as less urgent by some than, say, treating polycystic ovary disease or various other menstrual dysfunctions, but they are still important and legitimate uses.

Grumman wrote:
SirNitram wrote:
Do you have any experience with US health insurance at all?

If your argument is that the US health insurance industry sucks, I fail to see how forcing people to have greater dealings with them is going to fix the problem.

If it's a choice between dealing with the health insurance industry and not having access to healthcare then greater dealings has the pay off of access and hopefully better health for the individual. There really isn't an alternative in the US.

Some years ago I detailed the bullshit I had to go through just to get a fucking tetanus booster that I was able and willing to pay for out of my own pocket. I had to go out of state to get someone willing to do that for an uninsured person, and it took weeks to find that doctor.

Americans don't have a choice, outside of multi-millionaires who can wave a stack of $100 bills around until someone is willing to notice them. If you want healthcare you MUST go through the health insurance industry.

Grumman wrote:
Do you notice the word "either" there? That's because the other half of that sentence was talking about things like birth control pills. Widespread, predictable, stable expenses are poor targets for insurance because the whole point of insurance is to take isolated, unpredictable, unstable expenses and smooth them out into widespread, predictable, stable expenses.

Which is exactly why the term “insurance” is a poor choice for the healthcare system – it started as insurance, but then, as it was more and more accepted that preventive care was cheaper than dealing with an acute crisis, more and more preventive and/or “predictable, stable expenses” where added to help control long-term costs. Thus, it is no longer truly “insurance”. Which is why some of us prefer terms like “coverage” and “system” and are in favor of national (or at least state-level) healthcare coverage like just about every other civilized nation on the planet has.

Nonetheless, although the term “insurance” is a poor fit for the bullshit we currently have to contend with, due to historical reasons that's the term used.



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 Post subject: Re: Obama Offers "Accomodation" On Birth Control Rule PostPosted: 2012-02-12 05:05pm
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All right, Grumman has enough people replying to him at this point, I believe. If you haven't already posted in response to him before I made this post, please stay out of the debate (unless you're taking his side).

---

Anyway, as far as this compromise goes, I'd be very interested to see how it applies to self-insured groups, because if the mandate doesn't apply to them, then this is not actually a compromise so much as a complete surrender. Large institutions like hospitals and universities routinely choose to self-insure, which technically makes the institution is the insurance company; the insurance carrier is only providing administrative service and leasing access to their provider network. I know very little about Hawaiian insurance law, so maybe the administrating carriers have to offer a miniature birth control policy on the side to the members and the plan sponsors have no say in it; it would add some administrative complexity, but it's not unusual for self-insured groups to have fully insured subsidiary policies (dental, vision, etc.). I assume HHS hasn't written the new rule yet, but I'm very interested in seeing the outcome.

(I may have changed professions in the last year btw)



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 Post subject: Re: Obama Offers "Accomodation" On Birth Control Rule PostPosted: 2012-02-13 01:31am
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Amanda Marcotte wrote:
My guess is that they'll take their knocks and go home, but a lot of the damage has already been done.


Take their knocks and go home? Republicans doing the sensible thing? Um, nope. Not a chance in hell. Not today's GOP. They're too stupid to know when to back down anymore.

Sen. Roy Blount (R-MO) introduced a bill to allow insurance companies to opt out of providing contraception coverage on religious grounds, a measure that has the backing of Mitch McConnell. A parallel bill was introduced by Florida's Marco Rubio, which would allow employers to opt out of the birth control rule on religious grounds.

Linky

Talking Points Memo wrote:
A debate over access to contraception could be politically problematic for Republicans as polls show Americans overwhelmingly support the use of birth control and want insurance plans to cover the service for free. Tellingly, McConnell was eager to keep the focus on religious freedom as opposed to contraception itself.

“The fact that the White House thinks this is about contraception is the whole problem. This is about freedom of religion, it’s right there in the First Amendment. You can’t miss it — right there in the very first amendment to our Constitution,” McConnell said. “What the overall view on the issue of contraception is has nothing to do with an issue about religious freedom.”

McConnell went on to embellish the argument, claiming Obama is being “rigid in his view that he gets to decide what somebody else’s religion is.” He said that “this issue will not go away until the administration simply backs down.”

House GOP leaders also said Friday they will move forward with legislation to repeal the birth control rule in its entirety. Republicans from both chambers are aligning themselves with the Catholic Bishops who say the new policy remains unacceptable.


The Blount Amendment is Senate bill S.1813 and Rubio's bill is S.2043.

They really are that stupid.



