Women, math, and contraception

Inspired by an excellent March 2 post by Cassandra, I actually read what Sandra Fluke said to the House Democratic Committee before which she testified on February 23. I’ve now spent way too much time - both elapsed and actual - annotating Fluke’s testimony. It’s resulted in a post so long I can’t imagine anyone will read the whole thing but I’m putting it up anyhow because, well, I spent all that time.

As you’ll see, there’s a lot I don’t like about Fluke’s approach. She’s long on pathos and loaded language (“grandbabies”? really?) but short on economics. She’s free with percentages but stingy with sources. She presents opinions as facts. She seems to lack even the most rudimentary understanding of what a religion is.

Furthermore, what little I’ve learned about Fluke’s field of “reproductive justice” I don’t care for. That approach appears to, and Fluke's argument clearly do view women as helpless victims of their biology and of circumstance, with no power to shape their own lives, no ability to make decisions and choices. It’s awfully disheartening to see, after more than forty years of feminism, such a public endorsement of the view that, for women, biology is destiny.

Nonetheless, Fluke was speaking her mind on a matter of public policy and as little as I think of her views, I think far, far less of those who think it is appropriate to respond to her with sexual slurs, speculation about her sex life, and demands for voyeuristic involvement in that sex life.

In speaking of David Letterman’s nasty comment about one of Sarah Palin’s daughters, Little Miss Attila said, in part:

... sexually hostile jokes about adult women aren’t amusing [snip]

the intent of the media-entertainment complex is now, and always has been, to cow Sarah Palin into staying silent on political topics...

In speaking of Matt Taibbi’s porn-film comments on Michele Bachman (and, collaterally, Sarah Palin), Reclusive Leftist said:

You know, I would be the first to say that Michele Bachmann is an absolute nutjob. She really is. The stuff she believes is just ridiculous.

But you know what isn’t ridiculous? The fact that she’s female. Really. Femaleness is not some grotesque trait to be mocked; it’s not some character flaw; it’s not some weirdo political stance that is ripe for ridicule. And if you can’t criticize a woman’s politics without mentally subjecting her to the porn-film/inflatable-doll/nutcracker treatment, then you’re a goddamn sexist twit.

In speaking of the 2008 campaigns, Anglachel writes:

The assaults on women as women show us that using misogyny to intimidate and eradicate female participants (voters as well as candidates) is excusable in a way that racist assaults are not. Racist attacks have to be dog whistled because they cannot be made openly without immediate backlash and condemnation by people in power and major opinion makers. [snip]

But this outrage does not extend to women. Language and imagery denigrating women as women (bitch, shrew, whore, cunt, slut) are available on most of the well-trafficked locations of Left Blogistan, in the spring referring to Hillary, this fall referring to Sarah Palin.

Anyone who thinks this kind of language constitutes political discourse is sadly mistaken. Anyone who uses this kind of language as a political weapon is way out of line. It doesn't matter which side that person is on nor which side his or her target is on.

*****

Fluke’s testimony and my annotation follow. The testimony is in italics; my annotations are in regular type.

Hearing on women’s reproductive health and contraception before the House Democratic Steering and Policy Committee held on Feb. 23, 2012

This is the header/description of the venue in which Fluke’s testimony took place. Note three things:

1) The subject of the hearing is women’s reproductive health and contraception. This is not a hearing on Constitutional issues.
2) This is not a House hearing but one held by the Democratic Party only.
3) The hearing is not being held before a policy body, like a committee on the Constitution or a committee on health policy. I am not sure why this is the case. Perhaps the Democratic Party in the House does not have a policy committee before which this hearing could take place. Perhaps it was important to Nancy Pelosi to be in charge of this and so the hearing is taking place before a committee she chairs. Or perhaps there is another reason of which I am unaware

Transcript of testimony by Sandra Fluke, a student at Georgetown University Law School, a private Jesuit institution:

I do not know if this is part of the official transcript or simply something added by the person who posted this. From my point of view, the important word here is “private”.

