Pay Gap Myth Used To Deny Healthcare To Men

Now usually The Good Men Project is full of manginas and white knights but this is something I must syndicate:

Feds to Men: Buy Your Own Aspirin and Put It Between Your Knees
April 5, 2012 By Greg Peterson

Men will be paying more for insurance than they have in the past, yet receiving fewer preventive services than women, under the ACA. Part one of a two-part series on the surprising sex discrimination under the U.S. Affordable Care Act.

For the first time ever, the U.S. government will expand access to preventive health services for women without requiring equivalent coverage for men. The U.S. Affordable Care Act (ACA), sometimes labeled by critics as “Obamacare,” will be rolled out using rules likely to deny men equal access to contraception, sterilization, sexually transmitted infection prevention, domestic violence screening and counseling, and even counseling for HIV-positive men.

U.S. Health and Human Services (HHS) Secretary Kathleen Sebelius hailed these “historic guidelines,” emphasizing their gender-bias:

"Previously, preventive services for women had been recommended one-by-one as part of guidelines targeted at men as well. As such, the HHS directed the independent Institute of Medicine [IOM] to, for the first time ever, conduct a scientific review and provide recommendations on specific preventive measures that meet women’s unique health needs and help keep women healthy."

The problem is that HHS went well beyond obstetrical, gynecological, maternal health and chronic disease services, adding preventive health services not unique or important only to women, Yet the services will be provided on a no-cost-sharing basis only to women. Worse, men were already medically underserved compared to women for many of these services.


In a nutshell, women’s IUDs, contraceptive pills and implants, tubal ligations and birth control counseling must be provided without co-pays, doctor’s visit charges, or deductibles, while insurance companies will be free to charge men for vasectomies and contraceptive counseling. Women will universally receive free counseling if they test HIV-positive, but HIV-positive men will not. HPV can result in anal cancer and genital warts in men as well as cervical cancer in women, but no-cost HPV DNA testing will be added to free pap smears for women, while men pay for HPV tests or go without. The Centers for Disease Control found that 28.5 percent of men—over 40 million men—experience rape, physical violence, or stalking by an intimate partner. Those men, unlike women, will first have to ask for help and then pay out of pocket to receive it.

In contrast, a mental health service that men disproportionately need, is not a preventive health service under this Act or HHS guidelines. Men commit suicide at a rate nearly four times that of women. Young men are at particular risk: the National Institute of Mental Health reports that the suicide rate for young men during late adolescence is almost five times that of their female peers, and by their early twenties the rate rises to almost six to one. Reminiscent of Anatole France’s remark about the majestic equality of the law, suicide prevention services are excluded from the ACA / HHS no-cost-sharing package for both women and men.

Does President Obama’s Healthcare Plan Prohibit or Require Sex Discrimination?

HHS based its decision on Section 2713 of the ACA, which prohibits cost sharing (co-pays, co-insurance, and deductibles) in four specific categories of preventive health, including preventive health services for women. While many critics view the ACA as mere health insurance legislation, supporters argued it would put in place experimental approaches to lower the ruinous cost of American healthcare.

One such approach was an increased focus on removing access barriers to preventive medicine. But rather than ordering a bottom-up analysis of what preventive services would yield net cost-cutting benefits to the overall system if patient co-pays and deductibles were removed, Congress reached for three, off-the-shelf, clinically-based lists of preventive services. The three lists are: (1) recommendations of the U.S. Preventive Services Task Force (USPSTF), (2) immunization recommendations of the Centers for Disease Control (CDC), and (3) guidelines for pediatric preventive care supported by the Health Resources and Services Administration (HRSA) of HHS.

Noting that these three off-the-shelf lists did not specifically focus on women’s preventive health services, Senator Barbara Mikulski (D-MD) proposed what came to be known as the Women’s Health Amendment, which now appears as Section 2713(4). Thus Section 2713 of the ACA lumps together preventive services using very different clinical evidence standards — strict for USPSTF and CDC, looser for pediatrics, and no requirement for any evidence at all for women’s preventive health services.

Adam Sonfield of The Guttmacher Institute, a leading reproductive health think tank, speculated to GMP that perhaps insurance companies voluntarily may extend no-cost reproductive health services to men. He noted that Section 2713 of the ACA “establishes a floor, not a ceiling.”

Unfortunately, this disregards the last paragraph of Section 2713(a), which created what lawyers call a safe harbor, legally protecting insurers who deny coverage to men:

"Nothing in this subsection shall be construed to prohibit a plan or issuer… to deny coverage for services that are not recommended…."

