Monday, February 20, 2012

A Fisking of a Rebuttal to a Fisking

Our post Friday on Maggie Mahar's recent Time article on the impact of the birth control/abortifacient mandate seems to have struck a nerve. Ms Mahar responded in the comments section (Thanks, Maggie!) and was none too pleased. I would absolutely recommend that our readers check it out to get the full measure of Nate's rebuttal [ed: And while you're at it, Mike's take is also highly recommended].

Take it away, Nate:

Thank you for responding Maggie. As a side note, much of the material in my post was in a response I left at your Time article which was (for some mysterious reason) never approved.

"First, Henry claims that the average out-of-pocket cost for childbirth and pregnancy is around $2,000."

I don't see where Henry or I ever claimed this. As the sentence clearly states, that number came directly off the Federal Government's sample SBC, Summary Benefit Communication.

In regards to the issue being insurer cost, that is not what your article said:

"But in terms of the costs to give birth to the child, she is not much better off, because if she does become pregnant, her insurer, like many, would pay the bills above and beyond the co-pay."

As I showed, members paying $9 per month themselves would take 13 years to equal the out-of-pocket cost of a delivery. If you want to argue insurers should pay for birth control because it is in their financial interest, you must also accept that it is in the member's interest as well. If $9 per month for birth control is unaffordable, then 20% for cancer treatment must surely be unaffordable; why aren't we helping them with “free” chemo?

In the US, there are roughly 61 million women of child bearing age, which means $6.5 to $30.5 billion per year (calculations available on request). Divide that by $7,600/pregnancy and we would need to see a reduction in unintended births of up to 4 million. Seeing as we only have about 4 million births per year now, those numbers aren't possible to achieve. And that’s assuming no increase in the cost of birth control.

"As I note in my piece, when pregnancies are unplanned, and contraception is not used, the rate of complicated pregnancies is much higher."

What about when contraception is used and they still have an unplanned pregnancy? I have seen studies that say 5% of women on the pill get pregnant; it only takes 1 missed pill, a not uncommon occurrence. With over 11 million women on the pill, that is a lot of abortions and unintended pregnancies. Further destroying your claim insurers will save money.

"This is why insurers would not need to hike premiums if they offered free contraception. If all if their customers used contraception, and fewer of them had babies, they would save more than they spent waiving the co-pays."

This is really the crux: you have no experience in this field, have never worked with the real data, and don't cite a study to back this up. I have worked 20 years in this business and see the data in real time and know it will increase cost. Who’s more credible?

"Also, Nate ignores the fact that what Federal Employee's insurers were required to cover contraception, they Did Not Raise Premiums. (Again for the source, see my piece.)"

Since there’s no link to support this, one supposes this is another issue of credibility. On the other hand, it is a great argument for more "skin in the game" on the part of those Federal employees.

"Nate also assumes that if there were no co-pay, women would switch from generic Pills to prescription pills. Why? Presumably he assumes that women are too stupid to realize that the generics are just as good. In fact, experience shows that once patients switch to generics, they don't go back. "

I assume that based on 20 years of actual experience in the field, and thus 20 years of data on how people use brand name and generic drugs. But don’t take just my word for it:

"Aren’t generic drugs just the same as their brand name counter-parts? As it turns out, not necessarily."

Based on my experience, the owner of the brand will often outsource manufacturing to the generic makers, or the brand will supply the generic with just a different implant. In these cases, why would anyone take the brand name? Yet millions of people do: I see the claims. And then we have movement from generic to new patent-protected drugs with little to no increase in effectiveness. Often, these changes come with new patent protection and huge advertising budgets.

Which leads to this unsettling news:

"The government is considering setting higher standards for birth control drugs used by millions, saying that newer pills appear to be less effective at preventing pregnancy than those approved decades ago."

So I wouldn't say that women are "stupid" for falling for the advertising, yet it is clear that millions of them do. Something someone with any actual experience in the field would know. Billions have been spent on these new forms of birth control, and it could be argued it was all a waste. Now insureds and other taxpayers must pay 100% of this cost.

From the same MSNBC article:

"The original birth control pills approved in the 1960s allowed less than one pregnancy when taken by 100 women for at least a year, the FDA said. But in the last decade, the government has approved pills allowing more than two pregnancies for every 100 woman-years of use."

Let’s use a little common sense: millions of women paid a co-pay 2-3 times higher then the generic for a drug that was less effective. If the whole purpose of this is to prevent unintended pregnancies, why are we covering pills that fail twice as often?

"He also assumes that insurers would be able to raise premiums as much as they want, whenever they want ("why not raise it to $1,000?")"

I clearly was talking about pharmaceutical manufacturers raising the price to $1000. Follow the paragraph: the maker of Mirena increased the cost, what is to prevent them from raising it to $1000?

"or long-lasting birth control that is much, much cheaper (Source in my piece)"

Okay, let's do that math: Mirena cost $742 for the IUD, plus perhaps another $58 to insert (erring on the low side). Now we're at $800, which is $160 per year or $13 per month. That’s almost 50% more than the $9 generic Pill. Wouldn't you agree that's a pretty big hole in your "it's cheaper" argument?

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