“Leader [Nancy] Pelosi, members of Congress, good morning. And thank you for calling this hearing on women’s health and for allowing me to testify on behalf of the women who will benefit from the Affordable Care Act contraceptive coverage regulation.

Another clue that this is not a full House hearing. Had it been, the correct address would have been to the head of the committee or subcommittee, who must necessarily have been a Republican.

Note again that the hearing is on “women’s health”.

Fluke is explicitly announcing her position: as a supporter of the HHS mandate requiring the provision of contraception coverage as part the health insurance offered by employers. (At this point, it is not entirely clear whether that mandate will affect health insurance offered by schools to their students. I originally read that it would not; now I have read that it may.)

“My name is Sandra Fluke, and I’m a third-year student at Georgetown Law School. I’m also a past-president of Georgetown Law Students for Reproductive Justice or LSRJ. And I’d like to acknowledge my fellow LSRJ members and allies and all of the student activists with us and thank them so much for being here today.

Fluke is stating her qualifications for being here today. She is, as a student at a religious school, affected by whether that school provides health insurance that covers contraception. She is, more importantly, an expert on the subject of reproductive justice. I don’t know much about the concept of reproductive justice but I think the important points for this discussion are, according to Wikipedia (emphasis mine):

Advocates for reproductive justice have identified three main frameworks for advocating for women's sexual and reproductive needs: reproductive health, reproductive rights, and reproductive justice. [snip] The reproductive rights framework emphasizes the protection of an individual woman's legal right to reproductive health services, focusing on increasing access to contraception and keeping abortion legal. The reproductive justice framework utilizes an intersectional analysis of women's experiences and focuses on changing the structural inequalities that affect women's reproductive health and their ability to control their reproductive lives.

For reproductive justice activists, the primary difference between the reproductive rights and health frameworks and the reproductive justice framework is that the rights and health frameworks focus on protecting individual rights and choices, while the reproductive justice framework focuses on broader socioeconomic conditions and bringing about structural change. The emphasis on individual choice in the health and rights frameworks is considered problematic because it obscures the social context in which reproductive choices are made, ignoring the fact that many women do not have access to services or resources, such as quality health care services or health insurance. This lack of access limits the options available to these women.

Within this framework, Fluke’s testimony is utterly unexceptional; it follows this paradigm exactly.

(Applause)

“We, as Georgetown LSRJ, are here today because we’re so grateful that this regulation implements the non-partisan medical advice of the Institute of Medicine.

Fluke is explicitly saying that she is here “as Georgetown LSRJ”. That is, she is testifying as a representative of this organization. I believe this is in contrast to someone who presents his or her credentials - or has them elicited by a committee member - and then concludes with a statement such as, “I am here today as a private citizen.”

“I attend a Jesuit law school that does not provide contraceptive coverage in its student health plan. And just as we students have faced financial, emotional, and medical burdens as a result, employees at religiously-affiliated hospitals and institutions and universities across the country have suffered similar burdens.

This is the definition of what she sees as the problem: Georgetown provides a student health plan. That plan does not cover contraception. The lack of that coverage has caused hardship for the students at Georgetown. A similar lack at other religiously-affiliated institutions has caused hardship throughout the country.

One point that jumps out at me about this framing is the emphasis on religiously-affiliated institutions. One of the charges leveled against John McCain four years ago was that he had failed to support legislation requiring all insurance plans to cover birth control. At that time, the claim was that half of insurance plans did not cover contraception. Surely half the insurance plans in this country can’t be provided by religious groups?

“We are all grateful for the new regulation that will meet the critical health care needs of so many women.

The “we” here is a little unclear. She could be referring to all those who are suffering throughout the country but I read it as a reference back to her identity “as Georgetown LSRJ”. So “we” refers to herself, “fellow LSRJ members and allies and all of the student activists with us”.

“Simultaneously, the recently announced adjustment addresses any potential conflict with the religious identity of Catholic or Jesuit institutions.

This is a matter of opinion stated as a matter of fact. Fluke is unqualified to make this statement since she has not qualified as an expert on religious matters.

“When I look around my campus, I see the faces of the women affected by this lack of contraceptive coverage.