At the same time, Section 1557 of the ACA broadly prohibits sex discrimination. As any first year law student can tell you, all provisions of a law must be read together. Section 1557 starts, however, with an exception clause (“Except as otherwise provided in this title,”). This could allow the Obama administration to blame Senator Mikulski and the Democratic-controlled 111th Congress for mandating sex discrimination against men by limiting the benefit of Section 2713(4) to women.

On the other hand, the ACA is the signature achievement of President Obama, and HHS has taken full credit for making no-cost-sharing preventive reproductive health services available only to women. Moreover, it was clearly the actions of the IOM committee and HHS, not Congress, which extended Section 2713 to reproductive health care in a manner discriminatory against men. It may also be worth noting that the exception clause of Section 1557 would be of more legal use to an insurer refusing to extend no-cost reproductive health services to men, than it would be to HHS. HHS itself may be open to a sex discrimination lawsuit for its actions.

Despite Mr. Sonfield’s sunny view of insurance company generosity, insurers would be justified in citing the HHS action as a reason not to extend no-cost reproductive health care to men. If a Federal agency has acted to discriminate against men’s access to reproductive health care on the basis of sex, why shouldn’t an insurer take full advantage of the Section 2713 statutory safe harbor to do the same? Why should an insurer pay out any more than it has to, after all?

Senators Barbara Mikulski (D-MD) and Olympia Snowe (R-ME) sponsored key portions of Section 2713. The office of Senator Snowe had no comment for the GMP at press time, while Senator Mikulski responded to say that “additional protections for women” were “vitally important” because of women’s “unique medical needs” and “average” lower income levels. Dr. Linda Rosenstock, Dean of the UCLA School of Public Health, and Chair of the Institute of Medicine (IOM) committee that made the recommendations adopted wholesale by HHS, referred all questions to HHS. Dr. Paula Johnson of Brigham and Women’s Hospital in Boston, and an IOM committee member, also declined comment to GMP. HHS was repeatedly contacted by phone and by email, up to the Assistant Secretary for Public Affairs, Chris Stenrud. HHS did not offer a justification for its decision to discriminate against men’s access to reproductive health care.

Mind the Gaps

In light of the decision by HHS not to explain why it acted to foreclose men from equal access to no-cost reproductive health services, the report of the Institute of Medicine (IOM) committee which produced the recommendations adopted wholesale by HHS, entitled “Clinical Preventive Services for Women: Closing the Gaps” offers the key window into the underlying cultural assumptions.

The IOM report included this dissent by Anthony LoSasso, a health services economist with the University of Illinois at Chicago who is married to a prominent Ob/Gyn:

… "the committee process for evaluation of the evidence lacked transparency and was largely subject to the preferences of the committee’s composition. Troublingly, the process tended to result in a mix of objective and subjective determinations filtered through a lens of advocacy."

GMP contacted Dr. LoSasso, who, unlike members of the IOM committee majority, spoke with GMP. The IOM majority responded to Dr. LoSasso’s dissent but, in contrast to the detail included in the dissent, the majority response is a single, conclusory paragraph. It is available online through the link above.
Fairly read, the IOM panel majority report would appear to justify Dr. LoSasso’s dissent. A repeatedly stated reason why any given preventive healthcare service was recommended for women without out of pocket cost is that women need the service in question. However little if any effort was made to explain why men don’t need the same healthcare service when nothing about the service in question makes it useful only to women. Even when the IOM majority ultimately decided not to recommend a service for women at this time (as in the case of type II diabetes, which as the IOM report admits, strikes men and women about the same) the IOM majority reasoned that women would benefit more than men because more life would be preserved for women than men. The IOM panel majority’s reasoning violates the ACA ban on discrimination on the basis of life expectancy, arguing that men’s shorter life expectancy means women get more benefit from treatment. The IOM majority report also called for future identification of additional preventive health services, but only for women.

In fairness to the IOM committee, as quoted at the beginning of this article, the “independent” IOM was “directed” by HHS to focus purely on women. That does not, however, explain the actions of the Obama administration.

Another major justification given in the IOM majority report was the overall average income gap between men and women. The panel did not provide any citation for that claim. According to Dr. LoSasso, the gap was assumed to exist.

Yet a detailed analysis by Catherine Rampell in the Economix blog of The New York Times demonstrates that, even before adjusting for the greater number of hours worked outside the home by men, there is no significant pay gap between men and women earning below approximately $100,000 in annual income. (The scattergraphs in her analysis are especially eye-opening; the post is worth a careful read.) And, as reported in Time Magazine, among men and women under 30, women now out-earn men in 147 of 150 metropolitan areas in the U.S., largely because younger women have substantially outpaced men in educational attainment. As reported there, young women average 8-percent higher incomes than young men.

