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Mandatory Contraception
The real issue is excessive government regulation.

Georgetown law student Sandra Fluke

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Marc Siegel

As a practicing internist who prescribes contraception for women on a regular basis, I don’t see the current flame-throwing debate as being about religious principles or promiscuity, and certainly it isn’t about the need to save health-care dollars, as HHS Secretary Kathleen Sebelius has so disingenuously asserted.

Instead, in the age of Obamacare, the new insurance mandate is simply about increasing government regulation. But if you regulate insurers, they will fight back. If something is mandated, something else will be cut. Premiums will rise, not fall. Health-care costs will rise, not fall. While I think it is absurd and inflammatory to suggest that a law student like Sandra Fluke who wants her contraception paid for is necessarily promiscuous, at the same time it is equally absurd to suggest that mandating this kind of coverage will somehow save money while supposedly not implying a moral choice of one health-care service over another.

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What do you think insurers are going to do to cover the contraception mandate and still preserve a profit? Let me tell you: Even as they are raising premiums, at the same time they will deny other services such as MRIs and CT scans, or they will cut doctors’ fees. Wouldn’t it be ironic if your contraception was covered but you couldn’t ask your doctor to write the prescription for it because he could no longer afford to accept your insurance?

That’s the main problem with Obamacare in the first place. Its proponents talk about extending health care to more and more people when what they are actually doing is extending health insurance. Insurance that will ultimately buy you less while promising to get you more. Insurance that is easy to use, with no payments up front, provided that you can find a doctor to accept it. Insurance that will break the American bank as it extends entitlements in every direction except where we need them the most. Would you want flood insurance that covered every rainstorm but didn’t pay out when there is actually a flood? I wouldn’t. I want my health insurance to be there when I am actually sick. I want it to have the resources to cover the best and most effective technology.

Sandra Fluke is not necessarily sex-seeking just because she wants her birth control paid for by insurance. But is she considering that the money to pay for her contraception has to come from somewhere? Plus, from a medical perspective, she is not representative of the real contraceptive needs of America’s youth. She isn’t using the kind of birth control that I and other doctors would recommend. I would like to see more condom use among my single patients, because condoms do not only prevent pregnancy, they also cut down dramatically on the risk of sexually transmitted diseases. At a time when we have an epidemic of human papillomavirus, with the majority of young people turning HPV positive within five years of becoming sexually active, our national dialogue should be about condoms and the HPV vaccine, not about how women are going to pay for their birth-control pills.

Condoms are cheap. If the Obama administration feels strongly about contraception, I recommend that it have people handing condoms out on every street corner.

Instead of suggesting that we control health-care costs by making fewer babies, the way China does, or compelling us to pay premiums to cover services we may or may not believe in, Secretary Sebelius would be wise to consider that fewer insurance mandates would save us the kind of money we need to treat patients who are really sick. Isn’t that a more moral approach to health care than trying to stop our future patients from being born?

— Marc Siegel, MD, is a professor of medicine at the NYU Langone Medical Center and medical director of the center’s Doctor Radio. He is a member of the Fox News Medical A-Team and the author of The Inner Pulse: Unlocking the Secret Code of Sickness and Health



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