This begins what I like to think of as the “my heart bleeds purple peanut butter” portion of testimony. It is long on heart-reading stories and emotional language (“grandbabies”? really?), and utterly devoid of documentation.

“And especially in the last week, I have heard more and more of their stories. On a daily basis, I hear yet from another woman from Georgetown or from another school or who works for a religiously-affiliated employer, and they tell me that they have suffered financially and emotionally and medically because of this lack of coverage.

This is almost certainly true. I’m sure that there are cases where not having contraception coverage as part of one’s health insurance causes suffering (leaving aside the vagueness of that term) and Fluke’s position insures that she hears those stories. Furthermore, as the discussion of this topic heats up, it makes sense that “more and more” of these stories come out.

I would like to state for the record that I believe under certain circumstances the financial and medical suffering of citizens may be the business of the government. I am hard-pressed, however, to imagine a situation in which our emotional suffering is.

“And so, I’m here today to share their voices, and I want to thank you for allowing them – not me – to be heard.

Again, Fluke is not here as a private citizen; she is a representative of a particular organization. She is also explicitly stating that she is not telling her own story.

“Without insurance coverage, contraception, as you know, can cost a woman over $3,000 during law school. For a lot of students who, like me, are on public interest scholarships, that’s practically an entire summer’s salary. 40% of the female students at Georgetown Law reported to us that they struggle financially as a result of this policy.

Ah, yes, the math problem that has gotten so much attention. I’ll take a look at that issue in a moment but first notice what this paragraph does not say. It does not say:

For a student like me, on a public interest scholarship, that’s practically an entire summer’s salary.

Fluke is not referring to her own experience with birth control. She is stating that a women who wants birth control and is on the same type of scholarship Fluke is, will pay practically an entire summer’s salary for three years worth of birth control. So far as I - or anyone else- can tell from Fluke’s statement, she herself is not buying birth control nor is complaining about what birth control costs her personally.

Now for the math issue. I’ve run through the numbers (see the section “Show your work” at the end of this post) and it’s possible to make Fluke’s numbers look ballpark reasonable. It’s also possible to point out serious problems with the assumptions necessary to do so.

However, arguments over Fluke’s math are a “so what” discussion. Are those who attacked Fluke’s math saying that if Fluke is correct and three years worth of birth control does truly cost $3000 then it’s fine to force a private Catholic institution like Georgetown to pay for it; but if Fluke is wrong and three years worth of birth control can be had for a few hundred dollars then it’s wrong to force Georgetown to pay? I sincerely hope that is not the argument. Fluke’s math should have been dismissed with a gentle, “Regardless of whether three years of birth control costs $3000 or $300, it is simply wrong for the Federal government to force an employer to violate his or its religious principles.”

I did not know what a “public interest scholarship” was so I looked it up. This is a scholarship, provided by Georgetown, which pays for up to one-third of a student’s tuition and provides summer work for the student, with the understanding that the recipient will:

... spend at least half of his or her career in public interest law or to donate to the Law Center an amount at least equal to the scholarship.

This understanding is in the form of a “moral commitment”; there is no contract signed, no enforceable agreement.

(These pages also provide a brief biography of Fluke which seems to have been the source of some of the information about her that is floating around the Internet.)

It thus seems to me that Fluke is being given money and a summer job by Georgetown. In return, she is publicly chastising the source of her scholarship. (She may also be implicitly complaining that other women who receive this scholarship are not being paid enough for their summer work. That depends on whether we interpret her statement as a complaint about how much contraception costs or how little the scholarship pays.)

I would like to see more information on her statement that “40% of the female students at Georgetown Law reported to us that they struggle financially as a result of this policy”. Specifically I would like to know where that statistic came from; what is meant by “struggle”; and whether the women who report struggling would have no financial issues if their contraception was covered. I took a quick look at the Georgetown LSRJ website but did not immediately see a section to review polls (assuming that’s where Fluke’s number came from).