In short, for the poor, the middle class, and the young—for whom co-pays and deductibles pose the greatest hurdles—men face the same or greater financial barriers to health care than women. The IOM committee recommendation and the resulting HHS rule mandate that Kim Kardashian, Paris Hilton and Oprah Winfrey receive free reproductive health care, while a man employed as a garbage collector, gravedigger, or landscaper can be asked to shell out co-pays, co-insurance, and/or deductibles for the same care.

PART II CAN BE FOUND HERE

Here is my take on part II:

“Dr. LoSasso noted to GMP that young men have been the least likely to carry health insurance, instead gambling on their invincibility.”

This is not necessarily the case. Young men make on average 8% less than young women and furthermore more young men may be working under the roof of temp and contract companies many of which simply do not offer healthcare. However, being how expensive healthcare is along with the lower average wages of men I wouldn’t be surprised if men forgo healthcare expense when it is offered them….to make ends meet.

“Men are carefully trained from infancy not to show pain, not to complain about hard knocks and not to seek help.”

Men are first and foremost use and utility objects. Without male use and utility men are not granted the title of man. Men are not inherently valued as women nor inherently valuable. A man is not something one is, a man must “be” a man. This subjugation and status of men transcends to male worthiness and the desire to remain worthy in relation to ignoring possible compromise of bodily health.

Furthermore, without being useful or presenting one’s self to be used by women and society, whether it be as cannon fodder in war or simply to secure the choices and needs and desires and Liberty of women (as in the case of Feminist Marriage 2.0 laws, reproductive rights etc.) men have absolutely no value. Men are the worthless beasts of burden. This may be why 85% of the street homeless are men. This is where men end up if we are not able to be used by women or society.

"Worse, the HHS decision to allow insurers to bar men from no-cost-sharing birth control is likely to deny U.S. men truly effective, reversible birth control methods for years to come. We know from decades of research that effective, reversible hormonal and non-hormonal male birth control is achievable. But it will be costly to bring male birth control pills, implants, and procedures through FDA trials to market. Why would Big Pharma invest in the effort after HHS has decided that men can be subject to often sizeable co-pays, co-insurance and deductibles for hormonal birth control? Aren’t those cost barriers more likely to depress demand, making it less likely products will be brought to market?"

Yes, correct. With government subsidized female focused healthcare the non-free market incentive is created so that a male birth control pill will never see the light of day. This while at the same time creating incentive for big pharma to focus even more on women.

“Erin Gloria Ryan put it well in her recent Jezebel post: “When a woman consents to sex, she is not also consenting to pregnancy.” A woman in the U.S. has a constitutional right to terminate hosting a fetus and unilaterally end any obligation to support and raise a child. A precisely opposite legal regime applies to men.”

Which is why I believe in the male right to abortion. I promote young men to practice this right in their own lives whether women and their government concede to give men equal rights or not. The lack of male Liberty and equal protection under law should not be sacrificed on the alter of “women’s rights” extra choices and Liberty.

Reply to comment section of article:

“This double standard is pathetic, and the justification I always hear to differentiate it is only about body autonomy…You can’t use a woman’s body against her will, but in saying that it also gives the privilege of opting out of motherhood should she choose to do so yet men are given the “keep it in your pants” line, we expect men to be more responsible under the current law.”

I’m leery of men even being allowed to speak here but I will again venture to comment anyway. Here is my take on it. However provocative it might be this is how I see it:

I’ll tell you a secret women don’t want you to know…..it’s not about their body….its about the body of a child, the ramifications that child will have upon women’s lives and the ability to absolve themselves of said ramifications. Men….men on the other hand, we are the only gender responsible for conception. So….. depending on what life choice women decide for us we are stuck with it. Their choices, our responsibility. This way women’s choices aren’t hindered in anyway by a man’s choice in the matter. You do what you’re told. You are a sperm donor and a wallet.

You see, if it were ever found out that the debate really isn’t over women’s bodies then the concept of a mutual act leading to mutual responsibility will present itself and thus the product of said mutual act being mutual property of the life created. Under constitutional theory property ownership does not exist without rights over said property in which case the truth would be revealed that men have no property rights…only women.

Therefore the last thing women want men to have is property rights. If men were able to abort and women were to then decide to abort or not abort we would have whats called equal protection under law. We can’t have that now can we. Which leads us to the abduction of male individual Liberty in the name of supporting women’s.

So much effort is made to avert men from realizing our condition because quite frankly the entire system depends on male subjugation, male use and exploitation to maintain itself. This I believe is why women as a class, consciously or unconsciously attack men's rights and and avocation for our well being whenever these issues are brought up. Without male use, male utility, male subjugation women will not get what they want. This is what women call avocation for "equality". It is a ruse and a lie.