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Monday, July 25, 2005

Employers Cannot Not Pay For Female Contraception

Union Pacific Railroad tried to offer a health plan that would pay for Viagra and Male-Pattern Baldness, but not for prescription contraceptives for women, arguing that because fertility is "normal," contraception can't be considered medically necessary.  A federal court in Nebraska just found this policy to violate Title VII, arguing persuasively that pregnancy is a "disease."

If you doubt that it is a disease, read the judge's gender-neutral description of the disease after the jump.

Our typical patient becomes aware that he has contracted the disease when he experiences extreme fatigue, accompanied by nausea and  vomiting. These symptoms diminish after a few months, as his abdomen begins to distend. Pressure on his bladder requires that he urinate frequently. He feels hot and sweaty, and has headaches and dizziness. As his digestive tract slows, he becomes constipated and suffers heartburn and hemorrhoidal symptoms. His weight increases by twenty per cent, with most of the gain centered in his abdomen, altering his balance and causing strain and discomfort in his lower back. His breasts, ankles, and feet swell, and his legs cramp. His mobility, his sleep, and even his breathing are impaired as his abdomen expands to twice its normal circumference. Stretch marks appear on his thighs, chest and abdomen. The ligaments in his hips and pelvis soften, and he develops sciatica, causing tingling and numbness. After nine months, he feels the onset of intense, intermittent pain, accompanied by diarrhea and nausea. His pain increases and accelerates over approximately 15 hours as his genital opening, usually the size of a pencil lead, is stretched to a diameter of 10 centimeters. Surgical incisions are used to facilitate the opening of his genitals. His pain may require general anesthesia, but usually can be managed through other methods, such as injections in the fluid surrounding his spinal cord. He is encouraged to reject pain medication entirely so he can remain alert to assist in the treatment of his disease. The incisions and tears in his genitalia are closed with internal and external sutures. His breasts continue to swell, and his nipples become sore. Healing of his genitals takes about six weeks, during which time his pain may be relieved by sitz baths, heat lamps, ice packs, and anesthetic sprays. Finally, he has a heavy bloody discharge from his genitals, lasting several weeks.

Posted by Ethan Leib on July 25, 2005 at 06:57 PM in Current Affairs | Permalink


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Pregnancy is a medical condition that carries with it risk of related illness and even death. Contraception is a means of primary prevention from this potentially serious illness. As such, it should be covered by health insurance plans just like other primary means of prevention such as vaccinations. Erectile dysfunction is also a medical condition, which requires treatment as there is no primary preventative medication for it. Viagra and contraception are not equivalent. One is a treatment the other is a prevention. People deserve to have insurance coverage for both. Part of the problem lies in the fact that our society tends to sexualize health issues, which then makes people uncomfortable and unable to view these conditions objectively.

Posted by: MD in NJ | Aug 2, 2005 9:51:54 PM

Depression and mania are both diseases... it's "unnatural" to be unable to be happy...

Posted by: Paul Gowder | Jul 26, 2005 1:02:58 PM

Don’t confuse (a) the claim that the immunity from disease X is itself a disease because it’s “unnatural” to be unable to contract disease X with (b) the claim that disease Y, which is highly correlated with immunity from an independent disease X, is still a disease.

Posted by: Kate Litvak | Jul 26, 2005 12:35:05 PM

Likewise, if pregnancy is a disease, then, infertility (immunity to the disease of pregnancy) can’t also be a disease.

Not so! Simply because a thing is a disease does not mean that its immunity-conferring factor is not a disease. For example, sickle cells provide some immunity to the disease of malaria. Yet sickle cells also cause sickle cell anemia (although I think the real picture there is genetically more complicated).

Posted by: Paul Gowder | Jul 25, 2005 11:27:03 PM

Hmm. I know chickenpox is a disease, but the *immunity* to chickenpox isn’t a disease – even if a patient decides he wants to get rid of that immunity to experience life in its itchy fullness.

Likewise, if pregnancy is a disease, then, infertility (immunity to the disease of pregnancy) can’t also be a disease. So, an insurance company cannot at the same time cover contraceptives and infertility treatments. Which would presumably include erectile-dysfunction drugs that were actually covered by the insurance in question. Brilliant.

Posted by: Kate Litvak | Jul 25, 2005 9:58:41 PM

Interesting, but excessive... the pregnancy discrimination act would seem to specifically preclude (for the reasons noted by the court) the attempt to distinguish pregnancy from other medical conditions that the court so gruesomely refuted.

Posted by: Paul Gowder | Jul 25, 2005 9:41:36 PM

what a joke...

I continue to doubt it.

Posted by: mod | Jul 25, 2005 8:56:15 PM

I'm sure that line of argument is going to be real popular with certain persons.

Posted by: Ugh | Jul 25, 2005 7:25:51 PM

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