“One told us about how embarrassed and just powerless she felt when she was standing at the pharmacy counter and learned for the first time that contraception was not covered on her insurance and she had to turn and walk away because she couldn’t afford that prescription. Women like her have no choice but to go without contraception.

Fluke is claiming embarrassment is, literally, a Federal case. I guess I should address that claim since she seems to offer it in all seriousness but I’m afraid that’s just too ludicrous for me to go near. (Although if we’re going to get the Feds to do something about embarrassment, I’ve got a list.) Moving on.

This woman feels powerless. Well, she is. She is powerless to force the pharmacist to give her something she can’t pay for. She is powerless to force her insurance company to pay for something for which it did not contract and she did not pay. She is powerless to force Georgetown to offer a different insurance policy.

However, she was not powerless to read and understand the conditions of the insurance policy she signed up for. She was not powerless to choose a school other than Georgetown, one which would offer the kind of insurance that is so crucial to her. She was not powerless to understand that Georgetown’s insurance policy would not cover birth control pills and decide to postpone attending for a year while working at a crummy job and living in a crummy apartment with three roommates so she could save enough money to cover expenses when she did attend Georgetown.

Furthermore, she is not powerless to decide to refrain from sex until she can afford birth control pills. She is not powerless to do research on whether there are cheaper forms of contraception, perhaps even cheaper birth control pills. She is not powerless to ask her sexual partner (or partners - it is absolutely none of my business whether we’re talking singular or plural) to provide some form of contraception or to chip in for her purchase of birth control pills. And she is not powerless to leave school and take a job which will allow her to purchase items she wants to purchase.

To say, “Women like her have no choice but to go without contraception” is to make an intelligent, ambitious, hard-working, disciplined adult into a helpless pawn in life. I’m extremely uncomfortable with the idea that women have stopped waiting to be rescued by Prince Charming, only to begin waiting to be rescued by Uncle Sam. How about if we rescue ourselves? Or, better yet, let’s stop thinking that the very state of being female means we need to be rescued by anyone or anything. Instead, let’s start thinking in terms of what options we have, of making our own decisions and living with them, of taking care of ourselves. It’s like Fluke is living in some bizarre version of a 1950’s sitcom where wifey can’t take care of herself financially and must cajole hubby into doing so. Not everything retro is good.

“Just last week, a married female student told me that she had to stop using contraception because she and her husband just couldn’t fit it into their budget anymore. Women employed in low-wage jobs without contraceptive coverage face the same choice.

“Face the same choice”. What choice is that? Stop using contraception or ...? Women employed in low-wage jobs may not, in fact, have any choices; all they can do is go without contraception. Married women attending Georgetown, however, have all the options discussed for the single woman above, with the exceptions of deciding not to have sex until they can afford birth control (well, they could but ...) and of asking her partner to chip in. Budget, plan ahead, save up, shop around, quit school. Choices abound.

As for those low-wage women, I don’t necessarily have a problem with government funding for contraceptives for low-income people; in fact, I believe Medicaid covers birth control pills in at least some States. To me, that doesn’t mean we need to bring the weight of the Federal government to bear to get a square deal for people who are attending one of the top law schools in the country. There's a big difference between people who are poor because they have no options and people who are temporarily poor because they have chosen to be so.

“And some might respond that contraception is accessible in lots of other ways. Unfortunately, that’s just not true.

“Women’s health clinic provide a vital medical service, but as the Guttmacher Institute has definitely documented, these clinics are unable to meet the crushing demand for these services. Clinics are closing, and women are being forced to go without the medical care they need.

Again, a quick look at the Guttmacher Institute website did not turn up this report. If anyone can direct me to a copy of it, I’d be grateful.

“How can Congress consider the [Rep. Jeff] Fortenberry (R-Neb.), [Sen. Marco] Rubio (R-Fla.) and [Sen. Roy] Blunt (R-Mo.) legislation to allow even more employers and institutions to refuse contraception coverage and then respond that the non-profit clinics should step up to take care of the resulting medical crisis, particularly when so many legislators are attempting to de-fund those very same clinics?

