Tuesday, March 5, 2013

PROPOSALS FOR AFFORDABLE CARE ACT AND OTHER HEALTH AND HUMAN SERVICES PROGRAM REFORM

This is the second of two blog posts; the first looked at income and Social Security tax and reform here in March 2013.  This one will look at federal health care tax and benefits reform.

Now that the 2012 elections are well over, the Affordable Care Act is over a year old and implementation is progressing, it is worth looking anew at some ideas for removing the gender discrimination in the Act. 

BACKGROUND:  The current federal health and human services system, including the Affordable Care Act, has a bias that assumes women are the only biological parents of children and bear primary if not sole responsibility for their care and development.    These assumptions are not accurate, as every child has a male biological parent and ignoring this poses health hazards to children, and child development is particularly well supported when a child has two parents who bear responsibility for children's care and development.   While historically some problems such as an inability to prove or disprove paternity[1], may have clouded health research and policy development, paternity has now been provable for over 50 years.  Also, the bias in human services and welfare programs focusing on women as primarily responsible for the care and development of their children may have had to do with historical problems of local "head and master" marriage laws[2] or laws preventing married women owning property[3], discrimination preventing women from developing skills valued in the marketplace[4] or from earning money[5].   Many of these problems have also not existed or been declining for decades, however, and many families are increasingly structured around a 2-earner/2-parent model. 

In addition, since 1970 when paternity became provable, a significant amount of medical research has illustrated issues that can arise from the biological contribution of men to their children that were not visible before.  These include problems from (a) genetic deterioration in sperm as men age that is inherited by the child and becomes a permanent part of the human genome[6] and (b) epi-genetic effects on sperm, where a man's health affects his reproductive DNA and the state in which it gets transmitted to his children.  This evidence suggests it is in children's interest that men who want to have children have them children when they are younger and for them to take their own physical health with regard to reproduction seriously, something that women have been heavily educated and counseled about for years but men have not. 

Further, research into human evolution and how child development is affected by family structure has also illustrated why human beings, in contrast to other primates, have tended to form a family structure of two responsible parents, including evidence that human evolution from primates required at least some men to take this responsibility and that child development is heavily distorted by a poor relationship with parents, whether or not both parents are living in the household. 

When the government programs do not reflect these realities, however, this can create discrimination against these families, prevent their formation even when prospective parents are otherwise ready, willing and able to set them up this way and cause preventable problems to children and their development. 

PROBLEM IN THE AFFORDABLE CARE ACT PREVENTIVE SERVICES:  The Affordable Care Act provides for a no-copay "well woman" check up to all women, regardless of whether a woman is pregnant or even of reproductive age.  There is not a no-copay "well man" check up, however, despite the individual mandate in the ACA that requires men to have health insurance in the same way women are required to have it. 

Because the ACA also provides for a number of no-copay preventive care services and screenings to adults, including a number of aspects of preventive care that affect men who want to have children, such as diet and obesity counseling, HIV screening, immunization, sexually transmitted diseases, tobacco use and emotional health, these are all more accessible to women because they are relieved of the copay for the physician visit which is needed for access to these no-copay services.

Further, the ACA list of the adult no-copay preventive care services also has a separate list that women receive and men do not.[7]  Some of these relate to the biology of pregnancy or lactation, but many of them do not.  For example, women receive no-copay contraceptive education, counseling, methods, and procedures, while men do not.   While there are fewer high technology methods for male contraception that require a doctor's care than those for women's contraception, there are some.   Also, there is no explanation for education and counseling not being provided to men with no-copay as it is to women, without this education and counsel, preventable male reproductive health issues, including those that affect the health of their children, go undetected.  In addition, women also receive no-copay screening for domestic and interpersonal violence and men do not; while this is apparently oriented toward women as victims of this by men and possibly as perpetrators against children (and, although rare, against men), it seems that some men who are at risk for perpetrating violence against women or children might benefit from and welcome no-copay screening and counseling for this issue comparable to what women receive for no copay.

Some health policy experts have identified a bias in the health care system (prior to the ACA) against men's preventive care.[8]  They believe the shorter life expectancy of men is partly attributable to this bias.  Further, while men do not tend to consume health care services when they are young (perhaps in part because of the bias even among health care providers against male preventive care), they often become very expensive consumers in middle age and later life because of preventable problems, including chronic health care problems.  Many of the high costs of the health care system spent on treating middle-aged and older men could possibly be reduced by removing the bias against male preventive care and also improve the quality and length of men's lives.  The ACA is apparently currently just reflecting this costly bias.

Further, the health of the father is highly relevant to a child's health and welfare (both the genetic health of the biological father, and physical and emotional health of men who are parents to their children), and this bias against male preventive care thus harms children's health and welfare.[9]  With regard to family structure, there is the added problem that in 2-earner/2-parent families particularly, the man's presence not just as an earner but as a parent is required and therefore the health of the man is important.   Federal health and human systems biases against preventive care for men thus harm child health and welfare unless a man has the financial resources and knowledge to circumvent the biases.  

PROPOSED SOLUTION:  Add a no-copay "well man" check up to the covered services in the ACA.  Add no-copay preventive services for men to match the preventive services for women other than those relating only to the specific biology of pregnancy and lactation.   Add any preventive services for men needed for (a) the psychological and mental health issues associated with taking responsibility for meeting a child's need and (b) the specific biology of the male reproductive system, including types of contraception that require a doctor's care, education and counseling.  Add education and counseling on male reproductive health preventive care, such as male biological clock issues.

_________________________________

Any thoughts?  Please let us know them in the comments.


[1] Paternity became provable and disprovable through DNA evidence in 1970.  Cost for paternity testing now ranges from $150 to $1000.
[2] For example, Kirchberg v. Feenstra (S. Ct. 1981) invalidated the last state "head-and-master" marriage law, a community property law in Louisiana.  
[3] In the United States coverture laws that required all marital property to be in the man's name only were common in the 19th Century, although they began to be repealed extensively in the latter half of that Century continuing into early 20th Century.  In Reed v. Reed (S. Ct. 1971), the Supreme Court ruled that the Equal Protection Clause prohibited discrimination on the basis of sex in a family economic matter.
[4] Girls and young women now meet or exceed the percentage of boys and young men completing a variety of educational levels.  For example, in 2010, 62.8 percent of young men who graduated from high school enrolled in college, up 7.6 percentage points from 1970, but below the continuation rate for young women—74 percent in 2010, up 25.5 percentage points from 1970.http://blogs.edweek.org/edweek/inside-school-research/2011/05/report_boys_college_readiness.html
[5] For example, women now earn approximately 77% of the income from wages that men do on average, up from about 60% in 1980. 
[6] Geneticist James Crow has said that the greatest threat to the human genome is not "infertility but aging, fertile men" who reproduce because of the genetic deterioration in sperm as men age that is passed on to children and remains in the deteriorated state.  http://how-old-is-too-old.blogspot.com/2006/11/james-f-crow-as-men-age-their-sperm.html

No comments:

Post a Comment