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How We're All Paying for Rush Limbaugh to Take Viagra (And Why it Costs a Lot More Than Contraception)

No taxpayer money may ever cover the costs of a woman's contraception. But it may pay for Rush's Viagra.
 
 
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When conservative blowhards rant, you know they have something on their minds and it’s almost always themselves. So the people who yell loudest about class warfare have waged it successfully on behalf of the 1 percent. And the conservatives complaining about death panels did not object to the real ones in states like Arizona that denied Medicaid benefits to patients who died because of the transplants they could not get as a result. Similarly, you then hear Rush Limbaugh objecting that a mandate that university health plans cover contraception would mean taxpayers paying people to have sex, it can only mean that he is describing himself. And he may very well be. Let me explain.

First, Rush’s comment. As anyone who had listened to the media over the last week should know by now, the conservative radio commentator insulted Georgetown law student Sandra Fluke when she tried to testify before Congress. Fluke’s testimony maintained that contraceptive coverage was important to women because, without coverage, it could cost as much as $3,000 over the course of university enrollment and some women needed the birth control pill to control medical conditions such as ovarian cysts. Fluke told the sad story of a classmate who could not afford the pill and faces early menopause in her 20s as a result. Limbaugh calledFluke a “slut” and a “prostitute” and insisted that she “wants you and me and the taxpayers to pay her to have sex” and he later added “as many times and as often as they want, with as many partners as they want.”

The Obama administration, however, mandated that private plans cover contraception because doing so will save money, unlike coverage of Rush’s Viagra, which does cost the taxpayers money if he bought it through an employer-provided plan. Limbaugh made the news pages sometime ago when he was stopped with a bottle of Viagra as he was returning from the Dominican Republic, with four men to whom he was not married. He was detained because the Viagra was issued pursuant to a prescription in his doctor’s name, but once he signed an affidavit that it was in fact for his personal use, the matter was dropped.

Now, I don’t begrudge Rush his Viagra, if he has a problem with erectile dysfunction (though I certainly to do not favor posting his activities on YouTube). It would be nice, however, if Rush were to admit the taxpayer role in paying for his pills. Our existing healthcare today is a massive subsidy from the uninsured to the insured. The U.S. does not have a state-sponsored healthcare system partly because of a historical accident. The earliest forms of health insurance were modestly sized, physician-sponsored Blues programs. But it took U. S. government-imposed price controls during World War II to really grow the concept.

In the 1940s, private employers started to offer healthcare benefits to compete for new employees during a tight labor market. Employers deducted the cost of the programs as a business expense, but employees did not have to report the benefits as income on their tax returns. The result is a huge tax subsidy for healthcare benefits. The more money an employee makes – and the higher the marginal tax rate on the employee’s income – the more the employee might prefer additional income in the form of an untaxed medical benefit. So the best employer-provided healthcare plans, the so-called “Cadillac plans,” often go to the most highly compensated employees. CEOs love them. Mitt Romney as head of Bain Capital, highly sought-after commentators like Limbaugh, and some of the most generous union plans tend to have the most extensive coverage. While the Affordable Health Care Act proposes higher taxes on these plans, the changes won’t take place for years. And, in the meantime, the more extensive the employer-provided plan and the higher the marginal tax rate of the recipient, the greater is the effective taxpayer subsidy.

The fact that high-end medical insurance plans cover a drug like Viagra also affects what new products come to market. Researchers are more likely to invest in the development of medical innovations with a guaranteed market (and the ability to charge a high markup) than in medical care that depends on individual ability to pay. So not only do taxpayers subsidize Rush’s Viagra along with a host of other medical treatments, but the existence of healthcare plans that more heavily subsidize the wealthy and the employed increases the odds that less subsidized medical treatments will be less effective or more expensive.

In contrast, you as a taxpayer or an insurance buyer pay more if contraception is not included in healthcare plans like those at Georgetown. The administration mandate required that private employers provide contraception as part of preventive care because it is less expensive than the health costs of the delivery and birth of the unwanted child. Healthcare premiums for private insurance plans, such as those provided by Georgetown University, vary with the overall costs of coverage.

Since the Obama administration decision was based on a calculation that this would result in lower healthcare costs overall, it would not raise the premiums paid to insurance companies by private employers, employees, or university students. Moreover, students like Sandra Fluke receive no taxpayer subsidies. The savings, however, should be even greater for publicly funded programs such as Medicaid, which now pays for 40 percent of U.S. births. It is infinitely less expensive to fund contraceptive services than to pay for pregnancy and childbirth -- or avoidable hysterectomies.

So Rush is wrong not only about how the birth control works, but how the insurance mandate works. We may all be paying for Rush’s Viagra. But we would not pay a dime for Georgetown’s proprietary health insurance program to extend its healthcare coverage to offer the full range of preventive services to Sandra Fluke and her classmates. We are, however, paying a very high price, as taxpayers, citizens and health insurance customers, for the cost of unwanted pregnancies.

In fact, before the new administration mandate, private insurance coverage of contraception – as well as Viagra – had been expanding. Twenty-eight states already mandate coverage, with varying exceptions for religiously based institutions. According to the Guttmacher Institute, the expanded coverage has contributed to the growing class-based gap in unintended pregnancy. For women 200 percent above the poverty line – the group most likely to benefit from employer-based plans -- unintended pregnancy rates fell by 29 percent. For poor women, contraceptive access has been declining and the unintended pregnancy rate increased by 50 percent

Subsidizing the well-off and dismantling the infrastructure that helps poorer families is class warfare and it has had a devastating toll on American families.
 

June Carbone is co-author, with Naomi Cahn, of 'Red Families v. Blue Families' (OUP 2010) and 'Family Classes' (OUP forthcoming 2012).
 
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