When lawmakers and others suggest that non-profit clinics should do more, I imagine they are suggesting that those who consider free and low-cost contraception to be essential should themselves make private donations to those clinics. To Fluke, support for free and low-cost contraception must come from the government, either through governmental funding for it or through government forcing private organizations to provide it. The idea of achieving a worthy goal through voluntary action is unacceptable to Fluke - or, perhaps, incomprehensible

“These denial of contraceptive coverage impact real people.

“In the worst cases, women who need these medications for other medical conditions suffer very dire consequences.

“A friend of mine, for example, has polycystic ovarian syndrome, and she has to take prescription birth control to stop cysts from growing on her ovaries. Her prescription is technically covered by Georgetown’s insurance because it’s not intended to prevent pregnancy.

“Unfortunately, under many religious institutions and insurance plans, it wouldn’t be. There would be no exception for other medical needs. And under Sen. Blunt’s amendment, Sen. Rubio’s bill or Rep. Fortenberry’s bill there’s no requirement that such an exception be made for these medical needs.

This is a confusing series of paragraphs. Fluke talks of a woman who needs birth control pills for an illness. She concedes that Georgetown’s insurance plan covers it. She then claims that many religious institutions and insurance plans “wouldn’t” cover it. I can’t quite figure out the tense here. I think she’s saying that if her friend had attended a different religious law school, the insurance would not cover her. I don’t quite know how she gets there: She seems to be saying that although Georgetown’s insurance plan covers birth control pills provided they are needed to treat an illness, many other religious institutions would not cover the pills even then. I’d like to see some documentation on that.

If she is correct that under the bills she mentions the exemption is so broad that birth control pills would not be covered even for actual illnesses then those bills are poorly drafted. (I think any bill of this type is a mistake anyhow. We should not be passing a bill to restore a freedom granted in the First Amendment; it implicitly concedes that that freedom exists only at the whim of whoever is currently in power. This is a dangerous concession.)

“When this exception does exist, these exceptions don’t accomplish their well-intended goals because when you let university administrators or other employers rather than women and their doctors dictate whose medical needs are legitimate and whose are not, women’s health takes a back seat to a bureaucracy focused on policing her body.

The claim here is that even when insurance plans that don’t cover contraceptives make an exception for women who need birth control pills for an actual illness, that isn’t enough. In those situations, a prescription for birth control pills is scrutinized by someone to make sure they are, in fact, needed for an illness and that the woman and her doctor are not engaging in insurance fraud.

This is tricky and Fluke has loaded it up with some emotionally evocative boiler plate: women’s health; policing her body. To take a less loaded example, let’s assume I have an insurance policy that excludes coverage for psychiatric medications. That means, among other things, no anti-depressants. But I have a medical condition which is not psychiatric but which will be helped by taking anti-depressants. Accordingly, my doctor writes me a prescription for anti-depressants. In all likelihood, my insurance company will refuse to pay for it. This has nothing to do with my insurance company or my employer policing my body (or my brain). This has to do with the contract I signed with my insurance company and the company’s attempt to protect itself from having to pay for services for which they did not contract and which they did not consider when they set my premium.

“In 65% of the cases at our school, our female students were interrogated by insurance representatives and university medical staff about why they needed prescription and whether they were lying about their symptoms.

First, of course, I’d like to know where this statistic comes from. I assume neither Fluke nor LSRJ has access to students’ insurance records. Are they provided with some type of summary report from somewhere? Or is she talking about 65% of the people who have told LSRJ they are requesting coverage for birth control?

I’d also like to know on what basis the insurance company and the university medical staff decided which students to “interrogate”. Actually, I’d first like to know why they decided to interrogate any of the students. Were there more claims for these types of conditions than would be statistically predicted? Or does this, as Fluke implies later, arise from the fact that Georgetown is a Catholic institutions? In that regard, I’d like to know how non-religious employers who provide insurance that doesn’t cover birth control deal with these types of cases. Do they simply approve them with no questions asked, or do the insurance companies scrutinize such claims even in those situations?