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 Post subject: Re: Obama Offers "Accomodation" On Birth Control Rule PostPosted: 2012-02-13 08:18am
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RedImperator wrote:
No, the whole point of insurance (any insurance) is to transfer risk between two parties, the insurer and the insured--in this specific case, the risk that the insured will elect to go on birth control in the future (ignoring non-contraceptive uses for simplicity's sake). There's no minimum size or maximum frequency to the risk. Otherwise, by your logic, insulin shouldn't be covered by health insurance either.

Maybe it shouldn't. If the goal is purely to subsidise the cost of insulin, perhaps it should be subsidised directly by the government via taxes rather than by forcing healthy people to buy "diabetes insurance" from a third party.

Quote:
...if having birth control available cheaply to anyone who wants it is a desirable societal goal, then everyone was going to have to pay for it one way or another anyhow.

Sure, but a health insurance mandate isn't the only way to do it.

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 Post subject: Re: Obama Offers "Accomodation" On Birth Control Rule PostPosted: 2012-02-13 10:18am
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Broomstick wrote:
That's one of the issues with the jacked-up US health “system” - there is less consistency in insurance coverage than most people think there is, and the misunderstandings increase once you start discussing issues with people outside of the country who are unfamiliar with how things are done here.


You know, that's a pretty shrewd observation. I often run into the problem of talking past Americans when discussing health care, because the American system exists in what is almost an entirely different paradigm. And I can say I wam unusually well read on the American market (at least by the standards of the average Eastern European, anyways).

The experience of the patient in the US is something that is hard to get your head around when you grew up in an environment where people take health care for granted. Even if we do complain about lines and wait times and access to specialists etc, we never have to deal with stuff like wondering about being covered for one disease but not another, co-pays, policies that cover ambulatory care but not the doctor's conslutation, etc etc etc, so there's a tendency to assume certain things about the US that just aren't true.



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 Post subject: Re: Obama Offers "Accomodation" On Birth Control Rule PostPosted: 2012-02-13 10:40am
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Grumman wrote:
RedImperator wrote:
No, the whole point of insurance (any insurance) is to transfer risk between two parties, the insurer and the insured--in this specific case, the risk that the insured will elect to go on birth control in the future (ignoring non-contraceptive uses for simplicity's sake). There's no minimum size or maximum frequency to the risk. Otherwise, by your logic, insulin shouldn't be covered by health insurance either.

Maybe it shouldn't. If the goal is purely to subsidise the cost of insulin, perhaps it should be subsidised directly by the government via taxes rather than by forcing healthy people to buy "diabetes insurance" from a third party.
On what grounds? You seem to have an ideological or philosophical conception of insurance as something only intended to mitigate catastrophic risks, a view that is not shared by any of the major stakeholders in health care, including the carriers. What you're describing is a pure "major medical" plan, which do still exist, but typically only as subsidiary policies or low-cost "catastrophe" policies on the individual market; any group that tries to offer full time professional employees a major medical only policy is in a time warp from 1955.

Also, from the insurer's standpoint, insulin is truckloads cheaper than diabetic amputations. An annual stress test is cheaper than a heart attack. Birth control is cheaper than labor and delivery. It doesn't make any fucking sense for anyone--carriers, sponsors, or members--to stop covering preventative and maintence care because ultimately the costs of catastrophic care will rise. Even the carriers understand this: the biggest trend in the insurance industry--besides trying to adapt to PPACA--is pushing "wellness" and preventative care to lower long-term costs.

Quote:
Quote:
...if having birth control available cheaply to anyone who wants it is a desirable societal goal, then everyone was going to have to pay for it one way or another anyhow.

Sure, but a health insurance mandate isn't the only way to do it.
No, it's not. You could create a new voucher program. You could have Medicare cover it, like it already does dialysis. But doing either of those would require an act of Congress, and what do you think the chances of that are? Making the carriers cover it only requires HHS to write a rule. It's not a perfect solution by any stretch of the imagination, but it's better than nothing.



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 Post subject: Re: Obama Offers "Accomodation" On Birth Control Rule PostPosted: 2012-02-14 08:45pm
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PeZook wrote:
The experience of the patient in the US is something that is hard to get your head around when you grew up in an environment where people take health care for granted.

Here's a handy way to keep the difference in mind:

In a universal/national/socialized health care system everyone is ENTITLED to healthcare.

In the US system you are NOT ENTITLED to any medical care save immediate emergency measures to keep you from imminent death (and some folks think that is too generous).

Or, more simply - in Europe healthcare is seen as a RIGHT. In the US, it is seen as a PRIVILEGE.

[note that these are generalizations and are not intended to be the SPECIFIC views of any particular poster, including me.]



Now I did a job. I got nothing but trouble since I did it, not to mention more than a few unkind words as regard to my character so let me make this abundantly clear. I do the job. And then I get paid. - Malcolm Reynolds, Captain of Serenity, which sums up my feelings regarding the lawsuit discussed here.

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