A Semi-Pro Opinion about Health Insurance

(Important note up front: I am employed in the health insurance sector - specifically in privatized Medicaid and Medicare. Feel free to take my comments with large grains of salt and tequila as needed.)

What is this giant fuss about contraceptive coverage? I am astonished that this issue has gotten the media and pundit play that it has, yet here I am offering my own two cents.

Let's begin with a fundamental economic principle - there are costs associate with any purchase. Basically there ain't no free lunch. Somebody, somewhere is paying for everything we have in this country - be it clothing or shelter or food or health care. Health care is often referred to as a basic human right, but at the risk of infuriating pretty much everyone I know, I beg to differ.

Before you send me hate mail, let me clarify. I do believe it is a societal obligation for us as compassionate citizens of the wealthiest country in the world to ensure that everyone in our nation has access to quality health care.

As such, our tax system and annual budgeting process allots a certain percentage of all tax revenue to subsidize federal and state healthcare programs such as Medicare, Medicaid and the State Children's Health Insurance Program. Our government stretches each tax dollar until it squeaks to maximize health care access for persons that qualify for these programs. Remember too that Medicare revenue primarily consists of beneficiary contributions; your years of payroll contributions make up the bulk of the Medicare trust fund.

Thanks to healthcare reform, the eligibility criteria for Medicaid and other low-income programs will be expanded to include an additional and sizeable population segment. I'm not going to debate this topic in this post, but it is germane to my point that a whole lot more people will be covered in 2014 as a result of PPACA, and again, somebody will have to pony up the extra money to pay for it. Just pointing out a simple economic fact.

Now that we've established the payer for government healthcare (that would be YOU), you can rest easy knowing that the healthcare benefits covered under these programs are extraordinarily rich, often extending far above some benefit packages offered through employer-sponsored healthcare. And, with the exception of Medicare, they all include contraception.

Let's now talk about employer-sponsored healthcare...those of us who are lucky enough to have it are generally being asked to contribute more to the premium cost each year. It is a very rare occurrence these days for an employer to offer 100% employer-sponsored health benefits. Not only are the premium costs going up, but the benefits are often shrinking. Employers are faced with the annual challenge of figuring out what the company can afford to purchase, and the commercial insurance company is responsible for providing a menu of benefit packages from which the employer must choose.

Here's an analogy - if your company can only buy the cheeseburger and they ask you to pay for the fries, does it make any sense for you to be mad that you didn't get a ribeye?  Have you been discriminated against? Moreover, does it make sense for the government to step in and FORCE your company to give you a ribeye without passing the additional cost along to you?

Obviously the issue is far more complex than that, but in the recent debate over contraception coverage, it is less about cost and more about principle. The government does not get to decide what employers choose to purchase for their employees. To paint the employers with a misogynistic brush is goofy and irresponsible; they generally don't buy condoms or Viagra either.

In no way do I think Limbaugh was right to trash that law student in a public forum, but I also think that the media and people with ulterior motives have made a mountain out of mouse poop. The three-thousand-dollar cost estimate is absurd, but just for fun, let's say there was some substance to it. Is it really appropriate to make employers pick up the $3000 tab?

If there's a compromise to be had, I say we put prior authorization requirements on contraception so it can be prescribed as a covered benefit for medical necessity indications - not recreational prophylactic protection. What a long and windy post!