“For my friend and 20% of the women in her situation, she never got the insurance company to cover her prescription. Despite verifications of her illness from her doctor, her claim was denied repeatedly on the assumption that she really wanted birth control to prevent pregnancy. She’s gay. So clearly polycystic ovarian syndrome was a much more urgent concern than accidental pregnancy for her.

As far as I know, most states have insurance company oversight agencies and a legally mandated review process. I would like to know whether that was the case here and, if so, where that broke down.

“After months paying over $100 out-of-pocket, she just couldn’t afford her medication anymore, and she had to stop taking it.

Notice the “had to”. I did the reading on polycystic ovarian syndrome. The complications that can arise from not treating this condition are quite serious. In my view, this woman chose to risk her health rather than leave law school and find work so she could afford the medication she needed. In Fluke’s view, this woman was a victim of circumstances over which she had no control and about which she had no choice.

(I know I said cost was a “so what” issue but I can’t resist pointing out that Fluke’s estimate for a month’s worth of birth control pills has climbed from $75 or less to more than $100.)

“I learned about all of this when I walked out of a test and got a message from her that in the middle of the night in her final exam period she’d been in the emergency room. She’d been there all night in just terrible, excruciating pain. She wrote to me, ‘It was so painful I’d woke up thinking I’ve been shot.’

“Without her taking the birth control, a massive cyst the size of a tennis ball had grown on her ovary. She had to have surgery to remove her entire ovary as a result.

“On the morning I was originally scheduled to give this testimony, she was sitting in a doctor’s office, trying to cope with the consequences of this medical catastrophe.

“Since last year’s surgery, she’s been experiencing night sweats and weight gain and other symptoms of early menopause as a result of the removal of her ovary. She’s 32-years-old.

“As she put it, ‘If my body indeed does enter early menopause, no fertility specialist in the world will be able to help me have my own children. I will have no choice at giving my mother her desperately desired grandbabies simply because the insurance policy that I paid for, totally unsubsidized by my school, wouldn’t cover my prescription for birth control when I needed it.’

“Now, in addition to potentially facing the health complications that come with having menopause at such an early age – increased risk of cancer, heart disease, osteoporosis – she may never be able to conceive a child.

This is a tragedy and one that should not have occurred. The insurance company should be looking at a lawsuit here.

“Some may say that my friend’s tragic story is rare. It’s not. I wish it were

I’d like to see the numbers here.

“One woman told us doctors believe she has endometriosis, but that can’t be proven without surgery. So the insurance has not been willing to cover her medication – the contraception she needs to treat her endometriosis.

“Recently, another woman told me that she also has polycystic ovarian syndrome and she’s struggling to pay for her medication and is terrified to not have access to it.

“Due to the barriers erected by Georgetown’s policy, she hasn’t been reimbursed for her medications since last August.

“I sincerely pray that we don’t have to wait until she loses an ovary or is diagnosed with cancer before her needs and the needs of all of these women are taken seriously.

If Georgetown and its insurance company are frequently denying treatment to women (or men, for that matter) who need it, that is unacceptable. It seems to me a full audit of Georgetown’s insurance coverage by the appropriate regulatory agency is in order to determine how many claims are being incorrectly - or illegally - denied.

“Because this is the message that not requiring coverage of contraception sends: A woman’s reproductive health care isn’t a necessity, isn’t a priority.

Well, no. The message it sends is that Fluke’s definition of reproductive health and Georgetown’s definition of reproductive health are very different, a fact which Fluke and every other student at Georgetown either knew or could have known before deciding to attend.

“One woman told us that she knew birth control wasn’t covered on the insurance and she assumed that that’s how Georgetown’s insurance handle all of women’s reproductive and sexual health care. So when she was raped, she didn’t go to the doctor, even to be examined or tested for sexually transmitted infections, because she thought insurance wasn’t going to cover something like that – something that was related to a woman’s reproductive health.

Ace does an excellent job of pointing out how ridiculous this line of reasoning is.

“As one other student put it: ‘This policy communicates to female students that our school doesn’t understand our needs.’

What this policy should communicate to anyone paying attention is that Georgetown is a Catholic institution.

“These are not feelings that male fellow student experience and they’re not burdens that male students must shoulder.

I believe this is the heart of the reproductive justice approach: that because women are the ones who bear children, they suffer from hardships unknown to men and are, therefore, entitled to special treatment. I’m old enough to remember when this argument was used to keep women out of positions ranging from astronaut to President of the United States. I didn’t accept it then and I don’t accept it now.

“In the media lately, some conservative Catholic organizations have been asking what did we expect when we enroll in a Catholic school?

Again, this is the idea of being a competent actor, able to make decisions based on available information. The question really being asked is, “If this is so important to you, why did you elect to attend a school that did not provide this?”

“We can only answer that we expected women to be treated equally, to not have our school create untenable burdens that impede our academic success.

Actually, they expected to be afforded special treatment in order to make up for what they perceive as an unequal burden imposed on them by nature.

“We expected that our schools would live up to the Jesuit creed of ‘cura personalis‘ – to care for the whole person – by meeting all of our medical needs.

First, in expecting birth control to be provided by Georgetown, they were also expecting that their Catholic school would not live up to other creeds of the Catholic church. Second, Fluke seems to lack any understanding that, at least as I understand it, religions which oppose birth control believe that not providing it is caring for the whole person. This is not just Fluke twisting doctrine to suit her ends and not just Fluke denying the validity of that doctrine; this is a total lack of understanding of that doctrine.

“We expected that when we told our universities of the problem this policy created for us as students, they would help us.

If she is referring to the problem of women who need birth control pills for actual illnesses, this is a reasonable expectation. If she is referring to the problem of women who need birth control pills to prevent pregnancy, this is not.

“We expected that when 94% of students oppose the policy the university would respect our choices regarding insurance students pay for – completely unsubsidized by the university.

Again, this is Fluke simply ignoring the moral underpinning of Georgetown’s refusal to provide birth control. The idea that things don’t stop being sins just because everybody thinks they’re okay appears to be totally foreign to her.

Also, it sounds as if Georgetown has arranged for group insurance coverage for students but does not chip in to pay for that coverage. Given that most of the students at Georgetown are probably young and healthy, they might want to look into purchasing health insurance individually, outside Georgetown’s group plan. Then they can get the coverage they want.

“We did not expect that women would be told in the national media that we should have gone to school elsewhere.

Again, this has to do with the difference between how those who are saying this view choice and decision making, and how Fluke and her allies view it.

“And even if that meant going to a less prestigious university, we refuse to pick between a quality education and our health. And we resent that in the 21st century, anyone think it’s acceptable to ask us to make this choice simply because we are women.

Based on the stories Fluke told about women with polycystic ovarian syndrome and suspected endometriosis choosing to attend or to remain at, Georgetown even when it was clear they could not afford treatment for their illnesses while doing so, it is obvious that those women did choose “between a quality education and [their] health”; they chose the former.

What Fluke really means is that no one should have to forgo one thing they want in order to get another thing they want. “We refuse to pick”. All of life is picking or, more elegantly, choosing. Surely there is no more unrealistic idea than believing one can - more, is entitled to - have everything one wants.

Furthermore, no one is asking students to make this decision simply because they are women. Being a woman does not mean that birth control is necessary; being a man does not mean birth control is unnecessary.

Finally, this raises the issue of severability. Fluke appears to think very highly of Georgetown Law School (although I am a little uncomfortable with her referring to it as “prestigious” rather than, say, “excellent”) and with good reason:

Georgetown Law is one of the most prestigious institutions of legal education in the United States. The Law Center is one of the top ten most selective law schools in the United States, as well as one of the 14 law schools that consistently rank at the very top of U.S. News and World Report's annual rankings.

Yet it does not seem to have occurred to Fluke that it is the Jesuit culture that has produced such an excellent school. She believes that the excellence (or at least the prestige) of Georgetown exists, and will continue to exist, separate from the religious and moral principles that underpin it. She may be right but I would like to get some sense that she has at least considered this issue rather than it having never so much as crossed her mind.

“Many of the women whose stories I’ve shared today are Catholic women. So ours is not a war against the church. It is a struggle for the access to the health care we need.

This is the idea that access to something and having someone else pay for it are the same thing. I think people should have access to birth control pills; that is, buying birth control pills should be legal. I also think those who, despite their best efforts, cannot afford to pay for them should be helped financially by government medical programs, just as we help those who cannot afford any other prescription drug.

People attending law school at Georgetown are not people who, despite their best efforts, cannot afford birth control pills. Rather, they are people who have chosen a course of action that makes birth control pills a financial burden. I do not think it is the role of government to make it possible for people to attend law school at Georgetown.

(I also wonder if Fluke realizes that if Georgetown’s insurer starts covering birth control pills for contraceptive purposes, the premium students pay is going to go up. If half the students are women then the premium will probably go up by half the cost of the birth control pills, more assuming some of the male students are married and their wives are covered.)

“The President of the Association of Jesuit Colleges has shared that Jesuit colleges and the universities appreciate the modifications to the rule announced recently. Religious concerns are addressed and women get the health care they need. And I sincerely hope that that is something we can all agree upon.

The first sentence of this paragraph is quite literally true. Here’s the press release from the Association of Jesuit Colleges and Universities:

AJCU statement on change to HHS mandate for religious institutions

Washington, DC - The Association of Jesuit Colleges and Universities (AJCU) acknowledges and appreciates the compromise that President Obama has made to accommodate religious institutions in regard to the birth control mandate under the Affordable Care Act. We commend the Obama Administration for its willingness to work with us on moving toward a solution, and we look forward to working out the details of these new regulations with the White House.

February 10, 2012

Fluke’s interpretation of this in her second sentence is not quite accurate.

“Thank you very much.”

You're welcome.


*****

Show Your Work:

Georgetown is a three-year program for day students who go full-time. If we consider those students and we look at three full years (rather than the 2 years and 9 months that will presumably be the period from entering the law school to graduation), we’re talking about buying birth control for 1095 days. Since a “month” in birth control pill terms is (or was when I paid attention to the matter) 28 days, a student will have to purchase 39.1 packets of pills; let’s call it 40 to give Fluke as much leeway as possible. At $3000 for an academic career, that means Fluke is claiming each packet will cost $75.

How realistic is that number? According to a December 12, 2011, “Ask The Experts” page at Planned Parenthood’s website:

How much are birth control pills?

Birth control pills cost about $15–$50 a month. They may be purchased with a prescription at a drugstore or clinic.

Visit a Planned Parenthood health center, a clinic, or a private health care provider for a prescription. Your health care provider will discuss your medical history with you, check your blood pressure, and give you any other medical exam that you may need. If you need an exam, it may cost about $35–$250.

So Fluke’s number is high. What if we include the medical exam? A young woman on birth control pills would probably need to be seen once a year, so if we take Planned Parenthood’s high figure of $250, we come up with $750 over three years of law school. If we subtract that from Fluke’s $3000 figure, we’re left with $2250 for 40 birth control pill packets. That works out to $56 per packet which is in the ballpark of the high number for the cost of pills: $50.

There are some serious problems with this. A sexually active woman should be seeing her gynecologist once a year anyhow so it’s not exactly fair to consider the $750 for exams as strictly a birth control cost. Furthermore, the HHS mandate requires insurance plans to cover “preventive health care” with no co-pay. If that preventive care includes annual gynecological exams then even if an employer’s health insurance doesn’t cover the birth control pills themselves, it will cover the physical exam. And, finally, generic birth control pills are available from both Wal-Mart and Target for $9 per pack, which would make Fluke’s number way off. (It’s worth keeping in mind, however, that not all birth control pills are suitable for all women; some women may have to take non-generics for various reasons.)

So Fluke has presented a worst case scenario in terms of cost - she is, after all, an advocate arguing for a particular policy - but her numbers are not as ludicrous as reported, provided we are talking about birth control pills, as Fluke is. Those who want to talk about condoms should feel free to do so but birth control pills are the most effective means of contraception and, oddly, that matters to most women who don’t want to get pregnant.